Oyem et al.

(2024) FJPAS Vol 9(2) ISSN: 2616-1419

FUOYE Journal of Pure and Applied Sciences

Available online at www.fuoye.edu.ng

Urinary Tract Infection (UTI) Among Pregnant Women Attending Antenatal Care
in the Central Hospital Agbor, Delta State, Nigeria: A Public Health Perspective

I.M. Oyem1*, L. U. Oshilonyah1, J. C. Igborgbor1 and J. O. Ojugbo 2

1
Department of Biological Sciences (Microbiology Unit), University of Delta, Agbor
2
Department of Biology, Delta State University, Abraka

A R T I C L E I N F O
Abstract
Received: April 2024
Accepted: August 2024
Urinary tract infections (UTIs) is a common bacterial infection that affects any part of
the urinary system, including the kidneys, ureters, bladder, and urethra. During
Keywords: pregnancy, anatomical and hormonal changes create an environment favorable for the
Knowledge, Preventive proliferation of bacteria in the urinary tract, increasing the susceptibility to UTIs
practices, Level of education, which can lead to serious complications for both the mother and the foetus. This study
aimed to assess the knowledge of prevention practices related to UTI among pregnant
Interventions women attending antenatal care. A structured survey was conducted with a diverse
Corresponding author: sample of pregnant women receiving antenatal services in central hospital, Agbor. The
[email protected] findings revealed a varied level of awareness and understanding among the
ORCID ID: 0002-5883-5030 participants regarding UTI prevention practices. While a significant portion (83.6%)
Phone No:+23407034717335 of the respondents demonstrated a good grasp of preventive measures, such as
adequate hydration and personal hygiene, there were areas where knowledge gaps
were evident. Notably, knowledge about the importance of regular urine tests during
antenatal care and the consequences of untreated UTI. The results underscore the need
for targeted public health interventions during antenatal care appointments to enhance
pregnant women’s knowledge of UTI prevention. Improved awareness in this regard
can potentially reduce the incidence of UTI during pregnancy and mitigate associated
risks. Healthcare providers must play a pivotal role in delivering comprehensive
information and guidance, ensuring the well-being of both expectant mothers and their
unborn children.

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1.0 Introduction been 17.9% and asymptomatic form is

13% [6]. If asymptomatic infection is
Urinary Tract Infection (UTI) is a not treated, it leads to some clinical
common bacterial infection that affects manifestations such as low birth weight,
any part of the urinary system, including premature births and high mortality in
the kidneys, ureters, bladder, and urethra the mother and newborn [5] Symptoms
[1]. UTIs are prevalent in both men and are usually precipitated by sexual
women, but they are more common in intercourse [7]. UTI occur in both acute
women due to their shorter urethra, and chronic forms, in the former,
which allows bacteria to reach the patients complain of severe and low
bladder more easily [2], the leading back pain that may associate with fever
cause of UTIs is the invasion of due to the associated bacteraemia, while
pathogenic bacteria into the urinary tract, in the latter, a sensation of perineal
most commonly Escherichia coli fullness is felt. The common causative
(E.coli) [1]. agent is E. coli but micrococcal
Urinary Tract Infection (UTI) is a infections may account for up to 10 -
common medical concern affecting 20% of cases in sexually active women
pregnant women worldwide, therefore [8]. This infection reaches the bladder by
focused preventive measures and the ascending route, with the main
increased awareness are critical for symptoms as urinary frequency and
healthy and safe child bearing [3]. dysuria. Other infections that are due to
During pregnancy, anatomical and less common pathogens may usually
hormonal changes create an environment occur in the presence of gross structural
favorable for the proliferation of bacteria abnormality of the urinary tract or
in the urinary tract, increasing the neurological effects [9]. The common
susceptibility to UTI [4]. These source of E. coli in women is the faecal
infections can lead to serious flora. Introital colonization, which refers
complications for both the mother and to bacteria adhering to the vaginal wall,
the unborn child if left untreated. precedes the development of urinary
Therefore, implementing prevention tract infections in women and girls. In
practices during antenatal care is crucial males, the organisms frequently
to safeguarding the health and well- originate from the sub- preputial sac,
being of pregnant women [5]. Other which is the space between the penis and
factors that contribute to UTI risk the fore skin when still in place [10].
include sexual activity, urinary The higher prevalence among pregnant
catheterization, menopause, and certain women is attributable to the shortness of
medical conditions like diabetes. the female urethra and so is more liable
Based on performed research in Rwanda, to contamination during sexual
the prevalence of symptomatic urinary intercourse, urethra massage and even
tract infection in pregnant women has urination, with chronic flora that resides

