Chapter one

1.0 Introduction

1.1 Background of Study.

Urinary tract infection (UTI) is common health problem among pregnant women

Saidi(2018). This usually begins in week 6 and peak during week 22 to 24 of pregnancy due

to a number of factors including urethral dilatations, increased bladder volume and

increased bladder tone along with decreased urethral tone which contribute to increased

urinary stasis and urethrovesical refluxw. Chalilia(2019) up to 70% of pregnant women

develop glycosuria which encourage bacterial growth in the urine. Aissa(2019). An

incidence of asymptomatic bacteriuria, urinary tract infection has been previously reported

to be 13-29% in pregnant women Delzell(2017) compared with that of symptomatic

bacteriuria urinary tract infection which occur in 1-18% during pregnancy. Urinary tract

infection (UTI) may cause complications such as pyelonephritis, hypertensive disease of

pregnancy, anemia, chronic renal failure, premature delivery and fetal mortality

Dwyer(2018) the incidence of this complication can be decrease by treating promptly

asymptomatic bacteriuria (ASB) and symptomatic (SB) during pregnancy due to the

potential adverse sequelea of urinary tract infection in pregnancy. Urinary tract infections

refers to the presence of microbial pathogen within the urinary tract and its usually

classified by the infection site, bladder(cystitis), kidney (pyelonephritis) and also it can be

asymptotic or symptomatic (UTI) that occur in a normal genitourinary tract with no prior

instrumentation are considered as "uncomplicated" whereas "complicated ” infection are

diagnosed in genito urinary tracts that have structural or functional abnormalities

Kriptike(2019).Automatically UTI can be classified in to lower urinary tract infection

involving bladder and urethra and upper urinary tract infection which use to involve the

kidney and pelvis. The pathogenesis of urinary tract infection involves ascending infection

with coliform bacteria the bacteria incriminated in UTI includes Escherichia coli,

staphylococcus saprophyticus with remainder caused by Proteus and other gram negative

rods. zalmanovici et al(2018) the prevalence and degree of occurrence of two of these

organisms over other are Defendant on the environment. While not generally considered a

cause of significant mortality Hill et al (2018).Typically, symptoms associated with UTI,

include dysuria, urgency (the enhanced desire to void) if left untreated or under treated UTI

have the potential for serious and life threatening condition. This is more likely to be the

case where access to availability of timely and appropriate medical interventions is limited

may be due to inadequate number of health care providers. Possible conditions include

pyelonephritis which leads to renal scaring and sepsis Minassian et al(2016).

1.2 Statement of Problem

Urinary tract infection is a serious health problem affecting millions of people each year in

developing countries including Nigeria. The worldwide urinary tract infection incidence was

estimated to be around 150million persons per year Gofta(2017).due to its rapid spread one

of the most frequent seen medical case or complication in our antenatal clinics today. UTI

can be particularly dangerous in pregnant women in whom it has been shown that up to 50%

of those with asymptomatic bacteriuria go on to develop pyelonephritis an the women

experience higher rates of intrauterine growth Delzell(2019) the presence of UTI has also

been shown to increase the risk of preterm labor, preterm birth pregnancy induced

hypertension, preeclampsia and anemia Mazor-dray(2019) A prevalence of 25.3% was

observed which is similar to that of Akinloye et al(2016) in Ibadan with incidence of 21.7%,

however there is incidence rate of 45.7% in Ibadan, factors such as poor housing, poor

drainage system, lack of proper personal and environmental hygiene, genuine population

susceptibility. Also factors such as low socioeconomic status, sexual intercourse and

pregnancy among others are common among Nigerian women Kolawole (2019).UTI in

pregnancy poses a risk of complications which include premature birth, low birth weight,

still birth and pyelonephritis.

Therefore it ’s of paramount important to Carry out a detail research work on incidence of

urinary tract infection in pregnant women attending antenatal clinic at general hospital

Katsina, Katsina state from July 2021 to December 2021. In order to find out the factors that

are responsible for causing the infection among them, so that adequate safety measures or

precautions could be taken in order to control the incidence and slow down the spread of

infection.

1.3 Objective of the study.

This study aimed to determine the incidence of urinary tract infection among pregnant

women attending antenatal clinic at general hospital Katsina, Katsina state from July 2021

to December 2021. This could be achieved through the following objectives.

1. To determine the rate of occurrance of urinary tract infections (UTIs) among pregnant

women attending antenatal clinic at general hospital Katsina.

2. To determine the age distribution of urinary tract infection (UTI) among

pregnant women attending antenatal clinic at general hospital Katsina.

