COMMUNITY HEALTH NURSING TRAINING COLLEGE,

AKIM ODA

ASSESSING THE AWARENESS AND MANAGEMENT OF URINARY TRACT

INFECTION AMONG FINAL YEAR DIPLOMA STUDENTS OF COMMUNITY

HEALTH NURSING TRAINING COLLEGE, AKIM ODA

BY

ASARE BEDIAKO SAMUEL JUNIOR

MANTE JACQUELINE

PRINCE DANSO

LAWRENCIA AMPONSAH

RITA GHANSAH

A PROJECT WORK SUBMITTED TO THE AKIM ODA COMMUNITY HEALTH

NURSING TRAINING COLLEGE IN PARTIAL FULFILLMENT OF THE

REQUIREMENT FOR THE AWARD OF DIPLOMA IN

PUBLIC HEALTH NURSING

2023
 DECLARATION

Candidate’s declaration

We hereby declare that the research work is the result of our own original research except

references to other peoples’ work which has been duly cited and that no part of it has

been presented to another certificate in this Nurses’ Training School or elsewhere.

Name of candidate Signature Date

Asare Bediako Samuel Junior ………………….. …../……./…...…

Mante Jacqueline ………………….. …../……./…...…

Prince Danso ………………….. …../……./…...…

Lawrencia Amponsah ………………….. …../……./…...…

Rita Ghansah ………………….. …../……./…...…

Supervisor’s declaration

I hereby declare that the preparation and presentation of this project work was supervised

in accordance with the guidelines on supervision of project works laid down by Akim

Oda Community Health Nurses’ Training College.

Supervisor’s Name Signature Date

Mrs. Priscilla Rejoice Asante …………………….. …../……./…...…

i
 ABSTRACT

Urinary tract infections (UTI) are one of the most common infections worldwide,

especially in women and children. If not diagnosed and treated appropriately, it may lead

to severe illness and long-term complications.

The study was conducted among final year diploma students of Community Health

Nursing Training College, Akim Oda to assess the awareness and management of urinary

tract infection.

Quantitative cross–sectional descriptive study was used as the research design. Purposive

sampling technique was used in sampling.

The target population included all final year diploma students of Community Health

Nursing Training College, Akim Oda. Through purposive sampling technique,

questionnaires were administered to 50 respondents from the class.

Quantitative data collected from the field was analyzed using the 2019 version of

Microsoft Excel.

Risk factors for urinary tract infections include sexual activity, keeping urine for too

long, sharing of same underwears, unclean toilet facilities, and unprotected sex with a

woman who has a vaginal infection.

Prevention of urinary tract infection include hygiene include practice of personal hygiene

of genital parts after using the washroom, not wearing tight-fitting undergarments made

of non-breathing materials, drinking more water and protecting oneself with condoms or

sexual partners protecting themselves during sexual intercourse and reducing number of

sexual partners.

ii
 ACKNOWLEDGEMENT

We want to express our thanks to our supervisor, Mrs. Priscilla Rejoice Asante for her

support and direction. We thank the students of Community Health Nursing Training

College, Akim Oda, particularly final year diploma students. We are also grateful to the

principal of Community Health Nursing Training College, Akim Oda and the entire staff

for their direction.

iii
 DEDICATION

We dedicate this research work to our research supervisor, Mrs. Priscilla Rejoice Asante.

iv
 TABLE OF CONTENT

CONTENT PAGES

DECLARATION I

ABSTRACT II

ACKNOWLEDGEMENT III

DEDICATION IV

TABLE OF CONTENT V

LIST OF TABLES VII

CHAPTER ONE 1

1.0 INTRODUCTION 1

1.1 Overview 1

1.2 Background of the study 1

1.3 Statement of the Problem 2

1.4 Objectives of the Study 3

1.4.1 General Objectives of the Study 3

1.4.2 Specific Objectives of the Study 3

1.5 Research Questions 4

1.6 Significance of the Study 4

1.7 Delimitation of the Study 4

1.8 Definition of Terms 5

v
CHAPTER TWO 6

LITERATURE REVIEW 6

2.0 Overview 6

2.1 Introduction 6

2.2 The Urinary System 7

2.3 Urinary Tract Infections 8

2.4 Risk Factors of Urinary Tract Infections 9

2.5 Symptoms of Urinary Tract Infections 10

2.6 Diagnosis/Treatment of Urinary Tract Infections 11

2.7 Prevention of Urinary Tract Infections 12

CHAPTER THREE 14

METHODOLOGY 14

3.0 Overview 14

3.1 Project Area 14

3.2 Study Population 15

3.3 Study Design 15

3.4 Sampling Techniques 15

3.5 Data Collection Methods and Instruments 16

3.6 Data Analysis Techniques 16

3.7 Ethical Considerations 17

3.8 Study Limitation 17

vi
CHAPTER FOUR 18

RESULTS AND DISCUSSION 18

4.0 Overview 18

4.1 Socio-demographic characteristics of respondents 18

4.2 Awareness about Urinary Tract Infections 20

4.3 Risk Factors of Urinary Tract Infections 21

4.4 Age Range as a risk factor of Urinary Tract Infections 22

4.5 Causes of Urinary Tract Infections among Students 23

4.6 Management of Urinary Tract Infections 25

CHAPTER FIVE 27

DISCUSSIONS, SUMMARY, CONCLUSIONS AND

RECOMMENDATION 27

5.0 Overview 27

5.1 Discussion of Results 27

5.1.1 Socio-demographic Characteristics of Respondents 27

5.1.2 Awareness about Urinary Tract Infections 28

5.1.3 Causes of Urinary Tract Infections among Students 29

5.1.4 Management of Urinary Tract Infections 30

5.2 Summary and Conclusion 31

5.3 Recommendations 31

REFERENCES 33

APPENDIX 36

vii
 LIST OF TABLES

TABLE PAGE

Table 1: Demographic characteristics of respondents 18

Table 2: Awareness about urinary tract infection 20

Table 3: Causes of Urinary Tract Infection among students 23

Table 4: Management of Urinary Tract Infection 25

viii
 LIST OF FIGURES

FIGURE PAGE

Figure 1: Risk Factors of Urinary Tract Infections 22

Figure 2: Age Range as a Risk Factor of Urinary Tract Infections 20

Figure 3: Age Range as a Risk Factor of Urinary Tract Infections 20

ix
 LIST OF ABBREVIATIONS

CHNTS – Community Health Nurses’ Training School

UTI - Urinary Tract Infection

WHO – World Health Organization

GHS – Ghana Health Service

x
 CHAPTER ONE

1.0 INTRODUCTION

1.1 Overview

This chapter deals with the background of the study, statement of the problem, objective

of the study, research questions and significance of the study.

