title: Cessation of intravaginal practices to prevent bacterial vaginosis: a pilot intervention in Zimbabwean women.
abstract: OBJECTIVE
  Intravaginal practices--including behaviours such as washing with soap or other materials, using fingers or cloth, or insertion of herbs, powders or other products to dry, cleanse or 'tighten' the vagina--may increase women's risk of bacterial vaginosis by disrupting the vaginal microbiota. In Zimbabwe, intravaginal practices are common. The objective of this study was to assess the feasibility of an intervention based on the transtheoretical model of behaviour change (also called the 'stages of change' model) to encourage cessation of vaginal practices among a sample of Zimbabwean women.
  
  
  METHODS
  We conducted a 12-week behaviour change intervention to encourage cessation of intravaginal practices (other than cleansing with water) among 85 Zimbabwean women who reported these practices.
  
  
  RESULTS
  Self-reported intravaginal practices declined significantly over follow-up, with 100% of women reporting at least one intravaginal practice at enrolment compared with 8% at the final visit. However, we found no significant effect of this reduction on bacterial vaginosis prevalence in unadjusted or adjusted multivariable models (adjusted prevalence ratio for any practice vs none: 0.94, 95% CI 0.61 to 1.43).
  
  
  CONCLUSIONS
  While the intervention was successful in reducing women's self-reported engagement in intravaginal practices, we observed no corresponding benefit to vaginal health.
authors.affiliation: Division of Epidemiology, The Ohio State University, Columbus, Ohio, USA.
authors.forename: Allahna
authors.initials: A
authors.lastname: Esber
authors.affiliation: UZ-UCSF Collaborative Research Programme, Harare, Zimbabwe.
authors.forename: Precious
authors.initials: P
authors.lastname: Moyo
authors.affiliation: UZ-UCSF Collaborative Research Programme, Harare, Zimbabwe.
authors.forename: Marshall
authors.initials: M
authors.lastname: Munjoma
authors.affiliation: School of Health Sciences, College of Health Sciences, Walden University.
authors.forename: Shelley
authors.initials: S
authors.lastname: Francis
authors.affiliation: Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.
authors.forename: Janneke
authors.initials: J
authors.lastname: van de Wijgert
authors.affiliation: UZ-UCSF Collaborative Research Programme, Harare, Zimbabwe Department of Obstetrics and Gynaecology, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: Tsungai
authors.initials: T
authors.lastname: Chipato
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA.
authors.forename: Abigail Norris
authors.initials: AN
authors.lastname: Turner
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D006920:Hygiene; D010865:Pilot Projects; D011446:Prospective Studies; D016896:Treatment Outcome; D016585:Vaginosis, Bacterial / Q000517:prevention & control*; D015030:Zimbabwe
keywords: AFRICA; BACTERIAL VAGINOSIS; INTERVENTION STUDIES