Assessment of knowledge and awareness regarding urinary tract infections among the university students of Bangladesh

INTRODUCTION

Urinary tract infections (UTIs) are the inflammatory disorders of the urinary tract caused by the abnormal growth of pathogens.¹ Urinary tract infection may cause short-term morbidity in terms of fever, dysuria, and lower abdominal pain (LAP) and sometimes may result in permanent scarring of the kidney.² These are a significant cause of morbidity in females of all ages, infant boys and older men. Urinary tract infections (UTIs) are some of the most common bacterial infections, globally affecting 150 million people each year³. Serious sequelae associated with UTIs include frequent recurrences, renal damage in young children, pyelonephritis with sepsis, pre-term birth and complications caused by frequent antimicrobial use, such as high-level antibiotic resistance and Clostridium difficile colitis.⁴ Several factors such as gender, age, race, diabetes, urinary catheter, genitourinary tract abnormalities, circumcision, pregnancy, infants, elderly, HIV and hospitalization status causes significant risk for recurrent UTIs.⁵

Clinically, UTIs are classified as uncomplicated or complicated. Uncomplicated UTIs typically affect people who are otherwise healthy and have no structural or neurological urinary tract abnormalities; these infections are differentiated into lower UTIs (cystitis) and upper UTIs (pyelonephritis).⁶ Female gender, a prior UTI, sexual activity, vaginal infection, diabetes, obesity and genetic susceptibility are the main risk factors associated with cystitis.⁷ Complicated UTIs are defined as UTIs related with the factors that compromise the urinary tract or host defence, including urinary retention caused by neurological disease, urinary obstruction, immunosuppression, pregnancy, renal transplantation, renal failure, and the presence of foreign bodies such as calculi, indwelling catheters or other drainage devices.⁸ Catheter-associated UTIs (CAUTIs) are related with increased morbidity and mortality, and are the most common cause of secondary bloodstream infections. Risk factors for developing a CAUTI include prolonged female gender, catheterization, diabetes and older age.⁹

UTIs are mainly caused by both Gram-negative and Gram-positive bacteria, as well as by certain fungi. Uropathogenic Escherichia coli (UPEC) is the most common causative agent for both uncomplicated and complicated UTIs. For the agents involved in uncomplicated UTIs, UPEC is followed in prevalence by Klebsiella pneumoniae, Enterococcus faecalis, Staphylococcus saprophyticus, group B Streptococcus (GBS), Proteus mirabilis, Staphylococcus aureus, Pseudomonas aeruginosa, and Candida spp. For complicated UTIs, the order of prevalence for causative agents, following UPEC as most common, is Enterococcus spp., K. pneumoniae, S. aureus, Candida spp., P. mirabilis, P. aeruginosa and GBS.⁴

METHODS

Study area Dhaka city is the capital city of Bangladesh. The study was conducted at two leading private universities of Bangladesh which were Northern University Bangladesh and Stamford University Bangladesh. Respondents composed of Pharmacy undergraduate students and the students were divided into 5 classes-first year, second year, third year, forth year and Masters students. All students of Department of Pharmacy of the two universities were included in this research.

The study was a descriptive cross-sectional study, webbased survey, which was conducted from April 2020 to June 2020.A standard questionnaire was developed in the Google form focusing the knowledge and awareness regarding UTIs.

The questionnaires were randomly distributed to the male and female students of the selected universities. Appropriately fulfilled responses were collected for further analysis.

The data analysis was carried out by using Microsoft Excel version 10. The descriptive data such as distribution of respondents according to the knowledge and awareness regarding UTIs as well as demographic characteristics, were expressed in percentage and figures.

Chi square test was performed to identify the significance correlation among the factors related to knowledge and awareness.

RESULTS

Demographic characteristics of the respondents

Total 403 completed forms were collected from participants of 27 districts studying in different universities of Bangladesh; which given rise to a response rate of 80.60%. Among the respondents there were 61.04% female and 31.96% male.

About 72.95% of the total students lives in town and 27.05% in village; where the Dhaka district alone encompassed 81.89% of their residential area. Demographic data including gender, marital status, age, education level, home town and residential area of the respondents are shown in Table 1.

Prevalence of UTIs among the participants

Demographic figures about the prevalence of UTIs are presented in Table-2. This lower rate of infection may be due to poor knowledge and the social culture for hiding diseases like UTIs by both the men and women in Bangladesh. Among the infected ones the highest infection rate was found in the unmarried 19.11%, female 14%, 4th year students 8.19%, embracing the age group 22-24 (12%). On the other hand the male counterpart had the infection rate of 7%, which coincides with the prevalence of UTIs in men worldwide.¹¹

Advertency of UTIs among the participants

Among 403 participant in this survey, 370 (91.381%) was found to have advertency regarding UTIs showing good knowledge about this disease among the young generation.

Demographic characteristics regarding the awareness of UTIs for the subjects are presented in Table 3.

Knowledge of UTIs

About 76.92% correctly identified bacteria as the principle pathogens forming UTIs and 80.15% suggested antibacterial drugs for the treatment of UTIs. Statements are presented in Table 4.

Although most of the subjects (83.13%) were positive concerning the proper maintenance of hygiene as an approach to avoid UTIs, but 27.05% of them they do not know the accurate susceptible gender for UTIs and only 29.28% subjects know the possible symptoms of UTIs.