1.2 Background of the study

A urinary tract infection (UTI) is an infection in any part of the urinary system. The

urinary system includes the kidneys, ureters, bladder and urethra. Most infections involve

the lower urinary tract - the bladder and the urethra.

Urinary tract infections (UTIs) are symptomatic infections of the urinary tract, mainly

caused by the bacterium Escherichia coli. One in two women suffer from a UTI at least

once in her life. The young and sexually active are particularly affected, but it is also seen

in elderly, postmenopausal women. The likelihood of recurrence is high. A culture is

unnecessary in most cases.

About 150 million people develop urinary tract infection in a given year (Flores-Mireles

et al, 2015). It is more common in women than men. In women, UTI is the most common

form of bacterial infection. UTI results from bacteria entering the urinary tract from the

nearby vagina and perineum. Since these areas are normally heavily colonized with

bacteria and the urethral opening is located here, the urinary tract is vulnerable to

infection. Up to 10% of women have a urinary tract infection in a given year, and half of

women have at least one infection at some point in their lifetime. They occur most

frequently between the ages of 16 and 35 years (Colgan, 2017).

1
Two main types of UTIs are known based on how the infection is acquired: hospital

acquired UTI (Nosocomial UTI) and community acquired UTI. Hospital acquired UTI is

defined as the onset of UTI in patients, 48 hours after admission, while community

acquired UTI refers to the development of infections before admission to the hospital and

not within 10 days after the patient has been discharged. Escherichia coli is the

commonest cause of both community and hospital acquired UTI. Other common

uropathogens encountered in community acquired UTI include Staphylococcus

saprophyticus, Klebsiella pneumoniae, and Citrobacter spp. (Hodson, 2019).

According to results of a study conducted by Donkor et al, 2019, on Community acquired

urinary tract infections among adults in Accra, the prevalence of UTI in women was high

in females (79.8%) than in males (20.2%). Pregnant women constituted the key risk

population of UTI in Accra, while Amikacin remained a suitable drug for the treatment of

febrile UTI.

The high prevalence of multidrug resistance among the uropathogens highlights the need

for surveillance of antimicrobial resistance among these pathogens Lindert, (2020).

1.3 Problem Statement

Urinary tract infection (UTI) is one of the most common bacterial infectious diseases

encountered in clinical practice, and accounts for significant morbidity and high medical

costs. To reduce its public health burden, there is the need for local research data to

address aspects of prevention and management of UTI.

Low-dose antimicrobial prophylaxis remains effective in many clinical settings and can

be safely used for years in patients with recurrent UTIs; however, increasing

antimicrobial resistance may eventually limit its efficacy. Behavioral interventions (e.g.

2
cessation of spermicide or diaphragm/spermicide use or reduction in coital frequency)

may be effective but have not been actually studied as interventions. Studies clearly

demonstrate increasing antibiotic resistance in uropathogens causing both community-

and nosocomially acquired UTIs. Even in women with acute uncomplicated UTI,

increasing resistance to ampicillin (30%–40%), cephalothin (20%–30%), and TMP-SMX

(15%–20%) has been demonstrated in causative Escherichia coli (Gupta, 2016).

Data from the Birim Central Municipal Health Directorate indicate that there is a

continuous rise in urinary tract infections; 12062 cases in 2018, 12654 cases in 2019,

12654 in 2020 and beyond 13,000 as of the middle of 2023.

Even though UTI is common, there is less information on its prevalence among final year

diploma students of Community Health Nursing Training College, Akim Oda. The study

focuses of accessing its awareness and management among the students.

1.4 Objectives of the Study

1.4.1 General Objective

The main objective of this study is to assess the awareness and management of urinary

tract infection among final year diploma students of Community Health Nursing Training

College, Akim Oda.

1.4.2 Specific Objectives

1. To determine the awareness of final year diploma students. CHNTC, Akim Oda on

UTI.

2. To find out the causes of UTI among final year diploma students. CHNTC, Akim

Oda.

3
3. To identify the preventive measures and management of UTI among final year

diploma students. CHNTC, Akim Oda

1.5 Research Questions

The following questions were formulated to guide the study

1. What is the level of awareness of UTI among the youth?

2. What are the causes of UTI among the youth?

3. What are the preventive measures and ways of managing UTI?

1.6 Significance of the Study

Modern family planning methods are a cost-effective strategy for reducing high-risk

pregnancies, decreasing unsafe abortions, and allowing for birth spacing and limiting [1–

4]. Despite advances in contraceptive technology and availability, 214 million women

had an unmet need for modern family planning in 2017.

The results of this study will be beneficial to students, community health service

providers, future researchers and other interested individuals.

This study will be useful for the GHS to ascertain the extent to which their activities on

the management and control of the problem have been successful.

The results of this study will be beneficial to future researchers and other interested

individuals because this can serve as empirical data where suggestion on minimizing the

related effects of UTI in the community can be taken.

1.7 Delimitation of the Study

The study is delimited to the gathering of information on the awareness and management

of students of D20 class of CHNTS, Akim Oda on UTI.

4
1.8 Definition of Terms

Antimicrobial: A substance that kills microorganisms such as bacteria or mold, or stops

them from growing and causing disease.

Health: A state of being free from illness or injury.

Infection: process of infecting or the state of being infected with a disease-causing

organism.

Morbidity: the condition of suffering from a disease or medical condition.

Postmenopausal: is a term to describe the time after someone has gone through

menopause. When you are in postmenopause, your menstrual period has been gone for

longer than 12 consecutive months.

Symptomatic: serving as a symptom or sign, especially of something undesirable.

Urinary: elating to or denoting the system of organs, structures, and ducts by which

urine is produced and discharged, in mammals comprising the kidneys, ureters, bladder,

and urethra.

