Assessment of Genital Hygiene Among Pregnant Women Attending Antenatal Care Clinics in Selected
Health Facilities in Sokoto Metropolis, Sokoto State, Nigeria
Mansur O. Oche,1,2 Zainab K. Abdullahi,1 Habibullah Adamu, 1,2 Musa Yahaya,2 Saratu Bello3, Ahunna Z.
Ezenwoko,1 Abdulaziz M. Danmadami1.
1Department of Community Medicine, Usmanu Danfodiyo University Teaching Hospital, Sokoto 2Department of
Community Health, Usmanu Danfodiyo University, Sokoto. 3Department of Obstetrics and Gynaecology, Usmanu
Danfodiyo University Teaching Hospital, Sokoto
ABSTRACT
Correspondence:
Ahunna Zainab Ezenwoko,
Department of Community
Medicine,
Usmanu Danfodiyo University
Teaching Hospital, Sokoto.
zainabukwuani@gmail.com,
+2348037952645
Background: Infection in pregnancy is a preventable cause of maternal and
neonatal morbidity and mortality. Objectives: The study assessed the knowledge
and practice of pregnant women on personal and genital hygiene. Methods: A
semi-structured interviewer-administered questionnaire was used to collect data
among 427 pregnant women who were selected using a multistage sampling
technique in Sokoto metropolis. Mean and standard deviation were calculated for
continuous variables, categorical variables were summarized as frequencies and
percentages, and cross-tabulations were done to examine the relationship between
categorical variables using Chi-square/Fisher’s exact test and logistic regression.
The level of statistical significance was set at 5% (p<0.05). Results: The mean age
of the participants was 28.3 ± 7.1 years; the majority (91.1%) of the participants
had good knowledge of personal/genital hygiene, whereas a high proportion
(82.9%) of them had appropriate practice of personal/genital hygiene. Participants
with formal education had better knowledge of personal/genital hygiene (χ2
=10.709, p = 0.002), and their marital and educational statuses were found to be
the predictors of genital hygiene knowledge (aOR = 4.8, 95%CI = 1.8-13.2) and
(aOR = 2.5, 95%CI = 1.1 – 5.7) respectively. Similarly, in addition to participants’
marital status, their spouses' occupations were found to be determinants of
personal/genital hygiene practices. Conclusion: The respondents' marital status,
educational level, and occupation of their spouses were found to be the
determinants of personal/genital hygiene. Improving women's literacy level and
empowering them will improve their knowledge and practice of personal and
genital hygiene.
Keywords: Personal Hygiene, Genital Hygiene, Pregnant Women, Antenatal Care
INTRODUCTION
Hygiene refers to conditions and practices that help to
maintain health and prevent the spread of diseases, while
personal hygiene is maintaining the body’s cleanliness1.
Genital hygiene is a component of personal hygiene
that has a key role in preventing genital infections.
Pregnant women are more vulnerable to diseases and
infections associated with poor hygiene, so the
importance of adequate hygiene practices cannot be
overstressed. Infections in pregnancy are a preventable
cause of maternal and neonatal morbidity and mortality;
Oche et al. Genital Hygiene Among Pregnant Women Attending Antenatal Care Clinics
Tropical Journal of Obstetrics and Gynaecology (TJOG) Vol. 43 No. 4 (2025)/Published by Journalgurus
264
genital infections during pregnancy can be associated
with adverse pregnancy outcomes such as stillbirth,
preterm birth, low birth weight, and spontaneous
abortion. 2 Mother-to-baby transmission of infections can
occur in utero (congenital) or during delivery (perinatal),
and hematogenous spread as a result of maternal viremia,
bacteremia, or parasitemia also occurs.3 Some of the
genital infections that can occur as a result of poor
hygiene include Bacterial vaginosis, Syphilis,
Gonorrhea, other urinary tract infections, Hepatitis, etc. 3
Abnormal vaginal discharge is one of the commonest
presentations of genital infections with pregnancy, poor
perineal hygiene, long-term antibiotics use, multiple
partners, and frequent sexual intercourse, constituting
some of the risk factors. 4 Lack of hand-washing habits,
not using proper underwear, and not practicing genital
hygiene after using the restroom are described as
situations of poor hygiene.5 Modifying the mother’s
behavior of personal cleanliness will reduce the
likelihood of contracting a communicable disease, and
this can prevent maternal primary infection. 3
Previous studies in Turkey reported that the