1.4 Research Question.

1. What is the rate of occurrence of urinary tract infection among pregnant women attending

antenatal clinic at General Hospital Katsina?

2. What is the age distribution of urinary tract infection among pregnant women attending

antenatal clinic at General Hospital Katsina?

1.5 Significance of Study.

The study is very much important, because of its high occurrence; great effort has been

expended in ascertaining the full range of clinical effect caused by this infection. This

research work is useful for proper management of infected patient; however the health

education unit will take advantage of this work to be a great resources ethics for activities to

seminars and programs as regards to urinary tract infections control in our community. The

entire society and the students of medical field will benefit to the value of this research

project as reference of urinary tract infections.

1.6 Scope of the study

The field of the study intend to determine Incidence of urinary tract infection among pregnant

women of all ages attending antenatal clinic of General Hospital Katsina, Katsina state.
From july 2021 to December 2021. The study is confined to pregnant women of all ages

attending antenatal clinic of General Hospital Katsina from July,2021 to December 2021 . In

order to identify the rate of occurrence, and age of distribution of urinary tract infection

among pregnant women attending maternity unit General Hospital Katsina.

And also to find out some possible remedies to the problems, the study was limited to the

General Hospital Katsina considering the limited human resources time and materials

1.7 Operational Definition of Terms.

Antibiotics: are substance inform of drugs that can destroy or inhibit the growth of bacteria

and similar micro organism

Asymptomatic: that is not exhibiting ant symptoms

Bacteriuria: presence of bacteria in the urine

Infection: a uncontrolled growth of harmful microorganism in a host Pregnancy the

progression of stages from conception to birth

Retrospective: looking back ward

Symptomatic: that showing symptoms

UTI: is an acronym of urinary tract infection.

Maternity Unit: a unit designed for the care of pregnant women and her baby.

Bacteria: is a member of large group of unicellular micro organism which can cause disease

Incidence: The occurrence, rate or frequency of a disease

Pregnant women : is a woman that is carrying pregnancy for a period of 9 month.

Antenatal care: is the care you get from health professional during pregnancy.

Antenatal clinic: A clinic that women attend when they are pregnant so that the medical

staff can check that they and the baby are healthy.

Urinary tract infection: An infection in any part of urinary system which includes kidneys,

bladder, ureters and urethra.

Occurance: the fact or frequency of disease.

Chapter Two

2.0 Literature Review.

2.1 Conceptual Review

A urinary tract infection (UTI) is an infection from microbes; these are organisms that are

too small to be seen without a microscope. Most UTI are caused by bacterial, fungi and in

rare cases by viruses. UTI is among the most common infections in humans. UTIs can

happen anywhere in the urinary tract, the urinary tract is made up of kidneys, ureters,

bladder and urethra. But must UTIs only involve the urethra and the bladder in the Lower

tract. However it can affect the ureters and the kidneys in the upper tract. Although upper

tract UTIs are very rare than lower tract UTIs and they are also usually more severe. Urinary

tract infections have two types which are symptomatic and asymptomatic UTIs, 25% of the

patients develops acute symptomatic infections in pregnancy. It ’s thus significance to screen

all pregnant mothers for bacteriuria on the first antenatal visit. Akinloye,(2018).

Asymptomatic bacteriuria has been associated with preterm labor and low birth weight

infants in multivariate analysis found increase risk of preterm delivery Hamdon,

(2017)bacteriuria may persist after delivery, may result in to overt symptomatic infections

and chronic infections Pooja,(2019)

2.1.1 Classification of Urinary Tract Infection.

Urinary tract infection in pregnancy is classified as asymptomatic bacteriuria which is

defined as true bacteriuria (>100,000/ml) in the absence of specific symptoms of acute

urinary tract infections. And Symptomatic which include cystitis or pylonephrithis.

2.1.2 Asymptomatic Bacteriuria

Asymptomatic bacteriuria (ASB) is bacterial urinary tract infections that occur without any

symptoms Fasalu,(2015).

According to clinical microbiology and infection, (2019)Asymptomatic bacteriuria is the

presence of bacteria in the properly collected urine of a patient that has no signs or symptoms of

a urinary tract infection. Asymptomatic bacteriuria is very common in clinical practice. While

few infants and toddlers have asymptomatic bacteriuria, the incidence increases with age. The

incidence is up to 15% or greater in women and men age 65 to 80 years than and as high as 40%

to 50% after age 80. Most patients with asymptomatic bacteriuria will never develop

symptomatic urinary tract infections and will have no adverse consequences from asymptomatic

bacteriuria.