Uropathogens: Any pathogen of the urinary tract

5
 CHAPTER TWO

LITERATURE REVIEW

2.0 Overview

In this chapter, the scientific literature will be reviewed to increase the understanding of

the health problem studied, the theoretical framework for the research questions and the

empirical evidence for the study framework.

It includes the knowledge on the causes, the preventive measures and management of

Urinary tract infections (UTIs).

2.1 Introduction

Urinary tract infections (UTIs) are symptomatic infections of the urinary tract, mainly

caused by the bacterium Escherichia coli. The urinary system includes the kidneys,

ureters, bladder and urethra. Most infections involve the lower urinary tract - the bladder

and the urethra.

Women are at greater risk of developing a UTI than are men. If an infection is limited to

the bladder, it can be painful and annoying. But serious health problems can result if

a UTI spreads to the kidneys.

When it affects the lower urinary tract it is known as a bladder infection (cystitis) and

when it affects the upper urinary tract it is known as a kidney infection (pyelonephritis).

Symptoms from a lower urinary tract infection include pain with urination, frequent

urination, and feeling the need to urinate despite having an empty bladder. Symptoms of

a kidney infection include fever and flank pain usually in addition to the symptoms of a

lower UTI. Rarely the urine may appear bloody. In the very old and the very young,

symptoms may be vague or non-specific.

6
2.2 The Urinary System

The urinary system, also known as the renal system, produces, stores and eliminates

urine. The urinary system includes two kidneys, two ureters, the bladder, two sphincter

muscles and the urethra (Zimmermann, 2019). The urinary system works with the lungs,

skin and intestines to maintain the balance of chemicals and water in the body. Adults

eliminate about a quarter and a half (1.42 liters) of urine each day, depending on the

amount of fluid consumed and fluid lost through perspiring and breathing (David, 2021).

The primary organs of the urinary system are the kidneys, which are bean-shaped organs

that are located just below the rib cage in the middle of the back. The kidneys remove

urea; waste product formed by the breakdown of proteins, from the blood through small

filtering units called nephrons. Each nephron consists of a ball formed of small blood

capillaries, called a glomerulus, and a small tube called a renal tubule. Urea, together

with water and other waste substances, forms the urine as it passes through the nephrons

and down the renal tubules of the kidney. From the kidneys, urine travels down two thin

tubes, called ureters, to the bladder. The ureters are about 8 to 10 inches long

(Zimmermann, 2019).

The female and male urinary systems are very similar, differing only in the length of the

urethra. Urine is formed in the kidneys through blood filtration. The urine is then passed

through the ureters to the bladder, where it is stored (David, 2015). During urination the

urine is passed from the bladder through the urethra to the outside of the body.

7
2.3 Urinary Tract Infections (UTIs)

Urinary tract infections (UTIs) are one of the most important causes of morbidity and

health care spending affecting persons of all ages, including young women, children, and

the elderly. It is estimated that approximately 40% of women and about 29% of men

especially the elderly ones have had a UTI at some time in their lives (Zimmermann,

2019). A 2020 report indicated that 3.1% of intensive care visits were for UTIs (Weinick

et al., 2020). These infections are traditionally classified based on clinical symptoms,

laboratory data, and microbiological findings.

Sexually active young women are at greater risk of presenting UTIs (especially

uncomplicated cystitis) due to the proximity of their urethra to the bladder (short urethra)

and certain behavioural factors (Joseph, 2021). Urinary tract infections are the most

common bacterial infections in humans both in the community and hospital setting. It is

one of the most common bacterial infections encountered by clinicians in developing

countries (Todar, 2014). Globally it is estimated that, about 150 million people are

diagnosed with urinary tract infection each year and symptomatic urinary tract infection

result in 7 million visits to outpatient clinics, one million to emergency unit. Bacteria

usually reach the kidney by ascending from the lower urinary tract but may also reach the

kidney via the bloodstream (Rogers, 2014).

UTIs can be classified as follows:

i. Uncomplicated or complicated (based on the factor that triggers the infection)

ii. Primary or recurrent (depending on the nature of occurrence).

a. Uncomplicated and complicated urinary tract infection: This is a consequence of

bacterial infection and the prevalence is higher in women than men (Nicolle, 2018).

8
 This includes the common form of the infection like the cystitis and pyelonephritis

which affects the lower and the upper tracts leading to bladder and kidney infections.

In contrast, complicated urinary tract infection occurs in men and women at any point

of their life and has the tendency to produce severe outcomes resulting in death under

serious circumstances. These infections are highly intricate and are difficult to treat

and they are persistent (Rogers, 2014).

b. Primary or recurrent urinary tract infection: This is a common phenomenon that

is observed among women who have experienced uncomplicated UTIs and they are

classified as re-infection and relapse (David, 2015). Major cases of UTIs are referred

to as re-infections and the condition is encountered by the patient after several weeks

of antibiotic treatment. The less frequent type of recurrent UTI is known as relapse

which is an outcome of treatment failure and the patient encounters the condition

within two weeks of the previous infection. (Rudramurthy et al, 2015).

2.4 Risk Factors for Urinary Tract Infections

Urinary tract infections are common in women than men, and many women experience

more than one infection during their lifetimes.

Risk factors specific to women for UTIs include:

1. Female anatomy: A woman has a shorter urethra than a man does, which shortens

the distance that bacteria must travel to reach the bladder.

2. Sexual activity: Sexually active women tend to have more UTIs than do women who

are not sexually active. Having a new sexual partner also increases your risk

3. Certain types of birth control: Women who use diaphragms for birth control may

be at higher risk, as well as women who use spermicidal agents (Moore, 2018).

9
4. Menopause: After menopause, a decline in circulating estrogen causes changes in the

urinary tract that makes one more vulnerable to infection (David, 2021).

Risk factors specific to men for UTI include;

1. Problems with the prostate gland: Men become increasingly prone to UTIs as they

get older because of prostate problems, such as enlarged prostate (benign prostatic

hyperplasia) and prostatitis.

