5. Discussion
5.1. Recommendations for Future Research and Practice
At the end of the study, based on the findings on the sensitivity, specificity, PPV and NPV of dipstick urinalysis compared with urine culture, all the components of the dipstick urinalysis diagnostic test have inadequate sensitivities in diagnosis of ASB, with relatively high specificities and negative predictive values. Therefore, as a screening test, a negative predictive result is good at reassuring the patient that she does not have ASB.
110
Disjunctive pairing of dipstick urinalysis (i.e dipstick positive if either nitrite or LE or both are positive) would be favoured because of the beneficial effect of treating more women for ASB and the relatively lower risk of treating patients who are false positive.
The dipstick results showed that the number of sexual intercourse in the preceding week was a statistically significant factor associated with ASB, and the gestational age of the pregnancy was a statistically significant factor associated with ASB based on the urine culture results.
Family physicians should therefore take up the challenge of further research on the topic which could lead to improved knowledge and quality of care in our environment.
Education of the public, communities and health providers can be taken by the Family Physician on the need for early screening, diagnosis, treatment and follow-up of ASB.
5.10 Recommendations
Based on the findings of this study, the following recommendations are made:
1. In centres where urine culture test is available, booked ANC patients with a positive LE test or nitrite should have a culture test. However in centres where urine culture is not available, patients with a positive LE test and /or nitrite should be treated for ASB
2. Dipstick urinalysis may be used in primary health care centres by community health workers where urine culture is hardly possible because the required human expertise is lacking.
111
3. The need to conduct similar research between pregnant and non pregnant women to show if there is a difference in the sensitivity and specificity of dipstick urinalysis between the two groups is necessary.
112 REFERENCES
1. Shazia PS, Sharada VR, Rao RM, Rao RJ. Uropathogens and their Drug susceptibility patterns among pregnant women in a Teaching Hospital. Annals Biological Research 2011; 2(5):516-521.
2. Emilie KJ. Urinary Tract Infections in Pregnancy; Updated: Apr 11, 2012. Available from: http://emedicine.medscape.com/article/452604. Accessed 11th Jan, 2013.
3. Majed AS, Emad H. Urinary Tract Infection among Pregnant Women in North Jordan.
Mid East J Fam Med 2009; 7(8): 10-14.
4. Three Centres Antenatal Care Consensus Group. Antenatal screening for asymptomatic bacteriuria. Available from: //www.3centres.com.au/new_guidelines /asymptomaticbacteriuria.Pdf. Accessed 11th May, 2012.
5. Olaitan J.O. Asymptomatic bacteriuria in female student population in a Nigerian university. The internet J Microbiol 2006; 2(2) DOI: 10.5580/b0f.
6. Masinde A, Gumodoka B, Kilonzo A, Mshana SE. Prevalence of urinary tract infection among pregnant women at Bugando Medical Centre, Mwanza, Tanzania. Tanz J Health Research 2009; 11: 154-159.
7. Smaill F, Vazquez JC. Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database Syst Rev 2007; 18(2): CD000490.
8. Kutlay S, Kutlay B, Karaahmetoglu O, Erkaya S. Prevalence, detection and treatment of asymptomatic bacteriuria in a Turkish obstetric population. J Reprod Med 2003; 48: 627-630.
113
9. Smaill F, Vazquez JC. Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database Syst Rev 2007;18(2):CD000490.
10. Sevki C, Ayla SO, Rana K, Sibel S. Asymptomatic bacteriuria and antibacterial susceptibility patterns in an Obstetric Population. ISRN Obstet Gynecol 2011, Article ID 721872, doi:10.5402/2011/721872
11. Foxman B. Epidemiology of urinary infections: incidence, morbidity, and economic costs. Am J Med 2002; 113: 5–9.
12. ACOG. Antimicrobial therapy for obstetric patients. ACOG Educational Bulletin:
American College of Obstetricians and Gynecologists. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/9688495. Accessed 11th May, 2012.
13. US Preventive Services Task Force. Guide to Clinical Preventive Services, 2007:
Recommendations of the U.S. Preventive Services Task Force. Recommendations for Adults, Infectious Diseases. Available from http://www.ncbi.nlm.nih.gov/
bookshelf/br.fcgi?book=hscps2007&part=A50081. Accessed 10th June, 2012.
