Introduction

Background of the study

Urinary tract infection are serious health problem,affecting millions of people

each year, also urinary tract infection is the second most common type of infection
in the body.Moreover about 8.3 million of patients are affected by UTIs each
year.Women are specially Vulnerable for reason that are are not yet well
understood.One woman in five develops UTI during her lifetime.

 stasis a major cause of UTI during pregnancy

 obstruction of the flow of urine caused by stone

 presence of foreign body such as indwelling bladder catheter

 a decrease in General Body resistance such as observed in malnourished

individual

 use of immunosuppressive drugs

 disease condition example diabetes

The pathological regions of UTI include arthritis inflammation of the urethra

cystitis inflammation of the bladder etc. Infection of the urinary tract foods other
parts at risk of infection.It has been recognised for sometime that asymptomatic
bacteriuria is common in pregnancy does women are increased risk of UTI risk.
UTI is a common problem around 8.3million pregnant women reported the cases
of urinary tract infection per year globally which is due to increase in size and
weight of the uterus that directly disturbs the normal mechanism of the bladder and
that causes the symptoms like; incomplete voiding, dribbling of urine, frequent
micturition. The common microorganism for urinary tract infection is the E. coli
that reported in 80% cases and other causes like streptococcus, staphylococcus and
urinary catheterization are also the main cause of UTI.
 Adequate antenatall care interventions contribute to reduce the
complications caused by UTI.during pregnancy performing Routine Urine test
during antenatal care in asymptomatic pregnant women,to identify and treat those
with a symptomatic bacteriuria benefits both these women and newborn.A
systematic review show that the treatment for asymptomatic bacteriuria produced
at the risk of Pyelonephritis and low birth weight although it did not influence
preterm birth rate is possible that many newborns have come from pregnant
women with UTI in adequately treated during prenatal care,and towards the
assessment of the education of management of UTI during antenatal care. This
approaches different women. According to Ministry of as it verify management
according to several joint dimensions which have not been observed in the
literature namely the assessment of health professional,health services and
pregnant Health recommendation the main hypothesis that the hell professional are
those largely responsible for the difficulties in providing adequate prenatal care
regarding UTI. Studies have suggested that if urinary tract infections are untreated
it can lead to complication such as pyelonephritis, low birth weight babies,
premature delivery and occasionally still birth. So a thorough knowledge regarding
urinary tract infection is needed to be provided among primigravida mothers. This
study aims to assess the existing level of knowledge among primigravida women
on Urinary tract infection and to find-out the association of level of knowledge on
urinary tract infection of primigravida women with their selected demographic
variables.
1.2NEED OF STUDY

“Education is the deliberate and systematic influence exerted by the mature

person upon the immature person through instruction, discipline and the
harmonious development of all the power of the human being”

- Redden and Ryan.

Urinary tract infection is more commonly seen in Antenatal.Ignorance about

the potential of this health hazard also constitutes a barrier that prevents the
initiation of preventive and remedial measures at appropriate time. Comparing to
the urban population most of the pregnant women belonging rural area are still not
aware about this. Previous history of urinary tract infection increases the chance of
recurrent infection by 50%, presence of asymptomatic bacteruria increases the
chance by 25%, and abnormality in the renal tract is found in about 25%. About 2-
10% of young women are susceptible to asymptomatic bacteruria in pregnancy on
routine screening. If not detected early and treated promptly, this infection
complicates 1-3% of all pregnancies.

According to 1997 survey, urinary tract infection accounted for nearly 7

million outpatient cases and 1 million emergency cases during pregnancy. It is
resulting in 0.1 million hospitalizations. As per the WHO report, 20 to 50% of
pregnant women will experience bacteruria in their pregnancy, 5 to 10 % of them
are getting expose in their 1st pregnancy.