2. An uncircumcised penis.

3. Anal intercourse.

4. Unprotected sex with a woman who has a vaginal infection.

5. HIV infection (Rogers, 2014).

2.5 The Symptoms of a Urinary Tract Infection

Urinary tract infections do not always cause signs and symptoms, but when they do they

may include:

1. A strong, persistent urge to urinate. A burning sensation when urinating.

2. Passing frequent, small amounts of urine.

3. Urine that appears cloudy.

4. Urine that appears red, bright pink or cola-colored - a sign of blood in the urine.

5. Strong-smelling urine.

6. Pelvic pain, in women - especially in the center of the pelvis and around the area of

the pubic bone (Rogers, 2014).

10
2.6 Diagnosis/Treatment of UTI

Urine culture is traditionally the gold standard for diagnosing UTI. Microscopic

examination of the urine for the presence of bacteria (> 105 bacteria/ml urine) and/or

leukocytes (pyuria, >10WBC/μl of urine) is the first step in the laboratory diagnosis of

urinary tract infection (Collee et al., 2017). Proper collection methods are essential.

Collection of a clean, mid-stream specimen is the method of choice, since it entails no

morbidity, but a straight "in-and-out". Catheter specimen should be used if a clean-voided

specimen cannot readily be obtained. Urine must be processed immediately; if it remains

at room (or warmer) temperature, the small numbers of bacteria present as contaminants

will grow into "significant" numbers thereby giving a false result. A specimen taken from

a woman is easily contaminated, but quantitative estimation of the number of bacteria in

a voided specimen makes it possible to distinguish contamination from bacteriuria. A

count of >105 bacteria per milliliter indicates infection. The initial treatment efforts

involve the employment a variety of antimicrobial agents and this could in turn make the

pathogen resistant to commonly employed drugs. Such kind of treatment is referred to as

empirical treatment (WHO, 2018). The antimicrobial agents selected should inhibit E.

coli, since it accounts for 80% of uncomplicated lower urinary-tract infections.

Trimethoprim, co-trimoxazole, and fluoroquinolones are ideal agents, since they are

effective orally, they achieve good urine concentrations, and tend not to disturb the

anaerobic flora of the gut and the vagina. Studies have confirmed the safety of beta

lactam antibiotics like penicillin and cephalosporin during pregnancy (WHO, 2018).

However, these antibiotics are deemed to be safe due to the absence of teratogenic effects

that can bring about any physiological defects in the new born fetus but is sometimes

11
associated with allergic reactions. Studies by Davies, 2016 have also provided sufficient

evidences to confirm the property of antibiotic resistance exhibited by certain pathogens

against amoxicillin and ampicillin which in turn has limited their usage (Davis and

Balentine, 2016).

2.7 Prevention of Urinary Tract Infection

i. Hygiene: After bowel movements, clean the area around the anus gently, wiping from

front to back. Never wipe twice with the same tissue. Any wiping motion that starts

nearer to the rectum and then approaches the bladder-opening area moves potentially

pathogenic bacteria closer to the bladder. Use tampons for periods. Tampons are

advised during the menstrual period rather than sanitary napkins or pads because they

keep the bladder opening area drier than a sanitary pad, thereby limiting bacterial

overgrowth. Extremely effective is avoiding long intervals between urinating (David,

2015). Try to empty the bladder at least every 4 hours during the day while awake,

even if the need or urge to void is absent.

ii. Clothing: Do not wear tight-fitting undergarments made of non-breathing materials.

With such fabrics, accumulating moisture builds up .This leads to maceration of the

skin and bacterial over growth adjacent to the opening of the bladder. Cotton

underwear for general use is suggested (Weinick et al., 2020).

iii. Diet: Drink more water. Start with 1 extra glass with each meal. If the urine appears

any darker than a very pale yellow, this means not enough liquid is being ingested;

increase the fluid intake. Cranberry juice and cranberry pills have unproven benefit in

reducing urinary infections. They appear to be most effective in younger women

(Joseph, 2021).

12
iv. Medications: Take antibiotics only as prescribed by a doctor. If a medication has

been prescribed as preventive therapy, follow the physician’s instructions carefully.

Be aware that medications may be necessary for up to a year or more depending on

the nature and severity of the urinary infection problem. Take any prescribed

medication exactly according to the physician’s advice. Contact the physician or

pharmacist if no clear instructions are on the bottle of medicine (Rogers, 2014).

13
 CHAPTER THREE

METHODOLOGY

3.0 Overview

This chapter comprises the study design, population, project area, sample size, sampling

procedure, research instrument, data collection procedure and data analysis.

3.1 Project Area

The study was carried out at the Community Health Nursing Training College, Akim

Oda. It is located in the Birim Central Municipality in Eastern Region of Ghana and was

established in 1962. The school has trained a lot of nurses all over the country rendering

quality services to mother Ghana. Being the second Community Health Nurses Training

School opened next to Tamale Nurses’ Training School, it is well noted for its discipline

and academic excellence across the country. The school shares boundary with Jamaica to

the north, St. Francis Senior High/Technical School to the east, the Municipal

Government Hospital to the west and Caprice Hotel to the south.

It serves as the only public health institution which trains nurses in the municipality. It

offers two-year certificate and three-year diploma programmes, not only for the natives

of the municipality but citizens of the entire country who qualify for the programmes.

Akim Oda is a town in eastern Ghana and is the capital of the Birim Central

Municipality as well as the traditional capital of the Akyem Kotoku state, one of the three

states of the Akyem states, in the Eastern Region of Ghana. In 2013, Akim Oda had a

settlement population of 60,604 people. Currently the population of Akim Oda has risen

to 65,919 according to the 2020 population census.

14
Akim Oda lies in hilly area of south Ghana with rain forest vegetation in the Birim

River basin. There is significant rainfall during the rainy season from April to June and

again in September to November. A dry period is experienced between December to

February.

3.2 Study Population

The study population includes final year diploma students of the Community Health

Nursing Training College, Akim Oda.

The age range chosen for the study was 16 – 40years. This age range was chosen because

it is the range in which the age of students mostly fall in relation to admission

requirement and age of completion.

3.3 Study Design

The study design used was the quantitative cross–sectional descriptive study. Descriptive

cross-sectional studies provide data for describing the status of phenomena or

relationships among phenomena at a fixed point in time. This can be thought of as a

“snapshot” of the frequency and characteristics of a condition in a population at a

particular point in time. It involves the collection of data in order to answer questions on

assessing the awareness and management of urinary tract infection among final year

diploma students of Community Health Nursing Training College, Akim Oda.

