Abstract

In this study, our focus was to carryout  a critical analysis on the prevalence of urinary tract parasites in patients. The study specifically was aimed at ascertaining the the prevalence of urinary tract parasites in patients and demographic differentials (parity, gestational age, maternal age, economic status and level of education) among pregnant women in UNTH Enugu.

The study adopted the survey research design and randomly enrolled participants in the study. A total of 225 responses were validated from the enrolled participants where all respondent are pregnant women in UNTH Enugu.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Urinary tract infection (UTI) is the infection of any part of the urinary tract. The urinary tract consists of the kidneys, ureters, bladder and urethra. Any part of these structures can become infected but bladder and urethra infections are the most common (Anon, 2006). The bladder infection is known as cystitis while that of the urethra is known as pyelonephritis and is more serious.

The two types of UTI are lower UTI which is an infection of the lower part of the urinary tract (the bladder and urethra) and upper UTI which is an infection of the upper part of the urinary tract (kidneys and ureters). The upper UTI is potentially more serious than the lower one because there is a possibility of kidney damage.

Most UTIs are caused by bacteria that can live in the digestive tract, the vagina or around the urethra. Infection occurs when bacteria enter the normally sterile urinary system and multiply there. They produce enzymes which help them feed on tissues of the host and thus damage them (Adult Helath Advisor, 2005).

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.

1.2 Statement of the Problem

UTI in pregnancy leads to poor pregnancy  outcome. According to Haider, Zehr, Munir, and Haider (2010), the prevalence of UTIs in pregnancy 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 pregnancy 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 pregnancy 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 pregnant women 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 pregnant women who were treated of different ailments, 25  were diagnosed of UTI, representing 8  percent  of the population that had problem in pregnancy (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 pregnancy.

1.3 Purpose of the Study

The purpose of this study was to determine the prevalence of urinary tract parasites in patients and demographic differentials (parity, gestational age, maternal age, economic status and level of education) among pregnant women in UNTH Enugu.

1.3.1 Objectives of the Study

Objectives of the study are to:

1. determine the proportion  of  women  who  has  UTI among pregnant women attending antenatal care in UNTH

2. identify the common causal organisms of UTI among pregnant women attending antenatal care in UNTH

3. determine the differences in UTI occurrence among pregnant women attending antenatal care in UNTH based on parity

4. ascertain the differences in UTI occurrence among pregnant women attending antenatal care in UNTH based on gestational age

5. assess the differences in UTI occurrence among pregnant women attending antenatal care in UNTH based on maternal age.5. assess the differences in UTI occurrence among pregnant women attending antenatal care in UNTH based on maternal age.

6. examine the differences in UTI  occurrence among  pregnant women attending antenatal care in UNTH based on educational level.

7. determine   the  differences in  UTI occurrence  among pregnant women attending antenatal care in UNTH based on economic level.

1.4 Research Hypotheses

There would be no significant difference UTI among pregnant women attending antenatal care in UNTH based on their demographic differentials (parity, gestational age, maternal age, maternal level of education and maternal economic level).

1.5 Significance of the Study

The pregnant women will benefit from the findings of this study. If the demographics are associated with UTI in pregnant women, the finding will reveal the particular demographics of pregnant women that influence UTI. The information  will  help  nurses and other health care