In contrast to social, religious, and economic determinants of acceptance and sustained use of family planning in developing countries, perceived side effects resulting from reproductive tract infections can usually be ameliorated easily and expeditiously. This population-based study examines the magnitude and nature of morbidity due to reproductive tract infections among users of various contraceptive methods and among nonusers in a rural community in Bangladesh. Overall, 22 percent of the 2,929 women surveyed reported symptoms of reproductive tract infection. Of the 472 symptomatic women examined, 68 percent had clinical or laboratory evidence of infection. Users of intrauterine devices and tubectomy were each approximately four times as likely to report symptoms and seven times as likely to have examination-confirmed infection as nonusers. The epidemiology of reproductive tract infections in this population is addressed, and the findings are discussed in terms of their potential programmatic impact.
PIP: The prevalence of symptoms of reproductive tract infections (RTIs) among users of various contraceptive methods and nonusers was investigated in a population-based study conducted in rural Bangladesh. Overall, 22% of the 2929 women surveyed reported symptoms of RTI. Of the 472 symptomatic women examined, 68% had clinical or laboratory evidence of infection. The symptom most commonly reported (97%) was abnormal discharge. Among the 2726 women who could be classified as users of a single method, the percentage of women reporting symptoms varied by contraceptive method. IUD users and tubectomized women were 4 times more likely than nonusers to report abnormal discharge of lower abdominal pain, while users of hormonal methods were 1.6 times more likely to report these symptoms. Among women who had a confirmed RTI, 24% were tubectomized and 22% were IUD users compared to rates of 5.6% in users of hormonal contraception and 3.5% among nonusers. This suggests that tubectomized women and IUD users are 7 times more likely to have a confirmed RTI than nonusers. Multivariate analysis indicated that current birth control method, materials used during menses, prior contraceptive method use, and duration of current method use were the only factors significantly associated with the increased risk of infection. IUD users and tubectomized women were most likely to have lower tract infection, both when considered as all types of vaginitis and when limited to infections such as gonococcal and chlamydial cervicitis that can ascend into the upper tract. A major limitation of this study is that, for cultural reasons, only symptomatic women could be referred for examination. In addition, 24% of the symptomatic women refused examination. These findings suggest that family planning services in Bangladesh are associated with mild and reversible, yet relatively common, RTI. While this morbidity is outweighed by the benefits of family planning, clinics should make an effort to provide accurate diagnosis and treatment of RTIs and to discuss method-associated side effects.