- Email: [email protected]
Risk factors for STDs in Tamil Nadu, India
REPRODUCTIVE HEALTH PREDICTION OF PREGNANCY-INDUCED HYPERTENSION. J. Patumanond, N. Pichainarong, D. E. Grobbee. C E U , C h i a n g Mai University, C h i a n g Mai, Thailand. Objective: To develop and validate a model for the prediction of pregnancy-induced hypertension (PIH) in pregnant women attending an antenatal care clinic (ANC). Design: Prospective follow-up study with clinical data on 2,260 subjects collected from samples of pregnant women attending an ANC in 5 institutes. Setting: Four regional mother and child hospitals and one Bangkok metropolitan hospital. Participants: Derivation set: 1,760 pregnant women attending ANC at the regional mother and child hospital in Nakomsawan, Khonkaen, Yala and Ratchaburi between May 1, 1994 and January 31, 1995. Validation set: 500 subjects from Rajvithi Hospital in Bangkok during the same period. M a i n Outcome Measure(s): Pregnancy-induced hypertension. Results: Independent multivariate predictors of PIH were age of 30 years or older; pre-pregnancy body mass index of 21 kg per m 2 or above; mean arterial pressure of 85 mmHg or above; average weight gain of 0.3 kg per week or above; history of hypertension and/or P1H; and history of PlH in mother. Among subjects with no risk factors, the model identified 6.8% correctly as PIH cases. The probability of the condition increased to 66.7% in subjects with 5 risk factors. The model was validated in 500 subjects. None of the subjects in the "no risk" category developed PIH and the risk of the condition increased to 30.0% in subjects with 4 risk factors (3.1% of the population). Conclusions: These findings provide a means of identifying pregnant women who attended an ANC according to their risk of PIH. If prospectively applied to other settings, this model may be helpful in deciding whether to start a preventive intervention, or in a situation where an intervention is not available, referring pregnant women to another health care service for appropriate antenatal care.
BREAST-FEEDING AND RISK OF BREAST CANC E R . J. Patumanond, W. Sipiyarak, D. E. Grobbee. C E U , C h i a n g Mai University, C h i a n g Mai, Thailand. Objective: To examine the effect of breast-feeding on the risk of breast cancer. Design: Hospital-based case-control study with interview data on 320 subjects collected from female patients admitted to 5 hospitals. Setting: Three university hospitals, 1 Bangkok metropolitan hospital and The National Institute of Cancer, Bangkok, Thailand, during June to November 1995. Participants: Cases: 160 parous women with pathologically confirmed primary breast cancer. Controls: 160 parous women with other diseases admitted to medical and surgical wards of the same hospital as cases, frequency matched for menopausal status and the date of diagnosis (within 3 months). M a i n Outcome Measure(s): Breast cancer. Results: As measured by the odds ratio, the number of breast-fed children was associated with a decreased risk of breast cancer (risk reduction = 19% for each breast-fed child; 95 percent confidence interval, 9% to 29%). The risk of breast cancer was also marginally reduced by an increased duration of breast-feeding (risk reduction = 6% for each year of breast-feeding; 95 percent confidence interval, 0% to 13%). Conclusions: Various aspects of breast-feeding have been studied for their relation to the risk of breast cancer. Our findings provide support for the view that breast-feeding is protective against breast cancer. This protective effect is independent of reproductive and other potential confounding factors previously reported as determinants of breast cancer.
27S RISK FACTORS FOR STDs IN TAMIL NADU, IND I A . Abraham Peedicayil, APAC Study Group. C E U , Christian Medical College & Hospital, Vellore, India. O b j e c t i v e : To determine the factors influencing STD prevalence in the community, in Tamil Nadu State. Design: Proportionate to population cluster survey. A random selection process was used at the levels of districts, villages/urban wards and households in each cluster. Setting: Medical camps were held at 90 clusters in three districts. Only the targeted subjects were screened for STDs and given the questionnaire. Participants: Men (824) and Women (1154) aged 15 to 45 years residing in the target households. Measurements: Demographic data, behavioral questionnaire, syndromic diagnosis of STDs and collection of blood, urine, vaginal/urethral swabs and endocervical smears. Methods: A structured questionnaire and camp approach to collect STD prevalence data were used after training and pilot testing. Data were analyzed using SUDAAN software. Adjustments were made for cluster effect and observed differences in age and sex distribution based on the 1991 census data. Different regression models were used including separate ones for men and women. Results: The prevalence of any STD was 15.8% (95% CI 13,19), classical STDs 9.7% (95% CI 8,12) and that of HIV 1.8% (95% (;1 1.0,2.5). In the logistic regression analysis, factors affecting STD prevalence were skilled labor (OR 2.7; 95% C1 1.3,5.6), female gender (2.0;1.4,2.0), age 30-39 years (1.4;1.0,2.0), multiple sexual partners (1.03;1.0,2.9) and condom use (0.6;0.4,0.9). In women, age 30-39 years (1.8;1.1,3.0) higher education (0.4;0.2,0.9) and marriage (0.4; 0.2,0.9) were independent factors for classical STDs. In men, multiple sexual partners (1.05;1.03,1.08) was a risk factor for classical STDs. In women, teenage (0.02;0,0.1) and professional work (0.01; 0.01) were protective factors against HIV infection. In men, teenage (0;0,0.02) was protective while high sch~×~l education (14.3;1.3, 162.7) and tattoos (3.7;1.04,13.4) were risk factors for HIV. Conclusions: This study has shown that skilled laborers and women, especially aged 30-39 years, have high prevalence of STDs. High school education and tattoos may be risk factors for HIV infection in men. Interventional strategies need to take this into account.