14. Paul EI, Izekor PE, Eghafona NO, Enabulele OI, Ophori E. Asymptomatic bacteriuria among pregnant women. N Am J Med Sci 2010; 2 (6): 263-266.
15. Smaill F. Asymptomatic bacteriuria in pregnancy. Best Practice Research 2007; 21:
439–450.
16. Patel AD. Management of Urinary Tract Infections in Women. U S Pharm. 2007; 32 (9):
26-33.
17. Jones LA, Woodman PJ, Ruiz HE, Urinary tract infections in pregnancy. Available from http://emedicine.medscape.com/article/452604 overview. Accessed 17th May, 2012.
114
18. Tolosa JE. Antibiotics for Asymptomatic Bacteriuria in Pregnancy: RHL commentary (last revised: 14 January 2011). The WHO Reproductive Health Library; Geneva: World Health Organization.
19. Grover M.L, Bracamonte J.D, Kanodia A.K, Bryan M.J, Donahue S.P, Warner A et al.
Assessing Adherence to Evidence-based guidelines for the diagnosis and management of uncomplicated urinary tract infection. Mayo Clin Proc 2007; 82 (2): 181-185.
20. Eke GK, Anochie IC, Eke FU. Dipstick Urinalysis as a Screening Tool in the Diagnosis of Urinary Tract Infection in Children. Nig Med Prac 2010; 57 (4): 55-59.
21. National Institutes of Health. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC); May 2005. Available from: http://kidney.niddk.nih.gov.
Accessed 27th May, 2012.
22. Nicolle LE. Urinary tract infection: traditional pharmacologic therapies. Dis Mon 2003;
49:111–128.
23. Royal Coll of Obst and Gynaecol. Evidence based guidelines Antenatal care: routine care for the healthy pregnant woman. 2003. Available from: http://www.rcog.org.uk/
resources/Public/. Accessed 4th June, 2012.
24. Chaliha C, Stanton SL. Urological problems in pregnancy. Bri J Uro Int 2002; 89: 469-476.
25. Delzell JE, Lefevre ML. Urinary tract infections during pregnancy. Am Fam Phy 2002;
61: 713-721.
26. Kennedy E. Pregnancy, urinary Tract infections. March 28th, 2005. Available from: http:
// www.emedicine.com/ EMERG / topic 485.htm. Accessed 2nd June, 2012.
115
27. Le J, Briggs G.G, Mckeown A, Bustillo G. Urinary tract infection during pregnancy. The Annals Pharm 2004; 38 (10): 1692-1701.
28. Teppa RJ, Roberts JM. The Uriscreen test to detect significant asymptomatic bacteriuria during pregnancy. J Soc Gynecol Investig 2005; 12 (1): 50-53.
29. Herraiz M.A, Hernandez A, Asenjo E, Herraiz I. Urinary tract infection in pregnancy.
Enferm Infecc Microbiol Clin 2005; 23 (4): 40-46.
30. Colgan R, Nicolle L.E, McGlone A, Hooton T.M. Asymptomatic bacteriuria in adults.
Am Fam Phy 2006; 74 (6): 985-990.
31. Screening for symptomatic bacteriuria in pregnancy: urinalysis vs urine culture.
Available from findarticles.com/p/articles/mi_m0689/15-n5_v33/ai_11517594_31k.
Accessed 8th October 2012.
32. Banhidy F, Acs N, Puho E.H, Czeizel A.E. Maternal urinary tract infection and related drug treatments during pregnancy and risk of congenital abnormalities in the offspings.
BJOG 2006; 113 (12): 1465-1471.
33. Rocha P.N, Rehem A.P, Santana J.F, Castro N, Muniz A.L, Salgado K et al. The cause of urinary symptoms among Human T Lymphotropic Virus Type 1 (HLTV-I) infected patients: a across sectional study. BMC Infect Dis 2007; 7 (15):7-15.
