Study of Recurrent UTI among Mothers in the Philippines

INTRODUCTION

Background of Study

Millions suffer, only a few understand. In Barangay Ula, Recurrent UTI is one of the leading causes of morbidity among 40 households with a prevalence of 82.5% in which a bulk of 57% comprises of mothers.

Urinary tract infections (UTIs) are among the most prevailing infectious diseases with a substantial financial burden on society. An estimated 13,000 deaths annually are attributed to UTIs.

The magnitude of the problem worldwide is becoming very apparent.Globally, there are an estimated 150 million urinary tract infections per annum. Nearly 20% of women who have UTI will have another, and 30% of those will have yet another, but of the last group, 80% will have recurrences.

In the Philippines, UTI continues to be among the top five reasons for consultations in health facilities nationwide. It is one of the ten leading causes of morbidity in all ages with a rate of 127.84 per 100,000 population.

Recurrence of UTI among these mothers is greatly affected by behaviors. In this regard, the study would like to focus on the UTI-related behaviors of mothers, in Barangay Ula, diagnosed with recurrent urinary tract infection.

Review of Related Literature

According to Al-badr and colleague (2013), urinary tract infections (UTIs) are one of the most common clinical bacterial infections in women, accounting for almost 25% of all infections. Around 50–60% of women will develop UTIs in their lifetimes wherein Escherichia coliis the most common organism in all patient groups, but Klebsiella, Pseudomonas, Proteus,and other organisms are more common in patients with certain risk factors for complicated urinary tract infections (Kodner and Gupton, 2010).

Hooton and Gupta (2013) defined recurrent urinary tract infection as ≥2 infections in six months or ≥3 infections in one year. Most recurrences are thought to represent reinfection rather than relapse, although occasionally a persistent focus can produce relapsing infection.

Recurrent uncomplicated urinary tract infection is a common presentation to urologists and family doctors. A survey data suggest that 1 in 3 women will have had a diagnosed and treated UTI by age 24 and more than half will be affected in their lifetime. In a 6-month study of college-aged women, 27% of these UTIs were found to recur once and 3% a second time (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202002/).

Many women suffer from frequent UTIs. About 20 percent of young women with a first UTI will have a recurrent infection. With each UTI, the risk that a woman will continue having recurrent UTIs increases.Some women have three or more UTIs a year. However, very few women will have frequent infections throughout their lives. More typically, a woman will have a period of 1 or 2 years with frequent infections, after which recurring infections cease (http://kidney.niddk.nih.gov/kudiseases/pubs/utiadult/).

In a study of college women with their first UTI, 27 percent experienced at least one culture-confirmed recurrence within the six months following the initial infection and 2.7 percent had a second recurrence during this same time period. When the first infection is caused by Escherichia coli, women appear to be more likely to develop a second UTI within six months than those with a first UTI due to another organism. In a Finnish study of women ages 17 to 82 who had E. coli cystitis, 44 percent had a recurrence within one year(http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202002/).

A number of factors also appear to increase the risk of recurrent UTIs such as biological or genetic factors, behavioural risk factors and even the pelvic anatomy (http://www.uptodate.com/contents/recurrent-urinary-tract-infection-in-women).

In symptomatic women, predictors of recurrent UTIs include symptoms following intercourse, signs or symptoms of pyelonephritis, and prompt resolution of symptoms with antibiotics. Nocturia and persistence of symptoms between UTI episodes are strong negative predictors for recurrent infection (http://www.aafp.org/afp/2010/0915/p638.html).

According to Hooton and Gupta (2014), sexual intercourse, diaphragm-spermicide use, and a history of recurrent UTI are strong and independent risk factors for UTI. Even spermicide-coated condom use results in an increased risk of UTI. However, risk factors specific for recurrent UTI have received relatively less attention. In one large case-control study of women with and without a history of recurrent UTI, the frequency of sexual intercourse was the strongest risk factor for recurrent UTI in a multivariate analysis. Other risk factors identified were: 1) Spermicide use during the past year; 2) Having a new sex partner during the past year; 3) Having a first UTI at or before 15 years of age; and 4) Having a mother with a history of UTIs.

Sexual activity can move microbes from the bowel or vaginal cavity to the urethral opening. If these microbes have special characteristics that allow them to live in the urinary tract, it is harder for the body to remove them quickly enough to prevent infection. Following sexual intercourse, most women have a significant number of bacteria in their urine, but the body normally clears them within 24 hours. However, some forms of birth control increase the risk of UTI. In some women, certain spermicides may irritate the skin, increasing the risk of bacteria invading surrounding tissues. Using a diaphragm may slow urinary flow and allow bacteria to multiply. Condom use is also associated with increased risk of UTIs, possibly because of the increased trauma that occurs to the vagina during sexual activity. Using spermicides with diaphragms and condoms can increase risk even further (http://kidney.niddk.nih.gov/kudiseases/pubs/utiadult/).