majority of the participants had received information
about genital hygiene from healthcare professionals, and
most of those who wished to learn about genital hygiene
opined that healthcare professionals were their preferred
source of information. 5,6
A study in Iran by Amiri and colleagues reported
that genital hygienic practices such as infrequent change
of underwear and poor genital cleaning pre and post-
coitus were associated with urinary tract infection in
pregnancy. 7 Another study in Saudi Arabia reported
frequent sexual intercourse greater than or equal to three
per week and taking baths once or less per week to be
associated with urinary tract infection in pregnancy8. The
use of soap to clean the genital area affects the normal
flora of the vagina and can create a potential opportunity
for harmful microorganisms to cause infections among
women; the majority of respondents in a study by Sowole
et al. in Ogun state, southwest Nigeria were reported to
be using soap and water to clean their genitals.9 In a study
of genital behavior and practices in Cameroon,
Nkamedjie et al. reported that the majority, 70%, of the
participants showed a preference for cotton underwear,
and most (36%) used only water to clean their genital
area. 10
There is a need to maintain optimal genital
hygiene during pregnancy in order to prevent any
deleterious effects on the pregnancy and the unborn child.
It is in this regard that this study was carried out with the
aim of assessing the knowledge and practice of
personal/genital hygiene amongst pregnant women
attending antenatal clinics in Sokoto metropolis. It is
hoped that findings from this study will assist in
developing guidelines and policies on genital hygiene
practices amongst our pregnant women if the goals of
SDG3 (ensure healthy lives and promote well- being for
all at all ages) are to be achieved.
MATERIALS AND METHODS
Study Design and Setting
This cross-sectional study was carried out in the Sokoto
metropolis of Sokoto state. The State is located between
longitude 11’30°, 13’50° East, and latitude 4’to 6’0°
North of the Equator. It is bordered to the North by Niger
Republic, Zamfara State to the East, while Kebbi State
borders most of the South and Western parts. The 2020
projected population of the state was 5,313,527 based on
the 2006 general population census.11 The Health
Facilities in the metropolis are comprised of Primary,
Secondary, and Tertiary. The primary consists of Health
Posts, Dispensaries, Basic Health Clinics, and Primary
Health Care Centers; the Secondary is made up of
General as well as Private Hospitals, whereas the tertiary
consists of the State Specialist Hospital and the Teaching
Hospital.
The study was carried out amongst pregnant
women attending Antenatal care in selected health
facilities in the metropolis who must have had at least two
visits and do not have any serious medical or pregnancy
associated illness (exclusion criteria).
Sample Size Determination and Sampling Technique
The sample size estimation was done using the formula12
n = Z2pq/ where; n Sample size to be determined, Z
Standard normal deviate at 95% confidence interval =
1.96, p = Proportion of factor under study (knowledge of
genital hygiene among pregnant women = 50% (0.5) q =
Complementary probability of p =1-p = 0.5, d = Precision
(or margin of error) of 5% = 0.05. Using the above
formula, a sample size of 384 was obtained. Allowing a
90% response rate, 427 respondents were recruited into
the study.
A multistage sampling technique was used to
select the eligible respondents as follows:
Stage 1: Using simple random sampling by balloting,
two (2) Local Governments Areas namely Wamakko
and Sokoto South LGAs were selected out of the four
metropolitan LGAs. The health facilities in each of
the selected local governments were listed and
categorized into primary, secondary and tertiary.
Stage 2: Using simple random sampling by balloting,
one (1) health facility was selected from each
category of the above-listed facilities. The days each
of the selected facilities conducted antenatal care
(ANC) clinic were noted and the average monthly
Oche et al. Genital Hygiene Among Pregnant Women Attending Antenatal Care Clinics
Tropical Journal of Obstetrics and Gynaecology (TJOG) Vol. 43 No. 4 (2025)/Published by Journalgurus
265
attendance of ANC by the women was also obtained
from the health records unit of the facilities.