In addition 60.04% showed poor knowledge on the further consequences of untreated UTIs such as affecting the lung in the long run and 51.86% don’t know the adverse effect of urinary retention.

Awareness of UTIs

The awareness components were divided into three groups true, false and not sure. Table 5 presents statements from each groups. This study showed that cumulatively 77.79% respondents had positive attitude towards the measures against UTIs. Among the subjects 71.46% are against holding urine, 93.80% thinks drinking plenty of water is good for heath, 94.79% wanted to contact the doctor when get ill whilst 80.15% thinks sampling could be beneficial in the long run. On the other hand 70.47% respondents took the magnetite of the adverse effect of the UTIs.

DISCUSSION

Majority of respondents were unmarried (93.80%) with lower percentage (06.20%) were married and most of them were young having ages of 22-24 (48.39%) and 18-21 (48.14%). (Table-1) The average limit for age was found to be 21 years. Maximum respondents (58.81%) live with parents followed by mess (18.11%) and hostel (09.18%). All the respondents were from honours level with minimal (01.49%) from Masters level. The largest portion of respondents was the fourth-year students (35.24%) followed by second year students.

Analysis of the prevalence for the UTI (Depicted in Table -02) shows majority of the participants (79.81%) didn’t experienced UTIs, only 21.09% experienced it. Within the participants the overall infection rate experienced was lower than that reported by Christine M.Chu for Americans.¹⁰ Respondents with lower age limit like the students from 1^st to 3^rd year had a gradual increase in the infection rate. As major participants were young generation thus the overall scenario indicating age dependent increase in the infection rate.¹²

Amid the educational level the best awareness regarding the disease was observed for the 4^th year students 34.24%, while the age group 22-24 (45.41%) and unmarried (85.86%) female (57.07%) took the crown for the best awareness. For these young generations the book (59.55%) acted as the principle source of information. Other notable source was Media (Internet, TV; 19.11%) as well as Friends and family members (10.42%).

The knowledge amongst the subjects was categorized as yes, no and not sure in addition the treatment strategy and causative factors were characterized under the drug class and pathogens respectively. The study resulted most respondents had fair to good knowledge of various aspects of UTIs. This knowledge component suggests the implementation of measures to provide additional knowledge and make the young generations more aware in the prevention of UTIs. Educational program containing knowledge transfer may be effective to introduce the necessary information rendering the graduate students updated in this regard.

There was a significant role of education on the awareness of the subjects. The lack of understanding on the long term effect for UTIs could partly be attributed to the initially high knowledge for many items.

CONCLUSION

As the students are Pharmacy under graduate students, most of the students have good knowledge about UTIs, though in some cases, they are confused about the correct knowledge. The students have lack of understanding on the long term effect for UTIs. Awareness programs should be done to increase students’s knowledge about UTIs and make them aware to prevent UTIs and encourage them to visit doctors if necessary to reduce the sufferings of morbidity related to UTIs.

ACKNOWLEDGEMENTS

We express our heartfelt thanks to all individuals who participated in the study: respondents and data collectors.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

REFERENCES

1. 1. Prakash D, Saxena RS. Distribution and antimicrobial susceptibility pattern of bacterial pathogens causing urinary tract infection in urban community of meerut city, India. International Scholarly Research Notices. 2013. Available at: https://www.hindawi.com/journals/isrn/2013/749629/.
2. 2. Hoberman A, Charron M, Hickey RW, Baskin M, Kearney DH, Wald ER. Imaging studies after a first febrile urinary tract infection in young children. New England J Medic. 2003;348(3):195-202.
3. 3. Stamm WE, Norrby SR. Urinary tract infections: disease panorama and challenges. J Infec Dis. 2001;183(Supplement_1):S1-4.
4. 4. Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nature reviews microbiology. 2015;13(5):269-84.
5. 5. Martin O, Adamu AA, Julius T, Josephat NM, Eddie W, Charles DK, et al. Prevalence of Bacterial Urinary Tract Infections and Associated Factors among Patients Attending Hospitals in Bushenyi District, Uganda. 2019. Available at: http://hdl.handle.net/20.500.12493/151.
6. 6. Hooton TM. Uncomplicated urinary tract infection. New England J Medic. 2012;366(11):1028-37.
7. 7. Hannan TJ, Totsika M, Mansfield KJ, Moore KH, Schembri MA, Hultgren SJ. Host–pathogen checkpoints and population bottlenecks in persistent and intracellular uropathogenic Escherichia coli bladder infection. FEMS microbiology reviews. 2012;36(3):616-48.
8. 8. Lichtenberger P, Hooton TM. Complicated urinary tract infections. Current infectious disease reports. 2008;10(6):499-504.
9. 9. Chenoweth CE, Gould CV, Saint S. Diagnosis, management, and prevention of catheter-associated urinary tract infections. Infectious Disease Clinics. 2014,1;28(1):105-19.
10. 10. Chu CM, Lowder JL. Diagnosis and treatment of urinary tract infections across age groups. Am J Obstet Gynecol. 2018;219:40-51.
11. 11. Jhang JF, Kuo HC. Recent advances in recurrent urinary tract infection from pathogenesis and biomarkers to prevention. 2017;29(3):131-7.
12. 12. Medina M, Castillo-Pino E. An introduction to the epidemiology and burden of urinary tract infections. Ther Adv Urol. 2019;11:175.