1Distribution of contraceptive users and controls by age and marital status (n = 150). http://phcfm.org/index.php/phcfm/article/downloadSuppFile/207/506
2The prevalence of urinary tract infection amongst contraceptive users and the controls. http://phcfm.org/index.php/phcfm/article/downloadSuppFile/207/507
3Distribution of urinary tract infection amongst the participants from different socioeconomic classes. http://phcfm.org/index.php/phcfm/article/downloadSuppFile/207/508
4Association of urinary tract infection with type of contraceptive. http://phcfm.org/index.php/phcfm/article/downloadSuppFile/207/509
5Estimates of various statistical parameters. http://phcfm.org/index.php/phcfm/article/downloadSuppFile/207/510
DiscussionThis study discovered a predominance of participants within the 16–45-year age bracket and those that were married amongst the contraceptive users. This predominance can be explained by the fact that this is the reproductive age bracket, when sexual activity is a norm. The reduced number of contraceptive users in the older age group could be explained by the fact that, with aging, there is a decline in ovarian hormonal secretion during the menopausal transition, which may alter libido, sexual response and functioning, 18,19,20 with concomitant loss of interest in contraception. The widely used indicators of socioeconomic status include education, occupational status and income. 17 The contraceptive users in the low socioeconomic classes may be more prone to UTI due to the interplay of these social indicators. 15,21 The expected trend of a high prevalence of UTI in the lower socioeconomic classes was not observed in our study population, and this is not in agreement with previous reports. 22,23 It could be explained by the fact that the social indicators did not alter our participants’ exposure to the factors responsible for UTI amongst contraceptive users. The relevance of this finding is that, in planning health promotional programmes, equal attention should be given to people in all the socioeconomic classes. The overall prevalence of UTI (35.3%) amongst the contraceptive users was high. There was about a three-fold increased risk of the development of urinary tract infection amongst patients who were on contraceptives compared to non-users. This finding is consistent with that of other researchers. 24,25,26,27 The fact that the participants were asymptomatic makes it an unacceptable public health problem that calls for urgent intervention, in terms of health education and promotion and encouragement of the use of contraceptive methods that carry lesser risks of urinary tract infection. The high prevalence of UTI amongst the barrier contraceptive users in this study is in agreement with earlier studies that reported high prevalence of UTI amongst patients who used both the diaphragm with spermicide and spermicide-coated condoms. 28,29,30,31,32,33 Exposure to spermicides alone has been reported to increase the risk of vaginal colonisation and bacteriuria with Escherichia coli (E. coli), but not to the degree seen with the use of a diaphragm and spermicide. 25 In the population studied here, the use of diaphragm and spermicide in the form of foaming tablets was not popular, hence the low prevalence of their usage. The high prevalence of UTI amongst the barrier contraceptive users may therefore emanate from unhygienic conditions during application of the condom, 29 which was the commonest barrier method used in this study. Secondly, unlubricated condoms may abrade the vaginal wall and make it vulnerable to infections. Thirdly, it has been suggested that the users of the barrier methods are likely to have increased vaginal fluid pH, alterations in normal vaginal flora, and increased rates of introital colonisation with E. coli – all associated with UTI. 28The part played by the hormonal contraceptives in the aetiology of UTI was to a lesser degree than that reported in a study by Ziaei and colleagues. 26The effects of progesterone on muscle tone, peristalsis of the ureters and also on the urinary vasculature may account for the UTI in women who use hormonal contraceptives. 25ConclusionOn the basis of the findings of this study it can be concluded that contraceptive use is a significant risk factor for acquiring urinary tract infection, with the barrier methods being more predisposing. This warrants greater attention being paid to the reproductive health needs of the women, and health education for the hygienic or safe use of family planning methods. 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