2.1.3 SymptomaticBacteriuria
Symptomatic bacteriuria (SB) is bacterial urinary tract infections that occur or accompanied

with symptoms Fasalu, (2015).

Symptomatic bacteriuria is a common clinical problem especially in elderly people, which

occur more frequently in women than in men. Symptomatic bacteriuria is divided into lower

(cystitis) and upper (pyelonephritis) infection.

2.1.4 Etiology of UTI during Pregnancy.

Urinary tract infections in women are caused by a number of bacterial species, the majority

of which are from normal perineal flora. Most of the cases Gram-negative organisms are the

causative agents for UTI. Escherichia coli is one of the major causative organism in 85% of

community-acquired infections (Noor, 2019). Organisms like klebsiellapneumoniae, proteus

and providecia species, pseudomonas aeruginosa, Enterobacter and Serratia species may

also cause UTI. In rare conditions some organisms like Salmonella species, Mycobacterium

tuberculosis, Chlamydia, trachomatis, Candida species are also seen as infective agents for

UTI. Gram-positive organisms like Staphylococcus saprophyticus, Enterococcus faecalis

may also be a causative organism in 5 to 15% of UTI cases Hill,(2015). Sometime multiple

microbial organisms may be found causing infection in patients with renal calculi, chronic

renal abscesses, indwelling urinary catheters, or a fistula between the bladder and either the

bowel or the vagina Mshana, (2019).

Apart from these pathogens, pregnancy induced physiological changes in the urinary system

may also act as the promoting factors for UTI. Dilation of the ureters and renal calyces is

evident as early as 12 weeks and is studied to be caused by progesterone-induced relaxation

of their muscular layers. More importantly, as the uterus enlarges, it begins to compress the
ureters at the pelvic brim, particularly on the right Sandbarg,(2019). Vesicoureteral reflux

may first appear or worsen during gestation in some women, particularly multiparas.

Anatomical changes in bladder position in late pregnancy also may render it more

susceptible for the trauma, periurethral tears, large vulva lacerations, and epidural analgesia

for labor and delivery predispose to urinary retention and the need for catheterization arises

Zalmanovici,(2015).

2.1.5 Pathophysiology of UTI during Pregnancy.

Pregnancy causes many changes in the female ’s body. Factor like structural and hormonal

changes raises the risk of UTI in pregnancy. The anatomical factors like hydro-

ureter,hydronephrosis and vesicoureteric reflux may raise the occurrence of UTI in

pregnancy. hydroureter of pregnancy has been characterized by an increase in the diameter

of the urethral lumen, hypotonocity and lypomotility of and third trimesters, the right ureter

being more often dilated than the left Marchant,(2017). Increased weight of enlarging uterus

can cause urinary retention and progesterone induced urethral smooth muscle relaxation

may lead to urinary statis Hill,(2018).

Blood-volume expansion is accompanied by increases in the glomerular filtration rate and

urinary output. Increase in urinary output volume along with the loss of urethral tone may

result renal pelvis, and calyces stasis. This urinary statis and the presence of vesicoureteral

reflux are responsible for UTI and acute pyelonephritis in most cases Fasalu,(2015)

The increased excretion of nutrient like glucose, B-complex, vitamins etc. form a good

culture medium for bacterial growth indirectly Hytten,(2016). In pregnancy, urine PH gets

raised to a range suitable for the growth of E. coli. Glycosuria gets developed due to
impaired re-absorption by the collecting tubule and loop of Henle. About 5% of the filtered

glucose escapes proximal convoluted tubular re-absorption Windel,(2015).

In general, pregnant patients are considered as immune-compromised UTI hosts because of

the physiological changes associated with pregnancy. Also during pregnancy, there is a

great increase in the moistness which tends to increase the growth of bacteria Pritchard,

(2019).

These changes, along with short urethra (approximately 3 – 4cm in females) and difficulty

with hygiene due to a distended pregnant belly, increase the frequency of urinary tract

infection (UTIs) in pregnant women. Indeed, UTIs are among the most common bacterial

infections during pregnancy Pooja,(2019).

2.1.6 Epidemiology of Urinary Tract Infection (UTI)

UTIs are studied to be 14 times more frequent in women than in men. Bacteriuria occurs in

2 to 7 percent of pregnancies, particularly in multiparous women, as similar prevalence as

seen in non-pregnant women. The incidence of UTI during pregnancy increases with

maternal age. As the organisms responsible for infection (in terms of species and virulence

factors) are observed to be the same in pregnant and non-pregnant women, the basic

mechanism of entry of bacteria into the urinary tract is likely to be the same for both groups

Janson,(2014).