3.4 Sampling Techniques

The technique used was purposive sampling. Purposive sampling allows the researcher to

gather qualitative responses, which leads to better insights and more precise research

results.

15
The researchers collected information from the best-fit participants (nursing students)

because the results are relevant to the research context. It also allowed researchers

to target niche demographics which enabled them to obtain specific data for the research.

50 respondents made up the sample size selected. Our selection of respondents was

targeted on only one gender of students. 50 students were selected as the sample size.

3.5 Data Collection Methods and Instruments

The research instrument used was structured questionnaires. Questionnaire is a research

instrument that consists of a series of questions and other prompts for the purpose of

gathering information from respondents. It consists of list of questions referred to as

items which relate to the aims, objectives and the research questions of the research.

Questions were planned and created in advance, which means that all respondents were

asked the same questions in the same order. The respondents responded to questions by

answering structured questionnaires which were used because the entire population was

highly educated. Structured questionnaires were used because it is stable, consistent and

uniform.

3.6 Data Analysis Techniques

Quantitative data collected from the field was analyzed using Microsoft Excel 2019.

Graphs, tables and charts were generated to represents the results of primary data

collected from respondents.

16
3.7 Ethical Consideration

Informed consent was obtained from each respondents. Informed consent is compulsory

for research and clinical trials with human subjects. Researchers provided facts and

information about all details of the research study, including but not limited to the

purpose of the study. The participants were free to use the provided information to decide

on whether to participate in research studies. Importantly, obtaining informed consent

also entailed voluntary participation in the research study and ensuring the confidentiality

of the research participants.

3.8 Study Limitation

The procedure used for the study required the presence of the researchers before

questionnaires were worked on. Another limitation was related to the unwillingness of

some respondents to respond to our questionnaires because they had a task to perform or

other personal reasons.

Another important limitation was the smaller size of the sample; this limitation may not

permit accurate generalization of the research findings. All these limitations,

notwithstanding, the validity and reliability of the results were not compromised.

17
 CHAPTER FOUR

RESULTS AND FINDINGS

4.0 Overview

This chapter deals with results of socio-demographic characteristic of respondents,

awareness, causes and of measures to manage urinary tract infections. The chapter also

looks at the discussion of the main findings in relation to the research questions posed in

the study.

RESULTS
4.1 Section A: Socio-demographic characteristics of respondents
Table 4.1.1: Demographic characteristics of respondents.
Enquiry Frequency N0=50 Percentage(%)
Age
15 – 20 7 14.0
21 – 25 38 76.0
26 – 30 4 8.0
31 – 35 1 2.0
35 – 40 0 0.0
Total 50 100.0

Gender
Male 8 16.0
Female 42 84.0
Total 50 100.0

Marital status
Single 46 92.0
Married 4 8.0
Divorced 0 0.0
Widowed 0 0.0
Total 50 100.0

18
Ethnicity
Akan 32 64.0
Ga 6 12.0
Ewe 5 10.0
Other 7 14.0
Total 50 100.0

Religion
Christian 44 88.0
Islam 5 10.0
Traditionalist 0 0.0
None 1 2.0
Total 50 100.0
Source: field work, 2023

From the table, majority of the respondents being 38(76%) were between the ages of 21 –

25 whiles females being 42(84%) were the majority. With marital status, most of the

respondents 46(92%) were single. 32(64%) of the respondents trace their ethnic

background from Akan and 44(88%) were Christians whiles 5(10) belonged to the

Islamic religion.

19
4.2 Section B: Awareness about urinary tract infection
Table 4.2.2: Awareness about urinary tract infection
Enquiry Frequency N0=50 Percentage(%)
Knowledge about urinary tract infection
Yes 50 100.0
No 0 0.0
Total 50 100.0

Where urinary tract infection was first heard

School 29 58.0
Books 7 14.0
Internet 9 18.0
Hospital 5 10.0
Total 50 100.0

Gender risk of higher infections of urinary tract infection

Yes 40 80.0
No 10 20.0
Total 50 100.0

Gender that stands higher risk of acquiring urinary tract infection

Male 3 7.5
Female 37 92.5
Total 40 100.0

Is urinary tract infection transmissible?

Yes 42 84.0
No 8 16.0
Total 50 100.0
Source: field work, 2023

20
From Table 2, all respondents had heard of urinary tract infections as majority of them,

29(58%) heard of it from school and 9(18%) knew about it from the internet. 40(80%) of

the respondents said one of the risk factors of urinary tract infection is an individual’s

gender and majority 37(92.5) of those who said yes agreed that females stand the greater

risk of its infection. Majority being 42(84%) agreed that urinary tract infection is

transmissible.

4.3 Figure 1: Risk factors of urinary tract infection

Not drinking
much water
8%

Keeping urine Sexual activities

for too long 30%
20%

Sharing same
underwears
Unclean toilet
16%
facilities
26%

Fig. 1

Source: field work, 2023

From Figure 1 above, respondents were asked about the risk factors of urinary tract

infection and 15(30%) agreed that sexual activities is the cause of urinary tract infection,

13(26%) said unclean toilet facilities, 8(16%) said sharing same under wears, 10(20%)

said keeping urine for too long, and 4(8%) said not drinking much water is the cause of

urinary tract infection.

21
4.4 Figure 2: Age range as a risk factor of urinary tract infection

90
80
70
60
50
40
30
20
10
0
Yes No

From Figure 2, 41(82%) of the respondents agreed that age is a risk factor for acquiring

urinary tract infection.

Figure 3: Age range as a risk factor of urinary tract infection

30

25

20

15

10

0
Young people Adults Aged

Out of the 41 respondents who agreed to age range as a risk factor, majority 24(58.5%)

said the aged stand high risk of acquiring urinary tract infection, 14(34.1%) said adults

and 3(7.3%) said young people stand higher risk of acquiring urinary tract infection.