According to Wilkinson and Treas (2010), perinneal care is part of routine hygiene care. When washing the perineum, it must be from front to back to prevent contaminating the urethra with any fecal material left in the anus. Fecal particles left on skin can cause skin breakdown due to enzyme activity, and may increase the risk of a urinary tract infection because of the presence of E. coli in the feces.

During menstruation, it is important to change sanitary pads, tampons or menstrual cups regularly. The standard time for a sanitary pad is once every six hours, while for a tampon is once every two hours. Sanitary napkins are made of cotton wool and gel. When an individual bleed into one, most of the blood gets soaked in, but at a certain point the pad gets saturated and may leak. Another consideration is that menstrual blood – once it has left the body – gets contaminated with the body’s innate organisms. When these organisms remain in a warm and moist place for a long time they tend to multiply and can lead to conditions like urinary tract infection, vaginal infections and skin rashes. Therefore changing is essential (http://health.india.com/diseases-conditions/hygiene-during-menstrual-periods-10-things-you-should-know/).

General Objective

At the end of the study, we will be able to describe the UTI- related behavior of mothers in Barangay Ula, Tugbok, Davao City who were diagnosed with Recurrent UTI from 2009 to 2013 in terms of personal hygiene, sexual activity and birth control method.

Specific Objectives

1. To determine the personal hygiene practices of mothers base on the following parameters:
   1. Handwashing
   2. Perineal care
   3. Type of underwear used
   4. Usage and changing of panty liners
   5. Changing of sanitary pad during menstruation
2. To determine the sexual activity of these mothers
3. To determine the birth control methods used by mothers

Significance of the Study

This study will provide a reference point on the personal hygiene practices of mothers regarding UTI. The data gathered will be used as a guide in forming future program strategies in decreasing the prevalence of Recurrent UTI in the area.

The results of the study will also serve as an insight on the following parties:

• Barangay health care providers (doctors, nurses and midwives) – to provide and disseminate proper information to BHWs and mothers about the behavioural risk factors that can cause recurrence of UTI;
• Barangay health workers (BHWs) – as the most accessible source of information, they should be equipped with the proper and adequate information regarding the behavioural risk factors causing UTI;
• Mothers – to assess whether their personal hygiene practices are correct. This will also, in a way, equip mothers and correct any malpractices they have.

There are indeed many cases of recurrent UTI which were not prevented because the mothers have poor personal hygiene practices. Mothers should therefore be properly equipped with adequate understanding of the personal hygiene practices that can be of great importance in the prevention of UTI. Hence, this knowledge can lead to the resolution of this problem.

Definition of Terms

1. Behavioural Risk Factors – the elements that predisposes the mothers in having recurrent UTI.

2. Recurrent UTI – Recurrent Urinary Tract Infection; the reinfection involving the urinary tract including the kidneys, ureters, bladder, and urethra.

3. Mother – a person who has been pregnant and has already given birth regardless of her marital status.

4. Personal Hygiene Practices – set of actions performed to care for one’s health

5. Perineal Care – an everyday hygienic practice of washing the perineum

Chapter 2

Methodology

Research Design

Descriptive research was used in this study. The study aims to determine the Behavioural Risk Factors of Mothers diagnosed with Recurrent UTI in Purok 6, Barangay Ula, Tugbok District, Davao City.

Locale of the Study

The study will be conducted in Purok 6, Barangay Ula, Tugbok District, Davao City.

Unit Analysis

The subject of this study is a Mother diagnosed with Recurrent UTI residing in Purok 6, Barangay Ula, Tugbok District, Davao City.

Sampling

A total enumeration of 40 mothers will be included in the study.

Variables and Measures

Data Collection Procedure

The testing in this study is focused on the behavioural risk factors of mothers diagnosed with Recurrent UTI, through the scheduled interview of all Mothers in Purok 6, Barangay Ula, Tugbok District, Davao City.

Treatment of Data

The data was analyzed using the summary statistics like means and frequency distribution.

Ethical Consideration

We will provide each participant with informed consent forms. Confidentiality of participants’ information and answers will be of our paramount consideration.

Chapter 3

Results

This section shows the results of the study. The respondents were the 40 mothers of Purok 6, Barangay Ula, Tugbok District, Davao City.

Table 1. The Frequency Distribution of 40 Mothers According to Diagnosed Cases of Recurrent UTI

Table 2. The Frequency Distribution of 40 Mothers According to Behavioural Risk Factors

Chapter 4

Discussion

Limitation of the Study

The study was limited to all mothers residing in Purok 6, Barangay Ula, Tugbok, Davao City. This was limited on a scheduled interview with the participants.