A retrospective analysis of 24,000 births found the incidence of UTI during pregnancy to be

28.7% in Whites and Asians, 30.1% in blacks and 41.1% in Hispanics. When socioeconomic

status is controlled, no significant interracial differences seem to exist. Several patients’

level factors are associated with an increased frequency of bacteriuria during pnjmeriuria
the risk is double in women with sickle cell trait, other risk factors for bacteriuria include

diabetes mellitus, neurogenic bladder retention, history of vesicoureteral reflux, previous

renal transplantation, and history of previous UTIs Sandberg,(2019).Maintenance of proper

hygienic condition in practices and clothing, changes in coital patterns (e.g position,

frequency, postocoital antibiotics) can offset recurrence in individuals with high risk of

getting the disease Saygun,(2018).

Bacteriuria often develops in the first month of pregnancy and frequently associated with a

reduction in concentrating ability, suggesting involvement of the kidney. The smooth

muscle relaxation and subsequent urethral dilatation that accompany pregnancy are thought

to facilitate the ascent of bacteria from the bladder to the kidney. As a result,

bacteriuriaduring pregnancy has a greater propensity to progress to pyelonephritis (up to

40%) than in non-pregnant women Smaill,(2019).

2.1.7 Treatment of UTI during Pregnancy

UTIs are managed more aggressively in pregnant women than in non-pregnant women.

Urine samples should be sent for culture and empirical treatment given while awaiting

results. Nitrofurantion, Trimethoprim or Cephalexins are appropriate antibiotic of choices

(Although restrictions apply depending on the stage of pregnancy). Quinolones, e.g

Norfloxacin, should not be used during pregnancy John,(2016). Any discussion of treatment

should be prefaced with a discussion of behavioral methods that may be used to ensure good

hygiene and reduce bacterial contamination of the urethral meatus, thereby preventing in

adequate treatment and recurrent infection. Wipe front- to back after urinating or defecating,
wash hands before using the toilet, use washed cloths to clean the perineum, use liquid soap

to prevent colonization from bar soap, clean the urethral meatus first when bathing. The

above mentioned are the common behavioral methods suggested to avoid the disease

Benvieset,(2016).

Asymptomatic bacteriuria can be screened by using a urine culture at 6-12 weeks of

gestation schnarr et al.,(2018). All pregnant women with confirmed asymptomatic

bacteriuria should be treated with antibiotics. The choice of antibiotic can be guided by the

known sensitive; preferred drugs are as following Association of Medical Microbiologist,

(2013).

• Amoxicillin (if susceptible): 250mg three times a day.

• Nitrofurantoin: 50mg four times a day

• Trimethoprim: 300mg once a day (avoid in the first trimester).

• Cephalexin: 500mg twice a day (least preferred option) Serki,(2011).

All antibiotics should be given for seven (7) days to ensure cure Lumbiganon,(2019). The

eradication of bacteriuria can be confirmed by doing a urine culture after completion of the

therapy. It is recommended that urine cultures are repeated regularly until delivery Clinical

Knowledge Summaries (CKS),(2019).

2.1.8 Method to Prevent UTI During Pregnancy

Many general guidelines and suggestions can help women to avoid urinary tract infections

(UTIs) in most instances. These may be expediently divided into the categories of hygiene,

clothing, diet, activities and medications.

The following steps may reduce the chances of developing UTI during pregnancy.

Drink plenty of water and cranberry juice (choose one that doesn ’t contain sugar).

Check out the urine color often for abnormalities; if present try to get a medical advice.

Don’t ignore the urge to urinate and empty the bladder completely while urinating.

After a bowel movement, wipe yourself from front to rear to prevent bacteria in the stool

from getting near the urethra. Keep the genital area clean with mild soap and water.

Clean the genitals and the areas surrounding them and urinate before and after sexual

intercourse.

Avoid feminine hygiene products like sprays, powders and strong soap that can irritate the

urethra and genitals and make them a better breeding ground for bacteria. And don ’t use

douches during pregnancy.

Wear all-cotton undergarments.

Take showers rather than baths which tend to irritate urethral opening Akinloye,(2016).

2.2. Theoretical Review

This research study used Abraham Maslow ’s hierarchy of need as the theoretical framework,

indeed, based on the need. Human needs are ranked on ascending scale according to how

essential the needs are to survival.

Abrahman Maslow's hierarchy of needs is a theory of motivation which states that five

categories of human needs dictate an individual’s behavior. Those needs are

physiological needs, safety needs, love and belonging needs, esteem needs, and

self-actualization needs. Master class staff (2020).