22
4.5 Section C: Causes of Urinary Tract Infection among students
Table 4.5.3: Causes of Urinary Tract Infection among students
Enquiry Frequency N0=50 Percentage(%)
Main cause of urinary tract infection
Bacteria 43 86.0
Fungi 4 8.0
Viruses 3 6.0
Total 50 100.0

Practice of personal hygiene of genital parts after using the washroom

Yes 30 60.0
No 20 40.0
Total 50 100.0

How to clean up after using the washroom (or toilet)

From front to back 47 94.0
From back to front 2 4.0
Any of the above 1 2.0
Total 50 100.0
How many times panties are changed in a day
Once 14 28.0
Twice 33 66.0
Two days or more 3 6.0
None 0 0.0
Total 50 100.0

Where panties are dried after washing

At the washroom 11 22.0
On dry line under the sun 29 58.0
In the bedroom 10 20.0
Total 50 100.0

23
Having of sexual partners
Yes 44 88.0
No 6 12.0
Total 50 100.0

Number of sexual partners

One 31 62.0
Two 12 24.0
Three 3 6.0
Four and above 2 4.0
None 2 4.0
Total 50 100.0

Protecting oneself with condoms or sexual partners protecting themselves during

sexual intercourse
Yes 21 42.0
No 29 52.0
Total 50 100.0
Source: field work, 2023

From Table 3, majority of the respondents 43(86%) agreed that bacteria is the main cause

of urinary tract infection. 30(60%) of the respondents practised personal hygiene at their

genital parts after using the washroom, 47(94%) of them cleaned from front to back after

visiting the washroom (toilet), 33(66%) changed panties twice in a day and 29(58) dried

their panties on dry line under the sun. Majority of the respondents 44(88%) had sexual

partners as 31(62% of the total respondents) had one sexual partner. 29(52%) of the

respondents did not protecting themselves with condoms during sexual intercourse.

24
4.6 Section D: Management of Urinary Tract Infection
Table 4.6.4: Management of Urinary Tract Infection
Enquiry Frequency N0=50 Percentage(%)
Holding of urine for long causing urinary tract infection
Yes 36 72.0
No 14 28.0
Total 50 100.0

How long it is advisable to hold urine before urination

One hour 13 26.0
Two hours 4 8.0
Three hours and beyond 1 2.0
Immediate urination 32 64.0
Total 50 100.0

Type of under wears to be worn to prevent urinary tract infections

Tight fitting under wears 3 6.0
Loose under wears 11 22.0
Cotton under wears 29 58.0
Nylon under wears 7 14.0
Total 50 100.0

Having infection with urinary tract

Yes 31 62.0
No 19 38.0
Total 50 100.0

Visit the hospital whenever one had urinary tract infection

Yes 17 34.0
No 33 66.0
Total 50 100.0

25
Completion of antibiotic/antifungal course prescribed by the doctor/physician
Yes 37 74.0
No 13 26.0
Total 50 100.0

Best way to properly manage or treat urinary tract infection

See a herbal medicine practitioner 2 4.0
Buy antibiotics from the pharmacy 31 62.0
Visit the hospital to see the doctor 17 34.0
Total 50 100.0
Source: field work, 2023

From Table 4, 36(72%) of the respondents said holding of urine for long caused urinary

tract infection. 32(64%) advised that immediate urination is appropriate to reduce urinary

tract infection. 29(58%) agreed that wearing cotton underwear is appropriate to help

prevent urinary tract infection. 31(62%) had acquired urinary traction infection before

and 33(66%) of the respondents did not visit the hospital during infection but resorted to

other means. 31(62%) of the respondents bought antibiotics from the pharmacy to treat

urinary tract infections.

26
 CHAPTER FIVE

DISCUSSION, SUMMARY, CONCLUSIONS AND RECOMMENDATION

5.0 Overview

The chapter discusses the results of the study, the conclusion and recommendations. The

recommendations put forward have taken into consideration the findings and if

implemented, will help improve urinary tract infection.

5.1 Discussion of Results

5.1.1 Socio-demographic characteristics of respondents

According to the socio-demographic characteristics of respondents, the age range for the

study was between 15 and 40. According to Table 1, the highest percentage recorded

(76%) was for 21 – 25. According to an information provided by the Ghana High

Commission, the tertiary school going age in Ghana mostly falls within ages 18 -21. This

corresponds to results of the study as majority of respondents fell within the tertiary

school going age (Ghana High Commission, Canberra Australia, website, Homepage,

2024, https://ghanahighcom.org.au/site/education).

The number of females recorded was 42 (84%) higher than males according to results of

Table 1. Out of the 50 respondents, 46 (92%) were single and 4(8%) were married as

none were divorced or widowed. According to a research by Boadi et al, 2023, the

number of females in the Community Health Nursing College outnumbered the number

of males as most of the students were single and the results of this study confirms that. A

greater percentage of the respondents (64%) were Akans, followed by Ga and Ewe.

Majority of the respondents were Christians (88%), followed by Muslims (10%). This

correlates with the data of the Ghana Statistical Service according to the 2021 Population

27
and Housing Census where Akans were more than other ethnic groups (Akan - 47.5%)

and also majority of Ghanaians being Christians (71.3%).

5.1.2 Awareness about urinary tract infection

According to results from Table 2, awareness on urinary tract infection among

respondents was very high as all the respondents had an idea about the subject. More than

half of the students (58%) had heard about urinary tract infection from school, as 18%

first came across it on the internet, 14% from books and 10% from the hospital. This

trend is similar to a study by Donkor, Horlortu, Dayie and Obeng in Accra, Ghana, in

2019. The high level of awareness in Donkor et al, (2019) study was explained based on

the fact that majority of the respondents, (84%) had knowledge about urinary tract

infection and attributed their awareness to the numerous respondents who were educated

and could make research and inquiry at certain times in their lives from different areas.

Greater percentage of the respondents 40(80%) agreed that gender is a risk factor for

higher infections of urinary tract infection; and most 37(92.5%) out of the 40 admitted

that females stand higher risk than men. According to the literature review of this study, a

study by Moore, 2018, stated that gender is a risk factor of urinary tract infection and that

women stand higher risk than men. According to the literature review, Flores-Mireles et

al, 2015 confirmed also that UTI is more common in women than men and in women,

UTI is the most common form of bacterial infection.

