|Year : 2022 | Volume
| Issue : 1 | Page : 27-32
Awareness of Saudi women about causes of urinary tract infection and its complications in pregnant women in asir region
Asma Ali Asiri1, Ali Ahmed Alasiri2, Mofareh Ahmed Asiri2, Mohanad Qasem Alshabab2, Feras Mohammed Alqahtani2
1 Department of Obstetric and Gynecology, College of Medicine, Medical City, King Khalid University, Abha, Saudi Arabia
2 College of Medicine, King Khalid University, Abha, Saudi Arabia
|Date of Submission||21-Sep-2021|
|Date of Decision||05-Jan-2022|
|Date of Acceptance||02-Feb-2022|
|Date of Web Publication||27-Jul-2022|
Dr. Asma Ali Asiri
King Khalid University, Abha
Source of Support: None, Conflict of Interest: None
Background: Urinary tract infection (UTI) is one of the most common infections that occur during pregnancy. It can be symptomatic or asymptomatic and if left untreated, it could lead to maternal and perinatal morbidity and mortality complications. The highest prevalence of UTI in pregnant women is thought to be a result from significant physiological changes occur in the urogenital tract that lead to increasing the potential for pathogenic colonisation. Bladder volume increases and detrusor tone decreases and this will lead to stasis of urine and ascending of infection. In addition, pregnant women develop ureteric dilatation as the result of a combination of progestogenic relaxation of ureteric smooth muscle and pressure from the expanding uterus. Furthermore, this can lead to failure of treatment, recurrent infections, or significant morbidity and mortality with a poor outcome. The bacteria causing urinary infection in pregnancy are many, such as Escherichia coli, Gram-negative bacilli like Proteus mirabilis and Klebsiella pneumoniae. Staphylococcus saprophyticus is the second most frequently cultured uropathogen, 12 while other Gram-positive cocci, such as group B hemolytic streptococci, are less frequently isolated but remain clinically important. Other less common uropathogens include Staphylococcus aureus and Mycobacterium tuberculosis, which can arise through hematological inoculation rather than ascending infection. Nonbacterial causes include Chlamydia species and fungal infections, such as Candida albicans. Aim: The current study aimed to assess the awareness of Saudi women about the causes of UTI and its complications in pregnant women in Asir region, Southern of Saudi Arabia. Methodology: A cross-sectional study enrolled women at Asir region during the study period from Monday Feb 22, 2021–Jul 29, 2021 Data were collected using prestructured online questionnaire using social media platforms. Questionnaire included women bio-demographic data, children number, history of UTI, and awareness regarding UTI and its complications during pregnancy. Results: The study included 1662 Saudi females from Asir region with their ages ranged from 18 to 59 years with a mean age of 27.8 ± 12.4 years old. Majority of study participants (46%; 765) were single. Exact of 66.5% of the study females reported that pregnancy increases the chance of getting UTI. Regarding factors increases the risk of UTI in pregnant women, the most reported by the study females were prolonged retention of urine (72.4%). Also, 53.5% of the females know that the highest risk of getting UTI is at the 3rd trimester. As for complications for a pregnant woman with UTI, nephritis was known among 76.7% of the females. Conclusion: In conclusion, the current study revealed that females' awareness regarding UTI and its related causes and complications is poor in Asir region. Not all females know all risk factors, clinical presentation, or complications of UTI.
Keywords: Awareness, causes, complications, pregnancy, Saudi Arabia, urinary tract infection, women
|How to cite this article:|
Asiri AA, Alasiri AA, Asiri MA, Alshabab MQ, Alqahtani FM. Awareness of Saudi women about causes of urinary tract infection and its complications in pregnant women in asir region. King Khalid Univ J Health Sci 2022;7:27-32
|How to cite this URL:|
Asiri AA, Alasiri AA, Asiri MA, Alshabab MQ, Alqahtani FM. Awareness of Saudi women about causes of urinary tract infection and its complications in pregnant women in asir region. King Khalid Univ J Health Sci [serial online] 2022 [cited 2022 Aug 8];7:27-32. Available from: https://www.kkujhs.org/text.asp?2022/7/1/27/352522
| Introduction|| |
Urinary tract infection (UTI) is a disorder that frequently affects pregnant women, that occurs due to the anatomical nature of the woman's body in general and during pregnancy.,
These anatomical features facilitate infection through the existence of microorganisms in the urinary tract which causes the infection among women with higher rate among the pregnant woman., UTI causes serious complications that may be risky on the life of the mother and her child.
