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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 24  |  Issue : 2  |  Page : 114-120

Socioeconomic status of parents and the occurrence of pelvic inflammatory disease among undergraduates attending Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria


Department of Family Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria

Date of Web Publication24-Jul-2017

Correspondence Address:
Tijani Idris Ahmad Oseni
10 Jafaru Marughu Street, Off Igarra Road, P.O. Box 995, Auchi, Edo State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/npmj.npmj_28_17

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  Abstract 


Background: Pelvic inflammatory disease (PID) is a major cause of gynaecological morbidity globally. Complications from PID include infertility, ectopic pregnancy and chronic pelvic pain. Low socioeconomic status (SES) is a risk factor for the occurrence of PID. Objective: The aim of this study was to determine the association between SES of parents and the occurrence of PID among undergraduates attending Irrua Specialist Teaching Hospital, Irrua. Methodology: The study was a hospital-based, descriptive cross-sectional study. Three hundred and sixty female undergraduates attending the hospital were consecutively recruited and clinically assessed for the presence of PID using the WHO and CDC MMWR 2010 criteria for the clinical assessment of PID. Their SES was determined by Oyedeji social class categorisation. Data were analysed using Epi Info 3.5.4. Descriptive statistics were used to summarise the data, and Chi-square was used to test for association. Results: There was a significant association between SES of parents and multiple sex partners (P < 0.02), previous sexually transmitted infection (STI) (P = 0.05), unprotected sex (P < 0.001), history of induced abortion (P < 0.001) and surgical termination of pregnancy (P < 0.01). There was also association between occurrence of PID among respondents and multiple sexual partners (P < 0.001), previous history of STI (P = 0.02), non-persistent use of condom (P < 0.001), history of induced abortion (P < 0.01) and surgical termination of pregnancy (P < 0.01). There was however no significant association between SES of parents and occurrence of PID (P = 0.14) though PID was highest among respondents from low SES. Conclusion: Occurrence of PID among undergraduates was not associated with their SES. However, identified risk factors for PID among study population such as multiple sex partners, previous STI, unprotected sex and history of induced abortion were associated with the SES.

Keywords: Females, parents, pelvic inflammatory disease, socioeconomic status, undergraduates


How to cite this article:
Oseni TI, Odewale MA. Socioeconomic status of parents and the occurrence of pelvic inflammatory disease among undergraduates attending Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria. Niger Postgrad Med J 2017;24:114-20

How to cite this URL:
Oseni TI, Odewale MA. Socioeconomic status of parents and the occurrence of pelvic inflammatory disease among undergraduates attending Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria. Niger Postgrad Med J [serial online] 2017 [cited 2019 Dec 8];24:114-20. Available from: http://www.npmj.org/text.asp?2017/24/2/114/211458




  Introduction Top


Pelvic inflammatory disease (PID) is a common cause of morbidity in females globally.[1],[2],[3] PID is an infection caused inflammatory continuum from the cervix to the peritoneal cavity, which is most importantly, associated with fallopian tube inflammation which can lead to infertility, ectopic pregnancy and chronic pelvic pain.[4] Up to 40% of untreated lower genital tract infections progress to PID.[2] It is one of the most common and serious complications of sexually transmitted infections (STIs) in women.[1],[2],[5]

Studies have shown a high prevalence of sexual intercourse among school-going adolescents leading to high prevalence of PID among students.[2],[6] Students especially those in tertiary institutions are particularly vulnerable to engage in practices that will predispose them to develop PID as most of them are adolescents and young adults who are adventurous and tend to experiment since they are free from direct parental control in the campus.[2]

Likely reasons for increased risk of PID among young adults and adolescents include increased cervical mucosal permeability, a larger zone of cervical ectopy, a lower prevalence of protective anti-chlamydial antibodies and increased risk-taking behaviours.[7] Developing PID at this stage puts the patient at risk of the sequelae of PID such as infertility, ectopic pregnancy and chronic pelvic pain later in life when they eventually marry and desire to get pregnant.

