Preventive Measures Of Urinary Tract Infection Among Nursing And Midwifery Students: A Study At Bayelsa College Of Nursing Sciences

Project and Seminar Material for Nursing (Science)

Preventive Measures Of Urinary Tract Infection Among Nursing And Midwifery Students: A Study At Bayelsa College Of Nursing Sciences (Daniel)

Abstract

Urinary tract infection (UTI) represents a serious health problem among nursing and midwifery students. The severity of urinary tract infection depends both on the virulence of the bacteria and the susceptibility of the host. The aim of this study was to determine the prevalence of urinary tract infection and demographic differentials among nursing and midwifery students. The objectives were to determine the proportion of women who have UTI, identify the common causative organism and to determine difference in UTI occurrence among nursing and midwifery students based on demographic variables. Two hundred and twenty five nursing and midwifery students were investigated. Personal data were collected using a structured questionnaire. Early morning midstream clean urine samples were collected from all participants who were willing to participate for diagnosis of UTI. Urine samples were cultured using standard loop technique on blood agar, cystein lactose electrolyte deficient medium agar and macconkey agar. The result revealed that a total of 117 (52%) out of the 225 women had UTI. The organism most implicated was E. Coli (30.7%). From the findings it was concluded that UTI occur in adolescent, affecting older women and those with more number of children. Screening for UTI is important in every adolescent to reduce the incidence of low birth weight and prematurity and to also improve maternal and child health.

Table of Content

Title Page
Certification
Dedication
Acknowledgement
Table of Content
List of Tables
Abstract

Chapter One:

Introduction

1.1 Background of the Study
1.2 Statement of the Problem
1.3 Objective of the Study
1.4 Research Questions
1.5 Research Hypothesis
1.6 Significance of the Study
1.7 Scope of the Study
1.8 Limitation of the Study
1.9 Definition of Terms
1.10 Organisations of the Study

Chapter Two:

Review of Literature

2.1 Conceptual Framework
2.2 Theoretical Framework
2.3 Empirical Review

Chapter Three:

Research Methodology

3.1 Research Design
3.2 Population of the Study
3.3 Sample Size Determination
3.4 Sample Size Selection Technique and Procedure
3.5 Research Instrument and Administration
3.6 Method of Data Collection
3.7 Method of Data Analysis
3.8 Validity of the Study
3.9 Reliability of the Study
3.10 Ethical Consideration

Chapter Four:

Data Presentation and Analysis

4.1 Data Presentation
4.2 Analysis of Data
4.3 Answering Research Questions
4.4 Test of Hypotheses

Chapter Five:

Summary, Conclusion and Recommendation

5.1 Summary
5.2 Conclusion
5.3 Recommendation
REFERENCES
APPENDIX
QUESTIONNAIRE

Chapter One

Introduction

1.1 Background to the Study

Urinary tract infections (UTIs) during adolescent are among the most common health problems afflicting many women in their reproductive years (Wamalma, Onolo, & Makokha, 2013). nursing and midwifery students 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 adolescent 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 nursing and midwifery students 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 adolescent 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 adolescent 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 adolescent and they include the reduced ability of the kidneys to concentrate urine, leading to differences in urine ph and osmolality of urine in adolescent, 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. adolescent 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.

Understanding the factors that increase UTI in adolescent is fundamental to reducing and improving maternal health in adolescent. Based on this, it is important to investigate the preventive measures of urinary tract infection among nursing and midwifery students: a study at Bayelsa college of nursing sciences.

1.2 Statement of the Problem

UTI in adolescent leads to poor adolescent outcome. According to Haider, Zehr, Munir, and Haider (2010), the prevalence of UTIs in adolescent globally ranges from 13%-33% with asymptomatic bacteriuria occurring in 2-10% during pregnancies while symptomatic has been found to account for 1-18% during pregnancies. UTI in adolescent is a serious problem with complications such as prematurity and low birth weight. Prematurity and low birth weights are associated with poor infant survival.

Currently in Enugu State, in line with the sustainable development goals (SDGs no 3) which is to ensure healthy lives and promote well-being for all ages, urinalysis is one of the basic laboratory tests done in the first antenatal visit. This is to detect and treat UTI early in adolescent or reduce it to the barest minimum and to reduce the chances of prematurity and low birth weight which are linked with infant mortality. In spite of this effort the incidence of UTI is still common among nursing and midwifery students who attend ante-natal clinic at University of Nigeria Teaching Hospital (UNTH) ituku ozalla. From records available in University of Nigeria Teaching Hospital, Enugu, between June and September 2013, out of 300 nursing and midwifery students who were treated of different ailments, 25 were diagnosed of UTI, representing 8 percent of the population that had problem in adolescent (UNTH records). The questions being raised are, Is the problem due to maternal age, gestational age, parity, economic status and level of education or due to combination of these factors? There is need to identify the demographic factors which increase the occurrence of UTI in adolescent.

