PREVALENCE AND CONTRIBUTING FACTORS OF URINARY TRACT

INFECTIONS AMONG PREGNANT WOMEN: IN THE CASE OF ARADA

SUB CITY OF ADDIS ABABA CITY ADMINISTRATION
By:

Aynadis Gesese

ID. No

Under the supervision of: Zemichael Gizaw (PhD)

A Thesis submitted to Department of Public Health, Addis Ababa Medical and

Business College, Research and Publication office in partial fulfillment for the
requirement for the Award of the Degree of Masters of Public Health.

October / 2023

ADDIS ABABA, ETHIOPIA

I
DECLARATION

I hereby declare that this thesis, entitled “Prevalence and Contributing Factors of Urinary
Tract Infections among Pregnant Women: In the Case of Arada Sub-City of Addis Ababa
City Administration”, has been carried out by me under the guidance and supervision of
Zemichael Gizaw (Ph.D.). The thesis is original and has not been submitted for the award of any
degree or diploma to any university or institution.

Researcher’s Name Signature Date

_________________________ __________________ _______________

I
STATEMENT OF CERTIFICATION

This is to certify that this study entitled Prevalence and Contributing Factors of Urinary
Tract Infections Among Pregnant Women: In the Case of Arada Sub-city of Addis Ababa
City Administration”, undertaken by Aynadis Gesese in impartial fulfillment of the
requirement for the award of the Degree of Masters of Public Health from the Department of
Public Health, Addis Ababa Medical and Business College, Research and Publication Office, is
an original work and not submitted before any degree either at this college or any other
university.

Advisor name Signature Date

_________________________ __________________ _______________

II
 APPROVAL OF THESIS AFTER DEFENSE

Addis Abeba Medical and Business College

Department of Public Health

As members of the board of examiners, we examined this thesis entitled “Prevalence and
Contributing Factors of Urinary Tract Infections among Pregnant Women: In the Case of
Arada Sub-City of Addis Ababa City Administration by Aynadis Gesese. We hereby certify
that the thesis is accepted for fulfilling the requirements for the award of the degree of “Masters
of Public Health.”

Board of Examiners

Main Adviser’s Name: Signature Date

_____________________________________ __________________

External examiner: Name Signature Date

____________________ ________________ ________________

Internal examiner: Name Signature Date

_______________________________________________________

III
ACKNOWLEDGEMENT

First and foremost, I would like to thank God for giving me the strength to go through this. The
study was done with the support and efforts of lots of people. I would like to express my
gratitude and appreciation for the support and contribution of everyone who assisted me during
this thesis. I would like to offer my thanks to my advisor, Zemichael Gizaw (Ph.D.), for his
guidance and fast responses to my queries. I am endowed to thank the management and
employees of the Addis Ababa City Administration of Health Bureau, Arada Sub-City Health
Office, Arada, Semen, Janmeda, and Aware health centers who have permitted me to make the
study and showed interest by dedicating their time to filling out the questionnaires, which is the
foremost reason I am able to finalize the study.

IV
TABLE OF CONTENTS

DECLARATION............................................................................................................................................................................. I
Statement of Certification...................................................................................................................................................II
Approval of Thesis After Defense.................................................................................................................................III
Acknowledgement................................................................................................................................................................. IV
List of TABLES.......................................................................................................................................................................... VII
List of figures........................................................................................................................................................................... VIII
Acronyms.................................................................................................................................................................................... IX
Abstract......................................................................................................................................................................................... X
chapter one: Introduction...................................................................................................................................................1
1.1. BACKGROUND of the study............................................................................................................................................1
1.2. STATEMENT of the problem....................................................................................................................................2
1.3. SIGNIFICANCE of the study................................................................................................................................. 3
1.4. Objective of the study................................................................................................................................................. 4
1.4.1 General objective..................................................................................................................................................... 4
1.4.2 Specific objectives...................................................................................................................................................4
1.5. Research questions.......................................................................................................................................................4
1.6. DELIMITATION OF THE STUDY ...........................................................................................................5
1.8 OPERATIONAL Definition of Terms..................................................................................................................7
1.9. ORGANIZATION of the Study.............................................................................................................................7
Chapter Two.................................................................................................................................................................................. 8
REVIEW OF RELATED LITERATURE................................................................................................................................. 8
2.1. Introduction.................................................................................................................................................................. 8
2.2. HISTORICAL background...........................................................................................................................................8
2.3. Theoretical Review.............................................................................................................................................. 9
2.4. PREVALENCE of urinary tract infection.....................................................................................................10
2.5. Contributing factorsurinary tract infections.................................................................................................13
2.5.1. Age............................................................................................................................................................................ 13
2.5.4. Obstetric factors.................................................................................................................................................13
2.7.conceptual framework...............................................................................................................................................15
Chapter three............................................................................................................................................................................. 17
research Methdology.............................................................................................................................................................. 17
3.1 Introduction................................................................................................................................................................ 17
3.2. Description of the Study Area...............................................................................................................................17

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 3.3. Study Design................................................................................................................................................................. 18
3.4. Inclusion and exclusion criteria.....................................................................................................................18
3.4.1. Inclusion criteria................................................................................................................................................ 18
3.4.2. Exclusion criteria...............................................................................................................................................18
3.5. POPULATION and Sampling Design...................................................................................................................19
3.5.1 Population.............................................................................................................................................................. 19
3.5.2 Sampling Design.................................................................................................................................................. 19
3.5.3. Sampling Frame..................................................................................................................................................19
3.5.4. Sampling technique...........................................................................................................................................19
3.5.5. Sample size........................................................................................................................................................... 19
3.6. Data Collection Methods........................................................................................................................................... 21
3.7 Research Procedures.....................................................................................................................................................21
3.8 Reliability and Validity Assurance..........................................................................................................................21
3.8.1 Reliability................................................................................................................................................................ 21
3.8.2 Validity..................................................................................................................................................................... 22
3.9. Data Analysis Methods...............................................................................................................................................22
3.10. Ethical Issues............................................................................................................................................................... 22
CHAPTER FOUR........................................................................................................................................................................ 23
RESULTS AND DISCUSSION.................................................................................................................................................23
4.1 Response Rate............................................................................................................................................................... 23
4.2 Demographic Characteristics of the Respondents........................................................................................23
4.4. CONTRIBUTING factors of urinary tract infections (UTIs)......................................................................31
4.5. Effective prevention and treatment strategies for urinary tract infections (UTIs).......................41
CHAPTER FIVE.......................................................................................................................................................................... 46
SUMMARY OF FINDING, CONCLUSION AND RECOMMENDATIONS.................................................................46
5.1 Summary of Major Findings..................................................................................................................................46
5.2 Conclusion...................................................................................................................................................................... 50
5.3 Recommendations....................................................................................................................................................... 51
5.4. Further Research.....................................................................................................................................................52
References................................................................................................................................................................................... 53
Appendixies................................................................................................................................................................................ 55

VI
LIST OF TABLES

Table.
3. 1. Distribution of sample 20

Table 4 1. Response Rate...............................................................................................................23

Table 4. 2. Demographic Characteristics of the Respondents.......................................................24
Table 4. 3. The prevalence of urinary tract infections (UTIs........................................................28
Table 4. 4. Behavioral factors........................................................................................................31
Table 4. 5. Medical history............................................................................................................35
Table 4. 6. UTI-Related Factors....................................................................................................38
Table 4. 7. knowledge and awareness...........................................................................................40
Table 4 8.Hygiene Practices:.........................................................................................................41

VII
LIST OF FIGURES
Figure 2. 1 Conceptual Framework................................................................................................................................. 16

VIII
ACRONYMS

AIDS: Acquired Immune Deficiency Syndrome

ANC: Antenatal Care

CS: Caesarian Section

DM: Diabètes Mellites

E. Coli: Escherichia coli

GA: Gestational Age

HIV: Human Immune Deficiency Virus

HTN: Hypertension

Lab: Laboratory

LNMP: Last normal menstrual period

MOH: Ministry of health

RVF: Rectovaginal fistula

SPSS: Statistical package for social science

SVD: Spontaneous Vaginal Delivery

UTI: Urinary Tract Infection

Tel: Telephone

VVF: Vesicovaginal fistula

WHO: World Health Organization

WOA: Weeks of amenorrhea.

IX
ABSTRACT

Background: Urinary tract infections (UTIs) are a common concern during pregnancy, potentially
leading to adverse maternal and fetal outcomes.

Research gaps: The reasonably high prevalence of urinary tract infection in pregnancy and its
consequences on women and their pregnancies prompted Ethiopia's Ministry of Health to include
screening for and treatment of urinary tract infection in pregnancy in the standard obstetrics program
(MOH, 2010). However, the prevalence and contributing factors of UTIs in this population are not well
understood.

Objectives: The main objective of this study was to determine the prevalence and contributing factors of
urinary tract infections (UTIs) among pregnant women in the Arada sub-city, Addis Ababa, Ethiopia.

Methods: A health facility-based cross-sectional research design has been employed by using both
qualitative and quantitative approaches. The total population size was 1032 among these 288 randomly
selected pregnant women. The data gathered from the questionnaires was compiled using SPSS version
25 software and analyzed using descriptive statistics, frequency, and percentages. The result of the
analysis was presented using tables.

Results: The study found that a significant number of pregnant women are diagnosed with UTIs, some
experiencing recurrent infections. Most women with UTIs do not show noticeable symptoms. Treatment
rates varied, posing risks to both mother and fetus. Hydration habits and timely bathroom visits were
concerns. Sexual activity during pregnancy and pre-existing medical conditions were noted. Awareness of
UTI prevention and education from healthcare providers varied. Proper hygiene practices were generally
followed. Access to private toilets varied. High-risk sexual behaviors were reported by a small
percentage. The study highlights the need for improved diagnosis, treatment, and preventive measures for
UTIs in pregnant women.

Conclusion: The study findings underscore the significant prevalence of UTIs among pregnant women
and the importance of addressing this health issue. The study highlights the need for increased
awareness, education, and access to timely diagnosis and treatment of UTIs during pregnancy. The
findings also acknowledge the positive aspects of healthcare provider education, proper hygiene

X
practices, and adherence to recommended guidelines. Overall, the study contributes to the ongoing
efforts to enhance the health and well-being of pregnant women by addressing UTIs effectively.

Recommendation: To mitigate the impact of UTIs on pregnant women, routine screening for
asymptomatic bacteriuria and prompt treatment of UTIs are recommended. Health education programs
focusing on hygiene practices, adequate fluid intake, and safe sexual practices can also play a crucial
role in prevention.

Further research is needed to explore the specific factors contributing to the high prevalence of UTIs
among pregnant women in their late twenties. Investigate the effectiveness of educational interventions
and preventive strategies in reducing UTI incidence during pregnancy.

Keywords: Urinary Tract Infections, UTIs, Prevalence, Pregnant Women, Contributing

Factors, Asymptomatic Bacteriuria, Hygiene Practices, Prenatal Care.

XI
 CHAPTER ONE: INTRODUCTION

1.1. BACKGROUND OF THE STUDY

Urinary tract infection (UTI) is the most common disorder caused by bacterial agents in
pregnancy, which can lead to important complications in newborns of such mothers in cases of
inappropriate diagnosis and treatment. Urinary tract infection is a major health problem; it has
been reported among 20% of pregnant women, and it is the most common cause of admission in
obstetrical wards (J. Bakastet et al., 2005). Symptomatic and asymptomatic bacteriuria has been
reported among 17.9% and 13.0% of pregnant women, respectively (A. Masindeet al., 2009).

Globally, urinary tract infections and their associated problems are the cause of nearly 150
million deaths per year. The disease can progress in 40–50% of women (Totsika et al., 2012).
The prevalence of urinary tract infections in pregnancy ranges from 13–33%, with asymptomatic
bacteriuria occurring in 2–10%. Asymptomatic bacteriuria is now a recognized entity in the
range of urinary tract infections (Agersewet et al., 2012). Asymptomatic urinary tract infection is
the separation of a number of bacteria in a suitably collected urine sample obtained from a
person with no symptoms or signs of urinary tract infection (Nicolle et al., 2015).

According to studies done in Tanzania, the prevalence of urinary tract infections among pregnant
women was 15.5% (Masinde et al., 2009) and 13.3% in Uganda (Andabati and Byomugisha,
2010). Similar studies done in Sudan revealed the prevalence to be 14% (Hamdan et al., 2011).
Antepartum urinary tract infection has been found to be associated with poor per-natal outcomes
and adverse obstetric impediments. Furthermore, it has been observed that asymptomatic
bacteriuria can lead to cystitis and pyelonephritis, which can lead to acute respiratory distress,
transient renal failure, sepsis, and shock during pregnancy (Hamdan, Z.; et al., 2011). Screening
for and treatment of urinary tract infections in pregnancy has become a standard of obstetric care
(MOH, 2010).

The prevalence of UTI in pregnancy shows a global range of 13%–33%, with symptomatic
bacteriuria occurring in 1%–18% of women and asymptomatic cases in 2%–10% of women. The
prevalence reported in Tanzania was 15.5%, but higher than those in studies from Ethiopia
(10.4%) and Uganda (13.3%). This was; however, lower than the prevalence of 31.3% reported

1
in Egypt. Variations in prevalence rates from one country to another and among different regions
of the continent can be attributed to the environmental, economic, and social habits of a
community (Sabatini, 2015). The prevalence has remained constant, and most of the recent
observational studies, including those from developing countries, report almost similar rates.

1.2. STATEMENT OF THE PROBLEM

In sub-Saharan countries like Ethiopia, UTIs are among the most common health problems
affecting women in their reproductive years. Pregnant women are more susceptible to UTIs due
to a combination of hormonal and physiologic changes that predispose them to bacteriuria. The
incidence of acute pyelonephritis in pregnant women has also significantly increased. Factors
such as history of recurrent urinary tract infection, diabetes, low social economic status,
increasing maternal age, multiparty, and anatomical abnormalities of the urinary tract have also
been associated with a twofold increase in bacteriuria during pregnancy, but the risk factors
associated with UTI in Africa remain poorly investigated (Schnaret al., 2014).