Socioeconomic status (SES) was classified by Oyedeji into high, medium and low based on the occupation and level of education.[8] Low SES as measured by low levels of education, unemployment and low income [8],[9] may be associated with increased risk of PID.[2],[5],[9] The higher incidence of PID in women of lower SES may be due in part to a woman's lack of education coupled with low level of awareness of health and disease and her accessibility to medical care.[9] Adolescents and young females from low socioeconomic backgrounds commonly engage in sex for money, favours and material goods.[2] They may also engage more in sex with older men (so-called 'sugar daddies') for gifts, pocket money and school fees [2] as majority of such girls are often responsible for their fees and even send money to their poor parents from such proceeds. These men who make the decisions that affect sexual risk almost universally do not like to use barrier contraceptives; thus, sex in this vulnerable group is most likely to be unprotected.[2] Lack of access to good health care facilities for patients with STIs from low socioeconomic backgrounds may also facilitate progression to PID in this group. They are also at higher risks of unwanted pregnancies from unprotected sex, making them engage in abortion in the hands of quacks and under unsanitary conditions further increasing their susceptibility to PID.[10]

Edo state has one of the highest concentrations of young people in Nigeria, with young adults and adolescents making up about 32.9% of its total population.[11] Prevalent in the state are unplanned pregnancies and unsafe abortions, sex trafficking and prostitution, STI/HIV/AIDS, poor health-seeking behaviour of youths, high levels of youth unemployment and breakdown of parent–child communications among young adults and adolescents.[11]

The aim of this study was to determine the association between SES of parents and occurrence of PID among undergraduates attending Irrua Specialist Teaching Hospital (ISTH) to provide evidence-based information to plan and institute preventive measures aimed at behavioural change among this vulnerable group to reduce the scourge of the disease and its attendant sequelae.


  Methodology Top


The study was conducted in the Family Medicine Clinic, Gynaecological Clinic and Accident and Emergency Unit of ISTH, Irrua, Edo State, Nigeria. It was a descriptive cross-sectional study and data were collected between 1st February 2014 and 30th November 2014. Sexually active female undergraduates of reproductive age (15–49 years) from three tertiary institutions in Edo State (Ambrose Alli University, Ekpoma, Esan West Local Government Area; Auchi Polytechnic, Auchi, Etsako West Local Government Area; and College of Education, Igueben, Igueben Local Government Area) attending the Family Medicine Clinic, Gynaecological Clinic and Accident and Emergency Unit of ISTH, irrespective of their ailment, were evaluated for PID using the WHO criteria for the clinical diagnosis of PID (lower abdominal pain and pelvic tenderness on examination) as contained in the American Centre for Disease Control and Prevention clinical diagnostic criteria (CDC MMWR) of 2010.[10],[12],[13],[14] Students from the above three tertiary educational institutions routinely come to ISTH for medical consultation and treatment as it is the only tertiary health facility serving the area where the institutions are located (Edo Central and Edo North Senatorial Districts).

A total of 372 female undergraduates were recruited, of which 360 sexually active students who consented participated in the study. The sample size was determined using the formula N = Z 2 pq/d 2, where N is estimated sample size; Z is standard normal deviate corresponding to a confidence interval of 95% (1.96); P is prevalence of PID (70% in Osogbo, South-western Nigeria);[15]q is the proportion of those without PID in the population and d is the allowable relative error (5%).

All eligible female undergraduates who consented to participate in the study were consecutively enrolled into the study.

The instruments for data collection were semi-structured interviewer-administered questionnaire and Oyedeji questionnaire for socioeconomic class assessment.

Patients were evaluated clinically. All participants had their history taken and a detailed clinical examination conducted. They were considered to have PID if they had pelvic or lower abdominal pain and on examination had one or more of the following; cervical motion tenderness, uterine tenderness or adnexal tenderness.[12]

Those who did not meet the criteria above were, for the purpose of this study, categorised as not having PID. All the patients were evaluated and treated for their ailments, irrespective of whether the ailment was PID or not.

Oyedeji classification of social class instrument was used. It classified SES into high, medium and low based on the occupation and level of education of the parents. It is graded on a score of 1 to 5, 1 being the highest and 5 being the lowest. Each score has two variables, occupation and level of education. A person with a score of 1 to 2 belonged to the high socioeconomic class, 2.1 to 3 and 3.1 to 5 belonged to the medium and low socioeconomic class, respectively.

