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PREVALENCE OF URINARY TRACT INFECTION AND IT’S RISKS FACTOR AMONG SECONDARY STUDENTS
CHAPTER ONE INTRODUCTION
Background to the Study
Urinary tract infections (UTIs) during adolescent are among the most common health problems afflicting many women in their reproductive years (Wamalma, Onolo, & Makokha, 2013). secondary school students 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 adolescent 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 secondary school students 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 adolescent 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 adolescent 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 adolescent and they include the reduced ability of the kidneys to concentrate urine, leading to differences in urine ph and osmolality of urine in adolescent, 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. adolescent 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 adolescent is fundamental to reducing and improving maternal health in adolescent. 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 secondary school students.
Statement of the Problem
UTI in adolescent leads to poor adolescent outcome. According to Haider, Zehr, Munir, and Haider (2010), the prevalence of UTIs in adolescent globally ranges from 13%-33% with asymptomatic bacteriuria occurring in 2-10% during pregnancies while symptomatic has been found to account for 1-18% during pregnancies. UTI in adolescent is a serious problem with complications such as prematurity and low birth weight. Prematurity and low birth weights are associated with poor infant survival.
Currently in Enugu State, in line with the sustainable development goals (SDGs no 3) which is to ensure healthy lives and promote well-being for all ages, urinalysis is one of the basic laboratory tests done in the first antenatal visit. This is to
detect and treat UTI early in adolescent or reduce it to the barest minimum and to reduce the chances of prematurity and low birth weight which are linked with infant mortality. In spite of this effort the incidence of UTI is still common among secondary school students who attend ante-natal clinic at University of Nigeria Teaching Hospital (UNTH) ituku ozalla. From records available in University of Nigeria Teaching Hospital, Enugu, between June and September 2013, out of 300 secondary school students who were treated of different ailments, 25 were diagnosed of UTI, representing 8 percent of the population that had problem in adolescent (UNTH records). The questions being raised are, Is the problem due to maternal age, gestational age, parity, economic status and level of education or due to combination of these factors? There is need to identify the demographic factors which increase the occurrence of UTI in adolescent.
Purpose of the Study
The purpose of this study was to determine the prevalence of UTI and demographic differentials (parity, gestational age, maternal age, economic status and level of education) among secondary school students in UNTH Enugu.
Objectives of the Study
Objectives of the study are to:
- determine the proportion of students who has UTI among secondary school students in Government Girls College Damaturu
- identify the common causal organisms of UTI among secondary school students in Government Girls College Damaturu
- determine the differences in UTI occurrence among secondary school students in Government Girls College Damaturu based on parity
- ascertain the differences in UTI occurrence among secondary school students in Government Girls College Damaturu based on gestational age
- assess the differences in UTI occurrence among secondary school students in Government Girls College Damaturu based on maternal
- examine the differences in UTI occurrence among pregnant studentsin Government Girls College Damaturu based on educational
- determine the differences in UTI occurrence among secondary school students in Government Girls College Damaturu based on economic
Research Hypotheses
There would be no significant difference UTI among secondary school students in Government Girls College Damaturu based on their demographic differentials (parity, gestational age, maternal age, maternal level of education and maternal economic level).
Significance of the Study
The secondary school students will benefit from the findings of this study. If the demographics are associated with UTI in secondary school students, the finding will reveal the particular demographics of secondary school students that influence UTI. The information will help nurses and other health care providers to know the group of secondary school students that are more vulnerable. Also the information from the findings will help the hospital policy makers or stakeholders to know the factors affecting UTI and help to improve on their strategies towards reducing the incidence of UTI. Such practices may reduce UTI problems in adolescent; reduce the risk of premature delivery; and improve women’s health. On the other hand if UTI among secondary school students is not associated
demographic differences, this study will make room for other studies to be conducted to improve maternal and child health.
Scope of the Study
This study is delimited to Government Girls College Damaturu. The study is also delimited to the investigation of demographic differences (maternal age, parity, gestational age, economic status and educational level) in UTI occurrence among secondary school students in Government Girls College Damaturu
Operational Definition of Terms
- Urinary Tract Infection refer to the presence of bacteria in the urine. Urine samples of secondary school students will be collected and cultured within 24hours using standard loop technique on blood agar,cystein lactose electrolyte deficient (CLED) medium agar and macconkey agar in laboratory. UTI will be established if the urine sample counts greater or equals to 100,000 of bacteria per ml of
- Demographic differentials used in this study are parity, gestational age, maternal age and economic status that may be associated with the occurrence of urinary tract
- Economic level of the studentsrefer to the level of financial status of the studentsattending antenatal in UNTH
4 secondary school students refer to students between 20-49years who have one to six children irrespective of gestational age and marital status
PREVALENCE OF URINARY TRACT INFECTION AND IT’S RISKS FACTOR AMONG SECONDARY STUDENTS