CHAPTER ONE
GENERAL INTRODUCTION
1.1 Introduction

The likelihood of urinary tract infections (UTIs) is increased during pregnancy due to numerous
women’s physiological changes [1]. The main reason is due to urinary stasis and vesicoureteral
reflux caused by hormonal and mechanical changes [2]. In addition, short urethra and difficulty
with hygiene due to a distended pregnant belly make UTI the commonest bacterial infectious
during pregnancy which occurs in about 8% of pregnant women [3]. Furthermore, pregnant
patients are considered immunocompromised UTI hosts because of the physiologic changes
associated with pregnancy [4]. These changes increase the risk of serious infectious
complications from symptomatic and asymptomatic urinary infections even in healthy pregnant
women [5].
It is associated with increased risks of maternal and neonatal morbidity and mortality, even
when the infection is asymptomatic [6]. If asymptomatic bacteriuria is untreated in pregnancy,
the rate of subsequent UTI is approximately 25% [6]. Even though maternal UTI has few direct
fetal sequelae because fetal bloodstream infection is rare, uterine hypoperfusion due to
maternal dehydration, maternal anemia, and direct bacterial endotoxin damage to the placental
vasculature may cause fetal cerebral hypoperfusion [7].

It may also pose a serious health risk to a pregnant woman and developing fetus and cause of
antepartum intensive care unit admission [8]. It is associated with different maternal and
neonatal adverse outcomes such as low birth weight, premature labor and prematurity, still
birth, preeclampsia, maternal anemia and sepsis, and amnionitis [9, 10]. In addition, it is also
associated with premature rapture of membrane and low Apgar score. This may lead to
increased maternal and perinatal morbidity and mortality [11, 12]. Furthermore, UTI during
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pregnancy is independently associated with intrauterine growth restriction, preeclampsia,
preterm delivery, and cesarean delivery [13, 14]. In addition to those adverse risks, it also had
financial threats in which the annual health costs for UTI exceed two billion$. Screening for
these conditions in pregnant women is cost-effective, compared with treating UTI and its
complication [15].
Evidences showed that pregnant women in developing countries have higher rates of UTI and
its burden than developed nations [5, 16]. Previous history of UTI, preexisting diabetes,
increased parity, low socioeconomic status, immunosuppression, tobacco use, extreme maternal age, and late presentation for prenatal care are some of the risk factors [17, 18].
Among the common cause of UTI during pregnancy, Escherichia coli shared the highest while
the rest was caused by different pathogens like Klebsiella pneumoniae, Proteus mirabilis,
Enterobacter species, Staphylococcus saprophytic, and group B beta hemolytic streptococcus
[7].
In Cameroon, there is a dearth of studies regarding the prevalence of UTI and its associated
risk factors in pregnancy despite the fact that it causes major complications on the pregnant
women and their fetuses [3]. Therefore, this study is aimed at elucidating the prevalence and
associated risk factors of UTI among pregnant women. It is anticipated that knowledge on this
subject will contribute to the reduction of maternal and perinatal morbidity/mortality from UTI
among pregnant women. Therefore the objectives of this study is to assess the prevalence of
urinary tract infection among women at the azire integrated health center Bamenda , to identify
common risk factors associated with UTIs among pregnant women at the azire integrated health
center, to identify knowledge on prevention, to identify challenges in prevention of UTIs
among pregnant women at the azire integrated health center Bamenda.

1.2 Background of the Study
Urinary Tract Infections (UTIs) are among the most common bacterial infections affecting
individuals globally, with a disproportionately high burden in women, infants, the elderly, and
pregnant women [1]. UTIs affect more women than men, largely due to the female anatomy—
particularly a shorter urethra and its proximity to the anus—which facilitates bacterial entry
[2]. It is estimated that nearly 50–60% of women will experience a UTI in their lifetime,
compared to 5% of men [3]. In young women, increased sexual activity is a major risk factor,
and recurrences within six months are common [4]. UTIs are also frequently observed in
babies, older adults, and hospitalized patients, especially those with urinary catheters [5]. The
urinary system includes the kidneys, ureters, bladder, and urethra, which together function to
excrete waste while maintaining fluid balance. The system is designed to prevent backward
flow of urine, which helps minimize the risk of kidney infections [1]. UTIs are generally
confined to the bladder, producing symptoms like painful urination, urgency, and frequency,
but can ascend to the kidneys in more severe cases, such as pyelonephritis, which though less
frequent, is more serious [1,4]. Escherichia coli (E. coli) is the most common pathogen
responsible for UTIs, although other organisms can also be implicated [5]. While UTIs are
generally treatable with antibiotics, the emergence of antimicrobial resistance due to
inappropriate or excessive antibiotic use is becoming a major public health issue [6].
Consequently, there is an increasing emphasis on cost-effective and rational use of diagnostics
and antibiotics, as well as the promotion of non-antibiotic prophylactic strategies [7].

Globally, UTIs account for over 150 million cases annually, with estimated healthcare costs
exceeding $6 billion [6]. In the United States alone, over 7 million outpatient visits per year
are related to UTIs, making them the most common outpatient bacterial infection [8]. They are
also the second most common reason for antibiotic prescriptions [7]. Hospital-acquired UTIs
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(HAUTIs) account for approximately 40% of all nosocomial infections, making them the most
common healthcare-associated infection [9].
The prevalence of asymptomatic bacteriuria rises with age—from 2–7% in women of
childbearing age to as high as 50% in institutionalized elderly women [4]. Among men over
75, the prevalence is 7–10% [4]. In children, UTIs are more common in uncircumcised boys
under 3 months and in girls under one year [9]. In febrile infants aged 0–2 years, UTI
prevalence ranges from 2% to 20%, though estimates vary widely [9].

