URINARY TRACT INFECTION AND DEMOGRAPHIC DIFFERENTIAL AMONG PREGNANT WOMEN

1.1 Introduction

Urinary Tract Infection is the microbial invasion and subsequent multiplication in any parts of the urinary tract (urethral, bladder, ureters and kidneys) or the entire tract (Kolawole et al., 2009; Akinyemi et al., 1997; Stamm et al., 2001). Urinary Tract Infection (UTI) is a global public health challenge and is common among pregnant women partly due to prevailing anatomical and physiological changes during pregnancy (Boye et al., 2012; Hagos et al., 2015; Ahmed et al., 2016). Broadly speaking, UTI is the inflammatory response of the urothelium to microbial invasion (Enitan et al., 2014) and it is common both in the community and hospital settings (Mach et al., 2009).

As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitations of the Study and Definition of technical terms.

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1.2 Background of Study

Urinary tract infections (UTIs) in pregnant women continue to pose a clinical problem and a great challenge for physicians. Although the incidence of bacteriuria in this population is only slightly higher than in non-pregnant women, its consequences for both the mother and the unborn child are more severe. There is a much higher risk (up to 40%) of progression to pyelonephritis, and possibly increased risk of pre-eclamp- sia, premature birth and low neonatal birth weight (Schnarr et al., 2008; Farkash et al., 2012; Gravett et al., 2012; Foxman et al., 2002; Mazor-Dray et al., 2009; Bolton et al., 2012). Simultaneously, the enlarged uterus compresses the urinary bladder, thus increasing the intravesical pres- sure, which may result in vesico-ureteral reflux and urine retention in the bladder after miction, commonly observed in pregnant women. Uri- nary stasis and impairment of the physiological anti-reflux mechanism create conditions favorable for bacterial growth and ascending infection.

Treatment of UTI varies with the type diagnosed (complicated or uncomplicated UTI), but is usually empirical because of the common spectrum of urinary pathogens involve (Nickel et al., 2005; Nabbugodi et al., 2015). Antimicrobial resistance is a major public health problem worldwide. This is caused in part by the overuse and abuse of antimicrobials in clinical situations where they are not necessary or in prolonged courses of therapy when shorter durations are as effective (Hassan et al., 2011; Amin et al., 2009; Ali et al., 2014; Lee et al., 2016; Sultana et al., 2018).

The importance of pre-natal laboratory urine screening for bacteria to identify patients with asymptomatic bacteriuria cannot be underestimated. However, some women with UTI may present in the hospital at the late stage of the pregnancy. This hinders effective treatment of urinary infection and there may be no positive birth outcome even If antimicrobials had been administered (Morita et al., 2013; Siakwa et al., 2018; Bjerklund-Johansen et al., 2015). Most women with UTI are not aware of this condition. The infection is later diagnosed at the late stage of pregnancy which hinders effective treatment or positive birth outcome. UTI is a serious health problem affecting millions of people each year and is the leading cause of Gram-negative bacteremia. Establishment of base-line data is a very critical epidemiological effort in mitigating the complications of UTI in pregnancy.

Urine is an ultra-filtrate of blood with different molecules and salts and does not usually have bacteria as a normal constituent. When a bacterium finds its way into the urinary tract and multiplies there, it may cause infection. Though UTI affects both male and female, women are more susceptible than men due to the short urethra in females, lack of prostatic secretion, pregnancy and proximity of the female urinary tract to the rectal region which facilitates contamination of the urinary tract with faecal organisms (Ahmed et al., 2016; Valiquette et al., 2001).

Therefore, in Delta State where the research was carried out, the activities that was conducted is to know the Urinary Tract Infection and Demographic Differential among Pregnant Women Attending Antenatal Care in a Community.

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1.3 Statement of Problems

Investigation revealed that UTI is a serious health problem affecting millions of people each year and is the leading cause of Gram-negative bacteremia. Establishment of base-line data is a very critical epidemiological effort in mitigating the complications of UTI in pregnancy. Urinary tract infections in pregnant women continue to pose a clinical problem and a great challenge for physicians. Although the incidence of bacteriuria in this population is only slightly higher than in non-pregnant women, its consequences for both the mother and the unborn child are more severe. There is a much higher risk (up to 40%) of progression to pyelonephritis, and possibly increased risk of pre-eclamp- sia, premature birth and low neonatal birth weight (Schnarr et al., 2008; Farkash et al., 2012; Gravett et al., 2012; Foxman et al., 2002; Mazor-Dray et al., 2009; Bolton et al., 2012).

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1.4 Aim and Objectives of Study

The aim of the study is to examine the Urinary Tract Infection and Demographic Differential among Pregnant Women Attending Antenatal Care in Delta State Primary Health Care Centre in Warri-South Local Government Area. In achieving this aim, the following specific objectives were laid out as follows:

1. To identify the presence of unnoticed Urinary Tract Infection (UTI) among pregnant women
2. To assess the prevalence of urinary abnormalities in pregnant women with Suspected Urinary Tract Infection
3. To provide the report of the urine tract analysis to pregnant women which may help for their further health consciousness
4. To determine the prevalence, as well as the antibiotic susceptibility patterns of urinary bacteria among pregnant women attending the Antenatal Clinic (ANC)

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1.5 Research Questions

The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:

• Are there reports of the urine tract analysis to pregnant women which may help for their further health consciousness?
• Does the presence of unnoticed Urinary Tract Infection (UTI) has significant effect on pregnant women?
• What is the prevalence of urinary abnormalities in pregnant women with Suspected Urinary Tract Infection?
• What is the prevalence, as well as the antibiotic susceptibility patterns of urinary bacteria among pregnant women attending the Antenatal Clinic (ANC)?

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1.6 Research Hypothesis

In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.

Hypothesis One

• H0: The presence of unnoticed Urinary Tract Infection (UTI) does not have significant effect on pregnant women
• H1: The presence of unnoticed Urinary Tract Infection (UTI) has significant effect on pregnant women

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1.7 Significance of Study

This study will be of immense benefit to academic students and other researchers who intend to know more on this study and can also be used by non-researchers to build more on their research work. This study contributes to knowledge and could serve as a guide for other study.

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1.8 Scope of Study

The scope of the research is focused on the Urinary Tract Infection and Demographic Differential among Pregnant Women Attending Antenatal Care in Delta State Primary Health Care Centre in Warri-South Local Government Area.

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1.9 Limitations of the Study

During the course of this study, many things militated against its completion, some of which are:

1. Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
2. Research material: availability of research material is a major setback to the scope of the study.
3. Frequent power failure: This made the researcher append more money on fuel to ensure sustainable power.
4. Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).