The original hierarchy of needs five-stage model includes:

Maslow (1943) stated that people are motivated to achieve certain needs and that some

needs take precedence over others.

Our most basic need is for physical survival, and this will be the first thing that

motivates our behavior. Once that level is fulfilled the next level up is what motivates

us, and so on.

1. Physiological needs - these are biological requirements for human survival, e.g. air,

food, drink, shelter, clothing, warmth, sex, sleep.

If these needs are not satisfied the human body cannot function optimally. Maslow

considered physiological needs the most important as all the other needs become

secondary until these needs are met.

2. Safety needs - once an individual’s physiological needs are satisfied, the needs for

security and safety become salient. People want to experience order, predictability and

control in their lives. These needs can be fulfilled by the family and society (e.g. police,

schools, business and medical care).

For example, emotional security, financial security (e.g. employment, social welfare),

law and order, freedom from fear, social stability, property, health and wellbeing (e.g.

safety against accidents and injury).

3. Love and belongingness needs - after physiological and safety needs have been

fulfilled, the third level of human needs is social and involves feelings of belongingness.

Belongingness, refers to a human emotional need for interpersonal relationships,

affiliating, connectedness, and being part of a group.

Examples of belongingness needs include friendship, intimacy, trust, and acceptance,

receiving and giving affection, and love.

4. Esteem needs are the fourth level in Maslow’s hierarchy and include self-worth,

accomplishement and respect. Maslow classified esteem needs into two categories: (i)

esteem for oneself (dignity, achievement, mastery, independence) and (ii) the desire for

reputation or respect from others (e.g., status, prestige).

Maslow indicated that the need for respect or reputation is most important for

children and adolescents and precedes real self-esteem or dignity

5. Self-actualization needs are the highest level in Maslow's hierarchy, and refer to the

realization of a person's potential, self-fulfillment, seeking personal growth and peak

experiences. Maslow (1943) describes this level as the desire to accomplish everything

that one can, to become the most that one can be.
Individuals may perceive or focus on this need very specifically. For example, one

individual may have a strong desire to become an ideal parent. In another, the desire

may be expressed economically, academically or athletically. For others, it may be

expressed creatively, in paintings, pictures, or inventions. Mcleod S. (2022)

Application of the theory

With reference to the concepts introduced about Abrahman Maslows hierrachy of needs,

considering the physiological need that need to be met before proceiding to next need. If a

pregnant woman is having urinary tract infection her physiological needare not met before

preceiding to safety and security need.

Preceiding to safety and security need the mother (pregnant woman) and the fetus that she is

carrying will be at risk of been infected, she too that have the infection will alter her health

status by having sign and symptoms of infection.

More so, considering Abrahman Maslow hierrachy of need as he already stated in his

pyramid that the buttom need most be met before moving to next need, here the pregnant

woman most be free from that infection which can be achieve by treating the infection to

met the physiological need and proceed to next need. So Abrahman Maslow theory is very

vital considering the topic of research

2.3 Empirical Review

According to a research conducted by EzeugoigweNwachukwu, OnyinyeOnyebuchi, Orji

Michael, The incidence of urinary tract infections (UTIs) among pregnant women receiving

antenatal care at Kanayo specialist hospital and General hospital both in Onitsha was
considered to be high. Out of 200 urine samples of the pregnant women, 112 (56%) showed

growth of pathogenic bacteria highest prevalence of UTI is seen in primigravidty (45%) and

the lowest prevalence of UTI is seen in multi-gravidity (20%) which contradicts the findings

that have the highest prevalence of UTI among the multi-gravid as a result of pressure effect

of a bigger uterus on the ureter and pressure on the bladder from the descending part leading

to stasis of urine and the increased multiplication of urine. The study shows that pregnant

women within the age of 26-30 years had more infections than women within the age of 20-

25 years and it may be as a result of sexually activity which increases the risk of UTI and

the women of such age group are mostly sexually active. The report also found that

prevalence of UTI increases in sexually active women within the same age group.

Furthermore, the study shows that the most common ria isolated from the mid-stream urine

samples of pregnant women was Escherichia coli which is similar to the separate

findings.Nwachukwu,(2018)

Another research was also conducted by john L Brusch shows that E coli cause 70-95% of

both upper and lower UTIs. Various organisms are responsible for the remainder of

infections, including S saprophyticus, Proteus species, Klebsiella species, Enterococcus

faecalis, other Enterobacteriaceae, and yeast. Some species are more common in certain

subgroups, such as Staphylococcus saprophyticus in young women. However, S

saprophyticus can produce acute cystitis in older women and in young men and should not

be automatically regarded as a contaminant in the urine cultures of these individuals

Another research was also conducted by Noor, et al (2019) which revealed that Escherichia

coli is one of the major causative organism of urinary tract infection in 85% of community

acquired infections , another research was conducted by Oladipo A.O (2013) shows that the high
prevalence of UTI is dominant among pregnant women of all ages , he also find out that

escheriachia coli is the major cause of UTI with 31.5%.