Thereafter, proportionate allocation (PA) was done to
get the number of participants that were enrolled in
each of the facilities per LGA as follows:
PA (n) =
Average no. of pregnant women that attend ANC/month
in one selected facility
Total no. of pregnant women that attend ANC/moth
in one selected facility
Stage 3: Systematic sampling technique was used to
enroll 1 in 3 participants into the study using simple
random sampling by balloting.
Data Collection Tool and Procedure
A pre-tested, semi-structured interviewer-administered
questionnaire was used to collect participants'
sociodemographic information, knowledge of personal
and genital hygiene, and reported practices on personal
and genital hygiene. The questionnaire was designed in
English, translated into a local language (Hausa), and
then translated back to English to ensure consistency. The
questionnaire was then built in an Open Data Kit (ODK)
XML format and downloaded onto the data collectors'
smartphones/tablets. Three nurses and Resident doctors
were trained as research assistants to help in the
collection of data. Data were collected at the antenatal
care (ANC) clinics of the selected facilities as the
pregnant women waited to be attended to or were on their
way out after receiving care.
Ethical Clearance
The ethical approval for the study was obtained from the
Health Research Ethics committee of Usmanu Danfodiyo
University Teaching Hospital, Sokoto. Informed consent
was obtained from the participants.
Data Analysis
We carried out the data analysis using the Statistical
Package for Social Sciences (SPSS) version 25.
Frequency runs were done to edit and clean the e-data
further. Knowledge and practice variables were scored;
one mark was awarded to each correct answer on
knowledge and practice, while zero marks were awarded
to wrong or negative responses. The scores were
converted to percentages and graded. For knowledge, 0
to 49% was considered poor knowledge, and ≥ 50% was
considered good knowledge. Similarly, for practice, 0 to
49% was considered inappropriate, whereas ≥ 50% was
considered appropriate hygienic practices. Mean and
standard deviation were calculated for continuous
variables, categorical variables were summarized as
frequencies and percentages, and cross-tabulations were
done to examine the relationship between categorical
variables using Chi-square/Fisher’s exact test and logistic
regression. The level of statistical significance was set at
5% (p<0.05).
RESULTS
Sociodemographic Characteristics of Participants
All questionnaires were administered and filled out,
giving a response rate of 100%. The ages of the
Table 1: Sociodemographic Characteristics of
Respondents
participants ranged from 17 to 50 years (mean = 28.3 ±
7.1); the majority, 243 (56.9%) of the participants were
X sample size
Oche et al. Genital Hygiene Among Pregnant Women Attending Antenatal Care Clinics
Tropical Journal of Obstetrics and Gynaecology (TJOG) Vol. 43 No. 4 (2025)/Published by Journalgurus
266
between 21 to 30 years of age. Most, 404 (94.6%), were
married, 155 (36.3%) had attained tertiary education, and
179 (41.9%) were full-time housewives. More than half,
236 (55.3%) of the participants’ spouses had attained the
tertiary level of education, whereas 190 (44.5%) of them
were civil servants. Most, 300 (70.3%) of the participants
were multigravidas. (Table 1)
Figure 1: Awareness of Personal and Genital Hygiene
Figure 2: Source of Information for Personal and Genital
Hygiene Awareness
Knowledge of Personal and Genital Hygiene
The majority (90.2%) and (93.2%) of the participants
were aware of both personal and genital hygiene,
respectively. (Figure 1). Most (71.4%) of the participants
heard about personal and genital hygiene during their
antenatal clinic (ANC) visits. The majority, 388 (91.1%)
of the participants had good knowledge of genital and
personal hygiene, 395 (92.7%) of the participants knew
about the requirement for both personal and genital
hygiene. (Table 2).
