Among women of reproductive age, abnormal vaginal discharge is a common symptom of reproductive tract infections [1] . This issue frequently prompts women in this age group to seek medical care [2] [3] . Most often, infection of the vaginal mucosa is the cause of symptomatic vaginal discharge. However, disruptions in the vaginal flora can lead to vaginitis, which manifests as abnormal vaginal discharge [2] . Among these infections, three of the most prevalent causes are bacterial vaginosis, Trichomonas vaginalis, and Candida albicans infections [3] [4] . One critical component of the global health sector strategy on sexually transmitted infections (STI) is the emphasis on the effective management of STI symptoms, with abnormal vaginal discharge considered one of the symptoms associated with STI [5] . Studies have identified a number of risk factors for abnormal vaginal discharge in women of reproductive age.

These factors include multiple sexual partners [6] [7] , use of oral contraceptives [8] [9] , douching [10] [11] , pregnancy [8] [12] , hormone replacement, uncontrolled diabetes, immunosuppression, use of antibiotics, and intrauterine device [8] . Other reported risk factors were being single, partner infidelity [13] , advanced age, childbearing history [14] , past history of abortion [7] [15] , lower educational level and economic status [14] - [17] , history of sexually transmitted infection [7] , smoking [18] , and elevated level of sex hormones [8] [19] . Abnormal vaginal discharge carries significant implications for women’s well-being. It extends beyond the physical discomfort it can cause, affecting aspects of their lives such as sexual activity and social interactions, often leading to social stigma [20] . Abnormal vaginal discharge can also serve as a warning sign, indicative of potentially severe medical conditions, including pelvic inflammatory disease (PID) [21] , and cervical cancer [22] . Furthermore, the underlying infectious causes, STIs and bacterial vaginosis, in addition to causing genital symptoms, pregnancy complications, infertility, HIV transmission, and other psychosocial effects, affect sexual, reproductive, and maternal-child health [23] [24] .

In light of this, it becomes evident that understanding the factors that predict abnormal vaginal discharge among women of reproductive age is paramount. Such understanding is vital for the development of targeted interventions aimed at the prevention and management of the condition. Also, this study tends to fill a gap in research by assessing the association between the role of family and relationship dysfunction as a potential risk factor for abnormal vaginal discharge.

It is noteworthy that this study assessed the association between family dysfunction and abnormal vaginal discharge which is an area of gap in most previous studies. It is interesting to note that family dysfunction was found to be a predictor of abnormal vaginal discharge. The reason could be that dysfunctional family or relationships can lead to stress, which can weaken the immune system and upset the normal flora, thus, rendering women more susceptible to STIs and, consequently, vaginal discharge [25] . This finding aligns with a study that identified a significant relationship between psychosocial stress and vaginal discharge [26] . It has been documented that persistent exposure to psychosocial stress can lead to disruption of the vaginal microbiota leading to vaginal dysbiosis which can allow opportunistic organisms to overgrow causing vaginal infections [27] [28] . Another possible explanation could also be that those who experience family dysfunction may develop unhealthy coping mechanisms, such as substance abuse or sexual risk-taking behaviour. These behaviours can increase the risk of sexually transmitted infections (STIs), which can cause vaginal discharge.

In this study, respondents between 26 and 45 years old were more likely to have an abnormal discharge than their counterparts. This finding is somewhat consistent with a study that reported a higher prevalence of abnormal vaginal discharge in women within a similar age range (19 - 42 years) [29] . It is possible that the result is due to a change in the pH of the vaginal cavity, since the vaginal pH value is age-dependent and may be slightly higher than 4.5 for women in the perimenopausal stage [30] [31] . This increased vaginal pH has been shown to increase susceptibility to sexually transmitted infections [31] . Also, hormonal changes could account for the age-related difference because as women progress through their reproductive years, hormonal fluctuations can impact the vaginal microbiota, potentially leading to an increased susceptibility to infections and abnormal discharge [32] . Respondents who were students were found to be more likely to have an abnormal vaginal discharge than those in other occupations. This finding could be attributed to their increased likelihood of engaging in sexual activity, and having multiple sexual partners. This finding may also reflect disparities in lifestyle and daily routines between these groups. In addition, students are frequently faced with academic pressures, irregular sleep patterns, and higher levels of stress, which can affect their general health, including their vaginal health. In this study, use of oral contraceptives was also found as a predictor of abnormal vaginal discharge, and this is similar to findings from other studies [8] [9] . One possible explanation for this might be that oral contraceptives can alter the vaginal flora and increase the risk of developing vaginal candidiasis, a common cause of abnormal vaginal discharge [33] [34] . It was also noted that respondents who used water cisterns were more likely to have an abnormal vaginal discharge than respondents who used other types of sanitary facilities. In a study done in Cameroon use of water cistern was reported as a risk factor for vulvovaginal candidiasis [35] .

