Reproductive tract infections are extremely common among women that they are reported to affect one third of women of reproductive age around the world,according to a report by the World Health Organization.Sexually transmitted infections are also classified among the "top five disease categories",by WHO.The risk of women contracting RTIs are high in rural India,where,in the absence of toilets in villages,access to sanitation is still limited.
                          A group of public health researchers recently studied 3952 girls and women from two rural districts in India to understand the relationship between hygiene practices and self reported RTI symptoms.The researchers studied WASH practices-defined by access to water sanitation and hygiene-to understand whether the women transitioning through different reproductive stages are resorting to unhygienic situation practices increasing their risks of RTIs.
                          RTIs are a grossly unreported disease and socio-economic factors education and WASH risk factors may differ between women seeking care at a health care center,versus the broader population,especially for rural women with the lowest levels of WASH worldwide,the researchers said in the report.The study and its results assume significance since very few published studies explore the connections between water,sanitation access,related daily hygiene practices and their effect on the risk of contracting RTIs disease.
                           The study was conducted in two rural districts of Odisha namely,Khurda and Sundargarh.The researchers said that these two unconnected districts were chosen because the region has particularly low levels of water and sanitation coverage,and high maternal and child morbidity and mortality.
                            The researchers found new evidence linking WASH access with self-reported RTI symptoms in girls and women failing under different reproductive life stages in rural India.The study also concluded that WASH practices of girls and women varied across reproductive life stages.However,the associations between WASH practices and RTI symptoms were not influenced by various life stage status of those women.
                            According to the study,'self reported symptoms of RTI disease were less common in girls and women with access to a latrine and lower walking times to a bathing location".Crucally,symptoms were less common among those who reported bathing with soap water versus women who reported washing hands with soap after defecation.
                            Another crucial aspect dealt in the study is related to the stress women and girls in rural India undergo on a daily basis to find a safe place to defecate in the absence of toilets.
                            The journey to find a safe private location for defecation and urination is often stressful and physically challenging for women and can require walking long distances through unsafe terrain while carrying water for cleansing the report adds.This forces them to compromise on hygiene.Women may attempt to reduce this stress by carrying less water for genital washing or bathing less frequently,which has been a risk factor for RTIs in other studies.
                              According to researchers,this is the first study to structure analysis of risk factors for RTIs based upon a prior hypotheses that environmental exposures for women in settings like India can be moderated by social life stages.The report is hopeful that improving access to sanitation for women in rural areas may help curtail the rate in which RTI affects them.
                              "If water and sanitation access is an important determinant of RTI risk in women then global efforts to improve women's water and latrine coverage may reduce the burden of RTIs among the most vulnerable women worldwide"said the researchers.

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