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Urinary Tract Infection Prevalence among Pregnant Women

The Prevalence of Urinary Tract Infection among Pregnant Women Who Attended Antenatal Clinic at Federal Teaching Hospital

ABSTRACT

The objective of this research was  to determine the prevalence of urinary tract infection among pregnant women who attended antenatal clinic at Federal Teaching Hospital. To achieve this, a descriptive research design was used and the study was a retrospective study of pregnant women that attended antenatal clinic at federal teaching hospital . The study was carried out to ascertain the causes of urinary tract infection, the prevalence of urinary tract infection and to determine the treatment method used in management of urinary tract infection at federal teaching hospital. 38 cases of federal teaching hospital out of 270 pregnant women were elicited from patients folders and studied. A checklist was constructed in two sections to acquire the relevant information needed for the study. The causes of federal teaching hospital were poor personal hygiene, socio-economic status (income and finance) and frequent sexual intercourse. A prevalence of 14.1% and a ratio of 1:7 in 38 cases of federal teaching hospital for 5years were observed. Treatment modalities were urinary antiseptics and personal hygiene education. Nurses should intensify the mother craft given to pregnant women with much emphasis on personal hygiene to prevent federal teaching hospital in pregnancy.

CHAPTER ONE

INTRODUCTION

BACKGROUND OF THE STUDY

Urinary tract infections are bacteria infections that can strike almost anywhere along an individuals urinary tract. The urinary tract starts from the kidney, where urine is produced, in the ureters that carry urine to the bladder and in the urethra, which escorts urine outside the body. A urinary tract infection which is also called a bladder infection is a bacteria inflammation of any part of the urinary tract (Williams, 2006). It affects that part of the body that produces and excretes urine.

The everybody health network (2012) explains that urinary tract infection is more in female than male due to men having a  longer urethra  than the women. In areas of the urinary tract where urine pools or is prevented from moving along, it provides a suitable medium of environment for the growth and multiplication of bacteria causing inflammation in that part of the urinary tract that is being squished. Bacteria inflammation of the urinary tract could go without symptoms, sometimes the individual suffering it not knowing. In some other situations the bacteria causing the inflammation could make themselves forcefully known with symptoms like pain or burning sensation while urinating, cramps and pain in the lower abdomen and also more frequent and urgent urination.

America Academy of family physicians and American pregnancy association (2006) stated that urinary tract infection is common in pregnant women. Pregnant women are at increased risk for urinary tract infection starting in week six through to week twenty- four. Delzel (2006) evaluates the incidence of urinary tract infection in pregnancy to be up to 8% and Mile (2006) says its as high as 1 in 10 pregnant women. Pregnant women are more prone to bacteria inflammation of the urinary tract as a result of the changes that occur in the urinary tract of pregnant women. Considering the expansion of the organs in the urinary tract mostly the bladder due to the effect of progesterone and relaxin flooding the blood of a pregnant woman. A pregnant woman’s poor, battered bladder, which spends months on end being pummeled by her growing uterus and its occupant, is the perfect breeding ground for less welcome visitors, bacteria. The here-and-there compression, added to the muscle relaxing properties and progesterone circulating in a pregnant woman’s blood stream makes it much easier and much more likely for intestinal bacteria that live quietly in the skin and in the faeces to enter the urinary tract and make themselves at home. The most common bacteria tract infection can be prevented and other complications associated with them. Though emphasis had been made on practice like taking or drinking of adequate fluid so as to prevent stasis of urine, micturate after coitus and also the perineal area being wiped from front to back to prevent bacteria from the anus, entering the genital region. There is still an increasing incidence of urinary tract infection in pregnant women.

Urinary tract infections in the lower part of the urinary tract are no fun or to be taken lightly. A more serious danger is that bacteria will travel up through the bladder and ureters that connect the kidneys causing cystitis and pyelonephritis. Kidney infections that are not treated can be quite dangerous and may lead to pre-mature labour, low birth weight babies and more symptoms and complication to the mother and her baby in pregnancy. This study therefore aims at determining the prevalence of urinary tract infections among pregnant women who attended antennal clinic at Federal Teaching Hospital Abakaliki, Ebonyi State from 2008 till 2012.