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in the perineal skin. It includes the effect of water a day), regular and complete
of turbulence of the urinary stream [11]. bladder evacuation can prevent UTI
Urinary tract infections occur more often infection [15]. Sexual activity; is another
in women than men, at a ratio of 8:1. factor that predisposes pregnant women
Approximately 50-60% of women report to UTI (Staphylococcus aureus) for
at least one UTI in their lifetime, and example which is a member of skin flora
one in three will have at least one that might stay on the skin and get
symptomatic UTI necessitating transmitted during sexual intercourse)
antibiotic treatment by age 24 [9]. and enhances transmission of UTI
especially in females [9], Again, the
In a study conducted in Tanzania [12]. It practice of lubricating the vagina with
was observed that there was a high saliva, which may serve as an alternative
prevalence (63.47%) of urinary tract for low income earners to the use of
infections among participants at the vagina lubricants may predispose to
central hospital. The study found that UTI.
most of the participants (68.11%) have
little knowledge and awareness about The knowledge of UTIs is very crucial
urinary tract infections. According to in preventing its occurrence and
this study, the knowledge about urinary recurrence [5]. The introduction of
tract infection is still a problem despite knowledge-based public health
several studies that come with this factor Initiatives to antenatal care will go a
and recommendations. Even among long way in reducing the incidences of
universities in Nigeria, awareness of UTI UTI in Pregnant women. This issue
is low [13]. cannot be over- emphasized because of
the tremendous effect UTI has on the
UTI exists among pregnant women health of individuals, claiming lives
attending antenatal clinics with a under severe circumstances. However,
prevalence rate of 31.0% and knowledge proper treatment results in quick
and attitude regarding UTI and its recovery from the contagion. As earlier
prevention is low among pregnant stated, women are at a high risk of this
women [14]. The international incidence infection due to the short nature of their
of UTI is difficult to accurately assess urethra and because of this treatment
especially in developing countries. should be commenced as soon as it is
However, there is paucity of research on diagnosed so that the prognosis will be
pregnant women’s knowledge of positive.
prevention practice of urinary tract
infection in Nigeria and Delta State This paper assesses the knowledge of the
particularly. prevention practices of urinary tract
infection (UTI) among pregnant women
In addition, studies suggest that simple attending antenatal in the central
change in life style, such as good hospital, Agbor putting into cognizance
hygiene, adequate hydration (6-8 glasses

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their age and level of education as it education and UTI prevention practices,
affects the awareness and prevention of while the fourth section of the
this public health menace. questionnaire sought to establish the
relationship between preventive
2.0 Materials and Methods practices and urinary tract infection.
2.1 Study Area and Population The test re-test method was used to
A descriptive design was adopted as establish the reliability of the instrument.
considered fit for the study since it The instrument was tested using the chi-
involves gathering information from square statistical method at 0.05 level of
members of the population. Oral significance. The questionnaire was
permission was obtained from the Chief administered personally (face-to-face) to
Medical Director (CMD) of the Central the respondents. Some vital information
hospital, Agbor. Oral consent was also was passed to the respondents about the
gotten from the population of the study whole exercise. The questionnaire was
consisting of a hundred (100) women collected after completion. The personal
attending antenatal in Central Hospital, data collected from the study was
Agbor, Delta State between July and analyzed using simple percentages, the
September, 2023. A random sampling research hypotheses were analyzed using
technique was used to select the entire the chi-square statistical method at 0.05
population as a sample of the study. level of significance. The null hypothesis
(Ho) was rejected when the chi-square
2.2 Data Collection Instrument and calculated is greater than the chi-square
Statistical Analysis tabulated (critical region), otherwise it is
accepted.
The instrument used for data collection
for this research work was a structured 2.3 Research Hypotheses
questionnaire. The questionnaire
contained thirty-one (31) items drawn Ho1: There is no significant relationship
from the research hypotheses. The between age and knowledge of urinary
questionnaire is a close-end one with tract infection.
four sections. Sections A, B, C and D. Ho2: There is no significant relationship
The first section gathered personal between level of education and
information on the pregnant women knowledge of urinary tract infection.
attending antenatal. The second section
of the questionnaire was for the Ho3: There is no significant relationship
collection of information relating to age between the respondent’s preventive
and knowledge assessment of UTI. The practices and urinary tract infection.
third section was based on random
questions aimed at finding out the 3.0 Results
relationship between the level of 3.1 Data Presentation and Analysis