A study was conducted to find out about maternal urinary tract infection is
independently associated with adverse pregnancy outcome. It was a retrospective
population based study. The result of the study was, out of 1,99,093 deliveries,
2.3% had urinary tract infection during pregnancy and delivery. Patients with
urinary tract infection had significantly higher rates of intra-uterine growth
retardation, pre-eclampsia, caesarean deliveries and pre-term deliveries.

      Studies have shown that urinary tract infection in pregnancy may result in
maternal and foetal morbidity. The pregnant woman should be educated, about the
physiological changes during pregnancy which may be one of the risk factors for
development of urinary tract infection and also its prevention. Regular antenatal
care should be taken to minimize the complications of pregnancy, and to ensure a
healthy maternal and foetal outcome.

Jain Philip conducted a descriptive study to assess the knowledge and

practice regarding urinary tract infection during pregnancy among 80 antenatal
mothers at Sreeramapuram antenatal clinic in Bangalore city. The overall mean
knowledge was 4.3%. SD was 15.2%. However, the range in the mean knowledge
was found to be between 31.3% to 69.4%. The study shows that a more than half
of respondents (57.5%) knowledge level was inadequate. The relationship between
knowledge and practice was found to be positive and significant. The result
establishes the fact that the higher the knowledge better is the practice of the
respondent in prevention of UTI.

The above study shows that the antenatal women have less knowledge
regarding urinary tract infection and its preventive measures. The investigator,
during her clinical experience in Bangalore came across many pregnant ladies
diagnosed with UTI and found that they have lack of knowledge regarding UTI &
its preventive measures. It was also noted that most of these cases were from rural
areas. Hence the investigator felt that there is a need to conduct a comparative
study on the basis of the knowledge and attitude of urban and rural pregnant
mothers towards preventive measures of Urinary tract infection. The study also
focuses to construct and distributeSelf-instructional module regarding UTI and its
prevention in pregnancy aiming to decrease its incidence among antenatal women.

1.3 STATEMENT

“A descriptive study to assess the knowledge and practice regarding UTI during
pregnancy among antenatal mother of selected hospital in indore.”

1.4OBJECTIVE

1. To assess the knowledge regarding U T I in pregnancy among the ante natal

mothers at selected hospital.

2. To find out the relationship between the knowledge regarding prevent of U

T I in pregnancy and attitude towards preventive measures of U T I in

pregnancy among ante natal mothers at selected hospital.
3. The aim of the study was estimate the frecuency of UTI among the studied

pregnant women and assess the risk factor of UTI among them.
4. This study aimed to determine the level of knowledge, attitude, and practice

on UTI among pregnant women attending the Hospital for antenatal

checkups.
5. To identify knowledge, attitude, and practice regarding treatment of UTI

among pregnant women.

6. To find the correlation between knowledge and attitude regarding Urinary

tract infection (UTI) and its prevention in pregnancy.

1.5 OPERATIONAL DEFINITIONS

1. Assess- Assess refers to process of the critical analysis, valuation and

judgement of the knowledge and attitude of antenatal mothers in urban and
rural areas regarding preventive measures of U T I in pregnancy.

2. Knowledge: In this study it refers to the awareness or familiarity regarding

preventive measures of U T I in pregnancy expressed by the antenatal
mothers in urban and rural areas as measured by a structured knowledge
questionnaire.

3. PracticeTo do or perform (something) repeatedly in order to acquire or polis
h a skill.

4. UTI- A urinary tract infection (UTI) is an infection that affects part of the

urinary tract.

5. Preventive measures:In this study these refers to some activities that are
performed by the antenatal mothers for retarding or hindering the occurrence
of U T I in pregnancy.

6. Antenatal mothers- In this study antenatal mothers refer to the women

those who are primigravidasor multiparas;going through three  trimester of
pregnancy.
 7. Urinary tract infection-.A urinary tract infection, or UTI, is an infection in
any part of your urinary system, which includes your kidneys, bladder, ureters,
and urethra.

8. Pregnancy-Pregnancy is the term used to describe the period in which a

fetus develops inside a woman's womb or uterus.

