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PREVALENCE OF URINARY TRACT INFECTION AND DEMOGRAPHIC DIFFERENTIALS AMONG PREGNANT WOMEN IN UNIVERSITY OF NIGERIA TEACHING HOSPITAL, ENUGU.doc"

CHAPTER ONE

 INTRODUCTION 
Background to the Study
 Urinary tract infections (UTIs) during pregnancy are among the most common health problems afflicting many women in their reproductive years (Wamalma, Onolo, & Makokha, 2013). Pregnant women are at increased risk for UTIs beginning at the 6th week of gestation and peaking during 22 to 24 weeks of gestation due to a number of anatomical and physiological factors (Wamalma, Onolo, & Makokha, 2013). Screening for and treatment of bacteriuria in pregnancy has become a standard obstetric care in many countries. For instance, American College of Obstetricians and Gynecologists, National Institute for Health and Clinical Experience, and American Academy of Family Physicians strongly recommend screening for bacteriuria in all pregnant women at 12 to 16 weeks gestation with urine culture or at the first prenatal visit (Ashshi, Faidah, Saati, Abou, Al-Ghamdi, & Mohamed 2012). Urinary tract infection is a bacterial infection occurring in the urinary system. The urinary system consists of the kidneys, ureters, bladder and the urethra. The severity of UTI depends both on the virulence of the bacteria and the susceptibility of the host (Ade-Ojo,Oluleye,& Adegun, 2013). Although pregnancy does not increase the rate of UTI, it increases the risk of progressing to a full blown kidney infection, which can cause early labour and other pregnancy complications (Wamalma, Onolo, & Makokha, 2013). UTI portends adverse outcome if not treated. Studies have shown that 20-40 percent of UTI progresses to acute pyelonephritis if untreated whereas with treatment this risk reduces to 1-2 percent (Schnarr, 2008). Maternal complications include chronic pyelonephritis, anemia, and septicaemia. Fetal complications include intrauterine growth restrictions and prematurity (Ade-Ojo, Oluleye, & Adegun, 2013). There are factors that predispose to bacteriuria in pregnancy and they include the reduced ability of the kidneys to concentrate urine, leading to differences in urine ph and osmolality of urine in pregnancy, stasis of urine due to smooth muscle relaxation, effect of increased progesterone, pressure effect of the gravid uterus on the bladder and ureters impeding the free flow of urine (Ade-Ojo, Oluleye, & Adegun, 2013). UTI can occur in both males and females at any age. Bacteriuria increases with age, and women are affected more frequently than men. This is because of their short urethra which offers little resistance to the movement of uropathogenic bacteria, also structural and functional problems which occur with aging may prevent complete emptying of the bladder which leads to UTI. Also studies have shown that the body’s resistance to infection and ability to recover from infection diminishes with age (Smeltzer, Bare, Hinkle, & Cheever, 2008). In other words, older women may be more susceptible to infection than younger women due to ageing. Sexual intercourse or massage of the urethra during childbirth forces bacteria up into the bladder. This accounts for the increased incidence of UTI in sexually active women (Smeltzer, et al., 2008). The study by Wamalma, Onolo and Makokha (2013) showed that 72.4 percent of significant bacteriuria occurred among 25-34-year age group which is usually the active stage of sexual activities for most women. It has been noted that the probability of UTIs increases with gestational age (Okonko, Ijandipe, Ilusanya, Donbraye, Ejembi & Udeze 2009). This may, for instance, be explained by increased pressure of the pregnant uterus on the bladder leading to stasis of urine. Pregnancy and childbirth compel women to undergo processes that may expose them to UTI. For instance, higher parity may expose the woman to higher likelihood of contracting UTIs. Accessing standard healthcare is still an issue for a lot of women in developing countries due to limited knowledge and availability of qualified personnel and infrastructure. The available qualified personnel and infrastructure are sometimes beyond the affordability of majority of the women due to their low level of income and distance to orthodox health care facilities. Although government subsidises the healthcare services in such countries, it is not always available to some of the women. The consequence is that some of them engage in self-diagnosis and self-medication, utilisation of unapproved and ineffective traditional health practices, or patronise quack medical practitioners. Level of knowledge may be related to women’s knowledge of available standard medical facilities and personnel and the need to utilize them.

Project detailsContents
 
Number of Pages60 pages
Chapter one Introduction
Chapter two Literature review
Chapter three  methodology
Chapter  four  Data analysis
Chapter  five Summary,discussion & recommendations
ReferenceReference
QuestionnaireQuestionnaire
AppendixAppendix
Chapter summary1 to 5 chapters
Available documentPDF and MS-word format


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