Statement of Problem

          Uncomplicated urinary tract infection such as asymptomatic bactercenia if not well treated could progress to cystitis or pyelonephritis which could cause a premature labour and delivery of babies with low birth weight. Urinary tract infection could lead to a kidney infection that could hamper feotal and neotatal health or cause permanent secondary in fertility in pregnant women. Poor personal hygiene among females has also contributed to increased incidence of these infections. Despite the health education these women receive in the antenatal clinic, it has been observed that increasing cases of urinary tract infections are treated in the antenatal clinic. Although, these infections could be asymptomatic and pose no treat to both mother and child. It sometimes goes unnoticed by women suffering from them and later becomes life threatening to both mother and child.

Objectives of the study

          The objectives of the study were:-

  1. To ascertain the causes of urinary tract infection in pregnant women that attended antenatal clinic at Federal Teaching Hospital Abakaliki, Ebonyi State.
  2. To determine the prevalence of urinary tract infection among women who attended antenatal clinic and the effects of urinary tract infection on their health and their child.
  3. To identify the most common causative organism of urinary tract infection in pregnancy?

Significant of the Study

          This project work will;

  1. Increase the knowledge of mothers and health professionals in order to identify and diagnose urinary tract infection in pregnancy.
  2. Encourage pregnant women to take responsibility for their health and improve in their personal hygiene.
  3. Help to promote the health status of the pregnant women attending antenatal clinic in Federal Teaching Hospital Abakaliki, Ebonyi State.
  4. Assist in the reduction of maternal and neonatal mobility and mortality rates at Federal Teaching Hospital Abakaliki, Ebonyi State at large.

Research Questions

  1. What are the causes of urinary tract infection in pregnancy?
  2. What is the prevalence of urinary tract infection among pregnant women who attended antenatal clinic at Federal Teaching Hospital Abakaliki, Ebonyi State between 2008 to 2012?
  3. What is the most common causative organism of urinary tract infection in pregnancy?

Scope of the Study

          This study which is meant to determine the prevalence of urinary tract infections among pregnant women who attended antenatal clinic at Federal Teaching Hospital Abakaliki, Ebonyi State is restricted within Federal Teaching Hospital with special reference to pregnant women from 2008 till 2012.

Limitation of the Study

          This study is carried out at Federal Teaching Hospital Abakaliki, Ebonyi State. During the course of the study, the researcher has to contend with some factors that narrowed this study. Such factors include financial and time constraints, inadequate literature materials, inability to generalize because only one tertiary institution was reviewed.

Operational Definition of Term

–        Urinary Tract: The urinary tract or urinary system is an organ system that produces stores and eliminates urine. In a human, it includes two kidneys, two ureters, the bladder and the urethra.

–        Urinary Tract Infection: Urinary tract infection is a microbial (mostly bacteria) inflammation of any part of the urinary tract involving both the lower urinary tract (cystitis) or the upper urinary tract (pyelonephritis).

Antenatal Care/Clinic: Antenatal care is a care provided by midwives and obstetricians from the period pregnancy is diagnosed till the period of delivery to ensure that fatal and maternal health care satisfactory. Antenatal clinic is where pregnant women receive this antenatal care involving education, advice, supervision, education and information gotten from professionals.

– Pregnant Woman/Pregnancy: A pregnant woman is a woman with growing feotus in her womb. Pregnancy is a period from conception to delivery of the feotus with a normal duration of 280 days (40 weeks 9 moths and 7 days).

– Prevalence/Incidence: Prevalence is the rate at which an event will occur, experienced in ration or the total number of cases of a specific disease in existence in a given population at a certain time. Incidence is the number of a particular event occurring in a population in a given period of time expressed in percentage.

-Morbidity/Mortality: Morbidity is a diseased rate of a given population i.e. relating to diseased parts. Mortality is death rate of a given population.