Another research was also conducted at Kano by Muhammad Ali from department of

microbiology of Federal University Gusau Zamfara which shows that out of the total 145

subject , 23 subjects were diagnosed with urinary tract infection which accounted by 15.8% of

the pregnant women, and the highest incidence found among subject of ages category of 26-30.,

on the basis of socioeconomic status, most of the UTI patients were unemployed , rural dwellers

occupy large percentage among the study object.

Chapter Three

3.0 Methodology

3.1 Research Design

A retrospective study was conducted by analyzing the medical records of the patients who were

attending antenatal care at antenatal unit over the period of six month from July 2021 to

December 2021 at General Hospital Katsina.

3.2 Research Setting

The study was conducted at general hospital Katsina, with special regards to antenatal units.

General hospital Katsina is among the oldest secondary health institution in the northern part of

Nigeria, it was established since 1930s, but fully constructed and equipped in 1975, and
commissioned on 11th March, 1975 by Brigadier E.O Abisoye. The hospital comprised of

various areas of specialties, among which are medical, surgical, pediatric, accident and

emergency units, others are intensive care, dialysis, antenatal unit, laboratory, nutrition and

dietetic units among others.

The Hospital is blessed with various nurses, doctors and other distinguishes health care workers

which are all employed by the Katsina State Health Service Management Board.

The hospital is located at Yaranchi area of Katsina metropolis local government. There are 198

registered staff nurses of different specialty who are speciliased as Accident and Emergency,

Preoperative, Psychiatric, Midwives, Intensive Care Nurses among others which are distributed

to various wards according to their areas of specialty, and other health practitioners like Doctors,

pharmacies and lab scientist of different specialty.

The hospital is the training center for Basic Nursing students, various paramedical and medical

students from various institutions.

3.3 Target Population

The study comprises all the pregnant women who attended antenatal unit of General hospital

Katsina, from July 2021 to December 2021, which are 1494.

3.4 Sampling Size

A sample size of 306 women were selected from the total number of population, using Kregcie

and Morgan table

3.5 Sampling Technique

Simple random sampling technique was used during the study.

3.6 Instrument of Data Collection

A review of Medical records were used to obtain the basic data relating to incidence of urinary

tract infection among pregnant women attending antenatal clinic of general hospital Katsina from

July 2021 to December 2021 , the available record of the patients were reviewed and all the

necessary information was obtained and were analyzed inform of frequency table.

3.8 Reliability of instrument

The reliability of the instrument used for the study was determined through observation of the

good record system were record of past 3 years was seen. This was done by reviewing and

revising the existed medical record book and folders.

3.9 Method of data collection:

This was done by going to the medical record office where the folder of the patients who were

part of the study are kept to collect the necessary information.

3.10 Method of data analysis:

All demographic data was obtained along with the previous history and therapeutic management.

All data was analyzed by simple descriptive statistics. To compare data tables, histogram and

percentage methods

3.11 Ethical consideration:

Before embarking on this study the permission was obtained from the stakeholders of the

hospital, likewise the norms and ethics of the hospital and the nursing profession was respected

throughout the period of this study. All the data collected was kept with utmost confidentiality.
 CHAPTER FOUR

This chapter deals with presentation of result obtained through review of record, using table and

chats, proper labeling of table and charts, proper description of the contents of the table as well

as charts and answering of research question

Section A: Socio-demographic data

Table. 4.1.1: Age of the clients

Age range Frequency Percentage

Below 20years 11 14%

21-30 years 36 47%

31-40years 23 30%

41-50years 7 9%

Total 77 100%

From the table above majority of the client fall with the age range of 21-30 years have 36(47%),

followed by below 20years with 23(30%),then those within 31-40 years with 11(14%) and 41-50years

with 7(9%)
Table. 4.1.2: Marital Status of the Client

Marital Status of client Frequency Percentage

Married 66 86%

Divorced 7 9%

Widow 4 5%

Total 77 100%

From the above table 66(86%) of the client are married,followed by 7(9%) divorced and 4(5%)

widowed

Table 4.1.3: Religion of the clients

Religion Frequency Percentage (%)

Islam 67 87%

Christianity 10 13%

Traditional 0 0%

Others 0 0%
 Religion Frequency Percentage (%)

Total 77 100%

The above table shows that 67(87%) of the clients are Muslims, followed by 10(13%) Christians,

0 (0%) traditional and others 0(0%)

Table 4.1.4: clients Tribe

Tribe Frequency Percentage

Hausa 51 66%

Yaruba 5 6.5%

Igbo 4 5.5%

Fulani 17 22%

Total 77 100%

From the table above 51(66%) of the respondents are Hausa,followed by 17(22%) Fulani, 5(6.5%) Yaruba

and 4(5.5%) Igbo.