Diagnosed Cases of Recurrent UTI

The results showed that 33 mothers were diagnosed with Recurrent UTI while 7 of them were not diagnosed at all with the infection.

Behavioural Risk Factors

The results showed that all of the mothers were practicing handwashing before and after doing perinneal care. It also showed that a total enumeration of 40 mothers was washing their perineum everyday in which almost all of them were doing it about 1 to times a day. They knew that it is really important to maintain cleanliness within one’s self.

About 24 of the mothers were using water and soap in washing their perineum, 11 mothers were using feminine wash while 5 of the mothers were only using water for perinneal care. Out of the 40 mothers doing perinneal care, 19 were washing their perineum from front to back and the remaining 21 mothers were doing it from back to front.

The type of underwear used by 28 mothers was made of cotton while 8 of them used spandex and 4 used silk underwear. 22 mothers interviewed were using panty liners in which 19 of them changes their panty liners once to thrice in a day.

Of all mothers, 27 were still having their monthly menstrual period while 13 of them were already menopausal. Among the mothers who were still having menstruation, 18 of them were changing their pads at least 1 to 3 times a day, 8 mothers change 4 to 6 times in a day while only 1 mother changes her pad at least 7 times in a day.

There were 29 mothers who were sexually active who all had only 1 sexual partner. 26 of which were doing perinneal washing before sexual intercourse while 28 of the sexually active mothers were doing perinneal care after sexual intercourse and 26 of the said mothers were urinating before and after sexual intercourse.

No mother was with catheters at the time of interview. This means that catheter is not the cause of the recurrence of UTI among the 40 mothers in the Purok.

Birth control methods were used by only 18 mothers wherein 12 of them did not want to have a baby anymore while the remaining 6 were not yet ready to have a baby. The rest of the 22 mothers were not using any birth control methods because 18 of them were already menopausal and 4 of them were said to be pro-life. On the other hand, out of the 12 mothers who used family planning, 8 mothers used condoms.

With these results, it revealed that many of the mothers who were diagnosed with recurrent UTI were having personal hygiene malpractices such as washing their perineum from back to front wherein it moves bacteria from the anus close to the urethra. Another was how often they change their panty liners as well as their sanitary pads in a day as the pads get contaminated with the bodies’ innate organisms. When this happens, organisms will multiply in such warm and moist environment leading to urinary tract infections.

Chapter 5

Summary of Results, Conclusion and Recommendations

Summary

Urinary tract infections (UTIs) are among the most prevailing infectious diseases with a substantial financial burden on society.

Globally, there are an estimated 150 million urinary tract infections per annum. Nearly 20% of women who have UTI will have another, and 30% of those will have yet another, but of the last group, 80% will have recurrences.

In the Philippines, UTI is one of the ten leading causes of morbidity in all ages with a rate of 127.84 per 100,000 population. In Purok 6, Barangay Ula, Recurrent UTI is one of the leading causes of morbidity among 40 households with a prevalence of 82.5%. A bulk of 57% comprises of mothers.

The results showed that 33 mothers were diagnosed with Recurrent UTI while 7 of them were not diagnosed at all with the infection.

The results showed that all of the mothers were practicing handwashing before and after doing perinneal care. It also showed that a total enumeration of 40 mothers was washing their perineum everyday in which almost all of them were doing it about 1 to times a day. About 24 of the mothers were using water and soap in washing their perineum.

The type of underwear used by 28 mothers was made of cotton. 22 mothers interviewed were using panty liners in which 19 of them changes their panty liners once to thrice in a day.

Among the mothers who were still having menstruation, 18 of them were changing their pads at least 1 to 3 times a day, 8 mothers change 4 to 6 times in a day while only 1 mother changes her pad at least 7 times in a day.

26 out of 29 sexually active mothers were doing perinneal washing before sexual intercourse while 28 of the sexually active mothers were doing perinneal care after sexual intercourse and 26 of the said mothers were urinating before and after sexual intercourse. On the other hand, out of the 12 mothers who used family planning, 8 of them used condoms.

With these results, it only revealed that many mothers who were diagnosed with recurrent UTI were having personal hygiene malpractices.

Conclusions

At the end of the study, we were able to determine the personal hygiene practices of mothers base on handwashing, perineal care, type of underwear used, usage and changing of panty liners, and changing of sanitary pad during menstruation.

We were also able to determine the sexual activity of mothers associated with the prevalence of Recurrent UTI.

Lastly, we were able to determine the birth control methods used by mothers that predispose them to recurrent UTI such as the use of condoms and IUDs.

Recommendations

1. To the City Health Office: conduct lectures and seminars on Recurrent UTI
2. To the Barangay Officials: provide support on the programs on Recurrent UTI
3. To the BHWs: attend lectures and workshops regarding Recurrent UTI