 

CHAPTER FIVE

SUMMARY, CONCLUSION AND RECOMMENDATION, DISCUSSION OF MAJOR FINDINGS

   This chapter deals with discussion of major findings and data of the research work gotten form the checklist which are analyzed in previous chapters. Here, the project work is discussed under the following:

  • Discussion of demographic data
  • Discussion of findings gotten from research questions
  • Summary of the study
  • Implication to nursing
  • Conclusion draw from findings
  • Limitations for the study
  • Recommendations
  • Suggestion for further study

          Discussion of Demographic Data   

In 270 pregnant women who attended antennal clinic at Federal Teaching Hospital Abakaliki, Ebonyi State between 2008 and 2012. Majority of these women (198) range from 25-39 years which amounts to 73.3% of the pregnant case reviewed. These women are sexually active and at their reproductive peak.

According to their gestational ages and from analysis, majority of these pregnant women (76, 28.2%) were carrying pregnancies of 7-10 weeks old. These women are still very strong women and are activity tolerant.

According to their weights, majority of the pregnant women attending antenatal clinic between 2008 and 2012 at Federal Teaching Hospital Abakaliki, Ebonyi State weighed 70-79kg (48, 30.7%). These women could be said to be overweight but not obessed women.

According to marital status, 228 (88.1%) pregnant women are married while 32 (11.9%) pregnant women are single. Majority (88.1%) are married and family women i.e. they are wives.

According to their Religion, 223 (82.6%) are Christians, 35 (13%) are Muslims and 12 (4.4%). Majority are Christians.

According to the women’s parity, majority (34.4%) of the women attending antenatal clinic in FTH, Abakaliki are multiparous having a parity of 2-3.

          Discussion of Findings Gotten From Research Questions:

On the data analysed from research questions 1-5, the causes of urinary tract infection in pregnant women who attended antenatal clinic in PJH, Uburu between 2008 and 2012. Majority were due to Poor personal hygiene (50%). Other factors, socio-economic status of the women amounted to 31.6% and sexual intercourse amounted to 18.4%. With this analysis, poor personal hygiene, socio-economic status and seual intercourse are the causes of urinary tract infection.

According to Delzel (2006), poor personal hygiene Poor personal hygiene predisposes a pregnant woman to urinary tract infection. This is in line with Nicole (2008) that placed a note on poor personal hygiene, socio-economic status, sexual intercourse and diabetes mellitus as factors predisposing to urinary tract infection in pregnancy.

According to table 3, answering research question 2; on the prevalence of urinary tract infection in pregnant women who attended antenatal clinic in FTH, Abakaliki.

Here, of the two hundred and seventy pregnant cases reviewed, 38 pregnant women had urinary tract infection with a prevalence rate of 1:7 (14.1%) in women who attended antenatal clinic in FTH, Abakaliki.

According to Delzel (2006) a prevalence rate of 8% was recorded in pregnant women. Also Mile (2006) stated that there is a prevalence of urinary tract infection in 1:10 pregnant women. This project work is in accordance with this  Authors.

Analyzing table 4 answering research question 3 on the most common causative organism isolated in urinary tract infection. It was seen that the most commonly isolated organism during investigations for urinary tract infections in pregnancy is the Escherichia coli amounting to 55.3% of causative organism isolated in urinary tract infection. Other organisms were also isolated like the Klebsiella pneumonia (18.4%), staphylococcus sp. (13.2%), Proteus mirabilis (7.9%) and Proteus pseudomonas (2.6%). Escherichia coli is found in the human gut as a normal flora. Therefore, Escherichia coli was the most common causative organism isolated in urinary tract infection in FETH, Abakaliki between 2008 and 2012.

This project work is in line with Bryan (2011), who isolated E.coli as the most common causative organism of urinary tract infection. Also Delzel stated E.coli as the most common causative organism in UTI.

