Sociodemographic and Clinical Determinants of Laboratory Confirmed Vaginal Infections Among Non‑Pregnant Women in Katavi Region, Tanzania: A Call for Strengthening Point-of Care Screening Practices to Improve Women’s Health

Abstract

Background: Vaginal infections, especially bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC), affect women’s reproductive health and lead to adverse outcomes like preterm birth and pelvic inflammatory disease. In resource limited settings, socioeconomic disparities and limited access to diagnostic services increase the burden of these infections. Cultural norms and hygiene practices influence how symptoms are recognized and when care is sought, making clinical management more challenging. Identifying simple clinical and sociodemographic predictors of vaginal infection is essential for effective screening. We determined the prevalence of vaginal infections among non-pregnant women and examined related clinical signs and sociodemographic factors.
Methods: We conducted a cross sectional study from January 2024 to April 2025 at Katavi Regional Referral Hospital, enrolling 210 non-pregnant women aged 18 years or older. Women with active menstrual bleeding or antibiotic use in the past two weeks were excluded. Speculum examinations guided the collection of high vaginal swabs for Gram staining with Nugent scoring, the whiff test, and microscopic identification of Candida spp. and Trichomonas vaginalis. Sociodemographic data were retrieved from hospital records. Descriptive statistics characterized the cohort; chi-square tests and multivariate logistic regression identified factors associated with infection (entry P<.20; significance P<.05).
Results: The mean age was 28.5 ± 6.2 years (range 18–45 years). The overall prevalence of vaginal infections was 92%, including BV (40%), VVC (31.9%), and mixed BV + VVC (20%); Trichomonas vaginalis was detected in <1% and excluded from analysis. Clinical features, including vulvovaginal itching (P<.01), abnormal non-white discharge (P<.05), and a positive whiff test (P<.01), were significantly more frequent in infected women. In multivariate analysis, lower educational attainment (adjusted odds ratio [aOR], 3.15; 95% CI, 1.05–9.42; P=.041) and rural residence (aOR, 2.80; 95% CI, 0.98–8.00; P=.054) independently predicted infection.
Conclusions: Vaginal infections are highly prevalent among non-pregnant women in our setting. Use of clinical predictors such as itching, discharge characteristics and whiff testing can lead to a cost-effective screening. These results highlight the urgent need to strengthen point of care diagnostic practices and integrate them into community education and public health programs to improve women’s reproductive health outcomes.