9. Antenatal-antenatal is the period before something is born. An example of

an antenatal period of time is the third trimester of a human pregnancy.

10. hospital- an institution providing medical and surgical treatment and

nursing care of sick or injured people

1.6 Hypothesis

 H1- there is significant association of knowledge and pratice of antenatal

mother regarding UTI.

 H2- there is significant knowledge regarding risk factor regarding UTI.

 H3- there is significant knowledge of preventive measures of UTI.

1.7Limitations-

1. The study is limited to the 30 antenatal mothers from selected hospital in

indore..
2. The study is limited to antenatal mothers those are in the first and second
trimester of pregnancy.
3. The study is limited to the antenatal mothers those are between the age of 20
to 35 years.
1.8Assumptions-
1. Antenatal mothers may have varying level of knowledge regarding U T I in
pregnancy that can be measured by a questionnaire.
2.Antenatal mothers exhibit both positive and negative attitude towards
preventive measures of U T I in pregnancy that can be measured by descriptive
method.

1.9Scope of study-
The result of study will check the existing knowledge of antenatal mother
regarding UTI.

1.10Ethical consideration-
1)Informed consent will be taken.
2)Their will be no harm of participants.

1.11Summary- in this chapter we dealt with background of the study,need of the

study,statement of study, objective, operational
definitions,hypothesis,limitations,scope, assumptions,scope, ethical consideration.

1.12Plan of the writing report

The following chapters are included in theresearch project-

CHAPTER-1: Dealt with background of the study,need of the study,statement of

study, objective, operational definitions,hypothesis,limitations,scope,assumptions,
scope, ethical consideration.

CHAPTER-2: Will deal with an review of literature for study.

CHAPTER-3: will deal with research methodology of the study which includes
approach, research designs,variables, setting, samples and sampling technique,
development of descriptive tool and procedure for analysis.

CHAPTER-4: will discuss data analysis and interpretation.

CHAPTER-5: will include recommendation and limitation of the study,followed

by references and appendices.
2.1 REVIEW OF LITERATURE

“learn to see the gift in the adversity. By doing this will begin to find true peace
in your struggle”

The review of literature entails systematic identification, location, scrutiny, and

summary of the written material that contains information relevant to the research
topic was done to gain insight and to collect maximum information for laying the
foundation of the study.

The review of literature is discussed under the following sections

Section 1 - Studies related to knowledge about of Urinary Tract Infection of

antenatal mother.

Section 2 - Studies related to knowledge about risk factors and complications of

Urinary Tract Infection of antenatal mother.

Section 3 - Studies related to knowledge of antenatal mothers regarding preventive

measures Urinary Tract Infection in pregnancy.

Section :-1 Studies related to knowledge about of Urinary Tract Infection of

antenatal mother

Marziyeh Amiri 2013 In this cross-sectional retrospective study, 1132 women

admitted to Dr. Ganjavian and Ayatollah Nabavi Hospitals in Dezful City, Iran,
during 2012 - 2013 were randomly allocated into the case and control groups and
were matched based on their age, numbers of pregnancy, sex and diseases of their
children. UTI was the only difference between the two groups.
Sirjana adhikari 2015: A descriptive research design was employed for the study
and data was collected through direct face to face interview schedule. Non
probability purposive sampling technique was used to select the sample of the
study.
Hala m shaheen 2016 A case–control study nested in a cross-sectional
investigation was carried out on 250 pregnant women who were attending Berket
El Sabae Family Health Center in Menoufia Governorate. Data were collected
from the first of September to the end of November 2014. Each participant was
assessed using a predesigned questionnaire, which included age, personal history,
occupation, present history, past history, obstetric history, and personal hygiene.
Urine sample was collected from the studied women for analysis. According to
history and urine analysis women were divided into two groups: group I had UTI
and group II did not have UTI.

