Document Type

Capstone Experience

Graduation Date

12-2017

Degree Name

Master of Public Health

Department

Epidemiology

First Committee Member

Veenu Minhas

Second Committee Member

Elizabeth Lyden

Third Committee Member

Terra Uhing

Abstract

Background: The proportion of Chlamydia and Gonorrhea in Douglas County, Nebraska is significantly higher than Nebraska and the U.S. Consequently, the Douglas County Health Department has initiated numerous programs to combat STIs. However, the prevalence of Chlamydia and Gonorrhea has sharply increased in recent years. Adjacent to Douglas County is the Three Rivers Health District, including Dodge, Saunders, and Washington Counties. Few studies have assessed the burden of Chlamydia and Gonorrhea in the Three Rivers Health District.

Objectives: The objectives of the study were to 1) Compare Chlamydia and Gonorrhea by age, gender, and ethnicity for Dodge, Saunders, and Washington Counties. 2) Compare the prevalence of Chlamydia and Gonorrhea in the Three Rivers Health District to Douglas County, Nebraska, and the U.S. 3) Determine if the prevalence of Chlamydia and Gonorrhea in the Three Rivers Health District significantly changed between 2012 and 2016.

Methods: A cross-sectional study was performed with data collected between 2012 and 2016 from the Three Rivers Health District (N=1102). Cases of Chlamydia and Gonorrhea were descriptively compared by age, gender, and ethnicity for each county. The prevalence of Chlamydia and Gonorrhea in the Three Rivers Health District was compared to Douglas County, Nebraska, and U.S. with the Chi-Square test. The Cochran Armitage Test determined if the prevalence of Chlamydia and Gonorrhea in the Three Rivers Health District changed significantly between 2012 and 2016.

Results: Most chlamydia cases were in the 15-24-year-old age group in Dodge (75%: 379/508), Saunders (70%: 88/127), and Washington Counties (69%: 65/94). Females were more likely to have Chlamydia in Dodge (79%: 399/508), Saunders (81%: 103/127), and Washington County (67%: 63/94).

Gonorrhea followed a different distribution pattern. Most cases in Dodge County were in the 20-24 (31%: 9/29:) and 30+-year (52%: 15/29) age groups; Likewise in Saunders County with 46% (5/11) of Gonorrhea cases reported in 20-24-year-olds and 27% (3/11) in the 30+- year-olds. In Washington County, Gonorrhea was equally distributed by age. In Dodge County, females (48%: 14/29) and males (52%: 15/29) were equally likely to have Gonorrhea. Most Gonorrhea cases in Saunders County were female (83%: 8/11), and male in Washington County (67%: 6/9). Ethnicity, largely unreported, was not a valid determinant.

The odds of having Chlamydia in the Three Rivers Health District were significantly lower than Douglas County, Nebraska, or the U.S., respectively (OR=0.38, 95% CI: 0.33-0.44), (OR=0.58, 95% CI: 0.49-0.67) and (OR=0.51, 95% CI: 0.44-0.59). The odds of having Gonorrhea in the Three Rivers Health District was also significantly lower than Douglas County, Nebraska, and the U.S., respectively (OR=0.09, 95% CI: 0.33-0.44), (OR=0.58, 95% CI: 0.49-0.67), and (OR=0.14, 95% CI: 0.09-0.24).

The prevalence of Chlamydia in the Three Rivers Health District increased slightly from 182.6 cases per 100,000 to 201.5 cases from 2012 to 2016, a 10% increase (p=0.4). In comparison, the cases of Gonorrhea significantly increased during the same period from 10.3 cases per 100,000 to 16.6 cases, representing a 61% increase (p=0.0004).

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