Data were analysed using Epi Info 3.5.4 statistical software for epidemiology designed by Centers for Disease Control and Prevention (CDC), Atlanta, Georgia (USA). Analysis was performed by descriptive statistics to summarise the data, and Chi-square test was used to test for association between sexual history of respondents and their SES as well as between identified risk factors and occurrence of PID and P≤ 0.05 was considered statistically significant. Results were displayed using tables and frequency distribution. Prevalence of PID was determined from the study population during the period using the formula for calculating prevalence.[16]



Data were stratified into SES during analysis. Ethical approval for this study was obtained from the Research and Ethics Committee of ISTH, Irrua, Edo State, Nigeria, via protocol no ISTH/R and ETHICS COM/84 of 2nd September 2013. Written informed consent was obtained from all the respondents after details of the study including the aim and objectives were explained to them.


  Results Top


The ages of the respondents ranged from 16 to 35 years, with a mean age of 23.6 ± 3.6 years and median age of 23 years. Majority of the patients were 20–24 years amounting to 196 (54.4%), followed by those aged 25–29 amounting to 98 (27.2%).

Of the 360 respondents, 199 (55.3%) were university students, 110 (30.6%) attended polytechnic and 51 (14.2%) were in the college of education.

Most of the respondents 337 (93.6%) were sponsored by their parents. The rest were either sponsored by their spouses 16 (4.4%) or self-sponsored 23 (6.4%).

Apart from the main sponsors, 65 (18.1%) of the respondents had additional sponsors while the remaining 295 (81.9%) relied solely on the allowances they got from their parents or what they earned themselves. For those who had extra sponsors, 55 (15.3%) of them said that it was their boyfriend, 5 (1.4%) their husbands and the rest 5 (1.4%) were their relatives (uncles, aunts and brothers).

Most respondents 210 (58.3%) got <N10,000 as monthly allowance from their sponsors. This was followed by those who got N10,000 and <N20,000 who were 88 (24.5%). Those who got between N20,000 and <N30,000 were 33 (9.2%). Those respondents who received between N30,000 and <N40,000 were 18 (5%) and 3 (0.8%) respondents got between N40,000 and <N50,000. The remaining 8 (2.2%) respondents got ≥ N50,000 as monthly allowance from their sponsor. This is illustrated in [Table 1].
Table 1: Educational history of the respondents (n=360)

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Most of the respondents had fathers who were educated; 95 (31.7%) of them had secondary education, 94 (31.3%) had tertiary education and 73 (24.3%) had primary education. The remaining 38 (12.7%) had no formal education.

Among their mothers, 90 (27.5%) of them had no formal education, 89 (25.7%) had primary education, 87 (25.1%) had secondary education and 75 (21.7%) had tertiary education.

The fathers of the students engaged in various occupations; 106 (35.3%) were civil servants, 89 (29.7%) were farmers, 56 (18.7%) were artisans and the remaining 49 (16.3%) were traders.

Majority of the mothers were traders 153 (44.2%). Others were civil servants 78 (22.5%), farmers 78 (22.5%) and artisans 37 (10.7%).

The family sizes ranged from 2 to 34, with a mean of 8.4 ± 4.0 and median of 8. Most of the respondents 232 (64.4%) had families whose sizes ranged from 5 to 9. This was followed by respondents 70 (19.4) with family size of 10 to 14 persons and 4 (1.1%) with families of ≥20 persons.

Most of the respondents had parents of low SES 192 (53.3%) while 92 (25.6%) of the respondents had parents of middle SES and the rest 76 (21.1%) had parents of high SES. This is illustrated in [Table 2].
Table 2: Socioeconomic characteristics of parents of the respondents

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The relationship between sexual history of respondents and SES of their parents is shown in [Table 3]. The proportion of respondents with low SES decreased with increasing age at coitarche. All the three respondents who had sexual debut when they were <15 years all came from low socioeconomic backgrounds. This was followed by those who had it at age 15–19 years 138 (52.9%), 20–24 years 48 (53.9%) and 25–29 years 2 (40.0%). The difference in age at coitarche among the various SES was however not statistically significant (χ2 = 4.84, P> 0.70).
Table 3: Relationship between sexual history of respondents and socioeconomic status of their parents (n=360)

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The number of sex partners among respondents from the various SES showed that there was a statistically significantly higher proportion of respondents from low SES with multiple sex partners compared to respondents from middle and high socioeconomic classes (χ2 = 15.87, P< 0.02).

Of the 268 (74.4%) respondents with previous history of STI or PID, 175 (65.3%) of them were from low socioeconomic backgrounds while 50 (18.7%) and 43 (16%) of them were from middle and high socioeconomic backgrounds, respectively. The difference was found to be statistically significant (χ2 = 3.69, P= 0.05).

