Reducing the incidence of pregnancy-related urinary tract infection by improving the knowledge and preventive practices of pregnant women

Abstract

Objective

Pregnancy-related urinary tract infections (UTI) is the leading cause of obstetrical ward admissions and is responsible for poor maternal and perinatal outcomes. This study aimed to reduce the incidence of UTI by improving the knowledge and preventive practices of pregnant women through the implementation of a health education package.

Study Design

A health education package consisting of a seminar, sending of weekly text messages, and distribution of educational leaflets on UTI awareness and prevention was implemented in various rural health units in Pampanga, Philippines. A structured questionnaire was used to assess the pre- and post-intervention knowledge and preventive practices of pregnant women. Whereas, urinalysis results from the various rural health units were used to assess the incidence of UTI among the respondents.

Results

Significant improvement (p <  0.001) was observed regarding the participant’s knowledge and water intake after the intervention. Although there was no significant change (p =  0.16) in their hygiene statistically, all participants had improvements in hygiene practices after the intervention. The number of pregnant women who were positive for UTI also decreased significantly (p <  0.001) following the intervention.

Conclusion

The implemented health education package was able to reduce the incidence of pregnancy-related UTI by improving the knowledge and preventive practices of pregnant women.

Introduction

Urinary tract infection (UTI) refers to the unwanted proliferation of microbial pathogens within the urinary tract and is said to be the primary cause of health expenditure and morbidity among persons of all ages, causing over 1 million hospitalizations all over the world [1,2]. In the Philippines, UTI is the 4^th leading cause of morbidity among females, as stated in the Field Health Service Information System report of the Department of Health [3]. UTI can occur to anyone but is usually common among women [4]. Approximately one-third of adult women are diagnosed with UTI before the age of 24 [5].

UTI is reported to affect 20% of pregnant women and is the leading cause of obstetrical ward admission [6]. In a conducted study at the obstetrical ward of Khartoum North Hospital in Sudan, Africa, 20% of the pregnant women admitted were reported to be positive for UTI [7]. In a study done in California, the USA from 2007 to 2012, 2,892,756 women were included, of whom 140,910 (4.9%) had a diagnosis of a UTI related to an emergency visit or hospitalization during pregnancy [8]. UTIs are classified to be symptomatic or asymptomatic; reported among 17.9% and 13% of pregnant women, respectively [9]. Asymptomatic UTI among pregnant women can lead to complications, not only on women but as well as to the fetus. Several adverse perinatal outcomes like premature birth, low birth weight, and perinatal death have been implicated in pregnancy with UTI [9,10].

The occurrence of UTI is common during pregnancy due to the numerous physiologic and anatomic changes in a woman’s body [[11], [12], [13]]. Being a female itself is a risk factor due to reasons such as: having a short urethra, proximity of the vagina to the anus, and the inability to empty the bladder [14,15]. The proximity of the vagina to the anus could cause the transfer of fecal coliforms, which could result in UTI. Whereas, the urine of females have a more suitable pH for the growth of Escherichia coli compared to males [15,16]. Furthermore, glycosuria that develops during pregnancy also predisposes a woman to UTI since the environment is favorable for bacterial proliferation [11,17].

As the uterus expands in a pregnant woman, the increasing weight blocks the passage of urine from the bladder, therefore causing urine stasis, which in turn would cause the infection in the urinary tract. UTI among pregnant women, if left untreated, can lead to severe obstetrical complications, and poor maternal and perinatal outcomes [15]. Possible consequences of UTI in pregnancy include: undersized birth, abortion, hypertension, maternal anemia, preterm labor, thrombosis, chronic pyelonephritis, and phlebitis are related to UTI during pregnancy [18,19]. It can also lead to irreversible kidney damage, which results in renal failure and renal hypertension [15,18]. With the impending complications of pregnancy-related UTI, strategies should be done to reduce its incidence.

Proper health education, especially on different preventive practices, are some of the ways to reduce cases of pregnancy-related UTI. In line with this, a health education package that covers various techniques against UTI was implemented to determine the effects of the change in knowledge and preventive practices on the incidence of pregnancy-related UTI.