34. Thorman A.R, Steed L.L, Hulsey T, Soper D.E. Bacteriuria in pregnant women with sickle cell trait. Am J Obstet Gynecol 2006; 194 (5): 1366-1370.
35. Al-Achi, Antoine. An introduction to botanical medicines: history, science, uses, and dangers. Westport, Conn.: Praeger Publishers. 2008. p 126. ISBN 978-0-313-35009-2.
36. Curtis NJ. Management of urinary tract infections: Historical Perspective and Current Strategies: Part 1- Before Antibiotics. J Urol 2005; 173: 21–26.
116
37. Armstrong JA. Urinalysis in Western culture: A brief history. Kidney Int. 2007; 71(5):
384-387.
38. Diamandopoulos AA. Uroscopy in Byzantium. Am J Nephrol 1997; 17: 222–227.
39. Jasin J. The transmission of learned medical literature in the middle English Liber uricrisiarum. Med Hist 1993; 37: 313–329.
40. Oliver H. Bringing Urinalysis into the 21st Century: From Uroscopy to Automated Flow Cytometry. Sysmex J Int 2008;18: 38-43.
41. Colgan R, Nicolle LE, McGlone A, Hooton TM. Asymptomatic Bacteriuria in Adults;
September 2006. Available from: http://www.aafp.org/afp/2006/0915/p985.pdf. Accessed 23rd March, 2013.
42. Nicolle LE. Asymptomatic bacteriuria: when to screen and when to treat. Infect Dis Clin North Am 2003;17:367-394
43. Medscape. Managing Acute Uncomplicated Cystitis in the Era of Antibiotic Resistance.
Available from:http://www.medscape.com/viewarticle/460756_1. Accessed 23rd March, 2013.
44. Whitehead NS, Callaghan W, Johnson C, Williams L. Racial, ethnic, and economic disparities in the prevalence of pregnancy complications. Matern Child Health J Mar 2009; 13(2):198-205.
45. Versi E, Chia P, Griffiths DJ, Harlow BL. Bacteriuria in pregnancy: a comparison of Bangladeshi and Caucasian women. Int Urogynecol J Pelvic Floor Dysfunct 1997;
8(1):8-12.
46. Fatima N, Ishrat S. Frequency and risk factors of Asymtomatic bacteriuria during pregnancy. J Coll Physicians Surg Pak 2006; 16 (4): 273-275.
117
47. Mazor-Dray E, Levy A, Schlaeffer F, Sheiner E. Maternal urinary tract infection: is it independently associated with adverse pregnancy outcome? J Matern Fetal Neonatal Med 2009; 22(2): 124-128.
48. Sheiner E, Mazor-Drey E, Levy A. Asymptomatic bacteriuria during pregnancy. J Matern Fetal Neonatal Med 2009; 22(5): 423-427.
49. Tugrul S. Evaluation and Importance of Asymptomatic Bacteriuria in Pregnancy. Clin Exp Obstetr Gynecol 2005; 32 (4): 237-240.
50. Kutlay S, Kutlay B, Karaahmetoglu O, Ak C, Erkaya S. Prevalence, detection and treatment of asymptomatic bacteriuria in a Turkish obstetric population. J Reprod Med 2003; 48(8): 627-630.
51. Hazhir S. Asymptomatic bacteriuria in pregnant women. Urol J 2007; 4 (1): 24-7.
52. Bandyopadhyay S, Thakur J.S, Ray P, Kumar R. High Prevalence of Bacteriuria in Pregnancy and its Screening Methods in North India. Indian Med Assoc 2005; 103 (5):
259-266.
53. Al-Haddad A.M. Urinary tract infection among pregnant women in Al-Mukalla district, Yemen. East Mediterr Health J 2005; 11 (3): 505-510.
54. Tadesse A, Negash M, Ketema L.S. Asymptomatic Bacteriuria in Pregnancy: Assessment of Prevalence, Microbial agents and their Antimicrobial Sensitivity Pattern in Gondar Teaching Hospital, North West Ethiopia. Ethiop Med J 2007; 45 (2): 143-149.
