Prevalence, Risk factors, Disclosure barriers and testing patterns to chlamydia trachomatis in Buea

By:
TANYI PRIDE BOBGA
HS22P103
BSc. Medical Laboratory Sciences,
MSc Medical Microbiology & Parasitology, PhD Microbiology
SUPERVISOR
Prof. AKOACHERE JANE-FRANCIS
CO-SUPERVISOR
Dr. NJOUENDOU ABDEL JELIL
JULY, 2024
UNIVERSITY OF BUEA
FACULTY OF HEALTH SCIENCES DEPARTMENT OF PUBLIC
HEALTH AND HYGIENE
PREVALENCE, RISK FACTORS, DISCLOSURE BARRIERS AND TESTING
PATTERNS TO Chlamydia trachomatis AMONG SEXUALLY ACTIVE
INDIVIDUALS IN MOLYKO, BUEA
MPH THESIS DEFENCE ENTITLED:

Presentation Outline
Background
 Statement of the Problem
Rationale
Hypothesis
Objectives
Materials and methods
 Results and Discussion
 Conclusion & Recommendations
 Acknowledgments
References
2
OUTLINE

3
Background 1/2
 Chlamydia is a sexually transmitted infection (STI) caused
by Chlamydia trachomatis with over 19 serovars (Nielsen
et al., 2020, Ghasemian et al., 2023).
 >70% of genital C. trachomatis infections in women and
50% in men are asymptomatic (Niu et al., 2024).
 Untreated infection can result several complications such
│
pelvic inflammatory disease (PID), sapingitis, infertility,
Urethretis etc (Smolarczyk et al., 2021).

4
Background 2/2
 In 2020, WHO estimated nearly 129 million new cases of C.
trachomatis infection worldwide each year ( Li et al., 2023).
 In sub-Saharan Africa, about 105 million new genital CT per
annum, with about 100 million of those cases occurring in adults
(Bayigga et al., 2019, Passos et al., 2022).
 In Cameroon, the prevalence of infertility ranges from 15% to
30% and secondary infertility is twice as common as primary
infertility (Mbah et al., 2022).

5
Statement of the Problem
Chlamydia trachomatis↑│ affecting mostly adolescents and adults
up to 45 years due to vulnerability to multiple risk factors
(Armstrong-Mensah et al.,2021).
 Asymptomatic result in undetected persistent infections risk of
→ ↑
complications & transmission|Retesting (Changchang et al.,2023).
 Routine screening| Lacking in low- and middle income countries
(LMICs)| appropriate screening strategy remains unclear| lack of
evidence on epidemic patterns, cost effective screening.

6
Rationale
Chlamydia accounts to a large burden of STI, spread remains largely
unchecked due to ↓diagnostic rates, infrequent retesting, and
inefficient partner notification (Isfeld-Kiely et al., 2014,Broek et al.,
2019).
The silent spread: double threat unchecked transmission|
→
complications due to missed reinfections as a consequence.
Current control strategies fall short: prevalence fueled by
↑
underdiagnosis, asymptomatic reinfections aided by retesting rates
↓
& incomplete cascade of partner notification.

7
Objective 1/1
General Objective
The general objective will be to determine the prevalence, risk factors,
disclosure barriers, and repeat testing patterns towards Chlamydia
trachomatis amongst sexually active individuals in Molyko.
1. To Determine the prevalence of Chlamydia trachomatis amongst
sexually active individuals in Molyko, Buea;
2. To Determine the associated risk factors to Chlamydia trachomatis
amongst sexually active individuals in Molyko, Buea;
3. To identify associated disclosure barriers and repeat testing patterns
among sexually active individuals in Molyko, Buea.
 Specific Objectives

8
MATERIALS AND METHODS 1/3
Study Design
-Cross-sectional
Study Site
-Molyko, Buea
Municipality
Target Population
-Sexually active
Sample Size Calculation
- Cochran formula
n = sample size = pq/
Z= confidence interval for
Z distribution=1.96
p= 26.7%= 0.267 q=0.733
N=238 + 10% buffer
translate to 261
participants
Inclusion Criteria
- Participants 15 years
≥
-Sexually active resident
-Participant
comprehension & consent
Exclusion Criteria
-Pregnant women
-Participant
receiving treatment
-Cognitive
impairments
Sampling Method
-Purposive Sampling
-Consecutive
Figure 1: Flow Chart Materials and Methods

9
Figure 2: Flow Chart Materials and Methods

10
Data Analysis
Data was analyzed using SPSS version 23.
Univariate analysis: Descriptive statistics using mean ± SD for continuous
variables and frequencies (n) and charts for categorical variables.
Bivariate analysis: chi-square tests for our categorical variables with
significance set at p<0.05. A bivariate logistic regression model will be
used to screen predictors associated to Chlamydia positivity.
Multivariate analysis: the multiple logistic regression model will be used
to determine the effects of factors potentially associated to Chlamydia,
retesting and disclosure barrier.