Analyzing table 5 which answers research question 4 in the effect of urinary tract infection on maternal and child health. In the 38 women who were diagnosed with  urinary tract infection, only 10 (26.3%) women had a normal pregnancy till term and delivered normal babies. 28(73.7%) pregnant women had complications such as abortions, pre-maturity and intrauterine death. 10 (26.3%) had abortion, 13 (34.2%) had pre-mature labour and 5 (13.2%) had intrauterine death. This project work is in line with Delzel (2006) includes neonatal complications as intrauterine death. Gilstag et al (2008) stated prematurity, abortion and secondary infertility as complications of FTH on maternal and child health.

Analyzing table 6 and figure 2; which answers research question 5 on the most effective method of treatment used in urinary tract during pregnancy in PJH, Uburu between 2008 and 2012. Nitroforantoin plus cephalexin produced 50% efficacy, Sulfisoxazole produced 55.6% efficacy, Fosfomycin produced a 88.2% efficacy and Ampicillin produced a 14.2 efficacy. Fosfomycin plus personal hygiene was the most effective treatment method used to treat UTI in pregnancy in FTH, Abakaliki.

The Infectious Disease Society of America (2010) recommends Nitroforantoin, Fluroquinolone and Trimethopine antibiotics as treatment of UTI in pregnancy.

          Summary of the Study

          In summary, most of the pregnant women who attended antenatal clinic in FTH Abakaliki, Ebonyi State between 2008 and 2012 were sexually active and productive women, strong women, overweight, married and are Christians having 2-3 children. 14.1% of the pregnant women had urinary tract infection and Escherichia coli was the most isolated causes of the urinary tract infection with predisposing factors like poor personal hygiene, sexual intercourse and socio-economic status. Urinary tract infection had cause pre-maturity, abortion and intrauterine death in some of these pregnant women and their fetus. Fosfomycin plus personal hygiene practice was the most effective method used for treatment used.

Implication to Nursing

          From the study and findings of the research on the prevalence of urinary tract infections among pregnant women who attended antenatal clinic at Federal Teaching Hospital Abakaliki, Ebonyi State between 2008 and 2012. It is therefore deduced that nurses and other health professional including midwives attending to pregnant women at the antenatal clinic should intensity patient teaching with much emphasis laid on good diet, clothing and personal hygiene practices so as to prevent urinary tract infection and other infection in pregnancy.

Urinary tract infection can be as a result of blood borne infections and could be secondary to other disease as well like diabetes mellitus. Health professionals and nurses should be advised to carry out more regular check-ups and testing for pregnant women, to rule out any underlying infection or disease conditions that could cause urinary tract infection.

          Conclusions Drawn from Findings

Urinary tract infection is the single commonest bacteria infection in pregnancy with a prevalence rate of 14:1% in pregnant women who attended antenatal clinic in federal teaching hospital abakaliki Ebonyi State between 2008 and 2012. Urinary tract infection caused maternal and child hazard like pre-mature labour, abortion and intrauterine death in pregnant women. Escherichia coli, Klebsiella pneumonia, Staphylococcus also causing the infection as well. Treatment methods were based on antibiotics like fosfomycim and nitroforantoin. Also practices that improves personal hygiene were also used in treatment of the infection.

Limitation of the Study

          The study was carried out at Federal Teaching Hospital Abakaliki, Ebonyi State. The researcher, during the cause of study had to content with factors like financial and time constraints, inadequate literature materials and inability to generalize because of only one tertiary institution was reviewed.

  Recommendations

Based on the above findings, the following recommendations were drawn:

  • Nurses and midwives should create a trusting relationship with pregnant women for counseling and early diagnosis.
  • Nurses should intensity the mother craft given to pregnant women with much emphasis on diet, clothing and personal hygiene.
  • The mass media should be used to create more awareness on the preventive measure for urinary tract infections in pregnancy.
  • Women should be given more opportunity as men to be educated so as to elevate their socio-economic status and education status enabling them take responsibilities for their own health.

Suggestions for further Studies

          More research work should be done on this same topic in other health institutions and communities so that result can be compared and generalization made. Other hospitals can be used in the research work so as to improve professional diligence to duty.  

 

The Prevalence of Urinary Tract Infection among Pregnant Women Who Attended Antenatal Clinic at Federal Teaching Hospital

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