Abstract

Introduction : Urinary tract infection is a common contagion among men and women but incidence is quite high among women due to their anatomy. The incidence of the infection is higher among sexually active women and the possibilities of encountering the infection after a sexual intercourse is higher. Identified risk factors for such infections include sexual activity, spermicide-based contraception, delayed postcoital micturition, and a history of previous UTIs.


OBJECTIVES :


1. To assess socio demographic factors among patients of urinary tract infection.


2. To assess risk factors contributing to urinary tract infection.


Material and methods :


Total 91 female patients, who were diagnosed to have urinary tract infection were selected in our study. Data regarding socio-demographic and various risk factors was collected and frequency distribution tables were prepared.


RESULTS : Majority females (68%) were between 18-45 years old. About 64% patients belonged to rural area, and 90% patients belong to lower, or lower middle class. About 68% patient’s education was below high school and about 74% patients were married. Among risk factors for UTI, we found that sexual activity (in 83%) was most common risk factor for UTI.


CONCLUSION: Patient who are exposed to risk factors, should be given special attention by the visiting clinicians, so that early diagnosis can be made and early treatment can be started. Early diagnosis and treatment leads to less complications, morbidities and mortality. 

Introduction

Urinary tract infection is a common contagion among men and women but incidence is quite high among women due to their anatomy.1 Reproductive physiology of females makes them more vulnerable to the infection and can occur through orifices, like the urethra, vaginal opening, perineum, anus which are known to dwell their own microbial flora.2 The incidence of the infection is higher among sexually active women and the possibilities of encountering the infection after a sexual intercourse is higher.3,4 The infection usually affects the various parts of the urinary tract and the infection generally initiates from the lower urinary tract which comprises of the bladder and urethra and the infection is referred to as cystitis. The advancement of the condition results in the spreading of infection to the upper urinary tract affecting kidneys and the condition is referred to as pyelonephritis.5 The symptoms associated with bladder and kidney infections are contrasting which includes painful and frequent urination in case of cystitis whereas conditions like high fever and flank pain are commonly experienced in case of pyelonephritis.6 Identified risk factors for such infections include sexual activity, spermicide-based contraception, delayed postcoital micturition, and a history of previous UTIs.7 Although the prevalence of bacteriuria during pregnancy is similar to that in non pregnant women, pregnancy enhances the possibility of infection among women.8,9

OBJECTIVES

  1. To assess socio demographic factors among patients of urinary tract infection.

  2. To assess risk factors contributing to urinary tract infection.

Material and methods

This study was conducted in Vindhya hospital & research centre Rewa. Total 91 female patients, who were diagnosed to have urinary tract infection (both from out patients department and in patients department) were selected in our cross sectional study. Data regarding socio-demographic and various risk factors was collected and frequency distribution tables were prepared.

RESULTS

Total 91 female patients, who were diagnosed to have urinary tract infection, were taken as study subjects. Among them majority (68%) were between 18-45 years old. About 64 % patients belonged to rural area, 90% patients belong to lower, or lower middle class. About 68% patient’s education was below high school and about 74% patients were married.

Among risk factors for UTI, we found that sexual activity (in 83%) was most common risk factor for UTI. 36% patients had past history of UTI. 15% patients were taking oral contraceptive pills. 12% patients had hypothyroidism, 11% patients had urinary incontinence, about 10% patients were diabetics. 18% females were post menopausal, and 5% patients were pregnant.

Table 1 Showing Socio-Demographic Factors Among Study Patients

Socio-demographic factors Frequency Percentage
Age (in years) <12 12-18 18-45 >45 04 08 62 17 4.3 8.7 68.1 18.9
Residence Urban Rural 33 58 36.2 63.8
Education Illiterate Primary Middle High Higher secondary Above higher secondary 11 13 20 18 16 13 12 14 22 20 18 14
Socioeconomic status ( for urban patients ) Upper class Upper middle Lower middle Lower class 03 06 35 47 03 06.5 39 51.5
Marital status Unmarried Married others 18 67 06 19.7 73.6 06.7

Table 2 Showing Risk Factors for UTI In Study Patients

Name of risk factors
Urolithiasis 12 13
Catheterization 04 4.3
Renal tumor 00 00
Diabetes 09 9.8
Hypertension 07 7.6
Hypothyroidism 11 12
Current Pregnancy 05 5.4
Non functional kidney 02 2.1
Urogenital surgery 06 6.5
Incontinence 10 11
Infection in other body organ 03 3.2
Post menopause 16 18
Previous history of UTI 33 36
Oral contraceptive use 14 15
No. of days with intercourse in past 7 days ( Sexual activity ) 0 1 2 3-7 15 30 31 15 16.2 33 34 16.4
Diaphragm and spermicide use 04 4.3

DISCUSSION

According to study done by Dielubanza, EJ et al10, in postmenopausal females estrogen level decreases, this leads to loss of protective  , and chances of getting UTI increases. Another study done by Goldstein, I et al11 showed that in postmenopausal women sometimes   can sometimes occur, which is also an important risk factor for recurrent urinary tract infections in postmenopausal females. In our study, in postmenopausal females UTI was noted in about 18% studied patients. In our study most common age group affected was between 18-45 years which is sexually active group. We found that sexual activity was most common risk factor associated with UTI, about 83% patients had history of intercourse in last 7 days of whom 33% patients had history of one intercourse in last 7 days, and more than 50% patients had history of 2 or more times intercourse in last 7 days. Similar findings were also observed in other studies.Nicolle LE12 has shown in his study that in young sexually active women, sexual activity is the cause of 75–90% of bladder infections, with the risk of infection related to the frequency of sex. A study by Scholes D,13et al found that Frequency of sexual intercourse is strongest risk factor for recurrent UTIs.

A strong impact of socioeconomic class was seen with UTI in our study as about 90% patients belonged to the lower middle or lower socioeconomic group. Similar findings were noted in study conducted by Haider G14 as 80 % UTIs cases belonged to lower socioeconomic status. In our study frequency of UTI in pregnancy was 5.4 %. Similar findings were shown in other study where the frequency of UTI during pregnancy was 2.5%-8.7%15. The hormonal changes in pregnancy leads to decreased bladder tone, diminished peristalsis and dilatation of renal pelvis and ureter16,17 It has been claimed that pregnancy produces physical obstruction in the female urinary tract and obstruction is one of the important risk factor for the development of the infection.18,19 Diabetics are at higher risk of urinary tract infection due to the unfavourable metabolic changes such as elevated blood sugar levels, which suppress the immune system. In our study 10% UTI patients were diabetics, similar findings was found in study by Ramzan M.20

CONCLUSION

Our study clearly shows that chances of urinary tract infection increase in the presence of risk factors. We recommend that the patient, who are having such risk factors, should be given special attention by the visiting clinicians, so that early diagnosis can be made and early treatment can be initiated to reduce morbidity and mortality.