Due to the above factors, there are many different risk factors that are the leading causes of
urinary tract infections. Under normal circumstances, the urine is sterile until it reaches the distal
urethra. Some of these are: sex, age, pregnancy, catheterization, kidney stones, tumors, urethral
strictures, neurological diseases, congenital or acquired anomalies of the bladder, vesico-ureteric
reflux, suppressed immune system, diabetes mellitus, enlarged prostate, ureteric stresses, etc.
(Delzell, 2014).

Generally, there are many intrinsic and extrinsic risk factors that are the leading causes of urinary
tract infection. This study will be conducted to assess factors of urinary tract infection in the case
of Addis Ababa city, Arada subcity, and a selected health center among pregnant women.

Urinary tract infection is a health problem that affects women, especially during the pregnancy
period, and it is one of the leading causes of miscarriages, premature births, and the
underdevelopment of infants. Early treatment of infection reduces the probability of
complications, which may be very dangerous to the mother and the fetus, particularly in low-
income countries (Delzell, 2014).

Globally, the prevalence of urinary tract infections in pregnancy is 1.9–9.5%. Tanzania accounts
for 13% and Ethiopia for 10.4% (Sabatini, 2015). This could be due to the apparent fall in the

2
immunity of pregnant women (Nicolle et al., 2010). Asymptomatic bacteria show the vigorous
reproduction of bacteria in the urinary tract (WHO, 2014). About 10% of those with
asymptomatic bacteria develop symptomatic bacteria in their urine during pregnancy (Bailey,
2012).

The reasonably high prevalence of urinary tract infection in pregnancy and its consequences on
women and their pregnancies prompted the Ethiopian Ministry of Health to include screening for
and treatment of urinary tract infection in pregnancy in the standard obstetrics program (MOH,
2010).

However, the prevalence and contributing factors of UTIs in this population are not well
understood. Therefore, there is a need to investigate the prevalence and contributing factors of
UTIs among pregnant women in the Arada sub-city selected health center, Addis Ababa, to
inform effective prevention and treatment strategies.

1.3. SIGNIFICANCE OF THE STUDY

The significance of studying the prevalence and contributing factors of urinary tract infections
(UTIs) among pregnant women in the Arada sub-city-selected health center in Addis Ababa
includes:

1. Improved maternal and fetal health: UTIs during pregnancy can lead to complications
such as preterm labor, low birth weight, and sepsis. By understanding the prevalence and
contributing factors of UTIs in this population, healthcare providers can develop effective
prevention and treatment strategies, which can improve maternal and fetal health
outcomes.
2. Reduced healthcare costs: UTIs during pregnancy can result in hospitalization and other
medical interventions, which can be expensive. By identifying the contributing factors
and developing effective prevention strategies, healthcare costs can be reduced.
3. Improved quality of life: UTIs during pregnancy can cause discomfort and pain, which
can negatively impact a woman's quality of life. By preventing and treating UTIs,
pregnant women can experience a better quality of life during this critical time.
4. Identification of high-risk groups: By identifying the contributing factors to UTIs
among pregnant women, high-risk groups can be identified, and targeted interventions
can be developed to reduce the prevalence of UTIs in these groups.

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 5. Research gap filling: This study will contribute to the existing body of knowledge on the
prevalence and contributing factors of UTIs among pregnant women in the Arada sub-
city-selected health center, Addis Ababa, filling the research gap in this area. The
findings of this study can serve as a basis for further research and policy development.

1.4. OBJECTIVE OF THE STUDY

1.4.1 GENERAL OBJECTIVE

The general objectives of the study are to determine the prevalence and contributing factors of
urinary tract infections (UTIs) among pregnant women in Addis Ababa City Administration
Arada sub-city-selected health centers in 2023.

1.4.2 SPECIFIC OBJECTIVES

The specific objectives of the study were:

1. To determine the prevalence of UTIs among pregnant women in the Arada sub-city-
selected health center, Addis Ababa 2023
2. To identify the contributing factors of UTIs among pregnant women in Arada sub-city-
selected health center, Addis Ababa 2023
3. To develop recommendations for effective prevention and treatment strategies for UTIs
among pregnant women in the Arada sub-city-selected health center, Addis Ababa.

1.5. RESEARCH QUESTIONS

The research questions for studying the prevalence and contributing factors of urinary tract
infections (UTIs) among pregnant women in the Arada sub-city-selected health center, Addis
Ababa, include:

1. What is the prevalence of UTIs among pregnant women in Addis Ababa city
administration from Arada sub-cities selected health centers?
2. What are the contributing factors of UTIs among pregnant women in Addis Ababa city
administration from Arada sub-city-selected health centers?

4
 3. What are the recommendations for effective prevention and treatment strategies for UTIs
among pregnant women in the Addis Ababa city administration from Arada sub-city-
selected health centers?

1.6. DELIMITATION OF THE STUDY

The study on the prevalence and contributing factors of urinary tract infections (UTIs) among
pregnant women in the Arada sub-city selected health center, Addis Ababa, will have the
following delimitations:

1. The study only included pregnant women who reside in Arada, a city-selected health
center in Addis Ababa and seek antenatal care in public health facilities.
2. The study focused on the prevalence and contributing factors of UTIs among pregnant
women and did not explore other related health conditions or illnesses.
3. The study only collected data from pregnant women who were willing to participate and
provided informed consent.
4. Due to time and resource constraints, the study will not be able to follow up with
pregnant women to assess the effectiveness of treatment or prevention strategies.
5. The study was limited to the data that can be gathered through questionnaires and
medical records and may not capture all contributing factors to UTIs among pregnant
women.
6. The study did not assess the prevalence of UTIs among pregnant women who do not seek
antenatal care or who seek care in private health facilities.
7. The study was conducted during a specific period of time and may not capture seasonal
variations in the prevalence of UTIs among pregnant women.
8. The study was limited to the specific geographic location of Addis Ababa city
administration and the Arada sub-city selected health center, and the findings may not be
generalizable to other regions or countries.

5
1.7. LIMITATION OF THE STUDY

The limitations of the study on the prevalence and contributing factors of urinary tract infections
(UTIs) among pregnant women in Addis Ababa city administration and Arada sub-city-selected
health centers may include:

1. Limited sample size: The study was limited by a small sample size, which could affect
the generalizability of the findings to the larger population of pregnant women in Arada,
a city-selected health center in Addis Ababa.
2. Self-reported data: The study might be based on self-reported data, which may be
subject to recall bias or social desirability bias.
3. Lack of diversity: The study might not include a diverse enough sample of pregnant
women, which could limit the generalizability of the findings to pregnant women from
different backgrounds or with different risk factors.
4. Failure to account for confounding factors: The study might not account for other
factors that could contribute to the risk of UTIs, such as diet, lifestyle, or other health
conditions.
5. Incomplete data: The study was limited by incomplete or missing data from medical
records, which could limit the accuracy of prevalence estimates or the identification of
contributing factors.
6. Limited generalizability: The study was limited by its focus on a specific geographic
location and may not be generalizable to other regions or countries.
7. Lack of follow-up: The study was not followed up with participants to evaluate the
effectiveness of treatment or prevention strategies, which could limit the
recommendations that can be made based on the findings.
8. Resource limitations: The study was limited by resource constraints, such as time and
funding, which could affect the sample size, data collection methods, or the ability to
conduct a more comprehensive study.

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1.8 OPERATIONAL DEFINITION OF TERMS

1. Prevalence: The prevalence of urinary tract infections (UTIs) among pregnant women
refers to the proportion or number of pregnant women within a specific population who
have been diagnosed with a UTI. It is typically measured as a percentage or rate.
2. Urinary Tract Infections (UTIs): UTIs are bacterial infections that occur in any part of
the urinary system, which includes the kidneys, bladder, ureters, and urethra. In the
context of pregnant women, UTIs specifically refer to infections that are diagnosed
during pregnancy.
3. Contributing Factors: Contributing factors are variables or conditions that increase the
likelihood or risk of developing UTIs among pregnant women. These factors may include
physiological, anatomical, behavioral, or environmental elements that play a role in the
occurrence of UTIs.

1.9. ORGANIZATION OF THE STUDY

The thesis was organized into five chapters. Chapter one deals with the introduction: background
of the study, objectives of the study (general and specific), significance of the study, delimitation
of the study, limitations of the study, definition of key terms, and organization of the study.
Chapter Two addressed a review of the literature; Chapter Three discussed the research
methodology and instruments used within this study. Results and discussions were presented in
Chapter Four. Chapter Five summarizes and concludes with the findings of the study and states
recommendations based on the findings.

7
 CHAPTER TWO

REVIEW OF RELATED LITERATURE

2.1. INTRODUCTION

The overall intention of this chapter is to review some related literature. Hence, the chapter
contains theoretical and empirical literature review of prevalence and contributing factors of
unitary tract infections among pregnant women.

2.2. HISTORICAL BACKGROUND

Urinary tract infections (UTIs) have been recognized and documented throughout history,
although the understanding of their causes and treatment has evolved over time. Here is a brief
historical background of urinary tract infections:

Ancient Times: -The ancient Egyptians described symptoms similar to UTIs and recognized the
connection between urinary symptoms and the bladder. They used various treatments, including
herbal remedies and bladder irrigation.

Classical Era: - The Greek physician Hippocrates (460-370 BCE) described symptoms of
urinary tract infections and recognized that they could affect different parts of the urinary
system. The Roman physician Galen (130-200 CE) expanded on Hippocrates' work and
described the relationship between urinary symptoms and kidney diseases.

Middle Ages: During the middle Ages, there was limited progress in understanding UTIs. The
dominant medical theories were based on the concept of humors, and treatments often involved
bloodletting or the use of herbal remedies.

17th to 18th Century:- In the 17th century, anatomical studies by researchers such as Thomas
Bartholin and Giovanni Battista Morgagni provided a better understanding of the urinary system
and its connection to urinary tract infections.

In the 18th century, advancements in microscopy allowed scientists to observe bacteria for the
first time, leading to a better understanding of microbial causes of infections.

19th Century:-In the 19th century, with the development of the germ theory of disease,
researchers began to link bacteria to urinary tract infections. The use of antiseptic techniques,

8
such as hand washing and sterile catheterization, helped reduce the risk of infection during
medical procedures.

20th Century:-The discovery of antibiotics, such as sulfa drugs and penicillin, revolutionized
the treatment of UTIs in the mid-20th century. These medications were effective against many
common bacterial pathogens. With the emergence of antibiotic resistance, researchers had to
develop new strategies to combat UTIs. The development of a broader range of antibiotics and
antimicrobial agents helped address this challenge.

Recent Advancements:- In recent years, there have been advancements in diagnostic

techniques, such as improved urine culture methods and molecular testing, which allow for more
accurate identification of pathogens. Researchers continue to study the mechanisms of UTIs,
including the role of bio films and host immune responses, to develop new treatment strategies
and preventive measures.

It is important to note that the historical understanding and treatment of urinary tract infections
have varied across cultures and periods. Our current knowledge and approach to UTIs are based
on centuries of medical advancements and ongoing research.

2.3. THEORETICAL REVIEW

The theory of urinary tract infection (UTI) encompasses various aspects related to the etiology,
pathogenesis, and factors contributing to the development of UTIs. While the exact mechanisms
and interactions involved in UTIs can be complex and multi factorial, the following theories help
explain the occurrence and progression of UTIs:

1. Ascending Theory:-The ascending theory is the most widely accepted theory for the
development of UTIs, particularly for lower UTIs. It suggests that bacteria from the perineal or
gastrointestinal area ascend the urethra and colonize the urinary tract. Factors such as improper
hygiene, sexual activity, and anatomical abnormalities (e.g., urethral length, urethral meatus
location) can facilitate the ascent of bacteria into the bladder, leading to infection. From the
bladder, bacteria can further ascend to the ureters and kidneys, causing upper UTIs.

2. Bacterial Adherence and Invasion:-Bacterial adherence to the uroepithelium is a critical step

in UTI pathogenesis. The uroepithelial cells express specific receptors to which bacteria can
attach.Pili and fimbriae on the surface of bacteria, such as uropathogenic Escherichia coli

9
(UPEC), facilitate their adherence to uroepithelial cells. Once attached, bacteria can invade and
colonize the uroepithelial cells, forming intracellular bacterial communities (IBCs) or biofilms.
Bacterial invasion can help bacteria evade host immune responses and contribute to recurrent or
chronic UTIs.

3. Host Immune Response:- The host immune response plays a crucial role in mitigating UTIs.
Innate immune mechanisms, such as antimicrobial peptides, mucosal barriers, and the flushing
action of urine, help prevent bacterial colonization. Inflammatory responses, mediated by
immune cells and cytokines, are activated upon infection, aiming to clear the invading bacteria.
However, the immune response can also contribute to tissue damage and symptoms associated
with UTIs.

4. Bacterial Virulence Factors: Bacterial virulence factors contribute to the pathogenicity of

UTI-causing bacteria. UPEC, for example, produces various virulence factors, including
adhesins, toxins, and iron acquisition systems, which aid in colonization, invasion, and evasion
of the host immune response. Adhesins, such as type 1 and P fimbriae, facilitate bacterial
attachment to uroepithelial cells. Toxins, such as hemolysins and cytotoxic necrotizing factor 1
(CNF1), can damage host cells and promote bacterial survival. Iron acquisition systems, such as
siderophores, enable bacteria to obtain essential nutrients from the host.

5. Host Factors and Susceptibility:-Individual host factors can influence susceptibility to UTIs.
These include gender (females are more prone to UTIs due to shorter urethral length and close
proximity to the anus), sexual activity, menopause-related changes, urinary tract abnormalities,
urinary stasis, compromised immune system, and underlying medical conditions (e.g.,
diabetes).Host genetics may also play a role in determining susceptibility to UTIs, as certain
genetic variations have been associated with increased risk.

Understanding the theories of UTIs helps guide the development of preventive strategies,
diagnostic approaches, and targeted interventions to manage and treat UTIs effectively.

2.4. PREVALENCE OF URINARY TRACT INFECTION

Urinary tract infections (UTIs) are a common health issue worldwide, affecting both men and
women. The prevalence of UTIs can vary depending on factors such as age, sex, geographical

10
location, and underlying health conditions. Here's an overview of the prevalence of urinary tract
infections:

Overall Prevalence: UTIs are among the most common bacterial infections, accounting for
millions of healthcare visits annually. In general, women tend to have a higher prevalence of
UTIs compared to men. This is primarily due to anatomical differences, such as a shorter urethra
in women, which allows bacteria to reach the bladder more easily. UTIs are less common in
men, but the prevalence increases with age, particularly in men over the age of 50.