55. Hamdan ZH, Abdel HZ, Salah KA, Ishag A. Epidemiology of urinary tract infections and antibiotics sensitivity among pregnant women at Khartoum North Hospital. Ann Clin Microbiol Antimicrob 2011; 10:2-3
118
56. Turpin C.A, Minkah B, Danso K.A, Frimpong E.H. Asymptomatic Bacteriuria in Pregnant Women Attending Antenatal Clinic at Komfo Anoke Teaching Hospital, Kumasi, Ghana. Ghana Med J 2007; 41 (1): 26-29.
57. Obirikorang C, Quaye L, Addo K, Amidu N, Acheampong I. Asymptomatic Bacteriuria among Pregnant Women Attending Antenatal Clinic at the University Hospital, Kumasi, Ghana. J Med Biomed Sci 2012; 1(1): 38-44.
58. Aboderin A.O, Ako-Nai A.K, Zailani S.B, Ajayi A, Adedosu A.N. A study of Asymptomatic bacteriuria in Pregnancy In Ile-Ife, South Western Nigeria. Afr J Clin Exp Microbiol 2004; 5 (3): 252-259.
59. Akinloye O, Ogbolu D O, Akinloye O M, Terry Alli O A. Asymtomatic bacteriuria in pregnancy in Ibadan, Nigeria: a re-assessment. Br J Biomed Sci 2006; 63(3): 109-112.
60. Ajayi AB, Nwabuisi C, Aboyeji AP, Ajayi NS, Fowotade A, et al. Asymptomatic Bacteriuria in Antenatal Patients in Ilorin, Nigeria. Oman Med J 2012; 27(1): 31-35.
61. Akerele P, Abhuliren F, Okonofua J. Prevalence of asymptomatic bacteriuria among pregnant women in Benin City. Nig J Obstet Gynaecol 2001; 21(2): 141-144.
62. Amadi ES, Enemuo OB, Uneke CJ, Nwosu OK, Onyeagba RA, et al. Asymptomatic bacteriuria among pregnant women in Abakaliki, Ebonyi State. Nigeria. J Med Sci 2007;
7(4): 698-700.
63. Onyemelukwe N.F, Obi S.N, Ozumba B.C. Significant Bacteriuria in Pregnancy in Enugu, Nigeria. J College Med 2003; 8(2): 20-22.
64. Ijeoma IV, Ikeme AC, Okezie OA, Onyebueke EA. Asymptomatic Bacteriuria in pregnant women in Enugu, Nigeria. Trop Obstet Gynaecol 2006; 23(1): 12-13.
119
65. Oyetunji JA, Ahmed Y, Nwobodo EI, Airede LR, Ekele BA. Asymptomatic bacteriuria in pregnancy in Sokoto, Nigeria. Sahel Med J 2006; 9(1): 1-6.
66. Gyang MD, Dankyau M, Yohanna S, Madaki A. Is simple microscopy useful in the diagnosis of Asymptomatic Bacteriuria in pregnancy in Primary Care Setting? Nig J Fam Physicians 2012; 3(1): 7-14.
67. Buonanno AP, Damweber BJ. Review of Urinary Tract Infection. US Pharm 2006;
31(6): 26-36.
68. Alvarez JR, Fechner AJ, Williams SF, Ganesh VL, Apuzzio JJ. Asymptomatic bacteriuria in pregestational diabetic pregnancies and the role of group B streptococcus. Am J Perinatol 2010; 27(3): 231-234.
69. Guido S, Eberhardt K, Klaus G, Martha MM. The Diagnosis of Urinary Tract Infection.
Dtsch Arztebl Int 2010; 107(21): 361–367.
70. Gulfareen H, Nishat Z, Aftab AM, Ambreen H. Risk factors of urinary tract infection in pregnancy. J Pak Med Assoc 2010; 60(3): 213-216.
71. Nickel J.C. Management of recurrent urinary tract infections in premenopausal women.
Rev Urol 2005; 7 (1): 11-17.
72. Andrew J, James CB, Andrew JL, Christopher PP. The Use of Urinary Dipstick Tests to Exclude Urinary Tract Infection: A Systematic Review of the Literature. Am J Clin Pathol 2006; 126(3): 428-436.