Table. 4.1.5: Clients level of education

Level of education Frequency Percentage

Primary 20 26%

Secondary 41 53%

Tertiary 8 10.5%

Arabic school 8 10.5%

Total 77 100%
From the table above, 41 (53%) attended secondary school, followed by 20(26%) primary

school, then 8(10.5%) tertiary institution, and 8 (10.5%) attended Arabic school.

Table 4.1.6. Distribution of cases according to ages

Ages NUMBER OF CASES PERCENTAGE

Below 20years 8 10.5%

21-30years 36 47%

31-40years 22 29%

41-50years 11 13.5%

Total 77 100%

The result of the table shows that among 77 cases, client between 21-30 years with 36(47%)have

the highest cases,followed by client 31-40 years with 22(29%) cases, followed by client 41-50

years with 11(13.5%) cases and below 20 years have the least cases of 8(10.5%)

Table.4.1.7. Rate of occurrence

Month Frequency Number of cases Incidence(%)

July 51 13 25%

August 77 23 30%

September 46 10 22%
October 49 14 29%

November 43 9 21%

December 40 8 20%

Total 306 77 25%

The table above shows that 77 in August have the highest cases of 23(30%) followed by 51 client in

July with 13(25%), followed by 49 client in October with 14(29%), followed by 46 client in September

with 10(22%), followed by 43 client in November with 9(21%) and 40 in December with 8(20%)

4.2 Answering Research Question.

Question 1 What is the rate of occurrence of urinary tract infection among pregnant women

attending antenatal clinic at General Hospital Katsina?.

Answer.

The rate of occurrence of urinary tract infection among pregnant women attending antenatal clinic at

General Hospital katsina is 25%

Question 2.What is the age distribution of urinary tract infection among pregnant women

attending antenatal clinic at General Hospital Katsina?

Answer
The age distribution of urinary infection among women attending antenatal clnicat general

hospital katsina is highly in age range between 21-30years with 36(47%),followed by 31-40years

with 22(29%), followed by 41-50years with 11(13.5) and it ’s at lowest rate at the age below

20years with 8(10.5%)

Chapter Five

5.0 Discussion of Findings

This chapter deals with the discussion of findings and the relationship of each findings discussed

to literature review in the study , identified key findings what is implied with literature support

align findings with findings of previous study cited , implication to nursing , limitation of

study , summary , conclusion, suggest for further study.

5.1 Identification of key findings

From the data analyzed it shows that majority of the client age falls within 21-30yearswith

36(47%), followed by below 20years with 23(30%), then those within 31-40years with 11(14%)

and 41-50years with 7(9%) and the marital status of the client showed that 66(86%)of the client

are married followed by 7(9%) are divorced and 4(5%) widow and the religion of the client

showed that 67(87%)of the clients are Muslim, followed by 10(13%) Cristian and tribes of the
client showed that 51(66%)of the client are hausa, followed by 17(22%) Fulani,5(6.5%) yaruba

and4(5.5%) igbo and the client level of education 41(53%) attended secondary School, followed

by 20(26%) attended primary school, then 8(10.5%) attended tertiary school and 8(10.5%)

attended Arabic school.

On the rate of occurrence of urinary tract infection among pregnant women attending antenatal clinic at

General Hospital Katsina the findigs revealed that it's 25%.

On the age distribution of urinary tract infection among pregnant women attending antenatal clinic at

General Hospital Katsina the findings revealed that it's highly seen in age range between 21-30 years

with 36(47%) followed by 31-40years with 22(29%), followed by 41-50years with 11(13.5%) and it's at

the lowest rate at the age below 20years with 8(10.5%).