BACTERIAL VAGINOSIS IN EARLY PREGNANCY AND ADVERSE PREGNANCY OUTCOME. M. Purwa__zr,V. Agarwcd, B. Bhagat. C E U , G o v e r n m e n t Medical College, Nagpur, India. Background: Recent research has been focused on occult lower genital tract infection as an etiological factor for preterm birth (PTB). A few reports suggest that Bacterial Vaginosis (BV) a common condition may be associated with an increased incidence of PTB and Premature Rupture of Membranes (PROM). Objective: To assess the prevalence of BV in early pregnancy in asymptomatic women and the association between BV and PTB and PROM. Design & Setting: Observational prospective cohort study in secondary and tertiary care hospital. Participants: 1006 low risk pregnant women between 16-20 weeks' gestation were screened for BV by vaginal smear gram staining (Nugent's criteria) and for other lower genital tract infection by accepted criteria; and subsequently were followed until delivery to note pregnancy outcome. S a m p l e size: Prevalence of PTB = 7%, RR = 2, alpha = 0.01, beta = 0.10, and 10% lost to follow-up, n = 1034. M a i n Outcome Measure(s): Prevalence of BV, spontaneous lXI'B (<37 weeks' gestation) and PROM. Analysis: Descriptive, Univariate and MLR. Results: Prevalence of BV in early pregnancy was 11.53% (95% C1 9.5313.53). Women with and without BV were similar with respect to demographic characteristics. Follow up data were available for 938 (93.2%). Incidence of PTB was significantly higher in BV positive women as compared to BV negative women, 27.83% vs 4.86% (p = 0.000). On unconditional MLR, BV was significantly associated with increased risk of PTB (OR = 7.08, 95% CI: 4.12-12.18, p = 0.000) and PROM (OR = 8.11, 95% CI: 4.53-14.49, p = 0.000). On MLR other correlates for PTB were previous preterm birth (OR = 2.26, 95% CI: 1.31-3.90, p = 0.003) and presence of enteropharyngeal bacteria in vagina e.g.E, coli, Klebsiella spp (OR = 2.88, 95% CI: 1.06-7.81, p = 0.03). BV accounted for 82.53% of the attributable risk for spontaneous preterm birth. Conclusions: This observational study confirms that the presence of BV in early pregnancy is associated with increased risk of PTB and PROM. Multicentric interventional study is recommended.
BREAST-FEEDING AND RISK OF BREAST CANC E R . J. Patumanond, W. Sipiyarak, D. E. Grobbee. C E U , C h i a n g Mai University, C h i a n g Mai, Thailand. Objective: To examine the effect of breast-feeding on the risk of breast cancer. Design: Hospital-based case-control study with interview data on 320 subjects collected from female patients admitted to 5 hospitals. Setting: Three university hospitals, 1 Bangkok metropolitan hospital and The National Institute of Cancer, Bangkok, Thailand, during June to November 1995. Participants: Cases: 160 parous women with pathologically confirmed primary breast cancer. Controls: 160 parous women with other diseases admitted to medical and surgical wards of the same hospital as cases, frequency matched for menopausal status and the date of diagnosis (within 3 months). M a i n Outcome Measure(s): Breast cancer. Results: As measured by the odds ratio, the number of breast-fed children was associated with a decreased risk of breast cancer (risk reduction = 19% for each breast-fed child; 95 percent confidence interval, 9% to 29%). The risk of breast cancer was also marginally reduced by an increased duration of breast-feeding (risk reduction = 6% for each year of breast-feeding; 95 percent confidence interval, 0% to 13%). Conclusions: Various aspects of breast-feeding have been studied for their relation to the risk of breast cancer. Our findings provide support for the view that breast-feeding is protective against breast cancer. This protective effect is independent of reproductive and other potential confounding factors previously reported as determinants of breast cancer.