1.3 Objective of the Study

The objective of this study was to determine the preventive measures of urinary tract infection among nursing and midwifery students: a study at Bayelsa college of nursing sciences. the specific Objectives of the study are to:

Determine the proportion of students who has UTI among nursing and midwifery students
Identify the common causal organisms of UTI among nursing and midwifery students
Determine the differences in UTI occurrence among nursing and midwifery students based on parity

1.4 Research Question

What is the proportion of students who has UTI among nursing and midwifery students ?
What is the common causal organisms of UTI among nursing and midwifery students ?
What is the differences in UTI occurrence among nursing and midwifery students based on gender?
What is the differences in UTI occurrence among nursing and midwifery students based on age ?

1.5 Research Hypotheses

Ho: There would be no significant difference UTI among nursing and midwifery students based on their demographic differentials.

1.6 Significance of the Study

The nursing and midwifery students will benefit from the findings of this study. If the demographics are associated with UTI in nursing and midwifery students, the finding will reveal the particular demographics of nursing and midwifery students that influence UTI. The information will help nurses and other health care providers to know the group of nursing and midwifery students that are more vulnerable.

Also the information from the findings will help the hospital policy makers or stakeholders to know the factors affecting UTI and help to improve on their strategies towards reducing the incidence of UTI. Such practices may reduce UTI problems in adolescent; reduce the risk of premature delivery; and improve women’s health. On the other hand if UTI among nursing and midwifery students is not associated demographic differences, this study will make room for other studies to be conducted to improve maternal and child health.

1.7 Scope of the Study

This study is delimited to bayelsa college of nursing sciences. The study is also delimited to the investigation of demographic differences (age, gender, economic status and educational level) in UTI occurrence and prevention among nursing and midwifery students.

1.8 Limitation of the Study

In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, language barriers, and the attitude of the respondents. However, the researcher were able to manage these just to ensure the success of this study.

1.9 Definition of Terms

Urinary Tract Infection refer to the presence of bacteria in the urine. Urine samples of nursing and midwifery students will be collected and cultured within 24hours using standard loop technique on blood agar,cystein lactose electrolyte deficient (CLED) medium agar and macconkey agar in laboratory. UTI will be established if the urine sample counts greater or equals to 100,000 of bacteria per ml of urine.
Demographic differentials used in this study are age, gender and economic status that may be associated with the occurrence of urinary tract infection.

1.10 Organization of the Study

This research work is organized in five chapters, for easy understanding, as follows.

Chapter one is concern with the introduction, which consist of the (overview, of the study), historical background, statement of problem, objectives of the study, research hypotheses, significance of the study, scope and limitation of the study, definition of terms and historical background of the study.
Chapter two highlights the theoretical framework on which the study is based, thus the review of related literature.
Chapter three deals on the research design and methodology adopted in the study.
Chapter four concentrate on the data collection and analysis and presentation of finding.
Chapter five gives summary, conclusion, and recommendations made of the study.

Chapter Five

Summary, Conclusions and Recommendations:

5.1 Introduction

This chapter summarizes the findings on the preventive measures of urinary tract infection among nursing and midwifery students: a study at bayelsa college of nursing sciences. The chapter consists of summary of the study, conclusions, and recommendations.

5.2 Summary of the Study

In this study, our focus was on the preventive measures of urinary tract infection among nursing and midwifery students: a study at bayelsa college of nursing sciences.

The major findings in the study include:

More than half, 52 percent, of the respondents have had urinary tract infection.
The most common organism of urinary tract infections were E. Coli, Klebsiella, Staphyloccocus Aureus, and Pseudomonas Aeruginosa.
There was a significant difference between age and occurrence of UTI (P<.05).
There was a significant difference between gender and occurrence of UTI among nursing and midwifery students (P<.05). 5. There was no significant difference between gestational age and occurrence of UTI among nursing and midwifery students 6. There was no significant difference between maternal level of education and occurrence of UTI among nursing and midwifery students (P>.05).
There was also no significant difference between maternal economic status and occurrence of UTI among nursing and midwifery students (P>.05).

5.3 Conclusions

With respect to the analysis and the findings of this study, the following conclusions emerged;

UTI occur in adolescent, since 117(52%) nursing and midwifery students had UTI and the organism most implicated was E.coli 69(30.7%).
Higher parity is significantly associated with urinary tract infection among nursing and midwifery students(p < 0.05) 3. Age is significantly associated with urinary tract infection among antenatal women. 4. level of education and economic status were not significantly associated with urinary tract infection among antenatal women (P >.05)..

5.4 Recommendation

Based on the findings the researcher recommends that;

Students should endeavour to register antenatal in health facilities where they will be screened.

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