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Results on Bio-data of the respondents 3.2 Test of Hypotheses

as analysed using simple percentage are
shown in Tables 1, 2 and 3. The results In order to test the first hypothesis
show that 24% of the respondents are (Table 4a), questions 1, 2, 3, 4, 5 and 6
within the age bracket 18-25, 59% are in of the questionnaire were put into
the age bracket 26-35, while 17% are in consideration because of their relevance
the age bracket 36 and above, setting the to the hypothesis.
mean age of respondents at 32. From Table 4b, we observed that the
Also, 21% of the respondents were Chi-square calculated is 367 while the
primigravida, referring to women who Chi-square tabulated (critical value) is
are conceiving for the very first time 24.9 at 0.05 level of significance. Since
while 79% of the women were the calculated value is greater than the
multigravida, having had two or more critical value, the null hypothesis (Ho1)
conceptions in their lifetime. was rejected and it was concluded that
there is a significant relationship
Again, 18% of the respondents were first between age and knowledge of urinary
school leavers, 53% high school tract infection.
certificate holders, 26% of were
graduates while 3% have a post graduate
qualification.

Table 1: Age Distribution of the Respondents

Age in years Frequency Percentage

18-25 24 24

26-35 59 59

36 and above 17 17

Total 100 100

Table 2: Number of Pregnancies

Number of Pregnancies Frequency Percentage

1 21 21

2 32 32

3 28 28

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4 and above 19 19

Total 100 100

Table 3: Level of Education

Level of Education Frequency Percentage

FSLC 18 18

O'Level 53 53

Graduate 26 26

Post Graduate 03 03

Total 100 100

*FSLC: First School Leaving Certificate; O’Level: Ordinary Level (High School)

Table 4a: Relationship between age and knowledge of urinary tract infection.

S/N ITEM SA A SD D

1. Younger individuals possess comparable *34 17 28 21

knowledge about UTI as older ones (12.1) (11.9) (22.9) (37.5)

2. UTI knowledge is affected by factors other than 54 13 23 10

age (19.2) (9.2) (18.8) (17.8)

3. Lack of correlation between age and 35 33 29 03

UTI knowledge impact health care practices (12.5) (23.2) (23.7) (5.4)

4. Older age necessarily result in greater knowledge of 56 31 09 04

UTI (20.0) (21.8) (7.4) (7.1)
5. Age does not play a role in determining how 48 27 22 03
much one knows about UTI (17.1) (19.0) (18.0) (5.4)

6. There is no relationship between a person’s age 53 21 11 15

and their understanding of UTIs (18.9) (14.7) (9.0) (26.7)*

TOTAL 280 142 122 56

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*figures in the bracket are the expected frequencies derived from the observed frequencies while the results outside the bracket are the observed

frequencies.

SA= Strongly Agree, A= Agreed, SD = Strongly Disagree, D= Disagree

For hypothesis 2 to be tested (Table 5a), In order to test the hypothesis (Table 6a),
items 7,8,9,10,11 and 12 of the items 13, 14, 15, 16, 17 and 18 of the
questionnaire were proffered because of questionnaire were into consideration
their relevance to the hypothesis. because of their relevance to the
hypothesis.
From Table 5b, the Chi-square
calculated is 319.4 while the Chi-square From Table 6b, we observed that the
tabulated (critical value) is 24.9 at 0.05 Chi-square calculated is 474.3 while the
level of significance. The calculated Chi-square tabulated (critical value) is
value was found greater than the critical 24.9 at 0.05 level of significance. Since
value, therefore the null hypothesis the calculated value is greater than the
(Ho2) was rejected and it was concluded critical value, we reject the null
that there is a significant relationship hypothesis (Ho3) and conclude that there
between the level of education and is a significant relationship between the
knowledge of urinary tract infection. respondent’s preventive practices and
urinary tract infection.

Table 4b: Chi-square distribution of data on table 4a

Observed Expected (O-E)² (O-E)²/E

Frequency (O) Frequency (E)
34 12.1 479.6 39.6
54 19.2 1211.0 63.0
35 12.5 506.3 40.5
56 20.0 1296 64.8
48 17.1 954.8 55.8
53 18.9 1162.8 61.5
17 11.9 26.0 2.2
13 9.2 14.4 1.6
33 23.2 96.0 4.1
31 21.8 84.6 3.8
27 19.0 64.0 3.4
21 14.7 39.7 2.7
28 22.9 26.0 1.1
23 18.8 17.6 0.9

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29 23.7 28.0 1.2

09 7.4 2.6 0.3
22 18.0 16.0 0.8
11 9.0 4.0 0.4
21 37.5 272.3 7.3
10 17.8 60.8 3.4
03 5.4 5.7 1.0
04 7.1 9.6 1.4
03 5.4 5.7 1.1
15 26.7 136.8 5.1

Total 367

Table 5a: Relationship between level of education and knowledge of urinary tract
infection.