73. Smith PJ, Morris AJ, Reller BL. Predicting urine culture results by dipstick testing and phase contrast microscopy. Pathology. 2003; 35:161-165.
74. National Collaborating Centre for Women's and Children's Health. Antenatal care:
routine care for the healthy pregnant woman: Clinical Guideline (NICE). 2008. Available
120
at http://www.nice.org.uk/nicemedia/pdf/CG62FullGuidelineCorrectedJune 2008.pdf.
Accessed 13th April, 2013.
75. Gupta K. Stamm W.E. Urinary Tract Infections: Diagnosis. Available from:
http://www.acpmedicine.com/abstracts/sam/med0723.htm. Accessed 31st March, 2013.
76. Quirogo-Feucher G, Robles-Torres R.E, Ruelas-Moran, Gomez-Alcala A.V.
Asymptomatic Bacteriuria among Pregnant Women. An Underestimated Threat. Rev Med Inst Mex Sequro Soc 2007; 45 (2): 169-172.
77. Elizabeth C. Urinary tract infection in adults. CME 2004; 22 (4): 182-188.
78. Lindsay E, Nicolle MD. Asymptomatic bacteriuria- When to screen and when to treat.
Infect Dis Clin N Am 2003; 17: 367–394.
79. Gorelick MH, Shaw KN. Screening Tests for Urinary Tract Infection in Children: A Meta-analysis. Paediatr1999; 104: 1117-1118.
80. Lindsay E. Screening for Asymptomatic Bacteriuria in Pregnancy. Available from:
www.phac-aspc.gc.ca/publicat/clinic-clinique/pdf/s1c9e.pdf. Accessed 4th April, 2013.
81. Johnson C, Mitchell D. Urine microscopy and culture. Royal College of Pathologists in Australia Manual 2004; 4(12)
82. Jenkins R.D, Fenn J.P, Matsen J.M. Review of Urine Microscopy for Bacteriuria. JAMA 1986; 255 (24)
83. Abyad A. Screening for Asymptomatic Bacteriuria in Pregnancy : Urinalysis vs Urine Culture. J Fam Pract 1991; 33 (5): 471-474.
84. Mehnert-Kay SA. Diagnosis and Management of Uncomplicated Urinary Tract Infections. Am Fam Physician 2005; 72: 451-458.
121
85. University of Michigan Health. Guidelines for Clinical Care. Urinary Tract Infection Guideline. 2005; 1-9.
86. Wammanda RD, Aikhiombare HA, Ogala WN. Use of nitrite dipstick test in the screening for UTI in children. West Afr J Med 2000; 19: 206-208.
87. Nys S, Van MT, Bartelds AI, Stobberingh EE. Urinary tract infections in general practice patients: diagnostic tests versus bacteriological culture. J Antimicrob Chemother 2006;
57:955–958.
88. Rouse D.J, Andrews W.W, Goldenberg R.L, Owen J. Screening and treatment of asymptomatic bacteriuria of pregnancy to prevent pyelonephritis: a cost-effectiveness and cost- benefit analysis. Obstet Gynecol 1995; 86 (1): 119-123.
89. Health link worldwide. Different tests for different purposes. Adapted from the UNAIDS and WHO recommendations for HIV testing strategies, weekly Epidemiological record No. 12. Available from://www.aidsaction.info/ht/section2. html-84k. Assessed 25th June, 2013.
90. Jayalakshmi J, Jayaram VS. Evaluation of various screening tests to detect asymptomatic bacteriuria in pregnant women. Indian j Path Microb 2008; 51(3): 379-381.
91. Scottish Intercollegiate Guidelines Network. Management of suspected bacterial urinary tract infection in adults. A national clinical guideline; July 2006. Available from:
http://www.sign.ac.uk. Accessed 21st Oct 2011.
92. Birgul K, Ozenc C, Altan A, Aydan B. Evaluation of Rapid Urine Screening Tests to detect asymptomatic bacteriuria in pregnancy. Jpn J Infect Dis. 2006; 59:261-263.
