Factors Associated With the Occurrence of Endocervical Bacteria Among Women With Genital Discharge in Kinondoni Municipal, Dar es Salaam, Tanzania: A Cross-Sectional Study

Abstract

Background: Endocervical bacterial infections may contribute to genital discharge and adverse reproductive health outcomes. In Tanzania, limited access to microbiological diagnostic services and reliance on syndromic management may result in inadequate identification of bacterial causes. This study assessed the occurrence of endocervical bacteria and factors associated with bacterial culture positivity among women presenting with genital discharge in Kinondoni Municipal, Dar es Salaam, Tanzania.
Methodology: A cross-sectional study was conducted in March and April 2022 at Mwananyamala Regional Referral Hospital, Magomeni Health Centre, and Tandale Health Centre. Women aged 15 to 49 years presenting with genital discharge were consecutively enrolled. Endocervical specimens were collected using standard procedures and processed by bacterial culture, Gram staining, and biochemical identification. Data were analysed using STATA version 15.5. Chi-square tests and logistic regression were used to assess associations between endocervical bacterial positivity and selected sociodemographic, behavioural, reproductive, and clinical factors. Statistical significance was set at P<.05.
Results: A total of 219 women were enrolled, with a median age of 37 years. Endocervical bacteria were isolated from 137 (62.5%) participants, yielding 138 isolates; one participant had two bacterial species. The predominant isolates were Escherichia coli (42, 30.4%), Corynebacterium spp. (18, 13.0%), Staphylococcus aureus (17, 12.3%), and Klebsiella pneumoniae (11, 8.0%). Neisseria gonorrhoeae was isolated from one participant (0.7%). Bacterial positivity was significantly higher among intrauterine device (IUD) users than non-users (80.7% vs. 59.6%, P=.025). In multivariable logistic regression, IUD use remained significantly associated with positive endocervical culture (adjusted odds ratio [aOR] 2.76; 95% CI, 1.06 to 7.16; P=.036). No statistically significant associations were observed with age, marital status, education, parity, history of miscarriage, history of sexually transmitted infection or the use of protection during sexual intercourse.
Conclusion: Endocervical bacterial positivity was common among women presenting with genital discharge, with E. coli being the predominant isolate. IUD use was significantly associated with positive endocervical culture. Strengthening laboratory-based evaluation of genital discharge may improve identification of bacterial organisms and support appropriate clinical management. Further prospective studies using molecular diagnostic methods are warranted to clarify the clinical significance of endocervical bacterial colonisation and its relationship with IUD use.