Acceptability and adequacy of self-administered low vaginal swabs and clean catch urine by pregnant women in a rural setting in Bangladesh with assistance of community health worker (CHW)

Background : Bacterial vaginosis and urinary tract infections are prevalent in pregnancy (10-20%) and are associated with adverse pregnancy outcomes, which may be averted with early detection and treatment.

Methodology: Key informant interviews and focus group discussions were conducted in a community setting in rural Bangladesh to understand maternal perceptions of genitourinary infections and the self-collection of vaginal and urine specimens. Between 13-19 weeks of gestation, Community Health Workers (CHWs) taught pregnant mothers how to collect mid-stream clean catch urine samples and self administered low vaginal swabs (VS).

Results: The pregnant women reported that they were frequently affected by genitourinary tract symptoms during pregnancy and these were a common cause of concern. Although self-collection of vaginal and urine specimens had not previously been practiced in this conservative setting, mothers were willing to provide self-collected specimens if health benefits were explained and their husbands and in-laws were included in the decision making process. Over a seven month period, a total of 935 urine samples and 838 self-administered low VS were collected. The refusal rate was very low (1% for urine samples, 1.4% for vaginal swabs). Specimen quantity was adequate; with poor smear quality noted only 0.47% of vaginal specimens. For urine specimens, 0.4% of women were unable to produce specimen, and 12% of samples had mixed growth requiring recollection.

Conclusion: Even in a conservative, rural setting self-collection of urine samples and low vaginal swabs can be successfully and adequately obtained with proper training and counseling with the assistance of CHW.