Lifetime Prevalence in Women: It is estimated that about 50% to 60% of women will
experience at least one UTI during their lifetime. The risk of UTIs in women is influenced by
factors such as sexual activity, contraceptive methods, menopause, and underlying medical
conditions (e.g., diabetes, urinary tract abnormalities).

Prevalence in Men: UTIs in men are less common compared to women, but the prevalence
increases with age. In men, UTIs are often associated with underlying urinary tract
abnormalities, such as an enlarged prostate or urinary tract obstruction.

Prevalence in Children: UTIs can also occur in children, although the prevalence is generally
lower compared to adults. In infants and young children, UTIs may be more common in girls
due to factors such as improper hygiene, structural abnormalities, or vesicoureteral reflux (a
condition where urine flows back from the bladder to the kidneys). In older children, UTIs can
affect both boys and girls, but girls still have a higher prevalence.

Globally, urinary tract infection and its associated problems are the cause of nearly 150 million
deaths per year. The disease can progress in 40-50% of women (Totsika et al., 2012). The
prevalence of urinary tract infections in pregnancy ranges from 13-33%, with asymptomatic
bacteriuria occurring in 2–10%.
Urinary tract infection (UTI) is the most common disorder caused by bacterial agents in
pregnancy,which can lead to important complications in newborn of such mothers in case of
inappropriate diagnosis and treatment.
UTIs are the most common bacterial infections of pregnancy. UTI is a major health problem, it
has-been reported among 20% of the pregnant women and it is the most common cause of
admission in obstetrical wards (J.Bacak et al., 2005). Symptomatic and asymptomatic bacteriuria
has been reported among 17.9% and 13.0% pregnant women, respectively (A.Masinde et al.,

11
2009).
Minus earlier detection, urinary tract infection can cause kidney injury, high blood pressure in
pregnancy, among others (Kerureet al., 2013). The reasonably high prevalence of asymptomatic
urinary tract infection in pregnancy and its consequences on women and on their pregnancies
prompted Ethiopia ministry of health to include screening for and treatment of urinary tract
infections in pregnancy in the standard obstetrics and antenatal care guidelines (MOH, 2010).

Studies have indicated that 25% - 40% of untreated pregnant women with asymptomatic
bacteriuria will eventually develop to acute pyelonephritis as the most common cause of
predelivery hospitalization. Furthermore, even if pyelonephritis is treated immediately, the
condition significantly increases mortality and the number of infants with low-birth weights. In
addition, anemia, preeclampsia and premature rupture of fetal membranes, respiratory failure and
risk of septicemia and shock are other risk factors in UTI pregnancy. Moreover, children born
with mothers with pyelonephritis are much more prone to impairment of mental and motor
development. There is a significant statistical correlation between UTI and congenital
retardation.

Pregnant mothers in the age group of 21 - 30 years had the highest prevalence of UTI at 75.8%
followed by those aged 31 - 40 years at 12.1%, below 20 years of age at 9.1% while those above
the age of 40 years had the least prevalence of 3%. UTI prevalence was also high among mothers
in the second trimester (60.6%) compared to third trimester (24.2%) and first trimester (15.2%).
High prevalence of bacteriuria was observed among multifarious mothers (72.7%) as compared
to nulliparous (27.3%). Despite these variations, there was no significant association between
UTI and maternal age, parity, occupation, gestation, marital status or level of education P >0.05

Gram-negative bacteria isolates were more prevalent (78.2%) in UTIs than gram-positive
bacteria (21.2%). This could be due to the unique structure of gram negative bacteria which
facilitates their attachment to the uroepithelial cells, and tissue invasion resulting in an invasive
infection and pyelonephritis in pregnancy (17). E. coli was the most predominant pathogen
(44.5%) similar to other findings in Tanzania, Ethiopia and Sudan (3) (4) (17). K. pneumonia
was the second most prevalent uropathogen similar to related studies in the neighboring
Tanzania (4). S. aurous was dominant at 15.1%, but in general, the CFUs of this species were
always more than those of any other species.

12
2.5. CONTRIBUTING FACTORSURINARY TRACT INFECTIONS
The incidence of urinary tract infections hinge on various demographic, genetic, social as well as
some anatomic and metabolic factors (Athira, 2016).

2.5.1. AGE
Urinary tract infection during pregnancy is common and high in age group between 26-35 years.
The high incidence of UTI in the young reproductive age group is due to early pregnancy
particularly in the remote settings. Many studies considered advances in age a risk factor for
getting UTI in pregnancy because there is decline in glycogen level, deposition and decrease in
the Lactobacillusas part of ageing progression which increases bacterial adherence and attack by
pathogens and make them more vulnerable (Athira, 2016)
Majority of urinary tract infection among pregnant women is well-known in age group 26-30
years,followed by 21-25, and 31-35years. The youngest among those studied was 18 years and
oldest 45years(Care et al., 2016).
Turpin et al (2011) found that UTI was more prevalent in older age group. This can be explained
by decreased level of sex hormones in the aging process. Apart from this, the increase in age is
also associated with increased glycogen level, reduced Lactobacillus colony, acidity of the
vagina, and prevention of pathogen colonization, leading to increased vulnerability to ASB
(Hassan, et al.,2010).
2.5.2 EDUCATION LEVEL
Lower levels of education and low socio-economic grade have correlation with higher
prevalence ofASB in many studies and reports (Mokube et al., 2013). This is because education
improves the attitudes and beliefs of women. However, according to Onu et al., (2015), level of
education of the participants did not have any significant association with ASB; which disagrees
with Mokube et al.,2013.
2.5.3. SOCIO-ECONOMIC FACTORS
The prevalence of urinary tract infection was found to vary with socio-economic status of
respondents. The prevalence was higher in women with low socio-economic status compared to
middle and higher classes (Fatima and Ishrat, 2016)
However, according to Aiyeblehin et al., (2013), no relationship was established between UTI
and social-economic status of the pregnant women in his study.

2.5.4. OBSTETRIC FACTORS

2.5.4.1. Gravidity

13
According to Kerureet al., (2013), urinary tract infection in pregnancy was more common among
women with first pregnancies (53.85%) compared to multi-gravidae (46.15%). Parity and
gestational age considerably affect the prevalence of urinary tract infection. These have been
previously reported in many studies (Halder et al., 2010)
2.5.4.2. Gestational age
pregnant women in their third trimester of current pregnancy and those having more than one
child were mostly susceptible to acquire urinary tract infection. Numerous anatomical and
hormonal variations in pregnant women lead to urethral dilation and urinary inertia which
increased changes of developing UTI (Bankole et al 2015)
Studies have shown that with respect to trimester, majority of the pregnant women with UTI
were in third trimester, followed by second trimester and first trimester (Length, 2015)According
to a study by Agersewet al., (2013) from Ethiopia, (12.2%) of study subjects had history of
urinary tract infection.
2.5.5. GENETIC FACTORS
The presence of P-antigens on ABO blood group in the uro-epithelial cells act as receptors for E.
coli adhesion. In people with secretor status, ABO blood group antigens are secreted in body
fluids tocover the receptors for E. coli adhesion. Therefore, such persons hardly suffer from UTI.
Comparatively, for persons having no secret or status, the receptors for E. coli adhesion are
uncovered and exposed for attachment of bacteria hence resulting into recurrent UTI (Care et al.,
2016)

Metabolic factors like diabetes mellitus are associated with a high prevalence of perianal colony
by potential pathogens. presence of glucose in urine increases occurrence and severity of
infection in mothers with diabetes mellitus(emiliet al., 2012).
2.6. COMMON CAUSATIVE AGENTS OF URINARY TRACT INFECTIONS IN
PREGNANT WOMEN
Urinary tract infections (utis) in pregnant women can be caused by various bacteria. the most
common causative agents of utis in pregnant women are:

1. Escherichia coli (E. coli): E. coli is a bacterium commonly found in the gastrointestinal tract
and is the most common cause of UTIs in both pregnant and non-pregnant individuals. During
pregnancy, E. coli can easily ascend from the urethra to the bladder and cause an infection.

2. Group B Streptococcus (GBS): GBS is a type of bacteria that normally resides in the
gastrointestinal and vaginal tracts. It is estimated that approximately 10-30% of pregnant women

14
carry GBS in their vaginal or rectal area. While GBS is typically harmless to the pregnant
woman, it can cause UTIs or other infections in the urinary tract if it enters the urethra and
spreads to the bladder.

3. Klebsiella pneumoniae: Klebsiella pneumoniae is a type of bacteria commonly associated

with hospital-acquired infections. It can cause UTIs in pregnant women, particularly if they have
been hospitalized or have had recent medical procedures involving the urinary tract.

4. Proteus mirabilis: Proteus mirabilis is another bacterium commonly associated with UTIs,
including those in pregnant women. It has the ability to produce enzymes that break down urea,
leading to the formation of urinary tract stones and contributing to the development of UTIs.

5. Enterococcus faecalis: Enterococcus faecalis is bacteria commonly found in the

gastrointestinal tract and can cause UTIs in pregnant women. It is often associated with catheter-
associated UTIs or recurrent infections.

While these are the most common causative agents of UTIs in pregnant women, other bacteria
can also be responsible for UTIs. It's important to note that the choice of antibiotic treatment for
UTIs in pregnant women should take into account the local resistance patterns of bacteria in the
specific region to ensure effective treatment and avoid complications.

2.7.CONCEPTUAL FRAMEWORK

A conceptual framework for understanding the contributing factors to urinary tract infections
(UTIs) in pregnant women can help organize and analyze the various factors involved. Here is a
conceptual framework for the contributing factors to UTIs in pregnant women:

Figure 2. 1 Conceptual Framework

Contributing factors Prevalence of urinary

tract infections (UTIs)
 Biological factors in pregnant women
 Medical factors
 Socio economic and environmental factors
 Behavioral factors
 Micro bial factors

Source ; Review Literature

15
 CHAPTER THREE

RESEARCH METHDOLOGY

3.1 INTRODUCTION

This section describes the general methodology to be used in carrying out the research study. It
discusses the research design, the population and sample design, the research procedure, the data
collection, and the data analysis methods.

3.2. DESCRIPTION OF THE STUDY AREA

Arada Sub city is located in the heart of Addis Ababa, the capital city of Ethiopia. It is one of the
eleven sub-cities that make up the administrative divisions of the city. Arada Sub city is known
for its vibrant atmosphere, rich history, and diverse population.

It is a densely populated and vibrant urban area; Arada Sub city can be a suitable study area for
researchers interested in investigating social issues. These may include poverty, inequality, and
access to basic services, healthcare, education, and social disparities.

The availability and quality of sanitation infrastructure, including access to clean water and
proper toilet facilities, can significantly impact the prevalence of UTIs. Inadequate sanitation
facilities or a lack of clean water sources in certain areas of Arada Sub City may contribute to
increased UTI risk among residents, including pregnant women.

Socioeconomic factors such as poverty, low education levels, and limited access to healthcare
can influence the prevalence of UTIs. In Arada Sub-city, areas with lower socioeconomic status
may have a higher incidence of UTIs due to factors such as poor hygiene practices, limited
access to healthcare services, and a lack of resources for preventive measures.

Cultural practices and beliefs regarding personal hygiene, sexual behavior, and healthcare-
seeking behavior can impact UTI prevalence. Specific cultural norms within Arada Sub City may
influence practices related to hygiene, which can contribute to UTI risk among pregnant women.

16
Environmental factors, such as pollution or exposure to contaminants, can contribute to UTI
prevalence. In Arada Sub city, specific environmental conditions, including air pollution or poor
water quality in certain areas, may influence the risk of UTIs among pregnant women.

Arada Sub city is characterized by urbanization and population density, which can lead to
challenges related to sanitation, hygiene, and healthcare access. Overcrowded living conditions
and the concentration of people in limited spaces may contribute to the spread of UTIs among
residents, including pregnant women.

Understanding these unique characteristics of Arada Sub city are important when assessing the
prevalence and contributing factors of UTIs among pregnant women. It allows for targeted
interventions and strategies to address the underlying factors and reduce the burden of UTIs on
the population. These are just a few justifications for choosing Arada sub-city as a study area.

3.3. STUDY DESIGN

The study was used a cross-sectional research design. A cross-sectional research design is a
study design that involves collecting data from a population or sample at a specific point in time.
In the context of researching the prevalence and contributing factors of urinary tract infections
(UTIs) among pregnant women, a cross-sectional design would involve assessing the UTI status
and relevant factors of a group of pregnant women at a single time point.

3.4. Inclusion and Exclusion Criteria

Inclusion and exclusion criteria for a study on the prevalence and contributing factors of urinary
tract infections (UTIs) among pregnant women depend on the specific research objectives and
design. Here are the inclusion and exclusion criteria that could be considered:

3.4.1. Inclusion Criteria

All pregnant mothers who visited for ANC clinic, those pregnant women who was volunteer to
participate in the study, and pregnant women with and without symptoms of UTI who were
willing to participate in the study

3.4.2. Exclusion Criteria

17
A mother who are not willing to participate in the research or interview, mothers who are
mentally ill, Immune-suppressed such as those with HIV/AIDS, and Pregnant women who have
taken antibiotics(for UTI) for the last one week.

3.5. Population and Sampling Design

3.5.1 POPULATION

Population has been defined as any complete group of entities that share some common set of
characteristics (Zikmund ET AL., 2010). In this study, the target population was 1032 pregnant
women in Arada sub-city from 4 health centers.

3.5.2 SAMPLING DESIGN

Sampling refers to the process by which part of the population is selected and conclusions drawn
about the entire population (Cooper & Schindler, 2011). The sampling design describes in detail
the sampling frame, sampling techniques, and sample size.

3.5.3. SAMPLING FRAME

The sampling frame refers to the list of elements from which the sample is drawn and is closely
related to the population (Cooper & Schindler, 2011; Zikmund et al., 2010). According to
Cooper and Schindler (2011), it is a complete and correct list of population members only. The
framework for this study consisted of 1032 pregnant women from health centers in the Arada
sub-city. This number formed the sampling frame.

