Evaluación de los directivos por parte del Supervisor Escolar

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education which agrees with some previous studies^63,64,68. This could be due to higher level of sophistication, enlightenment and utilization of orthodox medicine among those with western education^64,68. Those who lack western education patronize traditional medicine more⁶⁴. This high patronage of traditional medicine which involves insertions into the vagina predisposes them to vaginal discharge⁶⁸. The increased frequency of vaginal discharge in unemployed patients reflects the role of poverty and dependence in disease causation⁶⁷. Marital status did not influence the risk of vaginal discharge and this may be due to the fact that majority of the women with and without vaginal discharge were married and therefore other social factors like unemployment of the husband rather than marriage might be the risk for abnormal vaginal discharge⁶⁷.

Vulval pruritus and dysuria were significant clinical features found to be associated with vaginal discharge. This finding was similar to a previous study which reported rates of 59 % and 18 % respectively²⁸. The high rate of vulval pruritus in my study may be explained by the increased frequency of candidiasis among those complaining of vaginal discharge19,20,28,29.

All the microorganisms isolated from the women were significantly more in number in those with vaginal discharge than those without complaint of vaginal discharge. As found in a similar study⁶³, this was due to the fact that those with complaint were likely to be infected^67,68. This perhaps explains why those without complaint had three times negative bacterial culture than the cases. The organisms isolated from samples of women without complaint of vaginal discharge were likely normal vaginal commensals and not infective since there were no symptoms associated with their presence.

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Candidiasis was the leading cause of vaginal discharge in the study. Although the result was lower than those of some earlier studies done on the same group of patients which reported 80.0 %, 46.0 % and 94.0 %^58,62,63, candidiasis was identified as the most prevalent cause of vaginal discharge in pregnancy in all the studies. The alteration in vaginal pH due to hormonal influence during pregnancy favours the growth of C. albicans^58,64,65. C. albicans is one of the very few organisms that can survive in this hostile environment, and it proliferates to become pathogenic⁶⁵.

The findings of G. vaginalis, E. coli, T. vaginalis, N. gonorrhoea, S. aureus, Klebsiella and Streptococcus species are similar to those of earlier studies^58,62,65. A previous study⁶⁶, on a general population recorded 30 % of bacterial vaginosis which is much higher than the present finding in the population of pregnant women. This may be explained by the inclusion of non-pregnant women in that study. The low prevalence of trichomoniasis and gonorrhoea could be explained by the strict religious and cultural beliefs which prohibit illegal sexual relationships in addition to the abuse of antibiotics.

Twenty three per cent of samples collected yielded negative bacterial growth and this finding was lower than 40 %⁵⁸ and 56 %⁶³ reported Jos and Kano respectively. Methodology as well as the proportion of women with leucorrhoea of pregnancy in these studies may be responsible for the difference in the prevalences⁶⁶. Majority of these women in my study with no bacterial growth in their samples may be having leucorrhoea which is a normal effect of pregnancy^64,67,68; the cervix produces increased fluid during pregnancy that helps to keep vaginal canal clean and infection free^67,68.It is also possible that a number of these women may harbour some infective agents that were not easily detected by the tools used in the study⁵⁸.

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A striking finding in this study was the proportion of women who despite the fact that they had no complaint of vaginal discharge, was found to have abnormal vaginal discharge on examination. The finding of vaginal discharge in 35.5 % of these women may be due to difficulty in self expression as seen in other complaints that have to do with reproductive organ.

The finding of statistically significant relationship of the colour and consistency of discharge with the risk of infection is similar to that of a previous study from Asia³¹. Majority of women with thick, whitish vaginal discharge had increased infection rate with the presence of microorganisms in up to 80 % of them. This finding supports those of other studies^31,69, and may be explained by the fact that Candidiasis is a common condition during pregnancy and its characteristic discharge is thick and whitish. More also, majority of those with vaginal discharge in pregnancy in this study had C. albicans infection.

All the HIV positive patients studied had C. albicans infection which agrees with finding from a similar study⁶³. The high prevalence of C. albicans among HIV positive pregnant women was because C. albicans is an opportunistic commensal in the vagina, which proliferates to become pathogenic in immunosuppressed individuals like HIV positive women^63,67,70.

All the microorganisms isolated had greater than 60 % sensitivity to amoxicillin-clavulanic acid (augmentin) while Streptococcus species and G.

vaginalis also had good sensitivity to erythromycin. These drugs are commonly used in pregnancy²².

The incidence of vaginal discharge was found to increase with trimester of pregnancy with 42 % of the women presenting during the 3^rd trimester. This supports finding from an earlier study ⁵⁸, which reported 37 %. This finding is

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due to increased hormonal influence with increasing gestation thereby leading to predisposition to infective vaginal discharge late in pregnancy⁶³.

Candida albicans was the commonest agent of infective genital discharge among pregnant women. The prevalence of trichomoniasis and gonorrhoea was among the least reported.

Young maternal age, low parity, lack of western education and unemployment were found to expose the pregnant women to the risk of vaginal discharge, and should have closer surveillance.

Thick whitish vaginal discharge, vulval pruritus and dysuria are significant risks for genital infection. These features should be looked out for in pregnant women presenting with vaginal discharge.

All cases of vaginal discharge in pregnancy should be investigated properly in order to determine the aetiology. Microscopy, culture and sensitivity should be done and treatment should be based on antibiotic sensitivity.