Abstract
<title>Abstract</title> <p> Background Vulvovaginal candidiasis during pregnancy is a worldwide problem because of its association with premature labor, preterm membrane rupture, spontaneous abortion, early delivery, newborn infection, postnatal morbidity, and maternal mortality. This study aimed to determine the prevalence and associated factors and establish an antifungigram of vulvovaginal candidiasis among pregnant women at Lira Regional Referral Hospital. Methods A hospital-based cross-sectional study was conducted on 138 pregnant women at Lira Regional Referral Hospital, recruited using systematic random sampling techniques. Microscopy and SDA supplemented with 2% chloramphenicol were used to diagnose vulvovaginal candidiasis due to growth and detection of different <italic>Candida species</italic> . Sugar assimilation test and Germ tube test was used to differentiate between C. <italic>albicans</italic> and non <italic>-albicans species</italic> . Antifungigram was performed using the disk diffusion method to evaluate the current resistance pattern. Associated factors were collected using a questionnaire. Data were analyzed using SPSS version 25.0. Logistic regression analysis was used, where a p-value < 0.05 was considered significant. Results The prevalence of VVC was 40.6%, with epidemiological shift towards non <italic>-albicans species</italic> dominating the infection profile at 65.07% compared to <italic>C. albicans</italic> (34.93%). Participants’ average age was 25.54 years, SD of ± 4.692, and the most significant factors were parity (AOR, 4.33; p < 0.001), prolonged antibiotic use (AOR, 4.88; p < 0.001), gestational age (AOR, 0.12; p = 0.003), previous VVC (AOR, 3.22; p = 0.043), and history of miscarriage (AOR, 7.42; p = 0.002). However, those who were over 25 years old, and had a history of UTIs were significantly more likely to develop VVC at bivariate level. No statistically significant differences were observed between educational level and occupation. Clotrimazole exhibited 90%–98% sensitivity across both <italic>C. albicans</italic> and non <italic>-albicans species (NACs).</italic> However, nystatin resistance was alarming at 80% among non <italic>-albicans candida species</italic> and 70.6% in <italic>C. albicans</italic> . Conclusion The prevalence of vulvovaginal candidiasis among pregnant women at Lira regional referral hospital remains significantly higher than global averages, driven by high parity, long-term antibiotic use, and a prior history of VVC. A profound, non-traditional shift was established toward NACs. Clotrimazole is a highly effective therapeutic option, showing a high sensitivity across both <italic>C. albicans</italic> and non <italic>-albicans species.</italic> Nystatin showed a high resistance to NACs and <italic>C. albicans</italic> , presenting a serious obstacle to normal treatment. </p>