27S RISK FACTORS FOR STDs IN TAMIL NADU, IND I A . Abraham Peedicayil, APAC Study Group. C E U , Christian Medical College & Hospital, Vellore, India. O b j e c t i v e : To determine the factors influencing STD prevalence in the community, in Tamil Nadu State. Design: Proportionate to population cluster survey. A random selection process was used at the levels of districts, villages/urban wards and households in each cluster. Setting: Medical camps were held at 90 clusters in three districts. Only the targeted subjects were screened for STDs and given the questionnaire. Participants: Men (824) and Women (1154) aged 15 to 45 years residing in the target households. Measurements: Demographic data, behavioral questionnaire, syndromic diagnosis of STDs and collection of blood, urine, vaginal/urethral swabs and endocervical smears. Methods: A structured questionnaire and camp approach to collect STD prevalence data were used after training and pilot testing. Data were analyzed using SUDAAN software. Adjustments were made for cluster effect and observed differences in age and sex distribution based on the 1991 census data. Different regression models were used including separate ones for men and women. Results: The prevalence of any STD was 15.8% (95% CI 13,19), classical STDs 9.7% (95% CI 8,12) and that of HIV 1.8% (95% (;1 1.0,2.5). In the logistic regression analysis, factors affecting STD prevalence were skilled labor (OR 2.7; 95% C1 1.3,5.6), female gender (2.0;1.4,2.0), age 30-39 years (1.4;1.0,2.0), multiple sexual partners (1.03;1.0,2.9) and condom use (0.6;0.4,0.9). In women, age 30-39 years (1.8;1.1,3.0) higher education (0.4;0.2,0.9) and marriage (0.4; 0.2,0.9) were independent factors for classical STDs. In men, multiple sexual partners (1.05;1.03,1.08) was a risk factor for classical STDs. In women, teenage (0.02;0,0.1) and professional work (0.01; 0.01) were protective factors against HIV infection. In men, teenage (0;0,0.02) was protective while high sch~×~l education (14.3;1.3, 162.7) and tattoos (3.7;1.04,13.4) were risk factors for HIV. Conclusions: This study has shown that skilled laborers and women, especially aged 30-39 years, have high prevalence of STDs. High school education and tattoos may be risk factors for HIV infection in men. Interventional strategies need to take this into account.
BACTERIAL VAGINOSIS IN EARLY PREGNANCY AND ADVERSE PREGNANCY OUTCOME. M. Purwa__zr,V. Agarwcd, B. Bhagat. C E U , G o v e r n m e n t Medical College, Nagpur, India. Background: Recent research has been focused on occult lower genital tract infection as an etiological factor for preterm birth (PTB). A few reports suggest that Bacterial Vaginosis (BV) a common condition may be associated with an increased incidence of PTB and Premature Rupture of Membranes (PROM). Objective: To assess the prevalence of BV in early pregnancy in asymptomatic women and the association between BV and PTB and PROM. Design & Setting: Observational prospective cohort study in secondary and tertiary care hospital. Participants: 1006 low risk pregnant women between 16-20 weeks' gestation were screened for BV by vaginal smear gram staining (Nugent's criteria) and for other lower genital tract infection by accepted criteria; and subsequently were followed until delivery to note pregnancy outcome. S a m p l e size: Prevalence of PTB = 7%, RR = 2, alpha = 0.01, beta = 0.10, and 10% lost to follow-up, n = 1034. M a i n Outcome Measure(s): Prevalence of BV, spontaneous lXI'B (<37 weeks' gestation) and PROM. Analysis: Descriptive, Univariate and MLR. Results: Prevalence of BV in early pregnancy was 11.53% (95% C1 9.5313.53). Women with and without BV were similar with respect to demographic characteristics. Follow up data were available for 938 (93.2%). Incidence of PTB was significantly higher in BV positive women as compared to BV negative women, 27.83% vs 4.86% (p = 0.000). On unconditional MLR, BV was significantly associated with increased risk of PTB (OR = 7.08, 95% CI: 4.12-12.18, p = 0.000) and PROM (OR = 8.11, 95% CI: 4.53-14.49, p = 0.000). On MLR other correlates for PTB were previous preterm birth (OR = 2.26, 95% CI: 1.31-3.90, p = 0.003) and presence of enteropharyngeal bacteria in vagina e.g.E, coli, Klebsiella spp (OR = 2.88, 95% CI: 1.06-7.81, p = 0.03). BV accounted for 82.53% of the attributable risk for spontaneous preterm birth. Conclusions: This observational study confirms that the presence of BV in early pregnancy is associated with increased risk of PTB and PROM. Multicentric interventional study is recommended.