3.5.4. SAMPLING TECHNIQUE

Sampling is defined as any procedure that draws conclusions based on measurements of a

portion of the population (Zikmund et al., 2010). Purposive sampling will be used to select four
health centers from 11 health centers located in the sub-city. The respondents from each health
center were identified using simple random sampling so that every respondent had an equal
chance of being selected to participate in the study.

18
3.5.5. SAMPLE SIZE

The sample size is determined based on a single population formula and the following
assumptions: prevalence of UTI among pregnant women = 24.8%, 95% confidence interval, 0.05
level of significance, and 5% margin of error.

For the purpose of this study, the researcher was used to select the sample size for the study,
which brought the sample size to 288 respondents, and it was calculated using the following
formula:

n = (Z α/2)² * p * q / (d²)

Z α/2 = 1.96 (for a 95% confidence level)

p = 0.248

q = 0.52 (complement of p)

d = 0.05

Using the formula:

n = (1.96)² * 0.248 * 0.752 / (0.05)²

n = 3.8416 * 0.248 * 0.752 / 0.0025

n = 0.7189853696 / 0.0025

n ≈ 287.59414784

So, according to the sampling determination formula and desiring to have a 95% confidence
level where (e) = 0.05, with a population of 1032, the resultant sample size became 288. The
researcher collected sample data from four health centers in Arada, Addis Ababa.

Two hundred eighty eight (288) sample respondents were taken, and the distribution was
selected as mentioned from four health centers in the Arada sub-city. Thus, the total sample size
of the study was 288, which is 27.9 % of the total population (288 /1032 x 100=27.9)

Table 3.1 illustrates the sample distribution in four health centers and the sample is proportionate
as the follows.

19
3. 4.Distribution of sample

1 Arada health center 271 271/1032*288 76 Random

sampling

2 Semen health center 320 320/1032*288 89 „

3 Janmeda health center 260 260/1032*288 73 „

4 Aware health center 181 181/1032 *288 50 „

Total 1032 1032/1032*288 288

Source: Medical records of each health centers (20203)

3.6. DATA COLLECTION METHODS

The study collects information from both primary and secondary sources of data collection. This
study focused on the use of primary data, which were collected from the target sample. A
structured questionnaire was used to collect the data. The data collection instrument for the study
has been developed based on literature from various scholars on the subject of the prevalence
and contributing factors of UTIs among pregnant women.

3.7 RESEARCH PROCEDURES

A structured questionnaire was developed by the researcher specifically for this study. The data
collection method used was a structured questionnaire, or more specifically, a self-administered
structured questionnaire. The data collection instrument (a structured questionnaire) was pilot
tested with 20 respondents of the total target respondents representing the 4 health centers who
were not included in the final selection of the population. The problems anticipated to be
encountered during the pilot testing of the data collection instrument will be addressed by
making the necessary adjustments to the questionnaire before administering it to the study
sample. After the revision of the data collection instrument, the whole study sample was
subjected to the data collection instrument.

20
3.8 Reliability and Validity Assurance

3.8.1 RELIABILITY

To increase the reliability of measurements, the researcher used a self-administrative interview

conducted by the researcher herself before conducting the actual data collection and pretesting
the questionnaire with a small sample of respondents. Ensure clear and unambiguous language;
arrange questions in a logical and coherent order; minimize response bias; and, before full-scale
implementation, conduct a pilot test of the data collection methodology to identify any
unforeseen issues or challenges and make necessary revisions based on the pilot findings.

3.8.2 VALIDITY

In order to ensure the quality of this research, the content validity of the research instrument was
checked. By incorporating expert judgment, reviewing existing literature, conducting pilot
testing, and analyzing item relationships, we can increase the content validity of the
questionnaire or measurement tool. Peer discussion with other researchers was also conducted
since it is another way of checking the appropriateness of questions. Moreover, copies of the
questionnaire were distributed to ten respondents as a pilot test. This is done to find out whether
the developing instrument measures what it is meant to measure and also to check the clarity,
length, structure, and wording of the questions. This test also helped the researcher get valuable
comments to modify some questions.

3.9. DATA ANALYSIS METHODS

Data editing and coding were done by the researcher to reduce errors during the data entry stage
and ensure that clean data was used for analysis. Descriptive analysis was done to check for the
meaning of the data provided using percentages and summaries. SPSS 22 was used to perform
descriptive statistics (mean, standard deviation).

On top of this, data from questionnaires was analyzed using descriptive statistics with the help of
data analysis software, the Statistical Package for Social Sciences (SPSS) package, which offers
extensive data handling capabilities and numerous statistical analysis routines that can analyze
small to very large data sets. Besides, tables and percentages are used during data analysis.

21
3.10. ETHICAL ISSUES

The purpose of the study was fully explained to all participants, and all of them will participate
in the study voluntarily. Also, because of the sensitive nature of the information being gathered
about the participants’ specific personal information, like their names, health status, and other
personal issues, all sensitive data collected for this study was kept anonymous.

22
 CHAPTER FOUR

RESULTS AND DISCUSSION

This chapter deals with analysis, and interpretation of the data collected through questionnaires.

4.1 RESPONSE RATE

A total number of 288 questionnaires were distributed to the sample selected randomly, however,
205 has completed with a response rate of 71%.

4.2 Demographic Characteristics of the Respondents

TABLE 4. 1.Demographic Characteristics of the Respondents

No. Demographic variables Frequenc Percent

y

1 Age Below 20 years 11 5.4

21-25 years 25 12.2

26-30 years 92 44.9

31-35 years 62 30.2

36-40 years 15 7.3

Total 205 100

2 Marital Status Single 41 20

Married 157 76.6

Divorced 7 3.4

Total 205 100.0

3 Educational background Illiterate 12 5.9

Read and write 19 9.3

Primary school 23 11.2

Secondary school 79 38.5

23
 College education 72 35.1
&above

Total 205 100.0

4 Occupational status Employee 92 44.9

Private business 44 21.5

House wife 52 25.4

Others 17 8.3

Total 205 100.0

5 Monthly family income Below 1000 birr 7 3.4

1001-3000 birr 21 10.2

3001-6000 birr 49 23.9

6001- 12000 birr 101 49.3

above 12001 birrs 27 13.2

Total 205 100.0

6 Family size 1-3 106 51.7

4-7 83 40.5

8-10 16 7.9

Total 205 100.0

7 Number of pregnancies 1-3 times 186 90.7

4-7 times 19 9.3

Total 205 100.0

8 Number of alive children 0 73 35.6

1-3 132 64.4

Total 205 100.0

9 Normal 96 46.8

Caesarean 57 27.8
Previous mode of delivery
First pregnancy 52 25.4

Total 205 100.0

24
About 5.4 % of pregnant women were below 20 ages, 12.2 % from 21 to 25 ages, 44.9 % from
26 to 30 ages, only 7.3 % related to 36-40 age. Therefore, most women were getting pregnant
age the age of 26 to 30 which was an appropriate time for getting pregnant. 5.4% of pregnant
women were below the age of 20, indicating a small percentage of teenage pregnancies. 12.2%
of pregnant women were between the ages of 21 and 25, suggesting a higher percentage of
pregnancies occurring in early adulthood. 44.9% of pregnant women were in the age range of 26
to 30, indicating a significant portion of pregnancies occurring in the late twenties. Only 7.3% of
pregnant women were in the age range of 36 to 40, suggesting a smaller percentage of
pregnancies occurring in the late thirties to early forties.
As can be seen from table 4.2, the majority of the respondents were married (76.6%), 20% were
single and the remaining (3.4%) were divorced. This shows that there is high number of married
pregnant women. Marital status itself is not a direct cause of urinary tract infections (UTIs).
However, certain factors associated with marital status may indirectly influence the risk of UTIs.
Here are some ways marital status can potentially impact UTIs: Sexual activity is a common risk
factor for UTIs. Married individuals may be more likely to be sexually active compared to single
or divorced individuals. Increased sexual activity can potentially increase the risk of UTIs,
especially in women. Married couples may have different contraceptive practices compared to
single individuals. Certain contraceptive methods, such as diaphragms or spermicides, can
increase the risk of UTIs. The choice and use of contraceptives can vary depending on marital
status and may influence UTI risk (D Scholes, 2000).
It is possible to understand from the above table that (5.9%) of the respondents were illiterate,
9.3 % can read and write, 11.2 % of primary school, 35.1% college education and above, and the
remaining 38.5% reached secondary education. Educational attainment can have a significant
impact on various aspects of individuals' lives, including employment opportunities, income
levels, access to healthcare, and overall well-being. Higher educational levels are often
associated with better job prospects, higher income potential, and improved access to resources
and opportunities. It’s worth considering that educational attainment can also influence health-
related behaviors and awareness, including hygiene practices and healthcare-seeking behaviors
(V Raghupathi, 2020)
Regarding the occupational status, 44.9 % of pregnant women were categorized as employees,
21.5% were engaged in private business, 25.4% were house wives, and the remaining 8.3%
pregnant women fall into others category.

25
Occupational status can indirectly impact the risk of urinary tract infections (UTIs) through
various factors related to work conditions, hygiene practices, and healthcare access. It is
important to note that the effect of occupation on UTI risk can vary depending on job-specific
factors, workplace conditions, and individual behaviors. Additionally, while occupation can be a
contributing factor, other factors such as personal hygiene practices, sexual activity, underlying
health conditions, and individual susceptibility also play a role in UTI development (T.
Tadesse, 2006).
Table 4.2 also shows that it was found that 3.4% of pregnant women categorized in income low-
income range ,10.2 % of family’s monthly income was low middle-income range, 49.3% of
family categorized in Upper-middle-income range, 23.9% of participants grouped under Middle-
income range and the remaining 13.2 % of family Higher-income range,

Income levels can indirectly influence the risk of urinary tract infections (UTIs) through various
factors related to healthcare access, living conditions, and lifestyle choices. While income itself
is not a direct cause of UTIs, lower income levels may be associated with certain factors that can
contribute to a higher risk. Healthcare Access: Higher income levels often provide individuals
with better access to healthcare resources, including regular check-ups, preventive care, and
timely medical treatment. Adequate healthcare access can help in early detection and
management of UTIs, reducing the risk of complications.

Hygiene Practices: Income can influence access to clean water, sanitation facilities, and hygiene
products. Individuals with higher incomes may have better access to clean restrooms, clean water
for personal hygiene, and quality sanitary products, which can contribute to better overall
hygiene practices and potentially reduce UTI risk.(T Emiru, 2013).

Income can affect living conditions, including the quality and cleanliness of housing.
Overcrowding, poor sanitation, and inadequate ventilation in low-income households may
increase the risk of UTIs due to a higher likelihood of exposure to infectious agents. Higher
income levels may afford individuals access to a more diverse and nutritious diet. Adequate
nutrition can support a healthy immune system, which plays a crucial role in preventing and
fighting infections, including UTIs. A well-nourished body is generally more resilient to
infections. Income disparities can contribute to differences in stress levels and lifestyle factors.
Individuals with lower incomes may face higher stress levels due to financial strain and may
engage in behaviors such as smoking, poor diet, or inadequate sleep, which can weaken the
immune system and potentially increase UTI risk (T Emiru, 2013).

26
Out of the participants in the study (51.7%) belongs to small size family and (40.5 %) belongs to
large size family and (7.9%) belongs to extended family. The size of a family, in and of itself, is
not directly linked to urinary tract infections (UTIs. However, certain factors associated with
larger family sizes, such as increased interpersonal contact and shared living spaces, may
indirectly contribute to a higher risk of UTIs. For example, if there are more individuals sharing
bathrooms or using communal facilities, there may be a greater likelihood of exposure to bacteria
that can cause UTIs (SE Abney, 2021)

About 90.7 % women for 1- 3 times of pregnancy, and the remaining 9.3% of women for 4-7
times of pregnancy.35.6 % of pregnant women had not alive children, where as 64.4% of
pregnant women had 1- 3 children. This indicates that the majority of pregnant women (90.7%)
have been pregnant between 1 and 3 times. It's important to note that this information does not
specify the outcomes of those pregnancies (e.g., whether the pregnancies resulted in live births,
miscarriages, or other outcomes).

Additionally, 35.6% of pregnant women reported not having any living children and 64.4% of
pregnant women reported having 1-3 living children. This data suggests that the majority of
pregnant women (64.4%) already have 1-3 living children, while a significant portion (35.6%)
does not have any living children. It's important to consider that each pregnancy and family
situation is unique. Factors such as personal choices, fertility, reproductive health, and other
individual circumstances can contribute to variations in the number of pregnancies and living
children among pregnant women. It's also worth noting that these statistics may vary across
different populations and regions. Demographic factors, cultural norms, and socioeconomic
factors can influence the reproductive patterns and family sizes in different communities.
Pregnancy and Postpartum Period: Pregnancy and the postpartum period can increase the
susceptibility to UTIs. Hormonal changes during pregnancy can affect the urinary tract, making
it more prone to infections. Additionally, childbirth can cause trauma to the urinary tract, making
it more susceptible to bacterial invasion. The postpartum period also involves hormonal changes
and potential disruptions in the urinary system, which can contribute to UTI risk. The presence
of living children, particularly infants or young children, can lead to interruptions in regular
urination patterns. Mothers may delay or hold urine for longer periods due to childcare
responsibilities, which can result in urinary stasis (reduced urine flow) and increase the
likelihood of UTIs. Taking care of young children often involves frequent physical contact and
hygiene-related tasks, such as diaper changing. If proper hygiene practices are not followed

27
consistently, there is an increased risk of introducing bacteria into the urinary tract, leading to
UTIs. The presence of living children may impact sexual activity patterns. Postpartum changes,
fatigue, and increased responsibilities associated with childcare can affect sexual activity
frequency. Reduced sexual activity can potentially influence UTI risk, as sexual intercourse is a
known risk factor for UTIs in women. Pregnancy and caring for young children can be
physically demanding and may lead to increased stress levels. Stress and fatigue can weaken the
immune system, making individuals more susceptible to infections, including UTIs (SC
Segerstrom, 2004)

Regarding to previous mode of delivery 27.8% of pregnant women who had C-section in their
previous delivery, 46.8% of pregnant women were normal and 25.4% of pregnant women who
were 1st time pregnant. Having a previous C-section may impact the options for delivery in
subsequent pregnancies. Some women may be candidates for a vaginal birth after caesarean
(VBAC), while others may be advised to have a scheduled C-section. The decision regarding the
mode of delivery should be made in consultation with a healthcare provider who can assess
individual circumstances and provide appropriate guidance. Women who had a previous normal
vaginal delivery may be more likely to have a vaginal delivery in subsequent pregnancies, but
this will depend on factors such as the presence of any complications or changes in the woman's
health. For first-time pregnant women, the mode of delivery will be determined based on various
factors, including the progress of labor, maternal and fatal well-being, and any potential
complications that may arise during pregnancy or delivery (Guise, J. M., Eden, K., Emeis, C., et
al, 2010).