DATA MANAGEMENT
Verification of questionnaire
Questionnaires that had above 20% missing information were
discarded.
While questionnaires with 100% information were coded
following GCP guideline.
Tool for data entry
Data was inputted Google Forms
Data protection
Saved in google drive, Email and Flash. 11

13
Sociodemographic characteristics of Population
Ngonde et al. 2017
(Cameroon)
-University students.
Okonofua et al.,
2015 in Nigeria
Adolescents
RESULTS AND DISCUSSION 1/10

14
Objective 1: Prevalence of Chlamydia trachomatis
 HighTop: 7.1 %
(18), ELISA: 7.5%
 IgGimm:30.8% Vs
15.8% (40).
Similar: Stary et al.,
2017
Hussen: 7.8 % C.
trachomatis
Figure 4: Prevalence of Chlamydia trachomatis
RESULTS AND DISCUSSIONS 2/10

15
Table 2: Association Sociodem and Prevalence
 ↑ 38(15.0%) of
overall prevalence
Vs 20-24 yrs.
Morsha et al.
(2016)
Higher: 24.4 % (15-24)
Ashezua et al.
(2018)
>30yrs
v

16
 Similar: Gupta et al.,
2020
(Re-infection was 20.4
% NAAT)
Figure 5: Re-infection rates

17
Objective 2: Determination of associated Risk factors to C.trachomatis
Table 3: Associated risk factors to C. trachomatis
 Feston et al.,
2019, Ghana
-casual sex
-History STI

18
Table 4: Risk factors (Bivariate and Multivariate)
Occupation:
-Financial
contraints
- Risk behaviors
Haggerty et
al.,2019
Pills
-Micro-environment
-immune syst↓
Honer et al. (2020)

19
Objective 3: Barriers to disclosure of Chlamydia and testing patterns
Figure 6: Proportion of Disclosure
Mkhize et al. (2017)
65% disclosure, SA
Asare et al. (2022)
78% disclosure Ghana

20
Qualitative Analysis of disclosure/Testing Barriers 8/10
Oyelade
et
al.
(2017)

21
Table 6:Factors Associated to Disclosure
McDonagh et al., 2020

22
Table 7: Retesting among study participants

23
Conclusion
Chlamydia trachomatis prevalence is significantly high, with 19% detected
by ELISA and 34.8% by immunochromatography.
 Several risk factors were identified for Chlamydia prevalence and re-
infection, including age, pill uptake, sexual route, casual sex, STI
diagnosis, and occupation.
 Despite a high willingness to disclose Chlamydia status (73.1%), barriers
such as lack of communication, anxiety, and stigmatization hinder
disclosure.
Females were more likely to disclose their status, and individuals engaged
in casual sex and those using contraceptive pills were more likely to retest.

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RECOMMENDATIONS
 Participant
-Participate in regular screening and engage in open communications
about STI’s and safe sex practice.
Ministry of Public Health
• 1. Enhanced Public Health Campaigns: Launch targeted awareness
campaigns focusing on high-risk groups, particularly adolescents and young
adults, to educate them about Chlamydia prevention and the importance of
regular testing.
• 2. Accessibility of Testing Services: Increase the accessibility and
affordability of Chlamydia testing and treatment services across
communities.

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ACKNOWLEDGEMENT
 I will love to acknowledge my Supervisor Professor Jane-Francis Akoachere
for her guidance, motherly approach and understanding via out this
dissertation write-Up.
 My Co-supervisor Dr. Njouendou Abdel who guided my journey from
undergraduate till now. I am grateful for encouraging me to take on an MPH
to cement my skills in infectious diseases, thankful for his immense efforts
on rigorously conceiving and developing this dissertation.
 The Dean of the Faculty, all Lecturers for the knowledge they shared
continue to share with me.

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REFERENCES
Okonofua, F. E., et al. (2015). Sociodemographic determinants of
multiple sexual partnerships among Nigerian adolescents. International
Journal of Adolescent Medicine and Health, 27(1), 75-82.
 Marie Chantal Ngonde, Sara Minka, Chéléa Matchawe, Emmanuel
Nnanga. “Prevalence And Risk Factors Of Chlamydia trachomatis In
Cameroonian Women Attending The Nkolndongo District Hospital In
Yaounde,” International Journal of Innovation and Scientific
Research,2017, 28(2), 87–92.
Stary, A., Chrenek, M., Kufneer, M., & Kaspirek, M. (2017).
Seroprevalence of Chlamydia trachomatis in high-risk populations:
Implications for screening strategies. Journal of Infection and Public
Health, 10(6), 731-737. doi:10.1016/j.jiph.2016.09.011.

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Hussen S., Wachamo D., Yohannes, Z. et al. Prevalence of Chlamydia
trachomatis infection among reproductive age women in sub Saharan Africa: a
systematic review and meta-analysis. BMC Infect Dis 18, 596 (2018).
• Haggerty CL, Gottlieb SL, Taylor BD, Low N, Xu F, Ness RB. Risk of sequelae
after Chlamydia trachomatis genital infection in women. The Journal of
Infectious Diseases. 2019; 201(S2)
• Horner PJ. The case for further treatment studies of uncomplicated genital
Chlamydia trachomatis infection. Sexually Transmitted Infections.
2020;82(4):340-343. doi:10.1136/sti.2006.020867.
• van der Helm JJ, Koekenbier RH, van Rooijen MS, Schim van der Loeff MF,
de Vries HJ. What is the role of hormonal contraception in the higher
prevalence of Chlamydia trachomatis infection among women than among
men? BMC Infectious Diseases. 2018;13:397. doi:10.1186/1471-2334-13-397.

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