Urinary tract infection (UTI) represents a serious health problem in pregnant women. The severity of urinary tract infection depends both on the virulence of the bacteria and the susceptibility of the host. The aim of this study was to determine the prevalence of urinary tract infection and demographic differentials among pregnant women in University of Nigeria Teaching Hospital Enugu. The objectives were to determine the proportion of women who have UTI, identify the common causative organism and to determine difference in UTI occurrence among pregnant women based on demographic variables. Two hundred and twenty five pregnant women that attended antenatal clinic within the period of study were investigated. Personal data were collected using a structured questionnaire. Early morning midstream clean urine samples were collected from all participants who were willing to participate for diagnosis of UTI. Urine samples were cultured using standard loop technique on blood agar, cystein lactose electrolyte deficient medium agar and macconkey agar. The result revealed that a total of 117 (52%) out of the 225 women had UTI. The organism most implicated was E. Coli (30.7%). Higher parity and older maternal age were significantly associated with UTI among pregnant women (P < .05). Gestational age, maternal level of education and maternal economic status were not significantly associated with the occurrence of UTI among the pregnant women (P > .05). From the findings it was concluded that UTI occur in pregnancy, affecting older women and those with more number of children. Screening for UTI is important in every pregnancy to reduce the incidence of low birth weight and prematurity and to also improve maternal and child health.
Background to the Study
Urinary tract infections (UTIs) during pregnancy are among the most common health problems afflicting many women in their reproductive years (Wamalma, Onolo, & Makokha, 2013). Pregnant women are at increased risk for UTIs beginning at the 6th week of gestation and peaking during 22 to 24 weeks of gestation due to a number of anatomical and physiological factors (Wamalma, Onolo, & Makokha, 2013). Screening for and treatment of bacteriuria in pregnancy has become a standard obstetric care in many countries. For instance, American College of Obstetricians and Gynecologists, National Institute for Health and Clinical Experience, and American Academy of Family Physicians strongly recommend screening for bacteriuria in all pregnant women at 12 to 16 weeks gestation with urine culture or at the first prenatal visit (Ashshi, Faidah, Saati, Abou, Al-Ghamdi, & Mohamed 2012).
Urinary tract infection is a bacterial infection occurring in the urinary system. The urinary system consists of the kidneys, ureters, bladder and the urethra. The severity of UTI depends both on the virulence of the bacteria and the susceptibility of the host (Ade-Ojo,Oluleye,& Adegun, 2013). Although pregnancy does not increase the rate of UTI, it increases the risk of progressing to a full blown kidney infection, which can cause early labour and other pregnancy complications (Wamalma, Onolo, & Makokha, 2013). UTI portends adverse outcome if not treated. Studies have shown that 20-40 percent of UTI progresses to acute pyelonephritis if untreated whereas with treatment this risk reduces to 1-2 percent (Schnarr, 2008). Maternal complications include chronic pyelonephritis, anemia, and septicaemia. Fetal complications include intrauterine growth restrictions and prematurity (Ade-Ojo, Oluleye, & Adegun, 2013).
There are factors that predispose to bacteriuria in pregnancy and they include the reduced ability of the kidneys to concentrate urine, leading to differences in urine ph and osmolality of urine in pregnancy, stasis of urine due to smooth muscle relaxation, effect of increased progesterone, pressure effect of the gravid uterus on the bladder and ureters impeding the free flow of urine (Ade-Ojo, Oluleye, & Adegun, 2013). UTI can occur in both males and females at any age. Bacteriuria increases with age, and women are affected more frequently than men. This is because of their short urethra which offers little resistance to the movement of uropathogenic bacteria, also structural and functional problems which occur with aging may prevent complete emptying of the bladder which leads to UTI. Also studies have shown that the body’s resistance to infection and ability to recover from infection diminishes with age (Smeltzer, Bare, Hinkle, & Cheever, 2008). In other words, older women may be more susceptible to infection than younger women due to ageing.
Sexual intercourse or massage of the urethra during childbirth forces bacteria up into the bladder. This accounts for the increased incidence of UTI in sexually active women (Smeltzer, et al., 2008). The study by Wamalma, Onolo and Makokha (2013) showed that 72.4 percent of significant bacteriuria occurred among 25-34-year age group which is usually the active stage of sexual activities for most women. It has been noted that the probability of UTIs increases with gestational age (Okonko, Ijandipe, Ilusanya, Donbraye, Ejembi & Udeze 2009). This may, for instance, be explained by increased pressure of the pregnant uterus on the bladder leading to stasis of urine. Pregnancy and childbirth compel women to undergo processes that may expose them to UTI. For instance, higher parity may expose the woman to higher likelihood of contracting UTIs. Accessing standard healthcare is still an issue for a lot of women in developing countries due to limited knowledge and availability of qualified personnel and infrastructure. The available qualified personnel and infrastructure are sometimes beyond the affordability of majority of the women due to their low level of income and distance to orthodox health care facilities. Although government subsidises the healthcare services in such countries, it is not always available to some of the women. The consequence is that some of them engage in self-diagnosis and self-medication, utilisation of unapproved and ineffective traditional health practices, or patronise quack medical practitioners. Level of knowledge may be related to women’s knowledge of available standard medical facilities and personnel and the need to utilize them.
Understanding the factors that increase UTI in pregnancy is fundamental to reducing and improving maternal health in pregnancy. Based on this, it is important to investigate whether some demographic factors such as maternal age, parity, gestational age, socioeconomic status, or level of education are associated with UTI among pregnant women.