122
93. Kodikara H, Seneviratne H, Kaluarachchi A, Corea E. Diagnostic accuracy of nitrite dipstick testing for the detection of bacteriuria of pregnancy. BMC Public Health. 2009;
123(5): 393-394
94. Blomberg B. Antimicrobial resistance in urinary bacterial isolates from pregnant women in rural Tanzania : implications for public health. Scand J Infect Dis 2005; 37(4): 262-268.
95. Akujobi C.N. Antimicrobial susceptibility pattern of klebsiella species from Ebonyi State University Teaching Hospital Abakaliki, Nigeria. Niger J Clin Prac 2005; 8 (2): 90-93.
96. Ozumba U.C. Increasing Incidence of Bacterial Resistance to Antibiotics by Isolates from the Urinary Tract. Niger J Clin Prac 2005; 8 (2): 107-109.
97. Habib A.G, Nwokedi E.E, Ihesiulor U.I, Mohammad A, Habib Z.G. Widespread antibiotic resistance in savannah Nigeria. Afr J Med Sci 2003; 32 (3): 303-305
98. Ehinmidu J.E. Antibiotics Susceptibility Patterns of Urine Bacterial Isolates in Zaria, Nigeria. Tropical J Pharm Res 2003; 2 (2): 223-228.
99. Jombo G.T, Egah D.Z, Banwat E.B, Ayeni J.A. Nosocomial and community acquired urinary tract infections at a Teaching Hospital in North Central Nigeria: Findings from a Study of 12,458 Samples. Niger J Med 2006; 15 (3): 230-236.
100. Amann U, Egen-Lappe V, Strunz-Lehner C, Hasford J. Antibiotics in pregnancy. Wiley Interscience J 2006; 15(5): 327-337.
101. Stamatiou K. Study on the Efficacy of Cefaclor for the treatment of Asymptomatic Bacteriuria and Lower Urinary Tract Infections in Pregnant Women with a History of Hypersensitivity to Penicillin. Clin Exp Obstet Gynecol 2007; 34 (2): 85-87.
123
102. Rouse D.J, Andrews W.W, Goldenberg R.L, Owen J. Screening and treatment of asymptomatic bacteriuria of pregnancy to prevent pyelonephritis: a cost-effectiveness and cost- benefit analysis. Obstet Gynecol 1995; 86 (1): 119-23.
103. Awonuga DO, Fawole AO, Dada-Adegbola HO, Olola FA, Awonuga OM.
Asymptomatic bacteriuria in pregnancy: evaluation of reagent strips in comparison to microbiological culture. Afr J Med Med Sci 2011; 40(4): 377-383.
104. Harvey S. Urinary tract infection. University of Maryland Medical Center. Available from:http://www.umm.edu/patiented/articles/what_symptoms_of_urinary_tract_infection s_0000363htm. Accessed 17th November, 2012.
105. Deborah A. Wing DA, Rumney PJ, Preslicka C, Chung JH. Daily cranberry juice for the prevention of asymptomatic bacteriuria in pregnancy: a randomized, controlled pilot study. J Urol 2008; 180(4): 1367–1372.
106. Visit plateau. Plateau state Government 2006. Available from:
www.plateau.org/visit/jos.html. Accessed 7th August, 2011.
107. Araoye MO. Subjects Selection. In: Research Methodology with Statistics for Health and Social Sciences, Nathadex Publishers, Saw-Mill, Ilorin; 2003: 117-118.
108. Ultimate social security Disability Guide: SSDI, SSI, How to win, Information Skilled and Unskilled work and Transferability. Available from: http//www.ultimatedisability guide.com/get_ssdi_and_ssi.html. Accessed 16th June, 2012.
109. Adeoye A. Textbook for Medical Laboratory Practice. In: Agwung-Fobellah D, Kemajou ST editors. 1st Ed Nigeria; FEMCO Publishers Limited 2007: pg 121-153 110. Centers for Disease Control and Prevention. Epi Info. 2008; 3.5.2. Available from:
http://www.cdc.gov/epiinfo/. Accessed April 25th June, 2012.
124
111. Sensitivity and specificity – Wikipedia, the free encyclopedia. Available from: //
www.en.wikipedia.org/wiki/sensitivity_and_specificity 36k. Assessed 25th June, 2013.
