Isolation of non-albicans Candida and associated factors among symptomatic women presenting with abnormal vaginal discharge at Mubende Regional Referral Hospital, Central Uganda: A cross-sectional study

Vulvovaginal infections contribute substantially to women's reproductive morbidity, yet little is known about the determinants of non-albicans Candida (NAC) in sub-Saharan Africa. Understanding population-level drivers is critical for prevention and control. We conducted a hospital-based analytic cross-sectional study among 314 symptomatic women aged 18-49 years presenting with abnormal vaginal discharge at the gynecologic clinic of Mubende Regional Referral Hospital, Central Uganda, between 1st May 2025 and 1st August 2025. High vaginal swabs were cultured and species identified using CHROM agar. Sociodemographic, behavioral, and clinical data were collected through structured interviews. Logistic regression identified determinants of NAC infection. The prevalence of NAC infection was 23.6% (74/314; 95% CI: 19.0-28.8). The most frequently isolated species were C. glabrata (41.9%) and C. tropicalis (29.7%). Key determinants included: having ≥2 sexual partners (aOR 9.41, 95% CI: 4.59-19.31), ≥ 3 vaginal infections in the past year (aOR 6.43, 95% CI: 3.21-12.89), HIV-positive status (aOR 5.37, 95% CI: 2.51-11.49), contraceptive use (aOR 2.70, 95% CI: 1.39-5.24), vaginal douching (aOR 2.25, 95% CI: 1.15-4.41), and recent antibiotic use (aOR 2.09, 95% CI: 1.06-4.11). NAC infections are highly prevalent among women with abnormal vaginal discharge in Uganda, driven by modifiable behavioral and clinical factors. Public health interventions should prioritize sexual health education, discourage vaginal douching, promote rational antibiotic use, and integrate screening and counselling for high-risk women, especially those with HIV. Interpretation should be cautious because alternative etiologies of vaginal discharge were not excluded and confirmatory species identification was not performed.