S/N ITEMS SA A SD D

7. Individuals with higher level of education possess a *21 47 23 09

better understanding of UTI (8.1) (23.8) (23.0) (20.9)

8. Level of education does not necessarily determine an 57 31 07 05

individual's knowledge of UTI (21.9) (11.6) (7.0) (11.6)

9. Level of education affect an individual's awareness 43 36 16 05

of the risk factors associated with UTI (16.5) (18.3) (16.0) (11.6)

10. Higher level of education contributes to more 27 21 42 10

accurate diagnosis and treatment of UTI (10.4) (10.6) (42.0) (23.3)

11. Individuals of lower levels of education are less 59 23 06 12

likely to have knowledge about the causes, (22.6) (11.6) (6.0) (27.9)
symptoms and prevention of UTI

12. There is noticeable difference in UTI knowledge 53 39 06 02

between individuals with varying levels of education (20.4) (19.7) (6.0) (4.6)*

TOTAL 260 197 100 43

*figures in the bracket are the expected frequencies derived from the observed frequencies while the results outside the bracket are the observed

frequencies.

SA= Strongly Agree, A= Agreed, SD = Strongly Disagree, D= Disagree

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Table 5b: Chi-square distribution of data on table 5a

Observed Expected (O-E)² (O-E)²/E

Frequency (O) Frequency (E)
21 8.1 166.4 20.5
57 21.9 6.8 0.3
43 16.5 702.3 42.6
27 10.4 6.7 0.6
59 22.6 1324.9 58.6
53 20.4 1062.7 52.0
47 23.8 538.2 22.6
31 11.6 376.4 32.4
36 18.3 313.3 17.1
21 10.6 108.2 10.2
23 11.6 129.9 11.2
39 19.7 372.4 18.9
23 23.0 0.0 0.0
07 7.00 0.0 0.0
16 16.0 0.0 0.0
42 42.0 0.0 0.0
06 6.0 0.0 0.0
06 6.0 0.0 0.0
09 20.9 141.6 6.8
05 11.6 43.6 3.7
05 11.6 43.6 3.7
10 23.3 176.8 7.6
12 27.9 252.8 9.1
02 4.60 6.8 1.5
TOTAL 319.4

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Table 6a: Relationship between the respondent’s preventive practices and urinary tract
infection.

S/N ITEM S.A A SD D

13. Sticking to a routine of good personal *44 36 09 11
hygiene can greatly reduce risk of UTI (14.2) (36.4) (6.7) (19.6)

14. UTIs can still occur in individuals who 23 21 44 12

maintain high level of cleanliness (7.4) (21.2) (32.6) (21.4)

15. Regular bladder evacuation and avoiding 86 10 2 2

urine retention are key preventive (27.7) (10.1) (1.5) (3.5)
measures against UTIs

16. Proper bladder function is generally 66 24 7 3

beneficial for overall health (21.3) (24.2) (5.2) (5.4)

17. Practicing good hygiene and preventive 01 03 71 25

measures has no impact on reducing the (0.3) (3.0) (52.6) (44.6)
risk of UTI

18. Individuals who consistently follow 90 05 02 03

recommended preventive practices are (29.0) (5.0) (1.5) (5.4)*
likely less to experience UTIs

TOTAL 310 99 135 56

*figures in the bracket are the expected frequencies derived from the observed frequencies while the results outside the bracket are the observed

frequencies

SA= Strongly Agree, A= Agreed, SD = Strongly Disagree, D= Disagree

4.0 Discussion awareness and understanding among the

From the results obtained from this respondents regarding knowledge of
study, there seems to be a varied level of UTI prevention practices. A

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significant portion (83.6%) of the [17]. However, there were areas where
respondents demonstrated a good grasp knowledge gaps were evident. Notably,
of preventive measures, such as adequate knowledge about the importance of
hydration and personal hygiene. This regular urine tests during antenatal care
corroborates with studies done in and the consequences of untreated UTI.
Philippines, which highlighted that good These observations we made were
hygiene practices were present in consistent with a similar study
women despite unsatisfactory conducted in Behbahan, Iran, which
knowledge levels of pregnant women showed women possessing moderate
[16]. In another study carried out in levels of knowledge with good attitude
Zambia, good hygiene and appropriate and health behaviours towards the
health related practices of pregnant prevention of UTI [18].
women, such as clothing manner, ways
of urination and washing techniques