UTI is one of the most common infections that occur during pregnancy. If not treated, it could lead to maternal and perinatal morbidity and mortality complications; also there are many risk factors that can lead to fail of treatment, recurrent infections, or significant morbidity and mortality with a poor outcome., It may be symptomatic or asymptomatic, which often makes diagnosis difficult, in many patients, UTIs are preceded by asymptomatic bacteriuria (UTI without signs and symptoms), and should be treated to avoid the complications such as acute pyelonephritis, low birth weight and preterm labor. The normal female urinary tract has a relatively short urethra and near to the anus, this anatomy increases the frequency of infections. A major risk factor for UTI is the use of a catheter; other factors are age, lower socioeconomic status, multiparty, past history of UTI, aminoaciduria, anemia, and diabetes mellitus. In addition, manipulation of the urethra, sexual intercourse, and frequent pelvic exams are also risk factors.
In a 2018 study conducted in the Philippines at the University of Angeles Foundation, the results of the study showed that raising awareness of pregnant women about UTIs and how to prevent it was a helpful factor in reducing the incidence of UTI. Another study was done about UTI shows that increasing of education among individuals will decrease the incidence of UTI. The current study aimed to assess the awareness of Saudi women about the causes of UTI and its complications in pregnant women in Asir region, Southern of Saudi Arabia.
| Methodology|| |
A cross-sectional survey was conducted including 1662 respondent females of general population in Asir region, Southern of Saudi Arabia. Due to the cultural barriers of conducting home to home survey, data were collected using the self-administered online questionnaire containing questions for females age, education, occupation, children number, history of having UTI and awareness of different items of UTI including causes, risk factors, signs and symptoms, complications, and treatment. The questionnaire was developed by the researchers after intensive literature review and experts consultation. It was reviewed by a panel of three experts independently and any suggested correction was applied. Final questionnaire was uploaded online using social media platforms by the researchers and their friends and relatives during the period from July 01, 2021 to July 07, 2021 till the sample size was adequate. Females who live out of Asir region, those who were <18 years and females with incomplete questionnaire were excluded.
The data were collected, reviewed and then fed to the Statistical Package for the Social Sciences version 21 (SPSS: An IBM Company). All statistical methods used were two tailed with alpha level of 0.05 considering significance if P ≤ 0.05. Overall, awareness level was assessed through summing up discrete scores for different awareness items. The overall awareness score range was 0–24 which was categorized to poor level if participants score was <60% of the overall score and good level of knowledge was considered if the participant s score was 60% or more of the overall score. Descriptive analysis was done by prescribing frequency distribution and percentage for study variables including respondents' personal data, history of getting UTI, and awareness regarding UTI and its complications during pregnancy. Cross tabulation for showing distribution of females' awareness level by their bio-demographic data was carried out with Pearson Chi-square test for significance and exact probability test due to small frequency distribution.
| Results|| |
The study included 1662 Saudi females from Asir region with their ages ranged from 18 to 59 years with mean age of 27.8 ± 12.4 years old. Majority of study participants (46%; 765) were single, while 842 (50.7%) were married and 55 (3.3%) were divorced/widow. As for females education level, 1378 (82.9%) were university graduated while 247 (14.9%) were graduated from high school. Considering occupation, 529 (31.8%) were housewives with no jobs, 374 (22.5%) worked at educational job and 200 (12%) were health care workers but 493 (29.7%) were students. Monthly income <5000 SR was reported by 908 (54.6%) participants and 429 (25.8%) had monthly income more than 9000 SR. Exact of 910 (54.8%) females had no children, 386 (23.2%) had 1-3 children and 366 (22%) had more than 3 children. Exact of 692 (41.6%) females were previously diagnosed with UTI [Table 1].