Chandra bala sekharan 2017 An overall prevalence of 63.47% was

observed in this study. The prevalence of urinary tract infection  was
significantly higher in females aged 18-29 years (58.54%) and whose
marital status is single (53.66%). cross-sectional descriptive study was
conducted which employed quantitative methods of data collection to
determine the prevalence of urinary tract infection . The study population
was females in the age group of 6-50 years at Kinondoni district receiving
health services at Mwananyamala Hospital.

Pradna 2017:- The study was conducted on 119 pregnant women attending
antenatal clinic by purposive sampling technique. The structured questionnaire was
used to collect data. Results: the study revealed that 77.3 % women had Average
Knowledge and 22.7% of sample had Poor Knowledge. Regarding attitude 69.7%
had Positive Attitude and 30.3% shown Neutral Attitude towards Urinary tract
infection during pregnancy. This study concluded that knowledge enhancement
program related to UTI during pregnancy may change.

Sanjav kumar gupta 2017 Eligible participants were pregnant women attending
antenatal clinic of secondary care center of rural Haryana from March to May
2015. Consecutive sampling was done to select pregnant women. Interview
schedule was administered to the selected women, and midstream urine sample
was collected. Urine sample was plated on MacConkey agar, and colony count was
done using standard methods.A total of 1253 pregnant women were included in the
study. The proportion of women with symptoms of UTI on the basis of history was
33.3% (95% confidence interval [CI] - 30.7, 35.9), and UTI by colony count was
3.3% (95% CI - 2.4, 4.5). The presence of UTI was found to be significantly
associated with the presence of any symptom of UTI on multivariate analysis
Khushboo yadav2019 A cross-sectional descriptive study was conducted among
the pregnant women attending for antenatal care check upThe prevalence rate of
asymptomatic urinary tract infection (AUTI) among pregnant women was found to
be 42%. The highest number of UTI cases found during pregnancy was in between
age 21-25 years (52.22%), in second gravida (51.59%), during 3rd trimester of
pregnancy (49.68%) and in winter with 52.22%. E. coli was principal organism to
cause AUTI (35.48%) during pregnancy. Amikacin, imipenem and nalidixic acid
were effective towards Gram negative bacilli whereas vancomycin, tetracycline
and amoxyclav were effective towards Gram positive cocci.

Section 2 - Studies related to knowledge about risk factors and complications

of Urinary Tract

Hani faidah 2013 The aim of the current study was to assess different risk factors
that may influence the infection among pregnant women in Makkah, KSA.it is
descriptive study. A total of 200 pregnant women that visited maternity and
children hospital in makkah were investigated. Personal data as well as medical
history and some risk factors data were collected using a well structured
questionnaire. Midstream clean catch urine samples for urinalysis, and urine
culture were collected from all investigated cases for diagnosis of UTI. The results
revealed the presence of significant association between some investigated risk
factors and UTI in pregnant women. The risk factors that were recorded to
influence UTI among pregnant women in the current study including advanced
age, low educational level, multiparity, as well as unsatisfactory personal hygiene.
Moreover, diabetic condition, using IUD as contraceptives and using panties of
silky materials are among the influencing factors. In conclusion, extreme care has
to be taken by pregnant women in particular and women in general towards
personal hygiene, type of contraceptives and type of panties materials. In addition,
diabetic condition should be avoided or controlled in order to decrease the risk of
UTI.

Tazebew Emiru,2013 A cross sectional study was done on antenatal mother, total
of 367 pregnant women with and without symptoms of urinary tract infection(UTI)
were included as a study subject from January 2011 to April 2011. Midstream
urine samples were collected and processed following standard bacteriological
tests. Data concerning associated risk factors were collected using structured
questionnaires and were processed and analyzed using Statistical Package for
Social Science.

