Prevalence of Urinary Tract Infection Among Pregnant Women Attending Federal Medical Centre Umuahia From the Year 2019-2022
CHAPTER ONE
Study Objectives
General
To determine the prevalence and outcomes of urinary tract infections among pregnant mothers attending antenatal clinic in Federal Medical Centre Umuahia.
Specific objectives.
- To determine the total number of mothers who attended ANC clinic at Federal Medical Centre Umuahia between 2019 and 2022
- To determine the number of mothers who tested positive for urinary tract infections.
- To determine the outcomes of UTI among mothers who attended ANC clinic at Federal Medical Centre Umuahia between 2019 and 2022.
CHAPTER TWO
LITERATURE REVIEW
Conceptual Review
Urinary tract infections (UTIs) by convention are defined either as a lower tract (acute cystitis) or upper tract (acute pyelonephritis) infection. Bacteriuria occurs in 2 to 7 percent of pregnancies, particularly in multiparous women, a similar prevalence as seen in non-pregnant women.
Urinary infections, with a spectrum from covert bacteriuria to severe pyelonephritis, commonly complicate pregnancy. Serious infections follow untreated silent bacteriuria in a fourth of cases, and routine screening can be justified in high-risk populations, particularly in those women from lower socioeconomic strata.
Despite an initial salutary response to a number of antimicrobial regimens, covert bacteriuria recurs in one-third of treated women whose risk of pyelonephritis again is at 25%. Acute cystitis may be unrelated to these other infections and responds readily to a number of regimens; however, single-dose therapy is not recommended because early pyelonephritis can be mistaken for uncomplicated cystitis.
Bacteriuria often develops in the first month of pregnancy and is frequently associated with a reduction in concentrating ability, suggesting involvement of the kidney (Kaitz, 2011). The smooth muscle relaxation and subsequent ureteral dilatation that accompany pregnancy are thought to facilitate the ascent of bacteria from the bladder to the kidney, as a result bacteriuria during pregnancy has a greater propensity to progress to pyelonephritis (up to 40 percent) than in nonpregnant women (Kass, 2010; Smaill, 2017) Bacteriuria has been associated with an increased risk of preterm birth, low birth weight, and perinatal mortality (Smaill, 2017). As an example, a review of over 50,000 pregnancies between 2019 and 2016 showed that women with bacteriuria and/or pyuria (no comment on the presence or absence of symptoms) in the last two weeks of pregnancy had a higher rate of perinatal mortality from a variety of causes than noninfected women(Naeye, 2019). Studies have also shown that treatment of bacteriuria during pregnancy reduces the incidence of these complications(Kass, 2010; Whalley, 2015) and lowers the long-term risk of sequelae following asymptomatic bacteriuria(Zinner SH, 2011).
CHAPTER THREE
STUDY METHODOLOGY
Study Design
This was a retrospective quantitative and qualitative cross-sectional study.
Study Population
The study population included pregnant mothers recorded to have attended ANC clinic at FMC Umuahia Hospital within the period of 2019 to 2022. Approximately 13,958 mothers access ANC services at FMC Umuahia Hospital per year with different and varying outcomes. The study only considered records of mothers who had signs of UTI and their urine samples had been taken into the laboratory for urinalysis.
CHAPTER FOUR
RESULTS
Out of the 6,230 mothers who attended ANC at Federal Medical Centre Umuahia between 2019 and 2022,103 mothers had their urine samples subjected to routine urinalysis and microscopic examination. Among the 103 samples, the present study revealed 91/103(88.3%) had positive results for UTI while 12/103(11.7%) had negative results for UTI giving a prevalence of 1.46%
CHAPTER FIVE
Conclusion
Urinary tract infection is a prevalent complication of pregnancy that can worsen maternal and perinatal prognosis. If not treated asymptomatic forms can progress to pyelonephritis, which is associated with preterm delivery, low birth weight infants and stillbirth.
Out of the 6,230 mothers who attended ANC at Federal Medical Centre Umuahia between 2019 and 2022,only 103 mothers were sent to the laboratory for urinalysis and out of these 91 mothers tested positive for UTI which gave a prevalence of 1.46%.This figure does not reflect the magnitude of UTI as one of the most common medical complications of pregnancy(Mittal & Wing,2015),probably because the study only considered mothers who were symptomatic leaving out the proportion of mothers who could be having asymptomatic bacteriuria and the screening method used has a poor sensitivity of 22-29%(Shelton et al,2011).
Gestational age and parity had influence on the prevalence of UTI in the study but maternal age was not found to be a significant factor.
Majority of the mothers were treated and cured with just a slight percentage of those treated being lost to follow up.
Given the increased incidence of UTIs during gestation, health care professionals must be aware that the choice of available anti-infective drugs are restricted, because of the risk of certain of these drugs for the fetus, and the potential for microbial resistance.
Early diagnosis followed by immediate and adequate therapy is essential during gestation, avoiding compromising maternal and neonatal health.
RECOMMENDATIONS.
- Screening and treatment of both symptomatic and asymptomatic urinary tract infection should be done for every pregnant mother attending antenatal clinic.
- Urine culture should be used for diagnosing UTI since it’s the gold standard by which other screening tests are evaluated and the microscopic evaluation for pyuria ,the presence of white blood cells has poor sensitivity of 22-29%(Shelton et al,2011)
- Follow up of mothers on treatment should be encouraged to help prevent occurrence of complications like recurrence.
- I would also recommend drug sensitivity testing to ensure that only the required drugs are given to these mothers to help prevent drug resistance and drug toxicity to both the mother and the fetus.
- Sensitization of mothers on the need to attend ANC and seeking medical advice in cases when they are feeling unwell should be encouraged.
- Outreach programmes where possible to screen those mothers who may not be able to access health facilities could in a way lower the burden of UTI during pregnancy.
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