|Table 1: Bio-demographic data of sampled Saudi females, Asir region, Saudi Arabia|
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[Table 2] illustrates the distribution of awareness regarding the causes of UTI and its complications among Saudi females, Asir region. Exact of 66.5% of the study females reported that pregnancy increases the chance of getting UTI. Regarding factors increases the risk of UTI in pregnant women, the most reported by the study females were prolonged retention of urine (72.4%), followed by hormonal changes during pregnancy (45.1%), previous diagnosis of UTI (41%), low level of environmental/personal hygiene (40.3%), and diabetes (30.6%) while old age during pregnancy and complaining of sickle cell anemia were the least reported factors (5.7% and 5.2%, respectively). Furthermore, 53.5% of the females know that the highest risk of getting UTI is at the 3rd trimester. As for complications for a pregnant woman with UTI, nephritis was known among 76.7% of the females, followed by preeclampsia and eclampsia (55.9%), chorioamnionitis (52.6%), and premature labor (38.9%) while anemia was known among 15.5% of the participants. With regard to complications of UTI on the fetus, premature baby was reported by 81.6% of the study females, low birth weight among (60.1%), and intrauterine death (50.4%) while intrauterine growth restriction was reported by 35%. Also, 95.6% of the study females think that urinalysis is important for a pregnant woman. As for the symptoms that a UTI patient feels, dysuria was the most reported (92.2%) followed by increase of urination frequency (62.8%), opaque urine (62.5%), urgency to urinate (59.4%), and blood in urine (48.9%). Only 8.7% reported for nausea and vomiting with diarrhea. The most known effective methods to prevent UTI during pregnancy were drinking an adequate amount of water (96.6%), going to the bathroom when needed and not holding urine (92.8%), ensure the cleanliness of clothes (53.4%), and drinking cranberry juice regularly (20.7%). Antibiotics as the most appropriate way to treat a UTI were known by 43.3% of the study females. The overall females awareness score ranged from 2 to 36 points with a mean score of 13.4 ± 6.0 out of 36 points.
|Table 2: Distribution of awareness regarding causes of urinary tract infection and its complications among Saudi females, Asir region|
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[Figure 1] shows overall awareness level regarding the causes of UTI and its complications among Saudi females, Asir region. Exact of 282 (17%) females had good awareness regarding UTI and its causes during pregnancy while 83% had poor awareness level.
|Figure 1: Overall awareness level regarding causes of urinary tract infection and its complications among Saudi females, Asir region|
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[Table 3] reveals the distribution of females' awareness level regarding UTI and its complications by their biodemographic data. Good awareness level was detected among 23.9% of females aged <25 years in comparison to 6.3% of those who aged more than 50 years with recorded statistical significance (P = 0.001). Furthermore, 25.2% of single females had good awareness regarding UTI compared to 10% of married females (P = 0.001). Good awareness was detected among 19.1% of highly educated females compared to 6.7% of females with below university educational level. As for occupation, 31.5% of health-care workers had good awareness level regarding UTI and its complication in comparison to 8.3% of housewives (P = 0.001). Furthermore, 23.1% of females with no children had good awareness compared to 9.6% of others who had (P = 0.001). Exact of 19.4% of females without previous history of UTI had good awareness level compared to 13.6% of those with (P = 0.002).
