AN ASSESSMENT OF THE PREVALENCE AND RISK FACTORS ASSOCIATED WITH URINARY TRACT INFECTION AMONG PREGNANT WOMEN IN OWERRI

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Urinary Tract Infections (UTI) are one of the most common medical complications of

pregnancy and the most common bacterial and nosocomial infections of all times second in severity to only respiratory tract infections. UTI refers to the invasion of the

urinary tract by non residual infectious organisms. The prevalence of UTI is greatly influenced by age, sex and factors that impair the defense mechanism which maintain the otherwise sterile condition in the normal urinary tract. Due to several anatomical and hormonal changes, pregnant women are more susceptible to these infections than non pregnant women (Raz, & Stamm, 2016).

Pregnancy causes several physical, hormonal, and functional changes in the urinary tract. This increases urine stasis and the ascending of microbially contaminated urine from the bladder into the ureters, causing urinary tract infection (UTI). The changes in the urinary tract and immunological changes associated with pregnancy, along with an already short urethra predispose women to UTI. Maternal UTI is the commonest nonintestinal infection in pregnant women globally, and it is a major health problem affecting up to 20% of expectant mothers (Hooton, 2020). UTIs can either be symptomatic or asymptomatic and are linked with serious obstetric complications and poor maternal and neonatal outcomes such as preterm birth, low birth weight, stillbirth, sepsis, maternal anaemia, pyelonephritis, preeclampsia, amnionitis, and neonatal deaths. Therefore, early diagnosis and treatment are timely and critical to prevent complications (Raz, & Stamm, 2016).

The prevalence of UTI among pregnant women varies among study populations. In Africa, it ranges from 11.6% to as high as 75%. In Ghana, the prevalence of UTI among pregnant women is represented by fragmented and small-size pocketed studies with a reported prevalence range of 60.4% to 70.2%. Approximately the most common reported pathogenic cause of UTI are members of the Enterobacteriaceae family which are responsible for 80% to 95% of all cases, of which Escherichia coli is the most frequently isolated bacteria.

It is estimated that one in three women of childbearing age will have a urinary tract infection (Gagnon, Sandall, & individual, 2017). Due to the normal physiological changes induced by gestation, pregnant women are easily susceptible to UTI1-4. UTI are characterized by the presenceof infectious agent in the genito-urinary tract (that cannot be explained by contamination) which have the potential to invade the tissues of the urinary tract and adjacent structures. The microbiological profile is well known and pathogens such as Escherichia coli have been present in the vast majority of cases.

The infection may be limited to the growth of bacteria in the urine, which frequently do not produce symptoms or it can result in several syndromes associated with an inflammatory response to the bacterial invasion. UTI also represents a wide variety of conditions including asymptomatic forms, urethritis, cystitis, acute pyelonephritis and

pyelonephritis with bateraemia or sepsis.

1.2  Statement of the Problem

The severity of an UTI is usually influenced by the virulence of the bacteria and the susceptibility of the host. Antibiotics such as ceftazidime, amoxicillin, cefoxitin, penicillin, and norfloxacin have been widely used to empirically treat clinically examined individuals with UTI. However, over time, inappropriate prescriptions for the treatment of UTIs along with their widespread use have caused bacteria to mutate and develop drug resistance. A UTI can be caused by bacteria resistant to common antibiotics. This makes treating UTIs more difficult and raises the risk of complications, underscoring the need for using antibiotics correctly and identifying the best drug.

The most reliable tool for diagnosing UTI is urine culture, as it helps to detect and quantify the pathogen causing the infection. In Nigeria, as it is with most developing countries, routine culture tests are not done for persons receiving antenatal care. Instead, a urine dipstick analysis is done which is woefully inadequate to assess UTI in pregnant women. Moreover, several factors, including parity, gravidity, gestational age, history of UTI, diabetes, anaemia, socio-economic status, educational status, sexual activity, and catheterization have been associated with an increased risk of UTI during pregnancy (Gao, Chan, & Sun, 2020).

In a recent research by Geerlings, & Hoepelman, (2014), in cultured urine samples taken from pregnant women visiting the health center, it was observed an unusually high occurrence of proteinuria, haematuria, and positive bacterial growth. These observations, along with the limited information on the prevalence of UTIs in Nigeria, raise serious concerns regarding the likelihood that pregnant women attending antenatal in Federal Medical Center Owerri seeking antenatal care would contract UTIs. Thus, the aim of this study is to investigate prevalence and risk factors associated with urinary tract infection among pregnant women attending ant-natal federal medical center Owerri.

1.3 Objective of the Study

The general objective of the study is to examine prevalence and risk factors associated with urinary tract infection among pregnant women attending ant-natal federal medical center Owerri. The specific objective is as follows:

To assess the prevalence rate of urinary tract infections among pregnant women attending antenatal care at Federal Medical Center Owerri.

To identify the risk factors of urinary tract infections among pregnant women attending antenatal care at Federal Medical Center Owerri.

To assess the effects of urinary tract infections among pregnant women attending antenatal care at Federal Medical Center Owerri.

1.4  Research Question

The following research questions will be answered in this study;

What is the prevalence rate of urinary tract infections among pregnant women attending antenatal care at Federal Medical Center Owerri?

What are the risk factors of urinary tract infections among pregnant women attending antenatal care at Federal Medical Center Owerri?

What are the effects of urinary tract infections among pregnant women attending antenatal care at Federal Medical Center Owerri?

1.5 Research Hypothesis

The following hypothesis have been formulated for the study

H0: The prevalence rate of urinary tract infections among pregnant women attending antenatal care at Federal Medical Center Owerri is low.

1.6  Significance of Study

The need for universal screening of all women during pregnancy for UTI should be advocated for. This will help in the diagnosis of UTI even in women with no risk factors. Further community-based studies should be carried out with longer follow up to determine the true burden of the condition and the long-term consequences of UTI and its complications on the children of patients.

1.7  Scope of the Study

This study focuses on prevalence and risk factors associated with urinary tract infection among pregnant women attending ant-natal federal medical center Owerri. Empirically, this study will assess the prevalence rate of urinary tract infections among pregnant women attending antenatal care, the risk factors of urinary tract infections among pregnant women attending antenatal care and the effects of urinary tract infections among pregnant women attending antenatal care.

This study will be carried out at the Federal Medical Center Owerri.

1.8 Limitation of the Study

This study was constrained by a number of factors which are as follows:

Just like any other research, ranging from unavailability of needed accurate materials on the topic under study, inability to get data.

Financial constraint, was faced by  the researcher, in getting relevant materials  and  in printing and collation of questionnaires.

Time factor: time factor pose another constraint since having to shuttle between writing of the research and also engaging in other academic work making it uneasy for the researcher.

1.9  Definition of Terms

Urinary Tract Infection (UTI): A urinary tract infection (UTI) is a bacterial infection that affects any part of the urinary system, including the kidneys, ureters, bladder, and urethra. It commonly causes symptoms such as painful or frequent urination, cloudy or bloody urine, and discomfort in the lower abdomen.

Pregnant women: Pregnant women are women who are expecting a baby or babies, typically during the period from conception to birth.

Antenatal: "Antenatal" refers to the period before childbirth, typically referring to the care and medical attention given to a pregnant woman during this time. It involves monitoring the health of both the mother and the developing fetus, providing necessary medical tests, advice on nutrition and exercise, and preparing for the upcoming delivery.