Another predictor of abnormal vaginal discharge was anal hygiene practices of cleaning from back to front. This practice can transfer bacteria from the anus to the vulva and into the vagina, potentially leading to faecal contamination, which is a known endogenous factor that may affect vulvar pH and thus lead to abnormal vaginal discharge [25] . Sexual frequency of more than twice a month was also noted as a predictor of abnormal vaginal discharge. This is in tandem with other reported studies that being sexually active increases the chances of abnormal vaginal discharge [12] . Sexual activity has been linked to disruptions in the vaginal microbiota possibly due to the transmission of infections [27] . The reason might be because bacterial vaginosis which is the most common cause of vaginal discharge among women of reproductive age can spread through sexual contact [36] . In this study, those who are retroviral disease positive were more likely to have abnormal vaginal discharge. HIV infection can increase the risk of developing various vaginal infections, such as bacterial vaginosis, candidiasis, and trichomoniasis [37] . Factors, such as immune deficiency, can disturb the normal vaginal flora and lead to recurrent vaginal infections and discharge [25] [30] . A diminished response to Candida albicans in lymphocytes from HIV-positive women has also been documented, highlighting their heightened susceptibility to candidiasis and underscoring the importance of compromised immunity [30] .

The findings from the study underscore the importance of age, occupation, contraceptive use, sanitation practices, sexual behaviour, HIV status, and family dynamics in understanding and addressing this prevalent gynaecological concern. Therefore, to improve women’s reproductive health, targeted interventions should be developed based on these identified predictors. These may include comprehensive sexual and reproductive health education on improved genital hygiene and contraceptive choices. Also, counselling and mental health support for dysfunctional families and relationships.

This study was cross-sectional, which means that it cannot establish causality.

Participant Serial Number

SECTION A: SOCIO-DEMOGRAPHIC DATA.

1. Age as at last birthday

18 - 25yrs 26 -35yrs. 36 - 45yrs

2. Level of Education

No formal education Primary Secondary Tertiary

3. Marital Status

Single Married Widowed Separated/Divorced

4. Occupation

Student Home Maker Civil Servant Civil Servant Farmer Civil Servant Business Executive

5. Socio-economic class

I II III IV V

SECTION B: FEATURES OF VAGINAL DISCHARGE

6a. Have you ever had vaginal discharge?

Yes No

6b. Do you have vaginal discharge now?

Yes No

6c. How old do you have the first episode? Less than

1 yr 1 - 5 yrs more than 5yrs

7. Within the past year, how many times have you had episodes of vaginal discharge?

once two to three times four times or more continuous

8. How will you quantify the disharge?

mild moderate severe

9. When is the discharge noticed to be present or become worse?

Just before menses after menses during sexual intercourse at all times

10a. Whats your perception of vaginal discharge?

Normal for women abnormal

10b. What do you think is the cause of vaginal discharge?

Don’t know “toilet infection” sexually transmitted infection mental stress

SECTION C: ASSOCIATED FEATURES

11. Does the discharge have an odour?

Yes No

12. What is the colour of the discharge?

milky/white yellow brownish green

13. How would you describe the nature of the discharge?

watery curd-like frothy

14. What other symptoms are associated with the discharge?

itching burning sensation Pain during urination pain during intercourse lower abdominal pain

SECTION D: RISK ASSESSMENT

15a. Do you practice Douching?

Yes No

15b. If yes, what do you use?

Salt in water antiseptic in water herbal preparation lime others specify

16a. Do you smoke?

Yes No

16b. If yes, on the average how many sticks do you smoke per day?

1 - 10 sticks 11 - 20 sticks 20 sticks and above

16c. For how long have you been smoking?

Less than one year 1 - 5 years more than 5 years

17. Which of the following contraceptive methods do you use?

Oral hormonal Injection Condoms IUCD Tubal ligation None

18. What type of toilet facility do you use most of the time?

pit latrine ventilation improved pit (VIP) water cistern (WC)

others specify

19. After urinating, how do you clean the vulva?

back to front front to back dabbing

20. After passing stool, how do you clean?

back to front front to back washing

21. During menses what do you use?

Sanitary pads Tampoons Tissue paper Clothing material

22. Have you had a miscarriage or termination of pregnancy in the past?

Yes No

23. In the past 6 months how many courses of antibiotics have you used?

None 1 - 3 times more than three times

24. In the past year how many sexual partners have you had?

None 1 2 > 2

25. In the past month how many sexual exposures have you had?

None 1 - 2 > 2

Section E: Other Co-Morbidities:

26. Body Mass Index (BMI):

Underweight Normal Overweight Obesity

27. Random Blood Glucose:

Normal Impaired Diabetes

28. Classification based on Retroviral screening:

Yes No

29. The vaginal fluid pH:

Less than 4.5 4.5 and above

30. The microscopy and/or culture result:

Candida B. vaginosis T vaginalis

31. Others:

None

FOR OCCUPATION

CLASS—OCCUPATION

I—Senior public servants, professionals, managers, large scale traders, business men, contractors

II—Intermediate grade public servants and senior school teachers

III—Junior school teachers, professional drivers, artisans

IV—Petty traders, laborers, messengers

V—Unemployed, full time house wife, students and subsistence farmers

FOR EDUCATION.

CLASS—EDUCATION.

I—University graduates or equivalent

II—School certificate holders ordinary level (GCE) who also had teaching or other professional training

III—School certificate or grade II teachers certificates holders or equivalent

IV—Modern three and primary six certificate holders

V—Those who could either just read and write or were illiterate

The exact class was gotten by calculating the average of the two classes.

Hardly ever = 0, Some of the time = 1, Almost always = 2. Scores of 0 - 3 = dysfunctional, 4 - 7 = moderately dysfunctional, 8 - 10 = functional.