5.2 Implication of findings with literature support

In reference to table 4.1.6 above the findings showed that the distribution of cases according to ages

showed that among 77 cases, client between 21-30 years with 36(47%)have the highest

cases,followed by client 31-40 years with 22(29%) cases, followed by client 41-50 years with

11(13.5%) cases and below 20 years have the least cases of 8(10.5%)

In reference to table 4.1.7 above the findings showed that the rate of occurrence of urinary tract

infection from July- December it revealed that 77 clients in August have the highest cases of

23(30%) followed by 51 client in July with 13(25%), followed by 49 client in October with

14(29%), followed by 46 client in September with 10(22%), followed by 43 client in November

with 9(21%) and 40 in December with 8(20%)

5.3 Align findings with literature support

The rate of occurrence of urinary tract infection among pregnant women attending antenatal clinic at

General Hospital Katsina the findigs revealed that it's 25%.in support to the study access rding to

Whitelead et al (2019) total of three hundred (300) urine samples of pregnant women attending

antenatal care were collected. Out of which 40 (41.9%), 46 (25.1%), 45 (24.6%) and 52 (28.4%) of the

antenatal patients showed significant bacteriuria, respectively, with overall prevalence of 183 (61.0%)

while 117 (39.0%) of the patients were negative with a significant difference . According to Okonko et

al(2009) in his study carried out on 80 pregnant women attending vantenatal clinics at Oluyoro Catholic

Hospital (OCH) in Ibadan showed that the incidence of UTIs in his study population is 47.5%

On the age distribution of urinary tract infection among pregnant women attending antenatal clinic at

General Hospital Katsina the findings revealed that it's highly seen in age range between 21-30 years

with 36(47%) followed by 31-40years with 22(29%), followed by 41-50years with 11(13.5%) and it's at

the lowest rate at the age below 20years with 8(10.5%). In support to the study done by Jacob et al ,

(2022)the prevalence of UTI among studied pregnant women was high (38.0%), and the most prone

maternal age group and trimester to UTI is 15-25 years and first trimester, respectively. And according

to the study done by Al-Haddad AM(2005) in Yemen, the highest rate of infection (53.7%) in pregnant

women was in the age range of 15 - 24 years.

5.4 Implications of findings to nursing

1. This study is of great benefit to the nurses and nursing profession at large, in a very

positive direction the study highlighted the current information on urinary tract infection

as well it digested the concept of urinary tract infection for better understanding among

Nurses

2. The study also reveals some causes of the urinary tract infection and it went further to

bring out some solution to the problems.

 3. If at all the findings of this research is effectively adhered by care providers with the

client care will surely going improved and this will definitely reflect credit upon nurses

and nursing profession .

4. It will serve as a guide in health educating preganant women on signs and preventive measures of

urinary tract infections and to seek for immediate care to the hospital.

5.5 Limitations of the study

During conduction of the research some constraints where met which include limited time for the study

and financial constraints.

5.6 Summary of the study

The research was conducted at General Hospital Katsina with emphasis to the maternity

complex the study try to find out the incidence of urinary tract infection among pregnant women

attending antenatal clinic at General Hospital Katsina the study is carried out from July to

December 2021

The study was categorized into five chapters; Chapter one deals with the background of the

study, statement of the problem, objectives of this study, research questions, significance of the

study, scope of the study, operational definitions of terms. In chapter two relevant and related

literature were reviewed based on the objective of the study and theoretical framework was also

reviewed. In chapter three, the chapter deals with It research methodology which comprises of

research design, research setting, target population, sampling size, sampling technique

instrument for data collection, validity of the instrument, reliability of the instrument, method of

data collection, method of data analysis and ethical consideration. In chapter four the

presentation, analysis and interpretation of various collected data from the respondents and in the
last chapter, chapter five it deals with discussion of findings, implication of findings with

literature support, align findings with previous studies, implication of findings to nursing

limitation of the study, summary of the study, conclusion, recommendation and suggestion for

further studies.

5.7 Conclusion

In conclusion, the result of this study revealed that there is high incidence of urinary tract

infection among pregnant women of all ages attending antenatal clinic of the General Hospital

Katsina from January 2019- December 2020, likewise the study identifies the causative organism

of the urinary tract infection among pregnant women.

5.8 Recommendations

Considering the findings obtained from the study some recommendations were made as follows:

1. Nurses should incalcate it in mind that urinary tract infection may be symptomatic and

asymptomatic in most cases.

2. Nurses should ensure routine screening for UTIs among pregnant women during their

antenatal visits has been conducted.

3. The appropriate antibiotics should be administered after sensitivity test have been

carried out in order to prevent cases from becoming higher and symptomatic which may

result renal damage

5.9 Suggestion For Further Studies

1. After going through the literatures and observing the general situation the following

research if conducted will greatly yield a positive result.

2. Prevalence of urinary tract infection among male of General Hospital Katsina.

3. Associated risk factors of urinary tract infection among pregnant women.

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