Table 2: Participants’ Knowledge of Personal/Genital
Hygiene
Table 3: Participants’ Correct Responses to Practice of
Personal/Genital Hygiene
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Tropical Journal of Obstetrics and Gynaecology (TJOG) Vol. 43 No. 4 (2025)/Published by Journalgurus
267
Table 4: Relationship Between Sociodemographic Characteristics of Respondents
and Knowledge of Personal/Genital Hygiene
Variable
Knowledge score
(n=427)
Good Poor
n (%) n (%)
P value
Test
statistic
OR (95% CI)
Age group (years)
1.159 (0.593 - 2.266)
17 – 25
17 (9.6)
χ2 = 0.185
26 – 50
21 (8.4)
p = 0.667
Marital status
Married
31 (7.7)
FE= NA
1.90 (0.073 – 0.497)
Unmarried
7 (30.4)
p = 0.002
Educational level
Formal
19 (6.1)
χ2 =10.709
2.962 (1.511 – 5.837)
Informal
19 (16.2)
p = 0.001
Occupation of the
respondents
Gainfully employed
15 (8.9)
χ2 = 0.000
0.997 (0.512 – 1.943)
Not gainfully employed
20 (8.9)
p = 0.994
Education of the
Husband/partner
Formal
25 (7.1)
χ2 = 8.296
2.796 (1.356 – 5.766)
Informal
13 (17.6)
p = 0.004
Occupation of the
husband
Gainfully employed
32 (8.8)
χ2 = 0.021
1.070 (0.428 – 2.673)
Not gainfully employed
6 (9.4)
p = 0.885
Parity
Primigravida
6 (8.6)
χ2 = 0.011
0.952 (0.382 – 2.371)
Multigravida
32 (9.0)
p = 0.916
Table 5: Predictors of Knowledge of Genital Hygiene
Variables
aOR
Knowledge of
genital hygiene
95%
Confidence
Interval
p
value
Lower
Upper
Marital status (Married* Vs Unmarried)
0.207
0.076
0.566
0.002
Educational level of the respondents
(Formal* vs informal)
0.405
0.177
0.929
0.033
Educational level of the husband (Formal*
vs informal)
0.707
0.286
1.745
0.452
Formal education = primary, secondary and tertiary, informal = none. *Reference
value, aOR- adjusted odds ratio
Oche et al. Genital Hygiene Among Pregnant Women Attending Antenatal Care Clinics
Tropical Journal of Obstetrics and Gynaecology (TJOG) Vol. 43 No. 4 (2025)/Published by Journalgurus
268
Practice of Personal and Genital Hygiene
Most, 354 (82.9%) of the participants had an appropriate
practice of personal and genital, and more than half used
cotton material for underwear and water only to wash the
genital area 250 (67.6) and 262 (61.4), respectively.
(Table 3).
There was statistically significant association
between knowledge of genital hygiene and marital status
p = 0.002; participants who were married had a
significantly better knowledge (92.3%) of
genital/personal hygiene compared to those who were
not. Similarly, those with formal education had
significantly (p = 0.001) better knowledge (93.9%) than
those who were not (Table 4). Participants' marital status
and educational levels were found to be predictors of
knowledge, as those who were unmarried were 5 times
less likely to have good knowledge of genital hygiene as
compared to those who were married (aOR = 0.207, p =
0.002, 95%CI = 0.076 – 0.566). Participants who had no
formal education were 2.5 times less likely to have good
knowledge of genital hygiene as compared to those have
formal education (aOR = 0.405, p = 0.033, 95%CI =
0.177-0.929) (Table 5).