|Table 3: Distribution of females' awareness level regarding urinary tract infection and its complications by their bio-demographic data|
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| Discussion|| |
This study is aimed to assess the level of women awareness regarding UTI in pregnancy especially the factors that make UTI more suitable in pregnant women. Furthermore its measure their knowledge about complications of UTI that may occur during and after pregnancy. UTI is mainly initiated by the precence of bacteria in urine. Escherichia coli attributes for 75%–90% of uncomplicated UTIs, Gram-negative bacilli such as Proteus mirabilis and Klebsiella pneumoniae. Staphylococcus saprophyticus is the second most frequently cultured uropathogen, while other Gram-positive cocci, such as Group B haemolytic streptococci, are less frequently isolated but remain clinically important. Other less common uropathogens include Staphylococcus aureus and Mycobacterium tuberculosis, which can arise via hematological inoculation rather than ascending infection. Nonbacterial causes include Chlamydia species and fungal infections, such as Candida albicans.,,,
The current study showed that females' awareness regarding UTI and its related complications during pregnancy was mostly poor, <1 fifth of them recorded good awareness level (17%). Two thirds of the females know that UTI incidence is higher during pregnancy, especially in the third trimester. Regarding UTI risk factors, three quarters of the females (3 out of each 4) mention that the urine retention is the a risk factor but less than half of them define the hormonal changes in pregnancy-previous diagnosis of UTI and poor personal hygiene are risk factors. Regarding maternal complications secondary to UTI in pregnancy: Nephritis was known among three quarters of the females, developing of preeclampsia was known by nearly half of the females and pregnancy can be complicated by Chorioamnionitis. Regarding pregnancy complicated by UTI: More than one third of the females (39%) mentioned the premature labor as one of the UTI complications on pregnant females. About fetus complications due to maternal UTI, more than 3 out of 5 females said the premature baby can happen, while two thirds of women told the baby will born with a low birth weight and half of them reported for intrauterine death. Considering symptoms of UTI, dysuria was known for nearly all the participant females and two-thirds of the females know about increased frequency of urination, opacity of their urine, and urgency. The most identified preventive measure of developing UTI was drinking of a lot of water which was reported by more than 90% of the study females followed by not holding the urine and urination when needed. For the treatment of UTI in pregnancy, antibiotics as an appropriate treatment method were known for less than half of the study females.
The estimated females' awareness level regarding UTI and its related causes and complications were much lower than many literature studies. Mangai et al. found that 82.2% of the study females were knowledgeable regarding UTI. Furthermore, they know about cleaning the perineum from front to back, keeping the genital area clean and dry, avoiding fluids that irritate the bladder such as alcohol and emptying the bladder frequently when full helps in the prevention of UTI. Santoso et al. reported that 9.1%, 69.7%, and 21.2% participants had good, fair, and poor knowledge regarding UTI, respectively. Furthermore, 65.7% and 64.6% had a positive perception with proper practice regarding avoiding UTI infection. Selamat et al. found that awareness and practice regarding UTI among university female students in Malaysia were moderate. In Bangladesh, 76.9% of university female students properly selected bacteria as the main pathogens causing UTIs and 80.2% know about antibacterial drugs for the treatment of UTIs. Furthermore, 60% had poor knowledge about the other consequences of untreated UTIs in the long run and 51.9% ignorant for the complications of urinary retention.
Locally, in Egypt, El Lawindi et al. found that 44% of Egyptian women attending Theodor Bilharz Research Institute, Giza could not score one with a maximum score of 3 points (out of 9). In Qatar, Saleh et al. found that 70.4% of the Qatari women believed that UI was abnormal and worth reporting to a doctor. Furthermore, more than half of them (51.9%) believed child birth is the main cause of UI, followed by ageing (49.5%), menopause (34.2%) and paralysis (25.3%). About 62.3% believe that UI can cause infection, while 20.5% believe that it can cause skin allergy and very few think that it can cause cancer or other disorders.
A study was conducted in Saudi Arabia show that most affected age between 20-39 years old and they have shortage in knowledge about UTIs and they are in need for more education. But in Faidah HS Study that conducted in Makkah, Saudi Arabia 78.9% of women with post graduate education had good knowledge.
There was a significant relation between the current study females age (young age), high educational level) and being health care worker with good awareness level. The surprising finding was that awareness was higher among none married females than married and among females with no previous history of UTI. This may be explained by that those groups are young aged females with high education so they have good personal hygiene and different sources of information making them aware of the disease and commit healthy lifestyle to avoid it.
| Conclusions and Recommendations|| |
In conclusion, the current study revealed that females' awareness regarding UTI and its related causes and complications are poor in Asir region. Not all females know all risk factors, clinical presentation, or complications of UTI. Awareness was higher among young aged females, highly educated females and those who work at the field of health care. Awareness programs besides health education sessions are recommended to increase females' awareness about UTIs and make them aware to avoid UTIs and motivate them to visit doctors if necessary to minimize the sufferings of morbidity related to UTIs.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]