4.3. The prevalence of urinary tract infections (UTIs

Table 4. 2. The prevalence of urinary tract infections (UTIs

No. Items Frequency Percent

1 In the past or current pregnancy, have you been Yes 76 37.1

diagnosed with a urinary tract infection (UTI)? No 129 62.9

2 Twice 58 28.3
How many times have you been diagnosed with
Three or more 16 7.8
a UTI during your current or previous
times
pregnancies
No 131 63.9

3 Did you experience any symptoms with your Yes 3 1.5

28
 UTI diagnosis during pregnancy?
No 202 98.5

4 Did you receive treatment for your UTI during Yes 84 41.0
pregnancy? No 121 59.0

(Source own survey, 2023)

Table 4.3 indicates that among the pregnant women surveyed, 62.9% reported that they had not
experienced a urinary tract infection (UTI) during their past or current pregnancies, while 37.1%
reported that they had been diagnosed with a UTI.UTIs are relatively common during pregnancy,
and these statistics suggest that a significant proportion of pregnant women in the survey have
experienced or are currently experiencing UTIs. It's important to note that UTIs can pose risks to
both the mother and the developing fetus if left untreated. Therefore, it's crucial for pregnant
women to receive appropriate medical care and treatment if they develop UTI symptoms.

Based on the responses of the pregnant women surveyed,7.8% reported having been diagnosed
with a urinary tract infection (UTI) three or more times during their current or previous
pregnancies. 28.3% reported having been diagnosed with a UTI twice during their current or
previous pregnancies.63.9% reported that they had not been diagnosed with a UTI during their
current or previous pregnancies.

These results indicate that a portion of the surveyed pregnant women had experienced multiple
UTIs during their pregnancies, with a smaller percentage reporting three or more UTIs, while the
majority had not been diagnosed with a UTI.

Recurrent UTIs can be a concern during pregnancy, as they may indicate underlying factors that
make a woman more susceptible to infections. It's important for pregnant women who experience
recurrent UTIs to consult with their healthcare provider for further evaluation and appropriate
management.

Based on the responses of the pregnant women surveyed, 1.5% reported experiencing symptoms
of a urinary tract infection (UTI) during their pregnancy.98.5% reported not having any
symptoms of a UTI during their pregnancy.

It's worth noting that not all individuals with UTIs may experience noticeable symptoms,
especially during pregnancy. Some pregnant women may have asymptomatic UTIs, which

29
means they have an infection but do not exhibit any noticeable symptoms. Asymptomatic UTIs
can still pose risks to the mother and the baby if left untreated.

Even if pregnant women do not have symptoms, routine screening for UTIs during prenatal care
is important to detect and treat any infections that may be present. This helps prevent potential
complications that can arise from untreated UTIs during pregnancy.

It's also important for pregnant women to be aware of the common symptoms of UTIs, which
can include frequent urination, a strong and persistent urge to urinate, a burning sensation during
urination, cloudy or bloody urine, and lower abdominal pain or discomfort. If they experience
any of these symptoms, they should promptly inform their healthcare provider for evaluation and
appropriate management. Overall, routine screening for UTIs during pregnancy, regardless of
symptom presence, is a standard practice to ensure the health and well-being of both the pregnant
woman and the developing baby.

Regarding receiving treatment for UTI during pregnancy 41% reported receiving treatment for a
urinary tract infection (UTI) during their pregnancy. 59% reported not receiving treatment for a
UTI during their pregnancy. It's important to emphasize that prompt treatment of UTIs during
pregnancy is crucial to prevent potential complications. UTIs, if left untreated, can lead to more
severe infections, such as kidney infections, which can pose risks to both the mother and the
baby.

According to PJ Habak, (2022), urinary tract infections (UTIs) are relatively common among
pregnant women. The following are the most common types of UTIs that can occur during
pregnancy:

Asymptomatic Bacteriuria (ASB): Asymptomatic bacteriuria refers to the presence of bacteria in

the urine without any accompanying symptoms. It is estimated that 2-10% of pregnant women
develop ASB. If left untreated, ASB can progress to a symptomatic UTI, such as a bladder
infection or kidney infection (PJ Habak, 2022).

Acute Cystitis: Acute cystitis is a UTI that primarily affects the bladder. It is characterized by
symptoms such as frequent and urgent urination, burning sensation during urination, cloudy or
bloody urine, and lower abdominal pain (PJ Habak, 2022).

Pyelonephritis: Pyelonephritis is a more severe UTI that involves infection of the kidneys. It can
cause symptoms such as high fever, chills, flank pain (pain in the back or side), nausea,

30
vomiting, and general malaise. Pyelonephritis requires prompt medical attention and treatment to
prevent complications (PJ Habak, 2022).

4.4. CONTRIBUTING FACTORS OF URINARY TRACT INFECTIONS (UTIS)

Table 4. 3.Behavioral factors

No. Items Frequency Percent

1 Amount of drinking water in a day Half litter per day 5 2.4

1 litter per day 52 25.4

1.5 litter per day 13 6.3

2 liters per day 135 65.9

Total 205 100.0

2 Do you consume an adequate amount of Yes 139 67.8

fluids to stay hydrated?
No 66 32.2

Total 205 100.0

3 Do you have a regular urination routine? Yes 171 83.4

No 34 16.6

Total 205 100.0

4 Do you empty your bladder completely Yes 176 85.9

when urinating?
No 29 14.1

Total 205 100.0

5 Do you go to the bathroom as soon as Yes 151 73.7

you feel the need to urinate?
No 54 26.3

Total 205 100.0

6 Are you sexually active during pregnancy Yes 147 71.7

No 58 28.3

Total 205 100.0

7 If yes, how frequently? 1 in a week 61 41.5

3 in a week 39 26.5

1 in two weeks 21 14.3

31
 1 in a month 26 17.7

Total 147 100.0

(Source own survey, 2023)

As shown in table 4.4 when the pregnant women who participated in the study were asked how
many litters of water they drink per day, 2.4% of participants drank half litter water per day,
6.3% of participants drank 1.5 litters of water per day, 25.4% of the participants drank 1 litter of
water pe day and the remaining 65.9% of the participants of the study stated they drank 2 litters
of water per day. Staying properly hydrated during pregnancy is important for the overall health
and well-being of both the mother and the developing baby. The amount of water needed can
vary depending on individual factors, such as activity level, climate, and overall health.

Drinking half a litter of water per day may be considered relatively low in terms of hydration. It's
generally recommended to consume an adequate amount of water to meet the body's hydration
needs, especially during pregnancy. Drinking 1.5 litters of water per day is closer to the
recommended daily intake for hydration. It's important to note that this amount can vary
depending on individual factors and should be assessed in conjunction with overall fluid intake
from other sources such as beverages and foods. Drinking 1 litter of water per day can also be
considered relatively low in terms of hydration, as it's recommended to consume an adequate
amount of water to support overall hydration and bodily functions. Drinking 2 litters of water per
day aligns more closely with the general hydration recommendations for adults, including
pregnant women. This amount can help maintain proper hydration levels and support the body's
physiological processes.

67.8% of the pregnant women who were asked if they drink enough fluids to maintain
dehydration answered “yes “while 32.2% of participants answered they do not consume enough
fluids.

It's positive to see that the majority of participants (67.8%) reported consuming enough fluids to
maintain hydration during pregnancy. Adequate fluid intake is important for supporting various
bodily functions, maintaining amniotic fluid levels, preventing dehydration, and promoting
overall health. However, it's worth noting that a significant portion of participants (32.2%)
reported not consuming enough fluids to maintain hydration. Insufficient fluid intake can lead to
dehydration, which can have adverse effects on both the mother and the baby. Dehydration

32
during pregnancy can increase the risk of complications such as urinary tract infections,
constipation, preterm labour, and reduced amniotic fluid levels

According K Lean (2019) dehydration can contribute to UTI complications due to its impact on
urinary tract function and immune response. Here are some reasons why dehydration can
increase the risk and severity of UTIs:

Reduced Urine Flow: When the body is dehydrated, there is a decreased volume of urine
produced. This reduced urine flow can lead to stagnant urine in the urinary tract, allowing
bacteria to multiply and increase the risk of infection. Insufficient urine flow can also hinder the
flushing out of bacteria from the urinary system, making it easier for them to adhere to the
urinary tract walls and cause infection.

Concentrated Urine: Dehydration results in more concentrated urine due to decreased fluid
intake. Concentrated urine contains a higher concentration of substances, such as salts and
minerals, which can irritate the urinary tract and contribute to the development of UTIs.
Additionally, concentrated urine may not effectively dilute and flush out bacteria, allowing them
to proliferate and lead to infection.

Impaired Immune Response: Dehydration can compromise the body's immune response, making
it less effective at fighting off infections, including UTIs. Adequate hydration is essential for
maintaining optimal immune function, as it supports the production and circulation of immune
cells and antibodies that help defend against bacteria and other pathogens.

Increased Urinary Tract Irritation: Dehydration can cause the urine to become more acidic,
which can irritate the urinary tract lining. This irritation can create an environment that is more
favorable for bacterial growth and colonization, increasing the likelihood of UTIs.

Most of the pregnant women who were asked whether they have regular urination routine, 83.4
% of the pregnant women answered “yes” and while 16.6 % of the participants answered “no”.

It's positive to see that the majority of participants (83.4%) reported having a regular urination
routine. This suggests that they are experiencing normal urinary patterns and are likely not
experiencing any significant discomfort or issues related to urinary function.

However, it's worth noting that a portion of participants (16.6%) reported not having a regular
urination routine. This could indicate that they are experiencing irregular or infrequent urination,

33
which may be worth discussing with healthcare providers. Changes in urinary patterns, such as
frequent urination, urgency, or painful urination, can sometimes be indicators of urinary tract
infections or other urinary-related issues that may require attention or treatment.

Urination plays a crucial role in the prevention and management of urinary tract infections
(UTIs) by helping to flush out pathogens from the urinary tract. Here's how urination is related to
UTIs:

Urination helps to expel bacteria and other pathogens from the urinary tract. When you urinate,
the flow of urine carries bacteria and other potentially harmful microorganisms out of the urethra
and urinary tract, reducing their presence and lowering the risk of infection. Increased urination
can aid in flushing out pathogens that may have entered the urinary tract. Urination helps dilute
the concentration of bacteria in the urinary tract. By regularly emptying the bladder through
urination, the urine volume increases, leading to a dilution effect. Diluted urine makes it more
difficult for bacteria to adhere to the urinary tract walls and multiply, reducing the likelihood of
infection.

Majority the pregnant women who were asked whether they empty their bladder completely
when urinating, 85.9% of participants were replied “yes”, and while the rest 14.1% of
participants were replied “no”. It's positive to see that the majority of participants (85.9%)
reported emptying their bladder completely during urination. When the bladder is not fully
emptied, it can lead to discomfort, increased frequency of urination, and potentially urinary tract
infections. However, it's worth noting that a portion of participants (14.1%) reported not
emptying their bladder completely. Incomplete bladder emptying can be caused by various
factors, such as hormonal changes, pressure on the bladder from the growing uterus, or
underlying bladder or urinary issues.

Determining whether the bladder is completely empty or not can be challenging without the use
of specialized medical equipment. However, there are a few methods commonly used to assess
bladder emptying:

Individuals can gauge their bladder emptying based on subjective sensations. They may feel a
sense of relief or decreased urgency after urination, indicating that their bladder has emptied to
some extent. However, relying solely on subjective sensations may not always be accurate,
especially in cases of incomplete bladder emptying.

34
Post-void residual measurement is a more objective method to assess bladder emptying. It
involves measuring the amount of urine left in the bladder after urination. This can be done using
techniques such as ultrasound or catheterization. Ultrasound is non-invasive and provides an
estimate of the volume of urine remaining in the bladder. Catheterization involves inserting a
thin tube (catheter) into the bladder to drain the remaining urine and measure its volume directly.
PVR measurement can help determine if the bladder is adequately emptying or if there is
incomplete bladder emptying.

Uroflowmetry is a test that measures the speed and volume of urine flow during urination. It can
provide information about the voiding pattern and help identify any abnormalities that may
indicate incomplete bladder emptying. While uroflowmetry can provide some insights into
bladder emptying, it does not directly measure the amount of urine remaining in the bladder.

73.3% of the pregnant women who were participating the study answered to the question, “do
you go to the bathroom as soon as you feel the need to urinate?” and the remaining 26.3% of the
participants answered that they not go to the bathroom as soon as they feel the need to urinate.
It's positive to see that the majority of participants (73.3%) reported going to the bathroom as
soon as they feel the need to urinate. This is generally recommended to ensure bladder health and
prevent complications such as urinary tract infections or discomfort from holding urine for
extended periods. However, it's worth noting that a significant portion of participants (26.7%)
reported not going to the bathroom immediately when they feel the need to urinate. There could
be various reasons for this, such as being occupied with other tasks, lack of convenient access to
a bathroom, or personal habits.

When asked whether they have sex while pregnant, 71.7% of pregnant women replied “yes” and
28.3% of the participants said they did not have sex during pregnancy. Sexual activity during
pregnancy can be safe for most women with uncomplicated pregnancies. However, there is a
potential link between sexual activity and urinary tract infections (UTIs) during pregnancy.
Sexually active during pregnancy leads to urinary tract infection.

Pregnant women are generally more prone to UTIs due to physiological changes that occur
during pregnancy. Sexual activity can further increase the risk of UTIs. The act of sexual
intercourse can introduce bacteria from the genital area into the urethra and urinary tract,
potentially leading to infection.

35
Also, of the 147 pregnant women who were sexually active during pregnancy 41.5% responded
that they had sex once in a week, 26.5% three times in a week,17.7% once a month, and the
remaining 14.3% participants responded that they had sex once in two weeks.