There was a statistically significant association
between participants' knowledge of genital hygiene (p =
0.009), marital status (p = 0.003), educational level (p <
0.001), occupation (p = 0.001), spouses' education (p <
0.001), spouses’ occupation (p < 0.001) and practice of
genital hygiene. Participants who had formal education
(96.5%) were involved in more appropriate practice than
those not educated. Similarly, the proportion of
Table 6: Relationship Between Sociodemographic Characteristics of Participants and Practice of Personal/Genital
Hygiene
Variable
Practice grading (n=427)
Appropriate Inappropriate
n (%) n (%)
Test statistic
P value
OR (95% CI)
Knowledge of genital
hygiene
Good
367 (94.3)
22 (5.7)
Fisher’s exact = NA
3.767 (1.492 – 9.511)
Poor
31 (81.6)
7 (18.4)
p = 0.009
Age group (years)
17 – 25
165 (93.2)
12 (6.8)
χ2 = 0.001
0.997 (0.464 – 2.143)
26 – 50
233 (93.2)
17 (6.8)
p = 0.993
Marital status
Married
381 (94.3)
23 (5.7)
Fisher’s exact = NA
0.171 (0.062 – 0.475)
Unmarried
17 (73.9)
6 (26.1)
p = 0.003
Educational level
None
99 (84.6)
18 (15.4)
χ2 = 18.798
4.942 (2.257 – 10.22)
Formal
299 (96.5)
11 (3.5)
p < 0.001
Occupation of the
participants
Gainfully employed
197 (97.5)
5 (2.5)
χ2 = 11.282
4.704 (1.760 – 12.577)
Not gainfully emplyd
201 (89.3)
24 (10.7)
p = 0.001
Education of the
Husband/partner
None
61 (82.4)
13 (17.6)
χ2 = 16.420
4.489 (2.056 – 9.802)
Formal
337 (95.5)
16 (4.5)
p < 0.001
Occupation of the
husband
Gainfully employed
347 (95.6)
16 (4.4)
χ2 = 21.741
5.528 (2.512 – 12.164)
Not gainfully emplyd
51 (79.7)
13 (20.3)
p < 0.001
Parity
Primigravida
62 (88.6)
8 (11.4)
χ2 =2.844
2.065 (0.875 – 4.870)
Multigravida
336 (94.1)
21 (5.9)
p = 0.92
χ2 = Pearson’s Chi square test, NA – Not available, p = p value (0.05)
Oche et al. Genital Hygiene Among Pregnant Women Attending Antenatal Care Clinics
Tropical Journal of Obstetrics and Gynaecology (TJOG) Vol. 43 No. 4 (2025)/Published by Journalgurus
269
participants whose husbands were gainfully employed
was higher than those not employed (Table 6).
Participants' marital status, educational level, occupation
and that of the husbands were found to be the predictors
of genital and personal hygiene practices, as participants
with formal education were 0.4 times more likely to have
a better practice of personal/genital hygiene (aOR =
0.0375, 95%CI = 0.147 – 0.957. p = 0.040) (Table7)
DISCUSSION
In this study, we assessed the knowledge and practice of
pregnant women on personal and genital hygiene. More
than half of the respondents were between the ages of 21
and 30 years; it is not surprising because, in the study
area, which is in northwest Nigeria, most women marry
before or by 18 years of age and expected to start
childbearing in their early 20s, this contrasts the findings
in Lagos where a high proportion of the respondents were
in their 30s indicating that they must have married a little
late compared to what was obtainable in the north13. The
study also revealed that most of the respondents were
married. This is not unexpected as most
cultures/traditions and religions in Nigeria mandate
couples to be married before having children; a similar
finding was reported in another part of Nigeria.
Most of the respondents in the study were aware
of personal and genital hygiene and confirmed receiving
such information from healthcare workers during ANC.
This is in conformity with what was reported in a
previous study from Turkey, where the majority of the
study participants received information about genital
hygiene from healthcare professionals5,6. However,
in contrast to this finding, a study from Cameroon noted
that more than half of the respondents admitted to
receiving information on genital hygiene from family
members. 10 Good knowledge of personal and genital
hygiene was demonstrated by the majority of the
respondents, most of whom believed to have known the
requirements for both personal and genital hygiene and
knew the harm that could arise from not maintaining
proper genital hygiene. This could be attributed to the
high literacy level observed among the respondents. A
significant finding from this study was the fact that the
proportion of respondents with good knowledge of
genital and personal hygiene was higher among those
with formal as compared to those with informal
education. Other studies also reported similar findings
where the study participants with higher education
exhibited a good understanding of genital hygiene13,14. In
contrast to our findings, a similar study from Kenya
reported that barely half of the women attending ANC
clinic had moderate knowledge of personal and genital15.