Charlotte Tchente Nguefack 2015 A cross-sectional study was conducted in 3

hospitals of Douala from January to April 2015. We consecutively recruited all
consented pregnant women aged 18 years and above attending antenatal clinics.
Socio-demographic characteristics, medical and obstetrical past history, clinical
signs and obstetric characteristics of the index pregnancy were collected.
Thereafter, urine were collected aseptically and subjected to routine macroscopy,
microscopy examination and culture. The culture was obtained by inoculation of
10 μl of urine Single urine samples were collected from a total of 354 pregnant
women. Of the 354 pregnant women tested, 35 had significant bacteriuria giving a
prevalence of 9.9%.

Annalyn Navarro2019 This study used an analytic cross-sectional design that

examined the KAP and beliefs of pregnant women about UTI based on the Health
Belief Model (HBM) constructs. The prevalence of UTI among pregnant women
was identified. Correlational analysis was also used to determine the association
between the sociodemographic factors and the prevalence of UTI and the KAP of
pregnant women. A total of 345 pregnant women from different RHUs and district
hospital in Pampanga, the Philippines, were recruited to participate in the study.
The prevalence rate observed among pregnant women was 35.94% (124/345).
Table 1 shows the sociodemographic characteristics of the respondents, who tested
positive and negative for UTI based on the diagnostic procedure of the rural health
centers and district hospital covered in the study.

Section 3: Studies related to knowledge of antenatal mothers regarding

preventive measures Urinary Tract Infection in pregnancy.

Dr gyan prakash tandi 2016 A prospective cross sectional observational

type. A total of 200 patients with suspected case of UTIs, majority belonged to age
group 26-35 years (47%) followed by 18-25 years (35%) and >45years (18%)
respectively. In our study 42% patients who were in III trimester associated with
UTIs, while who were in II trimester 37% and 21% in I trimester respectively. In
this study majority of pregnant women of UTIs were belonged to 3rd gravida
(40%) followed by 2nd gravida (28%), 1st gravida (20%) and >3rd gravida (12%)
respectively. In our study 84% women had past history of UTI. In our study most
of pregnant women were in low socioeconomic class (46%) as compared to middle
(37%) and high (17%) socioeconomic class. In present study 67% of the patients
were illiterate while 33% were literate. Incidence of UTI was more common in
illiterate due to their low level of education and poor hygiene.

Mafuyai Joseph Mangai 2019 A descriptive survey was adopted to assess the
knowledge and prevention measures of urinary tract infection among female
students resident in University of Jos hostels in which questionnaire was used to
gather relevant data. of Jos female residence; Village and Zion hostels are
accommodation facilities meant to shelter students during their period of stay in
the institution. The sample size was calculated using percentage method. There is
no significant relationship between the knowledge of urinary tract infection and the
prevention practices

BIKORIMANA JEAN PIERRE 2018 sAn explanatory-analytic study was

conducted in 120 pregnant women who referred to the health and treatment at
Gitwe hospital. The tool used for data collection was a multiple choice
questionnaire consisting of demographic information, knowledge, attitude and self-
efficacy. The validity and reliability of the questionnaire had been studied before
the investigation. Analysis of the data was conducted, using SPSS software.
RESEARCH METHODOLOGY

INTRODUCTION

Methodology is the systematic, theoretical analysis of the methods applied to a

field of study. It comprises the theoretical analysis of the body of methods and
principles associated with a branch of knowledge. Typically, it encompasses
concepts such as paradigm, theoretical model, phases and quantitative or
qualitative techniques.
A methodology does not set out to provide solutions—it is therefore, not the same
as a method. Instead, a methodology offers the theoretical underpinning for
understanding which method, set of methods or can be applied to a specific case,
for example, to calculate a specific result.

the chapter describe the method adopted for the study to assess the knowledge of
antenatal mother regarding UTI at selected hospital indore.
this chapter deal with the description of methodology and different steps which are
taken for gathering an organizing the data for investigation.it includes the
development of information structure survey method procedure for data collection
and plans for data analysis for assessment of knowledge of antenatal mother
regarding UTI.