A total of 69 (19.2%) respondents used barrier contraceptive (condom) anytime they had sex. Of this number 19 (27.6%), 21 (30.4%) and 29 (42%) were from low, middle and high socioeconomic backgrounds, respectively. The difference was found to be statistically significant (χ2 = 29.13, P< 0.001).

Those in the low socioeconomic class had the highest proportion of induced abortion compared to those in other social classes. The proportion of those presenting with induced abortion increased as the SES decreased. This difference was statistically significant (χ2 = 26.28, P< 0.001).

Surgical termination of pregnancy through dilatation and curettage was used more by respondents in the low socioeconomic class. There was a statistically significant difference in the method used by respondents in the various socioeconomic classes (χ2 = 17.55, P< 0.01).

The association between identified risk factors and occurrence of PID among respondents is as illustrated in [Table 4]. The higher the number of sexual partners, the higher the chance of PID (P < 0.001). Other risk factors associated with occurrence of PID were previous history of STI (P = 0.02), non-persistent use of condom (P < 0.001), history of induced abortion (P < 0.01) and surgical termination of pregnancy via dilatation and curettage (P < 0.01).
Table 4: Association between identified risk factors and occurrence of pelvic inflammatory disease (n=360)

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Of the 192 (53.3%) respondents from low socioeconomic class, 126 (65.6%) had PID. Of the 92 (25.6%) and 76 (21.1%) respondents from middle and high socioeconomic classes, 62 (67.4%) and 41 (53.9%) had PID, respectively. There was however no significant association between SES of parents and the occurrence of PID among respondents (χ2 = 3.97, P= 0.14).


  Discussion Top


Prevalence of PID among undergraduates attending ISTH was very high. In addition, a very high percentage of these students were sponsored by their parents and majority of them received [2] Those from high SES with sexual activity might be as a result of peer group influence or the usual adolescent behaviour.[2]

Early coitarche is a significant risk factor for PID.[2],[3],[17] The age at sexual debut in this study ranged from 13 to 30 years, with a mean age of 18.3 ± 2 years. Majority of the respondents attained coitarche between the ages of 15 and 19 years (72.5%). Those in the low SES attained coitarche earlier than those in the higher socioeconomic classes; for instance, those who had their sexual debut before the age of 15 years were all in the low socioeconomic class and they all had PID. A study by Kazhila in Namibia found age at first intercourse to be a significant risk factor for the occurrence of PID.[2] This is similar to findings by Simms et al.[6] and another study by Arinze et al. in Port Harcourt.[17] Both studies also found most of the women with PID attaining coitarche between the ages of 15 and 19 years.[6],[17]

Contraceptive use was low among the study population (28.9%). This compares with a study by Oye-Adeniran which found a low contraceptive use prevalence (11.1%) among Nigerian women of child-bearing age.[18] Contraceptive use was least among patients in low socioeconomic class (25.5%) compared to those in middle (28.3%) and high (37.3%) socioeconomic classes. This low level of contraceptive use, especially among those in low socioeconomic class, may be due to their inability to negotiate condom use with their older sexual partners who usually give them money for sex.[2] It could also be due to low level of awareness considering the fact that most individuals from low socioeconomic backgrounds have parents who are mostly uneducated or could barely read and write.[19]

PID was highest among students from low socioeconomic background, followed by those in the middle and least among those with high socioeconomic background, though the difference was not statistically significant. However, separate studies done by Simms et al.[6] as well as Dehne,[9] Suleiman and Tayo [20] and Ekpenyong and Etukumana [21] found a significant association between socioeconomic class and occurrence of PID with the disease highest among those from low socioeconomic background.[6],[9],[20],[21] These studies were however conducted among the general population as opposed to this study that was conducted among undergraduates.

This study found that there was no association between SES of parents and the occurrence of PID among undergraduates attending ISTH, Irrua. It therefore means that socioeconomic class of parents cannot be used in isolation to predict the occurrence of PID among undergraduates attending ISTH. However, other known risk factors of PID such as multiple sex partners (P < 0.02), previous history of PID/STI (P = 0.05), low barrier contraceptive use (P < 0.001), induced abortion (P < 0.001), particularly surgical termination of pregnancy via dilatation and curettage (P < 0.01) and increased number of abortions in the past (P < 0.001) were found to be significantly higher among students from low socioeconomic class compared to those from other classes.