Table 4. 4.Medical history

No. Items Frequency Percent

1 Do you have any pre- Hypertension 19 9.3

existing medical
conditions? Diabetes 25 12.2

Renal diseases 8 3.9

Others 37 18.0

No 116 56.6

Total 205 100.0

2 If your answer is DM which Insulin dependent (Type I) 7 28

type
non-insulin dependent (Type II) 8 32

Gestational 10 40

Total 25 100.0

3 Yes 153 74.6

Have you been diagnosed
No 52 25.4
with gestational diabetes?
Total 205 100.0

4 Have you undergone any Yes 29 14.1

urinary tract surgeries or
procedures in the past? No 176 85.9

Total 205 100.0

5 First ANC visit 1-3 months 114 55.6

4-6 months 85 41.5

Above 7 months 6 2.9

Total 205 100.0

6 How many antenatal visits 1-3 57 27.8

do you have in the current
pregnancy 4-6 127 62.0

7 and above 21 10.3

36
 Total 205 100.0

(Source own survey, 2023)

Table 4.5 shows when they were asked if they had any pre-existing medical conditions 56.6% of
participant pregnant women said” No”, 18.0% of participants had unspecified illness ,12.2% of
participants had diabetes, 9.3% of participants hypertension, and the remaining 3.9% of
participants had renal diseases. This shows it's important to note that pre-existing medical
conditions can have implications for the health and management of pregnant women. Healthcare
providers closely monitor and manage these conditions during pregnancy to ensure the well-
being of both the mother and the developing baby. For pregnant women without pre-existing
medical conditions, it's important to maintain a healthy lifestyle, attend regular prenatal check-
ups, and follow healthcare provider recommendations to support a healthy pregnancy.

The type diabetes does you have? 40 % of participants responded that, Gestational, 32% of
participants responded that they were non-insulin dependent (Type II) and the other 28% of
participants that were Insulin dependent (Type I). It's important to note that gestational diabetes
is a specific type of diabetes that occurs during pregnancy and typically resolves after childbirth.
Non-insulin dependent diabetes (Type II) refers to diabetes that can often be managed with
lifestyle changes, oral medications, or other non-insulin injectable medications. Insulin-
dependent diabetes (Type I) requires insulin injections for blood sugar control.

Pregnant women with gestational diabetes or any type of diabetes require specialized care and
management during pregnancy. They may receive guidance on monitoring blood sugar levels,
making dietary adjustments, engaging in physical activity, and potentially using medications or
insulin as prescribed by their healthcare providers.

Have you been diagnosed with gestational diabetes? The 74.6% majority of participants respond
“Yes” while the remaining 25.4% answered that they have not been diagnosed with gestational
diabetes. Gestational diabetes is a type of diabetes that occurs during pregnancy and typically
resolves after childbirth. It is characterized by high blood sugar levels that develop or are first
recognized during pregnancy. Regular prenatal care often includes screening for gestational
diabetes to identify and manage it promptly. When diagnosed with gestational diabetes,
healthcare providers typically work with pregnant women to develop a management plan.
Majority of 85.9% of participant respond “Yes” while the remaining 14.1% of the participants

37
replied “No” to the questions of whether have you undergone any urinary tract surgeries or
procedures in the past. Undergoing urinary tract surgeries or procedures in the past can indicate a
history of urological conditions or issues that required intervention. These surgeries or
procedures may include treatments for conditions such as kidney stones, urinary tract
obstructions, urinary incontinence, or other urinary tract-related problems. It's important for
individuals with a history of urinary tract surgeries or procedures to inform their healthcare
providers, especially when they are pregnant. This allows for proper evaluation and
consideration of any potential implications or specific care needs during pregnancy.

Regarding first ANC visit 2.9% of the participants had visited after seven months, 41.5% of
participants between 4 up 6 months, and 55.6% of the participants stated that they had visited in
the period of one up to three months.
Antenatal care is an important aspect of prenatal healthcare that involves regular check-ups and
screenings to monitor the health of both the pregnant woman and the developing baby. Early and
regular ANC visits are crucial for ensuring the well-being of the pregnancy and addressing any
potential risks or complications.
Ideally, healthcare providers recommend that pregnant women have their first ANC visit within
the first trimester, ideally during the first three months of pregnancy. This allows for early
assessment, identification of any potential issues, and the initiation of appropriate prenatal care.
Visiting between four and six months is still within a reasonable timeframe for the first ANC
visit, although it is generally recommended to seek care earlier if possible. Healthcare providers
can still provide necessary screenings, education, and interventions to support a healthy
pregnancy, even if the visit occurs in this timeframe. However, visiting after seven months for
the first ANC visit may be considered late. Early prenatal care is essential for proper monitoring
of the pregnancy, identifying and managing any potential complications, and optimizing the
health outcomes for both the mother and the baby. It's important for pregnant women to
prioritize timely and regular ANC visits as recommended by healthcare providers.
In addition, the number of antenatal visits among the study participants had visited 10.5% seven
or more times, 27.8% one up to three times and 62% of participants had visited for to six times in
the current pregnancy. Antenatal visits are important for monitoring the progress of the
pregnancy, assessing the health of the mother and the baby, and providing necessary care and
interventions. The number of recommended antenatal visits can vary depending on factors such
as the individual's health status, pregnancy history, and any specific risk factors.

38
In general, healthcare providers often recommend a schedule of regular antenatal visits
throughout pregnancy, typically starting early in the first trimester. These visits allow healthcare
providers to monitor the pregnancy's progress, perform necessary tests and screenings, address
any concerns or complications, and provide education and support to the pregnant woman.
Having seven or more antenatal visits indicates a higher level of engagement with prenatal care,
which is generally beneficial for the well-being of both the mother and the baby. It allows for
more frequent monitoring and the opportunity to address any emerging issues promptly.
Visiting for one to three antenatal visits may suggest that some participants had limited access to
or engagement with prenatal care. While it is beneficial to have more visits, these participants
may still receive important basic healthcare and screenings during their limited visits.
Visiting for four to six antenatal visits aligns with the recommended number of visits for many
low-risk pregnancies. This frequency allows for regular monitoring and timely interventions
when necessary.
Table 4. 5.UTI-Related Factors

No. Items Frequency Percent

1 Have you experienced any UTIs prior to Yes 101 49.3

becoming pregnant?
No 104 50.7

Total 205 100.0

2 If yes, how many times have you been diagnosed Twice 58 57.4
with a UTI during your current or previous 3 and above 43 42.6
pregnancies
Total 101 100.0

3 Yes 67 32.7
Have you experienced recurrent UTIs in the past? No 138 67.3

Total 205 100.0

(Source own survey, 2023)

Table 4.6 Indicate that the experience of having any UTIs prior to becoming pregnant 49.3%
reported having experienced urinary tract infections (UTIs) prior to becoming pregnant and
50.7% reported not having experienced UTIs prior to becoming pregnant. Experiencing UTIs
prior to pregnancy can be an indication of susceptibility to these infections. It's important for
pregnant women who have a history of UTIs to be aware of this and take preventive measures to
reduce the risk of developing UTIs during pregnancy.

39
Based on the responses of the 101 pregnant women who had experienced urinary tract infections
(UTIs) prior to becoming pregnant, 57.4% reported being diagnosed with UTIs two times during
their current or previous pregnancies and 42.6% reported being diagnosed with UTIs three or
more times during their current or previous pregnancies. These results demonstrate that a
significant portion of the pregnant women who had a history of UTIs experienced recurrent UTIs
during their pregnancies. Recurrent UTIs can be a concern as they may indicate underlying
factors that increase the risk of infections. Pregnant women who have a history of recurrent UTIs
are often provided with additional monitoring and preventive strategies to reduce the frequency
of UTIs during pregnancy.

Based on the responses of the participants 32.7% reported having experienced recurrent urinary
tract infections (UTIs) in the past and 67.3% reported not having experienced recurrent UTIs in
the past. Recurrent UTIs can be a significant concern as they may indicate underlying factors that
make individuals more susceptible to frequent infections. It's important for individuals who have
a history of recurrent UTIs to be aware of this and take preventive measures to reduce the risk of
future infections.

4.5. Effective Prevention and Treatment Strategies for Urinary Tract Infections
(Utis)

Table 4. 6.Knowledge And Awareness

No. Items Frequency Percent

knowledge and awareness

1 Yes 139 67.8

Are you aware of the preventive measures for
No 66 32.2
UTIs during pregnancy?
Total 205 100.0

2 Yes 169 82.4

Do you have information about the signs and
No 36 17.6
symptoms of UTIs?
Total 205 100.0

3 Are you aware of the potential risks and Yes 116 56.6
complications of UTIs during pregnancy?
No 89 43.4

Total 205 100.0

40
4 Have you been educated by healthcare providers Yes 160 78.0
about UTI prevention and treatment during
pregnancy? No 45 22.0

Total 205 100.0

(Source own survey, 2023)

Table 4.7 indicates that awareness of the preventive measures for UTIs during pregnancy,67.8%
of the pregnant women who participated in the study said “Yes”, while the remaining 32.2% of
participants said they had not awareness. Also 82.4% responded that they had information about
the signs and symptoms of UTIs and 17.6% did not have any information.
In terms awareness of the potential risks and complications of UTIs during pregnancy, 56.6%
said yes and the remaining 43.4% of the participant pregnant women said no. In addition, 78%
responded yes and 22% did not have education by healthcare providers about UTI prevention
and treatment during pregnancy. Generally, the result of the study indicates that the level of
Knowledge and awareness of the pregnant women on urinary tract infections (UTIs) it causes,
prevention, and treatment is high.
By being knowledgeable and aware of UTIs, individuals can take proactive steps to prevent these
infections, recognize symptoms early, seek timely medical attention, and follow healthcare
professionals' recommendations for treatment and prevention.
Table 4 7.Hygiene Practices:

No. Items Frequenc Percen

y t

1 Yes 190 92.7

Do you use any feminine hygiene products No 15 7.3

Total 205 100.0

2 How to frequently take shower? Every 1 day 29 14.1

Every 3 days 96 46.8

Every 1 week 80 39.0

Total 205 100.0

3 Do you practice proper hygiene in the genital Yes 200 97.6

area?
No 5 2.4

Total 205 100.0

41
4 What type of used toilet Improved 49 23.9

Private 42 20.5

Communal 114 55.6

Total 205 100.0

5 Yes 165 80.5

Do you wipe from front to back after using the
No 40 19.5
toilet?
Total 205 100.0

6 How to frequently change of pants Every 1 day 172 83.9

Every 2 days 30 14.6

Every 3 days 3 1.5

Total 205 100.0

7 History of sexual intercourse with multiple Yes 22 10.7

partners
No 183 89.3

Total 205 100.0

8 History of finger sex Yes 10 4.9

No 195 95.1

Total 205 100.0

Source own survey, 2023)

Table 4.8 shows the use of any feminine hygiene products. 92.7% of the participants responded
that they use feminine hygiene products, and 7.3% responded that they do not use any feminine
hygiene products.

As for how to frequently take shower, 14.1% of pregnant women responded that they take
shower every day, 39% of the participants take shower once in a week, and the 46.8% responded
that they take shower in every three days.

Maintaining good hygiene is crucial for preventing UTIs. Taking regular showers helps keep the
external genital area clean and reduces the chances of bacteria entering the urethra. However,
excessive cleaning, using harsh soaps, or scrubbing vigorously can disrupt the natural balance of

42
bacteria in the genital area, potentially making it easier for harmful bacteria to multiply and
cause an infection (Ilknur Demir, Gü zin Zeren Ö ztü rk and Asiye Uzun,2020).

97.6% of participants were practiced proper hygiene in the genital area and the remaining 2.4%
of participants replied that they do not take proper care of their reproductive organs or genital
areas. This result shows majority of 97.6% pregnant women were practiced proper hygiene in the
genital area. Therefore, practicing proper hygiene in the genital area is an important step in
reducing the risk of urinary tract infections (UTIs).

Regarding what type of toilet used, 20.5% of participants have private toilets, 23.9% of
participants have improved toilets, and most (55.6%) of the participants have communal toilets.
This implies that 55.6% of participants using communal toilets, such as those found in public
restrooms or shared facilities, can potentially increase the risk of urinary tract infections (UTIs).
Here are some considerations: Bacterial contamination: Communal toilets are used by multiple
individuals, increasing the chances of bacterial contamination. Bacteria from one person's urine
or feces can potentially contaminate the toilet seat, handle, or other surfaces. If proper cleaning
and disinfection practices are not followed, these bacteria can persist and increase the risk of
UTIs for subsequent users. Furthermore, insufficient cleanliness: Communal toilets may not
always be cleaned thoroughly or frequently enough to maintain optimal hygiene. Inadequate
cleaning can contribute to the accumulation of bacteria and create an environment conducive to
UTI-causing bacteria (Ilknur Demir, Gü zin Zeren Ö ztü rk and Asiye Uzun,2020).

Regarding wipe from front to back after using the toilet, 80.5 % of participant pregnant women
replied “yes” while the remaining 19.5% replied that they do not wipe from front to back after
using the toilet. This shows majority of pregnant women were wiping from front to back after
using the toilet. Wiping from front to back after using the toilet is an important hygiene practice
that can help reduce the risk of urinary tract infections (UTIs). Here's why: Preventing bacterial
transfer and minimizing contamination:
83.9% of pregnant women changed pant every day.1.5% of participants change pants every three
days and 14.6% change every two days. This indicates that changing pants or underwear
frequently can be beneficial for personal hygiene and comfort.
When we look at the history of having sex with multiple partners, 89.3% of the participants said
that “No” and only 10.7% of them responded that they have a history having sex with multiple
partners. This implies that abstaining from sex with multiple partners can indeed reduce the risk

43
of urinary tract infections (UTIs). Here's why: Reduced exposure to bacteria: Having sexual
activity with multiple partners increases the likelihood of exposure to different strains of
bacteria, including those that can cause UTIs. By limiting sexual encounters to a monogamous
relationship or reducing the number of sexual partners, the exposure to potentially harmful
bacteria is minimized.
Lower risk of introducing bacteria: Sexual activity can introduce bacteria from the genital area
into the urethra, increasing the risk of UTIs. By being in a monogamous relationship or
practicing abstinence, the chances of introducing new bacteria into the urinary tract are reduced.
Also 95.1% of the participants said that they had not history finger sex and only 4.9% of them
had a history of finger sex. This result shows that abstaining from finger sex (manual or digital
stimulation of the genital area), can reduce the risk of urinary tract infections (UTIs). Here's why:
Eliminating potential bacterial introduction: During finger sex, there is a possibility of
introducing bacteria from the fingers into the urethra, increasing the risk of UTIs. By abstaining
from this activity, the chances of introducing bacteria are eliminated. Minimizing irritation and
trauma: Finger sex, especially if not done with adequate lubrication or gentleness, can cause
friction, irritation, or even small tears in the genital area. These factors can create an entry point
for bacteria, potentially leading to UTIs. By abstaining from finger sex, the risk of such irritation
and trauma is minimized.