Appropriate genital and personal hygiene
practices were reported by most of the respondents in this
study, where a high proportion of the respondents
reported washing their genital area more than three times
a day and using water only, indicating that there may be
fewer chances of genital infection developing among the
pregnant women. This is in line with previously reported
findings of good hygiene practices among pregnant
women10,13-15. Even though most women desire genital
cleaning and see it as an important aspect of hygiene, the
current study revealed an interesting finding when only a
few of the respondents admitted using antiseptic in
genital cleaning. This finding may not be unrelated to the
fact that some women may consider antiseptic to be
Table 7: Determinants of Personal/Genital Hygiene Practice Among Respondents
Variables
aOR
Practice of
Genital Hygiene
95% Confidence
Interval
p value
Lower
Upper
Marital status (married vs
unmarried*)
0.207
0.051
0.845
0.028
Educational level of the
respondents (Formal vs
informal*)
0.375
0.147
0.957
0.040
Occupation of the respondents
(employed vs unemployed*)
0.317
0.110
0.913
0.033
Occupation of the husbands
(employed vs unemployed*)
0.321
0.132
0.784
0.013
Formal education = primary, secondary and tertiary, informal = none. Employed = civil servant, farmer, business, others,
unemployed = house wife, student. *Reference value, aOR- adjusted odds ratio
Oche et al. Genital Hygiene Among Pregnant Women Attending Antenatal Care Clinics
Tropical Journal of Obstetrics and Gynaecology (TJOG) Vol. 43 No. 4 (2025)/Published by Journalgurus
270
irritating to the genital area or might have been warned
against its use during ANC.
A study by Fashemi et al. suggested that some
vaginal cleansing products may be harmful to
Lactobacillus bacteria and alter the vaginal immune
environment16. Once the normal flora of the genitalia is
altered, it becomes a safe haven for various
microorganisms to flourish and wreak havoc in the forms
of various infections with far-reaching effects. A
similar study conducted in Cameroon observed that
only a few women used antiseptic in genital cleaning.10
More than half of the respondents in our survey
admitted having coitus three times or less in a week;
this is hygienically good as frequent sexual intercourse
is reported to increase the risk of urinary tract infection
among pregnant women17 and also associated with
recurrent cystitis18,19. As part of good hygiene practice,
most of the respondents in our study used cotton
underwear, which is reported to reduce the risk of
genital infection. Cotton underwear absorbs
perspiration, keeps the perineum dry and makes it less
likely for genital tract infections to develop20.
A study in Turkey showed that the rate of
wearing cotton linen was found to be below average21.
Our study revealed that participants' marital status and
the occupation of their spouses were the predictors of
personal and genital hygiene practices, and this is not
unexpected as the more educated an individual is, the
more likely that he/she is aware of health protection
and promotion behaviors; this conforms with the
findings of a previous study21. Another study observed
that the lack of a regular source of water supply and the
distance to the source of water supply were among the
factors that affected practices of personal hygiene among
the respondents13.
CONCLUSION
Respondents in this study demonstrated a high level of
awareness and knowledge of personal and genital
hygiene, and most of them got the information from
healthcare workers; a high proportion of the
respondents reported having appropriate practice of
personal and genital hygiene. The marital/educational
statuses of the respondents, as well as the occupation
of their spouses, were the determinants of knowledge
and practice of personal/genital hygiene. There is an
urgent need for public enlightenment and sensitization
to create more awareness of personal/genital hygiene.
Improving women's literacy level and empowering them
will improve their knowledge and practice of hygiene.
Acknowledgments
The authors wish to acknowledge all pregnant women
who participated in this study voluntarily. We extend our
gratitude to the management and staff of all the facilities
that were selected for this survey for their support and
cooperation. We want to thank all the nurses and
Residents Doctors who helped in the collection of data.
Conflict of Interest
The authors declare that they have no conflicts of interest
with respect to this paper.
Funding
There was no funding from any organization for the
conduct of this study. All the authors made financial
contributions towards the realization of this study, which
is for their academic progression
Authors Contribution
MOO conceived the study and reviewed the entire work,
ZAK and SB participated in the design of the study, data
collection and drafting of the manuscript, HA and MY
participated in data analysis and interpretation, AZE and
AMD wrote the discussion and reviewed the analyzed
data. All authors read and approved the work and each
author believes that the manuscript represents honest
work.
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