{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T13:41:51Z","timestamp":1772804511402,"version":"3.50.1"},"reference-count":34,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T00:00:00Z","timestamp":1772668800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Science and Education in Poland","award":["667\/WIM\/2024"],"award-info":[{"award-number":["667\/WIM\/2024"]}]},{"name":"Military Institute of Medicine\u2013National Research Institute, Warsaw, Poland"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Bacterial vaginosis and vaginal dysbiosis represent major causes of morbidity among women in sub-Saharan Africa, yet data from Madagascar remain scarce. This study aimed to assess the prevalence and determinants of vaginal bacterial infections among women in northern Madagascar and to explore how vaginal microflora composition reflects broader aspects of reproductive health. Methods: A cross-sectional study was conducted in April 2024 among 159 women (15\u201380 years) attending a rural second-referral clinic in Manerinerina, Ambatoboeny District. Sociodemographic and hygiene data were obtained through structured questionnaires. Vaginal pH was measured in situ, and Gram-stained smears were evaluated using the Nugent scoring system. The presence of Trichomonas vaginalis, Neisseria gonorrhoeae, and Candida spp. was assessed microscopically. Associations were analyzed using Chi-square or Fisher\u2019s exact tests, with p &lt; 0.05 considered significant. Results: Abnormal vaginal flora was observed in 68.6% of women, including 43.4% with BV (Nugent 7\u201310) and 25.2% with intermediate flora. Elevated vaginal pH correlated strongly with higher Nugent scores (p &lt; 0.01). T. vaginalis and N. gonorrhoeae were detected in 10.7% and 9.4% of women, respectively, and both were significantly associated with dysbiosis (p = 0.02 and p = 0.04). Poor hygiene practices, vaginal douching (79.1% vs. 64.5%; p = 0.04), and unsafe water sources (p = 0.04) were major behavioral and environmental determinants. Conclusions: Vaginal dysbiosis is highly prevalent among women in northern Madagascar and closely linked to modifiable hygiene behaviors and environmental conditions. In resource-limited settings, Gram-stained microscopy and Nugent scoring remain cost-effective tools for surveillance and patient care. Culturally adapted education, improved water access, and integration of low-cost diagnostics are essential for reducing the burden of vaginal infections in rural Madagascar.<\/jats:p>","DOI":"10.3390\/jcm15052008","type":"journal-article","created":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T09:22:14Z","timestamp":1772788934000},"page":"2008","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cleanliness Grades as Clinical Indicators of Vaginal Infection Burden in Women from Northern Madagascar: A Cross-Sectional Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6357-2418","authenticated-orcid":false,"given":"Daniel","family":"Kasprowicz","sequence":"first","affiliation":[{"name":"Clinique M\u00e9dicale Beyzym, Manerinerina RN6, Ambatoboeny District, Manerinerina 403, Madagascar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Franco","family":"Rajaomalala","sequence":"additional","affiliation":[{"name":"Clinique M\u00e9dicale Beyzym, Manerinerina RN6, Ambatoboeny District, Manerinerina 403, Madagascar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0505-6279","authenticated-orcid":false,"given":"Krzysztof","family":"Korzeniewski","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Tropical Medicine, Military Institute of Medicine\u2014National Research Institute, 04-141 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1932-9784","authenticated-orcid":false,"given":"Wanesa","family":"Wilczy\u0144ska","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Tropical Medicine, Military Institute of Medicine\u2014National Research Institute, 04-141 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Kaambo, E., Africa, C., Chambuso, R., and Passmore, J.S. 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