44
 CHAPTER FIVE

SUMMARY OF FINDING, CONCLUSION AND

RECOMMENDATIONS
In the previous chapter, analysis and interpretation of the study was made based on the data
obtained through questionnaire distributed with pregnant women in Arada sub city of
Arada,Semen, Janmedaand Aware health centers. Based on the analysis and interpretation,
conclusion and recommendations of the study were made as follows.

5.1 SUMMARY OF MAJOR FINDINGS

Based on the information gathered through the questionnaire in the Arada sub-city of Arada,
Semen, Janmeda, and Aware health centers, the major findings that the researcher came up with
are:

1. The demographic characteristics of pregnant women:

 The largest proportion (44.9%) of pregnant women is 26–30 years old. The majority
(76.6%) of pregnant women are married. 38.5% have secondary education, and 35.1%
have a college education or higher. 44.9% are employees, 21.5% are private businesses,
and 25.4% are housewives. 49.3% upper-middle, 23.9% middle, and 13.2% higher.
51.7% are small-sized, 40.5% are large-sized, and 7.9% are extended families. Most
(90.7%) have been pregnant 1–3 times. 64.4% have 1–3 living children. 27.8% had a C-
section, 46.8% had a normal delivery, and 25.4% were pregnant for the first time. This
distribution reflects the diverse delivery experiences of pregnant women.

2. The prevalence of urinary tract infections (UTIs:

 A survey conducted among pregnant women revealed that a significant percentage

(37.1%) had been diagnosed with a urinary tract infection (UTI) either during their
current or previous pregnancies. This indicates a high prevalence of UTIs among the

45
 surveyed pregnant women. Within the group diagnosed with UTIs, 7.8% reported
having been diagnosed three or more times during their pregnancies, suggesting a subset
of women experiencing recurrent UTIs. Interestingly, only a small proportion (1.5%) of
the pregnant women reported experiencing symptoms of a UTI, while the majority
(98.5%) did not have any noticeable symptoms. This suggests that most pregnant
women diagnosed with UTIs may not be aware of their condition. Alarmingly, 59% of
the surveyed pregnant women did not receive any treatment for their UTIs, while 41%
did receive treatment. It is crucial to note that untreated UTIs can pose risks to both the
pregnant woman and the developing fetus, emphasizing the importance of appropriate
treatment for UTIs during pregnancy.

3. Contributing factors of urinary tract infections (UTIs)

3.1. Behavioral factors

 The survey conducted on pregnant women revealed a range of water intake habits, with
the majority (65.9%) consuming 2 liters of water per day. However, a significant
proportion of participants (32.2%) reported not consuming enough fluids to maintain
hydration, suggesting potential issues with adequate hydration. Most pregnant women
surveyed (83.4%) had established a regular urination routine and were able to fully
empty their bladders (85.9%) during urination. However, a notable portion (26.3%)
delayed going to the bathroom despite feeling the urge to urinate. Regarding sexual
activity during pregnancy, the majority of participants (71.7%) reported being sexually
active, with varying frequencies, including once a week (41.5%), three times a week
(26.5%), once a month (17.7%), and once every two weeks (14.3%). These findings
highlight the diverse water intake habits, potential hydration issues, established urination
routines, occasional delay in responding to the urge to urinate, and varying levels of
sexual activity among pregnant women surveyed.

3.2. Medical History

 A survey conducted among participants revealed that a significant percentage (56.6%)

did not have any pre-existing medical conditions. However, a substantial proportion had
unspecified illnesses (18.0%), diabetes (12.2%), hypertension (9.3%), or renal diseases
(3.9%). Diabetes and hypertension were the most common pre-existing conditions.
Among those with diabetes, 40% had gestational diabetes, 32% had non-insulin

46
 dependent (Type II) diabetes, and 28% had insulin dependent (Type I) diabetes,
indicating the distribution of different types of diabetes among pregnant women in the
study. A majority (74.6%) of the participants were diagnosed with gestational diabetes,
while 25.4% had not been diagnosed with it. Only a small percentage (14.1%) of the
participants had undergone urinary tract surgeries or procedures in the past. In terms of
the timing of the first antenatal care (ANC) visit, 2.9% visited after seven months,
41.5% visited between four and six months, and 55.6% visited within the first one to
three months. Moreover, 10.5% of the participants had visited seven or more times,
27.8% had visited one to three times, and the majority (62%) had visited four to six
times during their current pregnancy, demonstrating the variation in the number of ANC
visits among the participants.

3.3.UTI-Related Factors:

 Among the respondents, 49.3% reported having experienced urinary tract infections
(UTIs) prior to becoming pregnant, while 50.7% had not experienced UTIs. Among the
101 pregnant women who had experienced UTIs before pregnancy, 57.4% were
diagnosed with UTIs two times during their current or previous pregnancies, while
42.6% were diagnosed with UTIs three or more times. Regarding past experiences,
32.7% of participants had recurrent UTIs, while 67.3% did not have recurrent UTIs.

4. Effective prevention and treatment strategies for urinary tract infections (UTIs):

4.1. Knowledge and awareness

 The study found that 67.8% of pregnant women surveyed were aware of preventive
measures for UTIs during pregnancy, while 32.2% had no awareness. The majority
(82.4%) had information about the signs and symptoms of UTIs, but 17.6% did not. In
terms of awareness of the risks and complications of UTIs during pregnancy, 56.6%
were aware, while 43.4% were not. Furthermore, 78% received education from health
care providers about UTI prevention and treatment during pregnancy, while 22% did
not. These findings indicate varying levels of awareness among pregnant women
regarding UTI prevention, symptoms, risks, and complications, emphasizing the need
for education and information dissemination to ensure proper prevention and treatment
of UTIs during pregnancy.

47
4.2. Hygiene practices

 The majority (92.7%) of the participants reported using feminine hygiene products,
while 7.3% did not use any. Shower frequency varied, with 14.1% showering daily, 39%
once a week, and 46.8% every three days. Most participants (97.6%) practiced proper
hygiene in the genital area, while 2.4% did not. Regarding toilet type, 20.5% had private
toilets, 23.9% had improved toilets, and the majority (55.6%) had communal toilets.
Wiping from front to back after using the toilet was practiced by 80.5% of participants,
while 19.5% did not. Changing pants every day was reported by 83.9% of pregnant
women, 1.5% every three days, and 14.6% every two days. The majority (89.3%) did not
have a history of sex with multiple partners, while 10.7% did. Additionally, 95.1%
reported no history of finger sex, while 4.9% did.

48
5.2 CONCLUSION

A significant proportion of pregnant women reported being diagnosed with UTIs during their
past or current pregnancies. Recurrent UTIs were experienced by some pregnant women. It is
noteworthy that the majority of pregnant women diagnosed with UTIs did not experience
noticeable symptoms. Although a significant proportion received treatment for UTIs, a
considerable number did not receive treatment, which can pose risks to both the pregnant woman
and the fetus.

Pregnant women had varying water intake habits, and a significant proportion may not be
adequately hydrated. Most pregnant women surveyed had a regular urination routine and were
able to empty their bladders completely. However, a significant proportion delayed going to the
bathroom despite feeling the urge to urinate. Sexual activity during pregnancy was common
among the participants, with varying frequencies. Pre-existing medical conditions, particularly
diabetes and hypertension, were prevalent among pregnant women. The timing and number of
antenatal visits varied among the participants. Almost half of the pregnant women surveyed had
experienced UTIs prior to becoming pregnant. A subset of participants had a history of recurrent
UTIs.

Awareness of preventive measures, signs and symptoms, and risks and complications of UTIs
during pregnancy varied among pregnant women. Education from healthcare providers about
UTI prevention and treatment was received by a majority of the participants, highlighting the
importance of providing information to pregnant women. The majority of pregnant women used
feminine hygiene products and practiced proper hygiene in the genital area. Shower frequency
varied among participants. Most pregnant women wiped from front to back after using the toilet
and changed pants every day. The majority had private or improved toilets, while a significant
proportion had communal toilets. A small percentage reported a history of sex with multiple
partners or finger sex.

49
These conclusions provide insights into the demographic characteristics, prevalence, contributing
factors, prior history, prevention and treatment strategies, and hygiene practices related to
urinary tract infections among pregnant women.

5.3 RECOMMENDATIONS

On the basis of analysis and finding, the following recommendations have been given:

 Develop educational materials and programs targeting pregnant women to raise

awareness about the prevalence, risks, and complications of UTIs during pregnancy.
 Provide information on preventive measures, including the importance of adequate
hydration, regular urination, and prompt bathroom visits when feeling the urge to urinate.
 Emphasize the significance of timely treatment for UTIs during pregnancy to reduce
potential risks to both the pregnant woman and the fetus.
 Ensure that healthcare providers effectively communicate information about UTI
prevention and treatment during antenatal visits.
 Encourage pregnant women to maintain adequate hydration by drinking an appropriate
amount of water throughout the day.
 Promote regular urination and avoiding delaying bathroom visits when feeling the urge to
urinate.
 Provide guidance on establishing a bathroom routine that allows for complete bladder
emptying.
 Educate pregnant women about the potential increased risk of UTIs associated with
sexual activity during pregnancy.
 Discuss preventive measures such as urinating before and after sexual activity and
practicing safe sex to reduce the risk of UTIs.
 Ensure appropriate management and monitoring of pre-existing medical conditions,
especially diabetes and hypertension, as they may increase the susceptibility to UTIs
during pregnancy.
 Collaborate with healthcare professionals to develop comprehensive care plans that
address both the pre-existing condition and the prevention of UTIs.

50
  Promote regular and timely antenatal visits to monitor the health of both the pregnant
woman and the fetus. Include discussions about UTI prevention, detection, and treatment
as part of routine antenatal care.
 Reinforce proper hygiene practices, including wiping from front to back after using the
toilet and changing undergarments daily.
 Encourage the use of private or improved toilets whenever possible to minimize exposure
to potential sources of infection.
 Provide guidance on appropriate feminine hygiene practices, such as avoiding harsh
soaps and douching.
 Advocate for improved access to clean and private toilet facilities in communities where
communal toilets are prevalent.
 Collaborate with local authorities to improve sanitation and hygiene facilities in areas
with inadequate infrastructure.

5.4. FURTHER RESEARCH

Conduct further research to explore the specific factors contributing to the high prevalence of UTIs
among pregnant women in the late twenties. Investigate the effectiveness of educational interventions and
preventive strategies in reducing UTI incidence during pregnancy. By implementing these
recommendations, healthcare providers and policymakers can work towards reducing the incidence of
UTIs among pregnant women, improving maternal and fetal health outcomes, and promoting overall
well-being during pregnancy.

51
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in Sharjah, United Arab Emirates. Eastern Mediterranean Health

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Ajayi, A. B., Nwabuisi, C., Aboyeji, A. P., Ajayi, N. S., Fowotade, A., &Fakeye
(2012).Asymptomatic Bacteriuria in Antenatal Patients in Ilorin, Nigeria,
27(1), 31–35.

Akinloye O, Ogbolu DO, Akinloye OM, Terryalli OA (2006). Asymptomatic

bacteriuriainpregnancy in Ibadan, Nigeria: a re-assessment. Br J Biomed
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Al-aali, K. Y. (2015). Prevalence of Asymptomatic Bacteriuria in Pregnant Women

,WestrenRegion , Taif , Sudia Arabia, 4(12), 1125–1131.

Bankole Oladeinde BH, Omoregie R, OladeindeOB.(2015). Asymptomatic urinary tract

infection among pregnant women receiving ante-natal care in a traditional birth

home in Benin City, Nigeria. Ethiop J Health Sci. Jan;25(1):3-8.

Bose, A. M., Pk, S., &Pulikkottil, S. K. (2016). iMedPub Journals Microbiological Profile of
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Care, A., Alrass, C., Qassim, A., Lele, U., Essa, A. Al, &Shahane, V. (2016). The Prevalence of
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ChandelLata R, Kanga Anil, Thakur Kamlesh et al., (2012). Prevalence of Pregnancy Associated
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Gayathree L, Shetty S, Deshpande SR, Venkatesh DT.(2010 ). Screening for asymptomatic

bacteriuria in pregnancy: An evaluation of various screening tests in Hassan
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Biol Med Res 2(3);740-742.

Halder G, Munir A, Zehra N, Haider A. (2010) Risk factors of urinary tract infection in
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among pregnant women. North Am J Med Sci. 2(6):263- 266.

Kacmaz B, Cakir O, Aksoy A, Biri A. (2006). Evaluation of rapid urine screening tests to detect
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in Sanandaj, Iran. IntBraz J Urol. 34(6):699-707.

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selected major risks , ISBN 978 92 4 156387 1.

APPENDIXIES

QUESTIONNAIRE

Questionnaires to assess the prevalence and contributing factor of UTI among pregnant women
which attend antenatal care follow up at this health center

Self-Introduction:

Dear Respondent; my name is Aynadis Gesese. Currently I am a graduate student at Addis

Ababa medical and business college Department of public Health. I am conducting a research in
this Health Center. We are interviewing pregnant mothers about the prevalence and contributing
factors of UTI in order to generate information necessary for the planning of appropriate
strategies (interventions) to prevent further complications of UTI during pregnancy. To attain
this purpose, your honest and genuine participation by responding to the question prepared is
very important &highly appreciated.
CONFIDENTIALITY AND CONSENT FORM

I would like you to answer some questions. Your answers are completely confidential. Your
name will not be written on this form. However your honest answer to these questions will help

54
us to better understand about UTI during pregnancy. We would greatly appreciate your help in
responding to this study. The interview will take about 10 - 20 minutes. Would you be willing to
participate?