Occurrence of PID among the study group was significantly associated with multiple sex partners (P < 0.001), previous STI (P = 0.02), non-persistent condom use (P < 0.001) and induced abortion in the past (P < 0.01) particularly surgical termination of pregnancy via dilatation and curettage (P < 0.01).

The study was hospital-based and among highly selective population. The findings, therefore, cannot be generalised. Identifying the true SES of parents was difficult as some students may not agree that their parents were poor or rich while others may have exaggerated the poverty/affluence of their parents.


  Conclusion Top


Prevalence of PID is high among undergraduates attending ISTH. Majority of the students were from low and middle socioeconomic backgrounds. Sexual activity was found to be high among these students either for pecuniary gain or social behaviour. History of unprotected sex and unwanted pregnancy with high rate of abortion was high among the group.

Occurrence of PID though more with students from low socioeconomic background was not related significantly to SES. However, other risk factors for PID such as unprotected sex, abortion, multiple sex partners and previous STI/PID were directly related to SES of parents.

Recommendations

Health education on the risk factors of PID and how they can be avoided should be embarked on by health workers. Undergraduates presenting to health facilities should be counselled on the prevention of PID as well as prompt treatment to prevent adverse sequelae associated with it later in life such as infertility, ectopic pregnancy and chronic pelvic pain.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Kazhila CC. Sexually transmitted infections in adolescents. Open Infect Dis J 2009;3:107-17.  Back to cited text no. 2
    
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Prasad JH, Abraham S, Kurz KM, George V, Lalitha MK, John R, et al. Reproductive tract infections among young married women in Tamil Nadu, India. Int Fam Plan Perspect 2005;31:73-82.  Back to cited text no. 6
    
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Oyedeji GA. Socio-economic and cultural background of hospitalized children in Ilesa. Niger J Paediatr 1985;12:111-7.  Back to cited text no. 8
    
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Dehne KL. Sexually transmitted infections among adolescents: The need for adequate health services. WHO: German Society for Technical Cooperation (GTZ) GmbH; 2005. Available from: http://apps.who.int/iris/bitstream/10665/43221/1/9241562889.pdf. [Last accessed on 2015 Jan 26].  Back to cited text no. 9
    
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Omoteso BA. A study of the sexual behaviour of university undergraduate students in Southwestern Nigeria. J Soc Sci 2006;12:129-33.  Back to cited text no. 10
    
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Aladeselu N. Draft Strategic Plan for Improving the Reproductive Health of Young Adults and Adolescents in Edo State Nigeria. Youth Reproductive Health Policy Database; 2002. Available from: http://www.youth-policy.com. [Last accessed on 2015 Jan 26].  Back to cited text no. 11
    
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Moses S. Pelvic Inflammatory Disease. Family Practice Notebook. Available from: http://www.fpnotebook.com. [Last accessed on 2015 Jan 26; Last updated on 2012 Apr 15].  Back to cited text no. 13
    
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Choudhry S, Ramachandran VG, Das S, Bhattacharya SN, Mogha NS. Pattern of sexually transmitted infections and performance of syndromic management against etiological diagnosis in patients attending the sexually transmitted infection clinic of a tertiary care hospital. Indian J Sex Transm Dis 2010;31:104-8.  Back to cited text no. 14
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Olowe OA, Alabi A, Akindele AA. Prevalence and pattern of bacterial isolates in cases of pelvic inflammatory disease patients at a tertiary hospital in Osogbo, Nigeria. Environ Res J 2012;6:308-11.  Back to cited text no. 15
    
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Rajvir B. Measures of information in epidemiology. In: Bhalwar R, editor. A Test Book of Public Health and Community Medicine. New Delhi: AFMC; 2008. p. 89.  Back to cited text no. 16
    
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Arinze AU, Onyebuchi NV, Isreal J. Genital chlamydia trachomatis infection among female undergraduate students of University of Port Harcourt, Nigeria. Niger Med J 2014;55:9-13.  Back to cited text no. 17
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Oye-Adeniran BA, Adewole IF, Odeyemi KA, Ekanem EE, Umoh AV. Contraceptive prevalence among young women in Nigeria. J Obstet Gynaecol 2005;25:182-5.  Back to cited text no. 18
    
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


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