In pregnancy, UTIs are particularly concerning due to physiological and anatomical changes
that increase susceptibility. These include hormonal-induced relaxation of smooth muscles,
leading to ureteral dilation and urinary stasis, and the pressure of the growing uterus on the
bladder, which limits complete drainage [12,13]. UTIs during pregnancy can lead to significant
maternal and fetal complications, including pyelonephritis, preterm labor, low birth weight,
hypertension/preeclampsia, fetal distress, and in severe cases, fetal death [14]. Research
conducted at the Buea Regional Hospital reported that 19.5% of low birth weight deliveries
were associated with UTIs [14]. UTIs in pregnancy are typically classified as symptomatic or
asymptomatic. Symptomatic cases often present with dysuria, frequency, and suprapubic
tenderness, while asymptomatic bacteriuria can progress to symptomatic infection if left
untreated [17]. The condition often begins by the sixth week of gestation and peaks around 22–
24 weeks [18]. Around 90% of pregnant women develop some degree of urethral dilation by
mid-pregnancy [18,19].
In Africa, specific regional data remain limited, but studies indicate high prevalence rates:
65.5% in Buea and 54% in Bamenda, Cameroon [15]. These figures point to a substantial public
health burden and underscore the need for effective prevention and management strategies,
particularly during pregnancy. Recurrent UTIs are a major challenge, with nearly half of those
affected experiencing a second episode within a year [8]. Factors associated with recurrence

and increased UTI risk include advanced age, catheter use, sexual activity, menopause, urinary
tract abnormalities, and comorbid conditions [7]. UTIs contribute significantly to personal
discomfort, increased physician visits, lost productivity, and reduced quality of life [11].
European data also suggest that recurrent infections are linked to increased absenteeism and
healthcare utilization [11].
Given the high prevalence and significant burden of disease, establishing cost-effective,
evidence-based strategies for diagnosis and management of UTIs is essential. Clinical
guidelines recommend limiting diagnostic testing to cases where results are likely to affect
outcomes, and minimizing the duration of antibiotic treatment to reduce resistance [19]. In
women with recurrent UTIs, self-initiated therapy or prophylactic treatment may be more
effective than repeated emergency care [19]. Additionally, non-antimicrobial preventive
measures, such as lifestyle modification and behavioral strategies, may help reduce recurrence
[20].

1.3 Statement of the problem

Urinary tract infection in pregnant women are bacterial infections of the urinary system that
can be classified into different types based on the site and severity of the infection. Urinary
tract infections (UTIs) represent one of the main public health problems in the world causing
significant associated morbidity and mortality in children and adult[21]. It is common in
women, especially pregnant women and poses a great therapeutic challenge, since the risk of
serious complications in both the mother and her child is high [22]. Pregnancy is a state
associated with physiological, structural and functional urinary tract changes with promotes
ascending infections from the urethra, unlike the general population UTI is more common in
pregnant women because the uterus which is located between the bladder and the rectum grows
and narrows the bladder anteriorly thereby narrowing it thus increases the risk of
infections[23].
UTIs complication in pregnancy are more severe and if not treated can lead to low-birth-weight
babies, premature delivery and sometimes dead of the mother and the baby if not treated [24].
Despite the fact that pregnant women are being educated everyday about UTIs by Nurses
during ANC, it is still disturbing that most pregnant woman still presents with urinary tract
infections[25]. There is an urgent need to find out why there are still an increased number of
urinary tract infections among this particular group of women since the complications are
dangerous to the mother and the baby. It is also noticed that pregnant women don’t have good knowledge on how to prevent this disease to (urinary tract infections), due to the increased in
UTIs because of poor implementation of the preventive measures of urinary tract infections is
what prompt the researcher to carry out research on the topic prevalence, associated risk factor
and effects of UTIs in pregnancy among pregnant women at the Azire medicalized health center
Bamenda
1.4 Research Questions
1.4.1 General Research Question
What is the prevalence and associated risk factors of urinary tract infections among pregnant
women at the Azire medicalized health center Bamenda?
1.4.2 Specific Research Questions
1. what is the prevalence of UTIs in pregnancy among pregnant women at the azire
medicalize health centre Bamenda.
2. what is the knowledge on prevention of UTIs in pregnancy among pregnant women at
the Azire medicalized health centre Bamenda3.what are the associated risk factors of UTIs in pregnancy among pregnant women at the
Azire medicalized health centre Bamenda.
4. what is the challenge in prevention of UTIs in pregnancy among pregnant women at the
Azire medicalized health centre Bamenda.
1.5 Research Hypothesis
1.5.1 Null hypothesis
1.There is no significant different between the prevalence of urinary tract infection and
knowledge on urinary tract infections among pregnant women attending ANC at the Azire
medicalized health center Bamenda.
1.5.2 Alternative Hypothesis
1.There is a significant association between the prevalence of UTIs and knowledge on UTIs
among pregnant attending ANC at the Azire medicalized health center Bamenda

1.5 .3 Main Objectives
To identify the prevalence and associated risk factors of urinary tract infection among pregnant
women at the Azire medicalized health center Bamenda
1.5.4 Specific Objections
1.To assess the prevalence of UTIs in pregnancy among pregnant women at the Azire
medicalized health center
2.To identify the common risk factors associated with UTIs in pregnancy among pregnant
women at the Azire medicalized health center Bamenda
3.To assess the knowledge on prevention of urinary tract infection among pregnant women at
the azire medicalized health center Bamenda
4. To identify challenges faced in prevention of urinary tract infection in pregnancy among
pregnant women at the Azire medicalized health center Bamenda