If yes, proceed

If no, thank and stop here.

Whom to contact

If you need more information and if you have question here is the contact address of the

Investigateur.

AynadisGesese Tel: 0910068155 ,e-mail Aynadis

CODE------------

Personal/ socio-demographic data

s.no Question Response Skip

001
Age ……………………

002 Marital status 1. Single

2. Married
3. Divorced
4. widowed
5.Others(specify)___________

55
003 Educational level 1. illiterate
2. Read and write only
3. primary school
4. secondary school
5. college education and above

004 Occupation 1. Employee

2. Private business
3. Housewife
4. Other specify____________

005 Family size ……………………………….

006 Monthly income ______________________

007 Gestational age(from medical history -------------------------

card)

008 Number of parity 1. Gravida -----------

2. Para-------------
3. Abortion ……
009 How many alivechildren do you Number of children………
have ?

010 Gap duration between past and current ______years

pregnancy

011 Pervious mode of delivery 1. Normal

2. Cesarean

012 first ANC visit 1.less than 3 month

2.3-6 months

56
 3.> 6 months

013 How many antenatal visits do you have 1. One

in the current pregnancy?
2. Two
3. Three
4. Four
5.five
6.six
7. seven
8 .EOther specify----------------

SECTION II: Objective 1; To identify the contributing factors of urinary tract infections (UTIs)
among pregnant women

Behavioral Factors:

201 How frequently do you drink water each

day?

202 Do you have a regular urination routine? 1.Yes

2. No

203 Do you practice proper hygiene in the 1.YES

genital area?
2.. NO

204 Are you sexually active during pregnancy 1.YES

2.. NO

205 If yes, how frequently?

57
Medical History:

206 Do you have any pre-existing medical 1. Hypertension

conditions
2. Diabetes

3. Renal disease

4. Other specify

207 If your answer is DM which type 1.Insulin dependent (Type I)

2. Non-Insulin dependent (Type II)

3. gestational

208 Have you been diagnosed with gestational 1.YES

diabetes?
2.. NO

209 Have you undergone any urinary tract 1.YES

surgeries or procedures in the past?
2.. NO

210 History of catheterization or other 1.YES

instrumentation(s)
2.. NO

If yes during what condition ……………………………………

…
UTI-related Factors:

211 Have you experienced any UTIs prior to 1.Yes

becoming pregnant? If yes, how many times? 2. no

212 If yes, how many times?

203 Have you experienced recurrent UTIs in the 1.yes

past? 2.no

58
214 Did you have a history of UTIs in previous
pregnancies, if applicable?

SECTION III Objective: 2 to determine the prevalence of urinary tract infections (UTIs) among
pregnant women,

301 In the past or current pregnancy, have you been 1.Yes

diagnosed with a urinary tract infection (UTI)?
2. No

302 . How many times have you been diagnosed 1. non

with a UTI during your current or previous
pregnancies 1.Once

2. Twice

3 Three or more times

303 Did you experience any symptoms with your 1.Yes

UTI diagnosis during pregnancy?
2. No

3.Not sure

304 Did you receive treatment for your UTI during 1.Yes
pregnancy?
2. No

SECTION IV Objective 3:- To develop recommendations for effective prevention and treatment
strategies for urinary tract infections (UTIs) among pregnant women,

Knowledge and Awareness:

401 Are you aware of the preventive measures for 1.yes

UTIs during pregnancy?
2. no

402 Do you have information about the signs and 1.yes

symptoms of UTIs?
2. no

403 Are you aware of the potential risks and 1.yes

complications of UTIs during pregnancy?
2. no

Hygiene and sanitation Practices:

404 Do you use any feminine hygiene products 1.YES

59
 2.NO

405 how to frequently of shower 1.every 1 day

2.every 3 days

3..every1week
4. Other

406 Do you practice proper hygiene in the genital 1. Yes

area? 2. NO

407 How to frequently of genital area 1 every morning

2.every morning
and bed time

3. Every urination
4. other

408 Do you wipe from front to back after using the 1.YES
toilet
2. NO

409 how to frequently change of pants 1.every 1 day

2.every 3 days
3..every 1 week
4. Other

410 what type of used toilet 1. Improved

2. Private
.3 communal public
4. Other

412 1.YES

History of sexual intercourse with multiple 2.NO

partners

413 History of finger sex 1. YES

2. NO

Fluid Intake:

414 How frequently do you drink water each day? ------------

Do you consume an adequate amount of fluids to

stay hydrated?

Urination Habits:

60
415 Do you have a regular urination routine? 1. YES

2.NO

416 Do you empty your bladder completely when 1. YES

urinating?
2.NO

417 Do you go to the bathroom as soon as you feel the 1. YES

need to urinate?
2.NO

Medical History and Prenatal Care:

418 Have you been educated by healthcare providers 1.YES

about UTI prevention and treatment during
pregnancy? 2.NO

የየአማርኛ የጽሁፍ መጠይቅ

መለያቁጥር----------------
የነፍሰ- ጡርየሆኑሴቶችየመረጃመስጫናየፈቃደኝነትመጠየቂያቅጽ
አዲሰአበባሜዲካልእናቢዝነስኮሌጅ
ክፍልአንድ፤ የመረጃመስጫቅጽ
1. ጥናቱየሚካሄድበትጤናጣቢያስም--------------------------------------------
2. የመጠይቁመለያቁጥር----------------------------------------------------------
መግቢያ፡ ስሜ-----------------------------
በ 2015 ዓ.ምከአዲስአበባሜዲካልእናቢዝነስኮሌጅተመራቂተማሪስሆንለመመረቅየሚያስፈልገኝጥናታዊፁሁፍለመስራትአዲሰ
አበባሜዲካልእናቢዝነስኮሌጅፒያሳካምፓስአስተባባሪነትበሚከናወነውጥናትእኔናአርሰዎአጠርያለ ከ 10-
15 ደቂቃሚወስድውይይትይኖረናል፡፡ ለዚህምውይይትእነዲተባበሩኝበትህትናእጠይቃለሁ፡፡
ወደውይይቱከመግባታችንበፊትስለጥናቱአላማናጠቅላላሁኔታስለማነብልዎትበጥሞናእንድያዳምጡኝእጠይቃለሁ፡፡
በመጨረሻምበጥናቱለመሳተፍመስማማተዎንናአለመስማማትዎንይነግሩኛል፡፡
የዚህጥናትአላማበአዲስአበባከተማበአራዳ ክ/ከስርላሉጤናጣቢያውስጥቅድመወሊድክትትልየሚያደርጉነፍሰ-
ጡርሴቶችየሽንትቧንቧኢንፌክሽበነፍሰ-
ጡርእናቶችላይያለውስርጭትእናኢንፌክሽኑእንዲኖርየሚያደርገውመንስኤዎችምንድንናቸውየሚለውንማወቅሲሆንጥናቱየሚ
ካሄድበትመንገድመረጃሰብሳቢውበሚያቀርበውመጠይቅይሆናል ፡፡
በቆይታዎሁሉምስጢርእንደምንጠብቅእያረጋገጥኩኝእያንዳንዱተሳታፊየተለየውበመለያቁጥርሲሆንስምዎንአንጠቅስም ፡፡
ለማንኛውምጥያቄየሚሰጡትምላሽለሰውአይሰጥም፡፡ የጥናቱውጤትሪፖርትምእርሰዎንአይገልጽም፡፡
በተጨማሪምየጥናቱሪፖርትቢታተምየሚያወጣውስለአጠቃላይተሳታፊሰዎችብቻይሆናል፡፡
መጠይቁበፈቃደኝነትላይብቻሲሆንየእርሰዎመሳተፍወይምአለመሳተፍእንዲሁምጥያቄዎችንመመለስፈቃደኛካልሆኑበጥቄውወ

61
ቅትአቋርጦመውጣትአሁንምይሁንወደፊትእርሰዎምይሁኑቤተሰበዎበሚያገኙትአገሌግሎትሊይምንምአይነትተጽዕኖአይኖረው
ም፤ በጥናቱላይተሳታፊበመሆነዎምየሚሰጥክፍያምአይኖርም፡፡
ለመሳተፍፈቃኛነዎት?
1. አዎ 2. አይደለሁም
አመሰግናለሁ!!!

ማስታወሻ፡ የትጥናቱተሳታፊበጥናቱላይመሳተፍፈቃደኛከሆኑወደፈቃደኝነትማረጋገጫቅጽይሂዱ፡፡
ክፍሌ 2፡ ነፍሰ-ጡርየሆኑሴቶችየፈቃደኝነትመጠየቂያቅጽ
ከታችፊርማዪንያኖርኩትእኔየጥናቱዓላማየተነገረኝሲሆንምጠየቀውንጥያቄየማቀውንመመለስእንደምችል፤
እኔየምሰጠውበዚህጥናትአገልግሎትብቻየሚውልሲሆንጥናቱላይስሜስለማያጠቀስየምሰጠውንመረጃበምስጢርእንደሚጠበቅ
ተነግሮኛል፡፡ ፍላጎትካለኝበጥናቱመሳተፍ ፤ጥያቄመመለስናበጥያቄውመካከልአቋርጬመውጣትእንደምችልተነግሮኛል፡፡
በዚህመሰረትበጥናቱመሳተፍፈቃደኛመሆኔንበፊርማዪአረገግጣለሁ፡፡
ፈርማ ----------------------------ቀን ------------------------------
ማስታወሻ፡
1. የጥናቱተሳታፊበጥናቱፈቃደኛከሆኑመጠይቁንይጀምሩ፡፡
2. የጥናቱተሳታፊፈቃደኛመሆናቸውንየሚያረጋግጥየመረጃሰብሰሳቢውስምናፊርማ
ስም _________________________________________________________
ፈርማ__________________________________
ስሌክ ____________________________________
ማንኛውምየሚያስፈልጋቸውነገሮችካለመረጃሰበሰሳቢውንምሆነዋናተመራማሪውንበአካልምሆነበአድራሻውይጠይቁ፡፡
የዋናተመራማሪውአድራሻ ፡፡
አይናዲስገሰሰ 0910068155e-mail aynadis401@gmail .com

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የጥናቱጥያቄዎች
ክፍል: ማህበራዊናኢኮኖሚያዊመረጃዎች

ተ. ጥያቄ ምላሽ ምርመ

ቁ ራ

00 እድሜሽስንትነው? --------------------አመት
1

00 የጋብቻሁኔታ? 1.ያላገባች
2
2.ያገባች(ባለትዳር)
3.አግብታ የፈታች
4.በሞት የተለየ
5.ሌላ /ይገለፅ/…………

00 የትምህርትደረጃሽስንትነው? 1.ማንበብና መጻፍየማትችል

3
2.ማንበብና መፃፍየምትችሉ
3.የመጀመሪያ ደርጃ ት/ም
የተማረች
4.ሁለተኛ ደርጃ ት/ም
የተማረች
5..ከዚያበላይየተማረች

00 ስራዘርፍ?
4
1.ቅጥረኛ(ደመወዝተኛ)
2.የግል ስራ

63
 3.የቤት እመቤት
4.ሌላ /ይገለፅ/………..

00
5
የቤተሰባችሁአባላትቁጥርስንትነው? ……………

00 የቤተሰባችሁወራዊገቢስንትነው? ………..
6

00 ከአሁኑፅንስጋርምንያክልጊዜ …………….
7
ፀንሰሻል?

00 ምንያህልልጆችንበህይወትወልደሻል? …………
8

00 በህይወትያሉልጆችብዛት…………
9
አሁንስምንያህልልጆችበህይወትአሉሽ?

01 የእድሜልዩነነትበቁጥር--------
0
በመጨረሻውልጅሽእናበእርግዝናሽመካከልምንያህልየእድሜልዩነት
አለ ?

01 የመጨረሻልጅሽንየወለድሽውበምንድንነው ? 1.በምጥ
1
2.በቀዶ ጥገና

01 የቅድመወሊድክትትከልስትጀምሪእርግዝናሽስንትወርነበር? 1.ከ 3 ወር በታች

2
2.3-6 ወር
3. ከ 6 ወርበላይ

01 ስንትጊዜየቅድመወሊድክትትልአድርገሻል? 1.ዛሬ የመጀመሪያዬ

3
2.ዛሬ ሁለተኛዬ
3.ዛሬ ሶስተኛዬ
4.ዛሬ አራተኛዬ

5.ዛሬአምስተኛዬ

6 .ዛሬስድስተኛዬ

7.ዛሬሰባተኛዬ

8.ዛሬስምተኛዬና ከዚያበላይ

64
ክፍልሁለት
201 ሽንትለመሸናትመቸገር? 1.አለ . 2.የለም

202 ሽንትቶሎቶሎመምጣት? 1.አለ

2.የለም

203 ሽንትማጣደፍ? 1.አለ

2.የለም

204 ሽንትሽትሸኚደምይቀላቅላል? 1.አዎ

2.አይደለም

205 የሆድመረበሽ? 1.አለ

2. የለም

206 ትኩሳትማንቀጥቀጥ 1.አለ

2.የለም

207 የጎንእናጎንላይመውጋት 1.አለ

2.የለም

208 ከዚህበፊትየሽንትቧንቧኢንፌክሽንአለብሽተብለሽታውቂያለሽ 1.አዎ

2. አላቅም

209 የሽንትቱቦገብቶሎትያውቃል 1.አለ

2.የለም

210 የሽንትቱቦገብቶሎትየሚያውቅከሆነበምንአይነትአጋጣሚ

………………………

211 ብዙጊዜሽንትለረዥምጊዜይይዛሉ 1.አዎ

2. አልይዝም

212 የጀርባአጥንትላይጉዳትደርሶቦትያውቃል 1.አዎ

65
 2.የለም

233 የሚታወቅበሀኪምየተረጋገጠበሽታአለሽ? 1.አዎ

2. የለም

214 አዎካልሽምንበሽታ? 1. የደምግፊት

2. የስኳር
3. የኩሊሉት
4.ሌላ /ይገለፅ/………..

215 የስኳርህመምአለካሉየሚጠቀሙትመድሃኒት 1.ኢንሱሊንተጠቃሚነዎት

2.ኢንሱሊንተጠቃሚአይደሉም
3.በእርግዝናጊዜየመጣነው

66