RESEARCH APPROACH:

 Research approach is a plan and procedure that consists of the steps of

broad assumptions to detailed method of data collection, analysis and
interpretation. It is therefore, based on the nature of the research problem
being addressed.

 the overall decision involves which approach should be useed to study a

topic. informin this decision should be the philosophical assumptions the
researcher brings to the study,procedures of enquiry(called research desings ,
and specefic research methods of data collection, analysis,and interpretation.
  A reseach approach tells the researcher as to what data is collect and how
to analyze.

RESEARCH DESIGN

Research design is the framework of research methods and techniques chosen by a

researcher. The design allows researchers to hone in on research methods that are
suitable for the subject matter and set up their studies up for success.

Research design is the arrangement of the condition or the collection of analysis of

data in a manner that aim to combine the research purpose with economy of
procedure.

The research design is s elected for this study is survey method in which the
opinion of the specefic population regarding UTI.

SETTING OF THE STUDY

The research setting is the location where the research takes place.

The setting for the present study is OPD ward of shree Indore Coth Market
Hospital, indore.

POPULATION

Population is reffered as thethe totality or aggregate of element showing some

common setoff criteria, it includes anything in totality.

In this study population refer to antenatal mother.

Target population

According to Polit and Beck (2008) The entire population in which the rsearcher is
interested and to which he or would like to generalize the results is called as target
population.
Accessible population

According to polit And Beck(2008)the portion of the target population which is

conveniently accessible to the investigator is called as accessible population.

SAMPLE

A sample is a subset of population selected to participate in research study.

(polit and hungler,1995).

The samples of this study are the patients who were visiting OPD for antenatal
checkupin Shree Indore Cloth Market Hospital.

SAMPLE SIZE

Sample size is a term used in research for defining the number of subjects included
as a sample.

SAMPLING TECHNIQUE

Sampling technique is the name or other identification of the specific process by

which entites of the sample have been selected.

In this study the samples were selected through non probability purposive sampling
technique . the limited time and and availability of the subjects as per the sample
inclusion criteria made the investigator to adopt this sampling technique for present
study.

 Inclusion criteria

 Those patients who were attending antenatal checkup at Shree Cloth Market
Hospital , Indore,(M.P.).
 Patients who wee willing to participate in the study.
 Patient who were oriented to date, place, and time .
  Patient who did not have any hearing or cognitive impairment.
 Patient who were present during the period of data collection.
 Patient who were able to read and understand either hindi or English or both.
 Patient who is able to cooperate with investigator.

 Exclusion criteria

 Those patient who were not willing to participate in study.

 Patient who were came not attending for antenatal checkup only.
 Patient who were not present at the time of data collection.
 Patient who did not come in inclusion criteria.

TOOL PREPRATION

A knowledge questionnaire was developed to assess the knowledge and practice.

For the selection of the items and development of the following steps were
followed:

1)Review of literature related to assess the knowledge and practice of antenatal

mother regarding UTI.

2)Consultation of experts.

DEVELOPMENT OF TOOL

The tool was developed after updating the basic theoratical knowledge. Necessary
literature related to knowledge and practice of antenatal mother regarding UTI was
reviewed for this purpose. The investigator’s own experience,theoretical
knowledge and guidance from the expert along with the review of literature helped
in developing the tool necessary for the study.

The tool used by the researcher consisted of two parts-

Part I:- Demographic perfoma.

Part II:- Questionnaire of assessing the knowledge and practice of antenatal
mother regarding UTI.
Part I Demographic Perfoma :

This part assessed the demographic variables likeage,sex,education,religion,

mother tongue, marital status,residence and types of family.

Part II structured questionnaire on knowledge and practice of antenatal

mother regarding UTI.

The tool contained 30 questions of which all were multiple choice questions,each
carrying one mark.

In this part 06 question were formed on introduction of UTI,06 questions were on

causes of UTI ,06 questions were based on sign and symptoms of UTI,06 were
based of management and prevention of UTI,06 questions were based on
complication of UTI.
 sNo.of
S. no part sub part Score
questions