112. Jazayeri A, Irajian G. Asymptomatic Urinary Tract Infection in Pregnant Women. Iran J Pathol 2009; 4:105–108.
APPENDIX I
COMPARISON OF DIPSTICK URINALYSIS WITH URINE CULTURE IN THE DIAGNOSIS OF ASYMPTOMATIC BACTERIURIA AMONG PREGNANT WOMEN ATTENDING ANTENATAL
CLINIC IN PLATEAU STATE SPECIALIST HOSPITAL JOS.
CONSENT FORM
I am Dr. KLA PONMWA, a resident in the Department of Family Medicine, Federal Medical Centre, Keffi. I am conducting a study to compare the use of Dipstick Urinalysis and Urine Culture in the
125
diagnosis of Symptomless Urinary Tract Infection among booked pregnant women attending Antenatal Clinic in PSSH Jos. This will not cost you extra money and will not be of any harm to you or your baby.
If you agree to take part in this study, you will be expected to carry out the following:
1. Get some information about you and any symptoms you may be having. Questions will be asked in clear terms and explanations given where necessary.
2. Routine clinical examinations
3. Give you two sample bottles for clean catch mid-stream urine for two different tests to screen for bacteriuria.
If you are found to have urinary tract infection in pregnancy, you will be treated free.
You are free to withdraw from the study at any time and you will still receive the full benefits of antenatal care.
Thank you.
I, ………..hereby willingly indicate my interest to participate in the above study having been duly informed of the details as above.
……… ………. ………..
Signature/Thumb Print. Date
APPENDIX II
QUESTIONNAIRE ON THE COMPARISON OF DIPSTICK URINALYSIS WITH URINE CULTURE IN THE DIAGNOSIS OF ASYMPTOMATIC BACTERIURIA AMONG PREGNANT WOMEN
ATTENDING ANTENATAL CLINIC IN PLATEAU STATE SPECIALIST HOSPITAL JOS.
Kindly fill in below/provide, the information requested for, in the spaces provided.
SECTION A.
Socio-demographic data:
126
1. Initials--- 2. ID No --- 3. Hospital No --- 4. Age in years (at last birthday) --- 5. Address --- 6. Phone No.--- 7. Marital status; [Married] [Single] [Divorced] [Separated] [Widowed]
8. Occupation: a. Client--- 9. Religion--- 10. Parity--- b. Husband---
11. LMP--- 12. Gestational Age in weeks --- 13. Highest level of education: None [ ] Primary [ ] Secondary [ ] Tertiary [ ]
14. Do you currently douch?(Use water to vigorously wash the inner walls of the vagina) [yes] [no]
15. How many wives or regular sex partners does your husband or sex partner have? --- 16. How many times did you have sexual intercourse in the preceding week? --- 17. When was the last intercourse in days? ---
SECTION B.
History:
1. Dysuria [yes] [no] 9. Any history of UTI in the past? [yes] [no]
2. Frequency [yes] [no] 10. Antibiotics used 7days prior to visit [yes] [no]
3. Urgency [yes] [no] 11. Diabetes mellitus [yes] [no]
4. Suprapubic pain [yes] [no] 12. Sickle cell anaemia [yes] [no]
5. Fever [yes] [No] 13. Any renal pathology [yes] [no]
6. Loin pain [yes] [no] 14. History of Pelvic injury from trauma [yes] [no]
7. Foul smelling vaginal discharge in the last six months[yes] [no]
8. Other symptoms [specify]………..…
127 SECTION C.
Clinical findings:
1. Weight [ Kg]
2. Height [ M]
3. Temperature [ °C]
4. Pallor [yes] [no]
5. Jaundice [yes] [no]
6. Pulse Rate [ b/min]
7. Blood Pressure [ mmHg]
8. Suprapubictenderness [yes] [no]
9. Renal-angle tenderness [yes] [no]
10. SFH [ cm]
11. Fetal Heart Rate [ b/min]
12. Other signs [specify]……….
SECTION D.
Test Result:
1. DIPSTICK 2. M/C/S
APPENDIX III
LE Nitrite Mic Culture Sensitivity
128
129 APPENDIX IV
130
131 APPENDIX V
132