Prevalence of Ct widely varies from time to time, region to region, study population, study setting, and type of laboratory diagnosis method. [14] The prevalence of Ct among pregnant women found in this study is low when compared to results obtained by other authors. [5]–[7] This includes the findings from a meta-analysis in 2018 that reported a pooled prevalence of Ct in women of the reproductive age group in sub-Saharan Africa to be 7.8% and 7.6% in health facility studies. [14] This result is however higher than that obtained by Ankuma et al of 2% among a similar population using rapid chromatographic antigenic detection in cervical swabs, a study that was conducted in another part of Northern Nigeria. Some studies have reported no positive finding, as exemplified by Ghosh et al in India, in which they reported no positive case of Ct infection among 40 pregnant women using a similar ELISA technique. [15] Studies reporting a higher prevalence of Ct infection employed polymerase chain reaction (PCR) as the diagnostic technique which has been reported to be superior in Ct detection. [16] The ELISA test is more useful in seroepidemiological studies and also valuable in the diagnosis of Ct when the test for direct detection of the bacteria is negative or difficult to perform as in the upper genital infection. Though its major drawback is that it cannot distinguish current from past Ct infection. [17]
The prevalence of Ct obtained among pregnant women in this study is also lower than prevalence obtained among infertile women in the same setting and other climes. The variable higher prevalence of more than 50% has been reported among infertile women.[18]–[22] This supports the role of Ct in causing infertility. The additional adverse reproductive outcomes associated with Ct infection include miscarriage and stillbirths. [23], [24] However, from our study, seropositive pregnant women had similar parity and also reported similar miscarriage and stillbirth rates as seronegative women. This finding lends credence to the results of other workers that did not find Ct infection to be associated with miscarriage or stillbirth. [25]–[27]
Though some studies have shown young age (≤ 24 years) to be significantly associated with Ct infection, all seropositive pregnant women in this study were found to be aged ≥ 25 years and are similar to findings of Huai et al. [11], [28], [29]
The association found between religion and Ct infection is likely because the study population was predominantly of the Islamic faith. We found no association between chlamydial infection and the level of education in our study. All seropositive women in our study were well educated, likely a reflection of the high educational level in the general study participants. The low prevalence rate of Ct infection found in pregnant women in this study may be explained by the findings of a study conducted in Northern Nigeria by Ige et al. They reported a higher prevalence of 26% women of reproductive age using polymerase chain reaction, but also found that women with a low level of education had over four-fold increased odds of having Ct infection.[30] Additionally, a report from a meta-analysis found a low educational level to nearly double the odds for Ct acquisition. [31]
Conclusion and Recommendations
Our study found a low prevalence of Ct infection among pregnant women attending antenatal care. Seropositive pregnant women were well educated and gainfully employed. This study highlights the need for continued investigation into Ct infection in pregnancy preferably using the more advanced diagnostic techniques. These results provide a good basis for larger facility-based studies, as well as in the community; to institute programmes that could help to prevent and control this infection. Since chlamydia can be easily treated, such programme could help in lowering the transmission of chlamydia, which may help lower incidences of maternal disease, adverse pregnancy outcomes as well as neonatal disease.