Majority being 42(84%) agreed that urinary tract infection is transmissible. Respondents

were asked about the risk factors of urinary tract infection and 15(30%) agreed that

sexual activities is the cause of urinary tract infection, 13(26%) said unclean toilet

facilities and 8(16%) said sharing same under wears. 41(82%) of the respondents agreed

28
that age is a risk factor for acquiring urinary tract infection. Moore, 2018 confirms from

the literature review of this study that sexually active women tend to have more UTIs

than do women who are not sexually active.

5.1.3 Causes of Urinary Tract Infection among students

Urinary tract infections (UTIs) are symptomatic infections of the urinary tract, mainly

caused by the bacterium Escherichia coli. One in two women suffer from a UTI at least

once in her life. This is clearly stated by Flores-Mireles et al, 2015 from the literature

review of this study. From Table 3, majority of the respondents 43(86%) agreed that

bacteria is the main cause of urinary tract infection. 30(60%) of the respondents practised

personal hygiene at their genital parts after using the washroom compared to 40% who

did not. 47(94%) of them cleaned from front to back after visiting the washroom (toilet).

A research by David, 2015 recommended that after bowel movements, one should clean

the area around the anus gently, wiping from front to back. Never wipe twice with the

same tissue. Any wiping motion that starts nearer to the rectum and then approaches the

bladder-opening area moves potentially pathogenic bacteria closer to the bladder.

33(66%) changed panties twice in a day and 29(58) dried their panties on dry line under

the sun. Majority of the respondents 44(88%) had sexual partners as 31(62%) of the total

respondents had one sexual partner. 29(52%) of the respondents did not protecting

themselves with condoms during sexual intercourse. The literature review of this study

explains that having a new sexual partner also increases risk of infection and those who

had sex without protection with condoms stand higher risk as UTI is transmissible

through sex.

29
5.1.4 Management of Urinary Tract Infection

From Table 4, 36(72%) of the respondents said holding of urine for long caused urinary

tract infection but 14(28%) did not agree. 32(64%) advised that immediate urination is

appropriate to reduce urinary tract infection. In a study by Hodson B. (2019), it was

evident that in some cases, holding on urine for too long can cause bacteria to multiply

which may lead to urinary tract infection (UTI). The research recommended that one

avoids holding on urine for extended periods of time, as it can increase the risk of UTIs,

especially if a person has a history of frequent UTIs.

29(58%) agreed that wearing cotton underwear is appropriate to help prevent urinary tract

infection and 11(22%) recommended the use of loose under wears. This confirms the

literature review of this study as explained by Weinick et al., 2020, that wearing tight-

fitting undergarments made of non-breathing materials accumulates moisture builds up.

This leads to maceration of the skin and bacterial overgrowth adjacent to the opening of

the bladder. Cotton underwear for general use is suggested.

31(62%) had acquired urinary traction infection before and 33(66%) of the respondents

did not visit the hospital during infection but resorted to other means. Many of the

respondents having UTI before can be attributed to sexual interactions with sexual

partners who might be infected and contracted them from other multiple sexual partners.

31(62%) of the respondents bought antibiotics from the pharmacy to treat urinary tract

infections. The numbers of respondents resorting to drugs might be due to proximity and

convenience with the pharmacy.

30
5.2 Summary/ Conclusion

From our study it can be concluded that, there is a high level of awareness of urinary tract

infection. Many of the students have had urinary tract infection at least once in their

lifetime. Many students practised personal hygiene at their genital parts after using the

washroom (toilet).

Also, the knowledge of students on the causes and management of urinary tract infection

is high but measures should be put in place to increase its education. Still, the level of

knowledge of some students is low in Community Health Nursing Training School, Akim

Oda. This percentage however still indicate a risk in the spread of UTI considering the

number of students in the school.

5.3 Recommendations

From this research work findings, the following recommendations are suggested to the

following institutions and agencies in charge of health:

1. The management of Community Health Nursing Training School, Akim Oda should

conduct more health screening that includes urine analysis among students for early

detection of Urinary Tract Infection in the school.

2. The management of Community Health Nursing Training School, Akim Oda should

monitor and inspect regular cleaning of washrooms and toilet facilities of the school

through prefects and tutors.

3. The management of Akim Oda Community Health Nurses’ Training College should

organize more seminars on urinary tract infection for student's especially fresh

students yearly.

31
4. Many researchers needs to be conducted by Ghana Health Service, Birim Central

Municipal Assembly on urinary tract infection in the municipality to enable data to

support its management.

5. The management of the school should organize seminars and educate students on

urinary tract infections through tutors and invitation of external resource persons.

32
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Colgan, R. (2017). "Diagnosis and treatment of acute uncomplicated cystitis". American

Family Physician. 84 (7): 771–776. PMID 22010614

Collee, M., Verest, L., Van Esch, J., Van Ree, W., & Stobberingh, E. (2017).

Management of acute uncomplicated urinary tract infections in general practice in

the south of the Netherlands. Br J Gen Pract 2000; 50: 309-310

David, C.D. (2015). Female urinary tract. MedLine Plus Medical Encyclopedia.

11(2): 44-47

David, E. (2021). Antibiotic failure in the treatment of urinary tract infections in

young women. J Antimicrob Chemother 2001; 48: 895-901.

Davies, J,. & Balentine, D. (2016). Origins and Evolution of Antibiotic Resistance 51,

Microbiology and Molecular Biology Reviews, 74: 417-433.

Donkor, H., Horlortu, O., Dayie, T., & Obeng, M. (2019). Urinary tract infections in a

Tertiary Hospital in Accra, Ghana. African Journal of Clinical and Experimental

Microbiology; 14(3): 169-173.

Flores-Mireles, A., Prasad, K.N., Prasad, A., Gupta, S., Ghoshal, U., & Ayyagari, A.

(2015). Extended spectrumbeta-lactamases in Escherichia coli & Klebsiella

pneumoniae & associated risk factors. Indian J Med Res.129 (6):695-700

Gupta, K., Hooton, T.M., & Naber, K.G. (2016). Infectious Diseases Society of

America, European Society for Microbiology and Infectious Diseases.

International clinical practice guidelines for the treatment of acute uncomplicated

cystitis and pyelonephritisin women: a 2016 update by the Infectious Diseases

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 Society of America and the European Society for Microbiology and Infectious

Diseases. Clin Infect Dis. 52(5): 103-20.

