Asymptomatic Bacteriuria Among Pregnant Women Attending Antenatal Clinic of General Hospital Ekwulobia
Chapter One
AIM OF STUDY
Asymptomatic bacteriuria is common in pregnant women and if untreated could lead to serious complications. Although asymptomatic bacteriuria could also lead to such complications, this fact is not well known.
This study is to determining the prevalence of asymptomative bacteruiria among pregnant women attending antenatal clinic at the General Hospital Ekwulobia.
CHAPTER TWO
LITERATURE REVIEW
PREVALENCE OF ASYMPTOMATIC BACTERIURIA IN PREGNANCY.
Asymptomatic bacteriuria is common, with varying prevalence by age sex, sexual activity and prevalence of genitourinary abnormalities (Bakke, et al: 1999, Weities et al; 1993, Chaudhry et al (1993). Escherichia coli is the most common organism isolated from patients with asymptomatic bacteriaria.
Infecting organisms are diverse and include: Enterobacteriacea, Pseudomonas aeruginosa, Enterococcus species and the group of Streptococcus. Organisms isolated in patient with asymptomatic bateriuria will ne influenced by patient variable. Healthy person will likely have E. Coli, where as a nursing home resident with a catheter is more likely to have multi-drug resistant polymicrobic flora (e.g P. aerginosa).
Some studies have postulate that since asymptomatic bacteriauria, usually caused by aerobic gram-negative bacilli or staphylococcus heamolytieus can lead to urinary tract infection (UTI), a urine culture should be stained from all women early in pregnancy even in the absence of urinary tract infection symptoms (Connolly et al; 1999, Delzell et al; 2000).
In Ghana, Turpin et al; (2007) reported a prelevence of 7.3% at Komfo Anokye Teaching Hospital. The predominat organism were Escherichia coli and Staphylococcus aureus. Akerele et al; (2001) also reported 8.6.6% in Benin City. A prevalence rate of 7% in pregnant women has been reported in Ethiopia (Gabre-Selsassic 1998). In Canada the prevalence rate varies from 4-7%. The prevalence is higher among individual inlower scio-economic classes and those with a past history of asymptomatic urinary tract infection (Nicolle, 1994).
In Nigeria, Olusanya et al: (1993) reported prevalence reate of 23.9% in Sagamu. Also in research paper published by (Onyeagba et al; 2007) on asymptomatic bacteriuria among pregnant women attending antenatal iin Abakaliki Ebonyi State, out of the 150 subjects screened 78.7% (118) had asymptomatic bacteriuria while 21.3%(32) had none. Thirty (30% )of the subjects had one type of bacteria. The frequency of isolation of bacteria. The frequency of isolation of organism was Staphylococcus aureus (27.1%). Echerichia coli (25.2%), klebsilla (23.7%), Proteus (10.2%), Streptococcus (8,.5%) and Pseudomanas aeruginosa (5.1%) pregnant woman in their third trimester had the higher prevalence of asymptomatic bacteriuria (36.4%, the age group 31-35 years had the highest prevalence with respect to age while farmers had the highest (90%) with respect to occupation.
More so, the incidence of asymptomatic bacteriuria in pregnant women attending antenatal clinic in Usman Danfodiyo University Teaching hospital Sokoto state revealed that (8.0%) was significant, mainly caused by Escherichia coli
PREDISPOSING FACTORS
The apparent reduction in immunity of pregnant women appears to encourage the growth of both commensal and non-commensal micro-orgganism (Scott et al; 1990). Other facors to be codisered include, age of the mother, gestational age, socio-econmic factors ( occupation), parity, kidney transplant patients, pregnant mother, patients with cord injuries,. Patient with indwelling urethral catheters.
In healthy women, the prevalence of bacteriuria increase with age, from 1% in females 5-14 years of age to more than 20% in women at least 80 years of age living in the community (Nicolle, 2003).
Studies of women with diabetes show no difference between initially asymptomatic bacteriuria and non-bacteriuria women in the incidence of urinary tract infection mortality progression to diabetic complications at 18 monthss or 14 years (semet kowska et al; 1995, Geerlings et al; 2001)
Patients with chronic indwelling foley catheters are uniformly bacteriuric, but catheters are warranted only if the patients is symptomatic (warren et al; 1982).
The highest prevalene of asymptomatic bacteriuria was observed among women in their third trimester (33.1%) and least in first trimester (30.5%) (Onyeagba et al; 2007).
Also based on occupation, farmers had the highest prevalence of asymptomatic bacteriuria (90%). Olusanya et al; (1993) observed that most pregnant women with significant bacteriuria belong low socio-economic group.
CHAPTER THREE
MATERIAL AND METHOD
STUDY AREA
This research shall be carried out at the General Hospital Ekwulobia, Anambra State.
STUDY POPULATION
The study population consists of 100 pregnant women attending antenatal clinic at General Hospital Ekwulobia, between November and December 2015. They shall be given questionnaire which made it possible to collect information on their age, gestational age, occupation and parity.
COLLECTION OF SPECIMEN
The nurses instructed the pregnant women on how to collect early morning mid stream urine clean catched method (vandepitte et al; 1991). The specimens shall be sent to the laboratory for microscopy, culture and biochemical test.
PREPARATION OF CULTURE MEDIA
The culture media used shall be nutrient agar, blood agar and cysteine lactose electrolyte deficiency agar (CLED),mac conket agar. The culture media shall be prepared according to the instructions of the manufactures, required amount of powered medium shall be weighed and dissolved in distilled water in a conical flask and sterilized at 1210 for 15 minutes at 15 psi pressure
CENTRIFUGATION
10mls of urine samples collected were centrifuged for about 5 mins at 3000 revolution per minute (RPM) to obtain the sediment of urine. After 5 mins, the supernatant shall be discarded leaving the deposit(sediments).
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