Table 6b: Chi-square distribution of data on table 6a

Observed Expected (O-E)² (O-E)²/E

Frequency (O) Frequency (E)
44 14.2 888 62.5
23 7.4 242.7 32.7
86 27.7 3398.9 122.7
66 21.3 1998.1 93.8
01 0.3 0.5 1.6
90 29.0 3721.0 128.3
36 36.4 0.2 0.44
21 21.2 0.4 0.2
10 10.1 0.1 0.1
24 24.2 0.4 0.2
03 3.0 0.0 0.00
05 5.0 20.3 4.0
09 6.7 5.3 0.8
44 32.6 11.4 0.4
02 1.5 0.3 0.2
07 5.2 3.3 0.6
71 52.6 338.6 6.4
02 1.5 0.3 0.2
11 19.6 73.9 3.8
12 21.4 88.4 4.1
02 3.6 2.5 0.7
03 5.4 5.6 1.0
25 44.6 384.2 8.6

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03 5.4 5.4 1.0

TOTAL 474.3

Age played a significant role in knowledge about prevention of UTI than

determining the knowledge of UTI those with no formal education.
among the participants as the older and Therefore, the former are less prone to
more experienced women who were UTI complications. Gondwe and Alfred
multigravida had more knowledge of also corroborated this assertion when
UTI prevention practices. This is in line they reported that pregnant mothers who
with studies carried out by Adhkari and did not complete their secondary
Dhakal on knowledge of urinary tract education and those from indigent
infection among primigravida women backgrounds were ignorant of the
and Esan and co-workers in Ekiti State, symptoms of UTI [22], hence
Nigeria [19], [20]. In their descriptive complications such as low birth weight,
design on knowledge of UTI among premature births and high infant
primigravida, Adhkari and Dhakal mortality were reported among these less
revealed that 64.63% of the women had educated women. [5], [13]. Esan et al.,
no information about UTI, while 24.3% also revealed that pregnant women
had poor knowledge of the infection. In between 20-29 years had better
a similar study done in Banha, Egypt, knowledge of UTI as compared to those
age and educational attainment levels that were less than 20 years. [20].
were predictors of positive attitude Furthermore, this study revealed that
towards additional knowledge to prevent pregnant women who adhered to UTI
UTI [21] prevention practices such as adequate
The level of education of the pregnant hydration, proper bladder function,
women in this study, contributed to the regular urine tests and personal hygiene,
knowledge of prevention practices greatly reduced risk of UTI. This was in
against UTI. More educated women agreement with the findings of several
were perceived to have greater authors [15], [16], [17], [20].
knowledge of UTI prevention practices
than their less educated counterparts. 5.0 Conclusion
This aligns with the study carried out by The assessment of knowledge regarding
Esan and co-workers in Ekiti State [20] prevention practices of urinary tract
where a statistically significant infection (UTI) among pregnant women
association was found between certain attending antenatal care in the central
socio-demographic variables such as age hospital, Agbor was x-rayed. The
and level of education and respondent’s findings from this study reveal a
knowledge of UTI. They reported that multifaceted landscape of awareness,
pregnant women with higher educational understanding, and potential areas for
backgrounds were likely to have better improvement in tackling the problem of

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UTI in pregnancy. On one hand, a

substantial portion of the surveyed Competing interests
pregnant women, especially the Authors declare no competing interests.
multigravida and the more educated
class, exhibited a commendable level of Funding
knowledge about UTI prevention No funding was received for this
practices. These women were well research work.
informed about the significance of Authors’ contributions
proper hydration, personal hygiene, and IM analyzed and interpreted the data
regular antenatal check-ups, which are obtained from the pregnant women
significant in reducing the risk of UTIs. regarding UTI and wrote the manuscript.
However, the study also uncovered gaps LU and JC assisted in the formulation
in knowledge among some pregnant and distribution of the questionnaire
women, particularly concerning the used for the research. JO conceived the
importance of regular urine tests during work and did the background study of
antenatal care and the potential the work. All authors read and approved
consequences of untreated UTIs. It is the final manuscript.
imperative therefore to address these Acknowledgements
knowledge deficits as they can have far- Not applicable.
reaching implications for maternal health
and fetal well-being. This can be References
achieved through improvements in the
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