CHAPTER ONE

INTRODUCTION

A urinary tract infection is an infection that affects parts of the urinary system, including the bladder and urethra. It happens when germs, usually bacteria, enter the urinary tract and multiply. UTIs can cause pain and discomfort. Symptoms often include a strong urge to urinate, burning during urination, and cloudy urine [1]. UTIs are common, especially in women. They can be treated with antibiotics. If not treated, they can lead to more serious health problems.

UTIs are mostly caused by bacteria from the bowel that enter the urinary tract. Factors that increase the risk include poor hygiene, sexual activity, and certain medical conditions. Women are more likely to get UTIs due to their anatomy, which makes it easier for bacteria to reach the bladder National Institute of [2]. Other causes can include using a catheter or having a weakened immune system. Drinking less water can also increase the risk. Knowing the causes can help prevent UTIs.

During pregnancy, UTIs can be more common and may pose risks to both the mother and baby. If untreated, they can lead to kidney infections, which can cause serious complications American College of Obstetricians and Gynaecologists [3]. Pregnant women with UTIs may experience more severe symptoms. It is important to diagnose and treat UTIs promptly during pregnancy to protect both the mother and child. Regular check-ups can help catch infections early. Awareness and management of UTIs are crucial for a healthy pregnancy.

1.1 Background to the study

Globally, urinary tract infections are a prevalent concern during pregnancy, affecting approximately 10-20% of pregnant women. In countries like India, the prevalence can reach as high as 60.7%, while in the United States, it is estimated that 8-10% of pregnant women experience a UTI [4, 5]. The primary infectious agent responsible for these infections is Escherichia coli (E. Coli), which accounts for about 80-90% of cases, although other pathogens such as Klebsiella pneumoniae and Staphylococcus saprophyticus are also implicated [6]. Complications from UTIs during pregnancy can lead to significant health issues, including pyelonephritis, which may result in preterm labour, low birth weight, and increased risk of maternal morbidity, [7]. A study in Brazil indicated that untreated UTIs could double the risk of adverse pregnancy outcomes, emphasizing the necessity for effective screening and management strategies in this population [8].

In Africa, UTIs are also a significant health concern during pregnancy. In Ethiopia, a systematic review and meta-analysis revealed a pooled prevalence of 15.37% among pregnant women, with factors such as low family income, multiparity, and previous history of UTIs significantly associated with higher infection rates [9]. The complications arising from UTIs during pregnancy can be severe, including low birth weight, preterm birth, and maternal anaemia, which can lead to increased morbidity and mortality for both mothers and infants [9]. In Nigeria, studies have reported UTI prevalence rates ranging from 8% to 30%, with complications such as pyelonephritis and preterm labour being common outcomes [10]. Similarly, in South Africa (SA), the prevalence of UTIs in pregnant women has been noted to be around 20%, with significant associations found between UTIs and adverse pregnancy outcomes, including preeclampsia and foetal growth restriction [11]. These show the critical need for effective screening and management strategies to mitigate the risks associated with UTIs in pregnant women across various African regions.

In Cameroon, the prevalence rates of UTIs in pregnancy warrants attention. The prevalence of UTIs among pregnant women in various regions, including the Buea Health District, can be as high as 31% [12]. Many cases are asymptomatic, with studies showing that approximately 28.7% of asymptomatic pregnant women still test positive for UTIs [12]. The consequences of untreated UTIs during pregnancy are serious, leading to complications such as preterm labour, low birth weight, and pyelonephritis, which can adversely affect both maternal and foetal health [13]. A retrospective study reported that infections, including UTIs, were a leading cause of low birth weight, accounting for 19.5% of cases in the region [14]. UTIs are associated with increased risks of hypertensive disorders, including preeclampsia, with a reported prevalence of 17% among affected women in Cameroon [15]. The predominant pathogen identified in these infections is Escherichia coli, which exhibits varying resistance patterns to commonly used antibiotics, complicating treatment options [12]. These trends same as with the rest of Africa shows that there is an urgent need for routine screening and effective management strategies to mitigate the risks associated with UTIs in pregnant women in Cameroon.

1.2 Problem Statement

Urinary tract infections are common among pregnant women globally, affecting their health and well-being. UTIs can cause symptoms like pain, burning during urination, and frequent urges to urinate. If left untreated, they can lead to more severe complications, such as kidney infections, which pose risks to both the mother and the developing foetus [3]. Awareness and early detection are crucial, as many women may not recognize the symptoms, leading to delays in treatment.

In Africa, the burden of UTIs during pregnancy is particularly high, making up to pooled prevalence of 15.37% among pregnant women gglobally. Many women face barriers to accessing healthcare, such as geographical isolation and inadequate medical facilities. Cultural beliefs can further complicate the situation, as some women may hesitate to seek medical help due to stigma or fear [9]. A lack of education about UTI prevention and treatment contributes to the high incidence of these infections. The combination of these factors can result in greater health risks for both mothers and their babies, including higher rates of complications like anaemia and pregnancy-related hypertension [9].

In Cameroon, UTIs are a pressing health concern for pregnant women. The healthcare system grapples with challenges such as negligence among women. Many women are unaware of the preventive measures that can help reduce the risk of UTIs [12]. Effective prevention strategies include staying well-hydrated, practicing good personal hygiene, and attending regular prenatal check-ups. When preventive measures are not taken, UTIs can lead to severe consequences, including kidney damage, preterm labour, and low birth weight, which can impact the long-term health of both mother and child. There is therefore the need to assert the level of practice of these control measures among women given the exhibition of similar trends leading to UTIs occurrence among women in the region. This study therefore aims at assessing the preventive practices for urinary tract infections among pregnant women at the regional Hospital Bamenda.

1.3 Research Questions

1.3.1 Main Research Question

What are the preventive practices for urinary tract infections among pregnant women at the Regional Hospital Bamenda?

1.3.2 Specific research objectives

1. What is the prevalence of urinary tract infections among pregnant women at the Regional Hospital Bamenda?
2. What is the knowledge on urinary tract infections among pregnant women at the Regional Hospital Bamenda?
3. What are the preventive practices of urinary tract infections among pregnant women at the Regional Hospital Bamenda?
4. What are the difficulties faced in the prevention of urinary tract infections by pregnant women at the Regional Hospital Bamenda?

1.4. Research Objectives

1.4.1 Overall Research Objective

To assess the preventive practices for urinary tract infections among pregnant women at the Regional Hospital Bamenda.

1.4.2 Specific Research Objectives

1. To determine the prevalence of urinary tract infections among pregnant women at the Regional Hospital Bamenda.
2. To assess the level of knowledge on urinary tract infections among pregnant women at the Regional Hospital Bamenda.
3. To assess the preventive practices of urinary tract infections among pregnant women at the Regional Hospital Bamenda.
4. To identify the difficulties faced in the prevention of urinary tract infections by pregnant women at the Regional Hospital Bamenda.