Haruna. M.S; Magu, J.; Idume, J; Nosiri, C. Garba, M.A (2014). Antibiotics

Susceptibility of some Uropathogenic Bacterial Isolates from Ahmadu Bello

University Teaching Hospital Zaria, Nigeria. Journal of Pharmacy and Biological

Sciences; 9 (2): 20.

Hodson, B. (2019). Molecular characterization of extended-spectrumbetalactamase

producing Enterobacteriaceae in a Saudi Arabian tertiary hospital. The Journal of

Infection in Developing Countries. 8(03):282-8.

https://ghanahighcom.org.au/site/education, Ghana High Commission,

Homepage, Canberra, Australia.

Joseph, R. (2021). Cranberries for treating urinary tract infections. [Cochrane Review.]

Cochrane Dtabase Syst 2021; British Journal of General Practice, September

2022 759 Review article 2: CD001321.

Lindert, T. (2020). Phenotypicand Molecular Characterization of ESBL Producing E. coli

in Bangladesh. Journal of Clinical and Diagnostic Research, 14: 444-462

Moore, E.E. (2018). Sexual Intercourse and Risk of Symptomatic Urinary Tract

Infection in Post-Menopausal Women. J Gen Intern Med. 23: 595–599.

Nicolle, L.E. (2018). Uncomplicated urinary tract infection in adults including

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413–416.

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Rogers, S., Faisal, M., & Hasnain, S. (2014). Antibiotic susceptibility pattern and

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versatile tools fornanotechnology. Brazilian Journal of Pharmaceutical

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Weinick, R.M, Burns, R.M., & Mehrotra, A. (2020). Many emergency department visits

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35
 APPENDIX

COMMUNITY HEALTH NURSING TRAINING COLLEGE,

AKIM ODA

QUESTIONNAIRE FOR A STUDY TO ASSESS THE AWARENESS AND

MANAGEMENT OF URINARY TRACT INFECTION AMONG FINAL YEAR

DIPLOMA STUDENTS OF COMMUNITY HEALTH NURSING TRAINING

COLLEGE, AKIM ODA.

Introduction

This study is being conducted by students of the Community Health Nursing Training

College, Akim Oda to assess the awareness and management of urinary tract infection

among final year diploma students.

We therefore appeal to you to answer the following questions as candidly as possible by

ticking or circling the right option or write where necessary. Where applicable, you may

tick/circle as many as possible. You are assured that the information given out shall be

treated with confidentially. Thank you in advance for your cooperation.

Section A: Background Information of Respondents (please tick all which apply)

1. Age range
15 – 20 [ ]
21 – 25 [ ]
26 – 30 [ ]
31 – 35 [ ]
35 – 40 [ ]

2. Gender:
Male [ ]
Female [ ]
36
3. Marital status
Single [ ]
Married [ ]
Divorced [ ]
Widowed [ ]
4. Ethnicity
Akan [ ]
Ga [ ]
Ewe [ ]
Other [ ]
5. Religion
Christian [ ]
Islam [ ]
Traditionalist [ ]
None [ ]

Section B – Awareness of urinary tract infection among students

6. Have you heard of urinary tract infection?
Yes [ ]
No [ ]
7. Where did you first hear about urinary tract infection?
School [ ]
Books [ ]
Internet [ ]
Hospital [ ]
8. Does a gender stand the risk of higher infections?
Yes [ ]
No [ ]
9. If yes in ‘8’ above, which gender stands the risk of higher infections?
Male [ ]
Female [ ]

37
10. Is urinary tract infection transferable?
Yes [ ]
No [ ]
11. Which of the following may increase the chance of acquiring UTI?
Sexual activities [ ]
Unclean toilet facilities [ ]
Sharing same underwears [ ]
Keeping urine for too long [ ]
Not drinking much water [ ]
12. Does age range increase the chance of acquiring UTI?
Yes [ ]
No [ ]
13. If yes in ‘12’ above, which age range stands higher risk?
Young people [ ]
Adults [ ]
Aged [ ]

Section C
Causes of Urinary Tract Infection among Students.
14. Which of the following is the main cause of urinary tract infection?
Bacteria [ ]
Fungi [ ]
Viruses [ ]
15. Do you practice personal hygiene at your genital parts after using the
washroom?
Yes [ ]
No [ ]
16. How do you clean up after using the washroom (or toilet)?
From front to back [ ]
From back to front [ ]
Any of the above [ ]

38
17. How many times do you change your panties in a day?
Once [ ]
Twice [ ]
Two days or more [ ]
None [ ]
18. Where do you dry your panties after washing?
At the washroom [ ]
On dry line under the sun [ ]
In the bedroom [ ]
19. Do you have sexual partners?
Yes [ ]
No [ ]
20. If yes in ‘19’ above, how many sexual partners do you have?
One [ ]
Two [ ]
Three [ ]
Four and above [ ]
None [ ]
21. Do you protect yourself with condoms or do your partners protect themselves
during sexual intercourse?
Yes [ ]
No [ ]

Section D
Management of Urinary Tract
22. Can holding of urine for long cause urinary tract infection?
Yes [ ]
No [ ]
23. If yes in ‘22’, for how long is it advisable to hold urine before urination?
One hour [ ]
Two hours [ ]
Three hours and beyond [ ]
Immediate urination [ ]

39
24. What type of under wears should be worn to prevent urinary tract infections?
Tight fitting under wears [ ]
Loose under wears [ ]
Cotton under wears [ ]
Nylon under wears [ ]
25. Have you had urinary tract infection before?
Yes [ ]
No [ ]
26. Did you visit the hospital whenever you had urinary tract infection?
Yes [ ]
No [ ]
27. If ‘yes’ in 26, did you complete the antibiotic/antifungal course prescribed by the
doctor/physician?
Yes [ ]
No [ ]
28. What do you think is the best way to properly manage or treat urinary tract
infection?
See a herbal medicine practitioner [ ]
Buy antibiotics from the pharmacy [ ]
Visit the hospital to see the doctor [ ]

Thank you for taking the time to fill in the questionnaire. Your feedback is
appreciated.

40