Assessment of Significant Bacteriuria, Bacterial Profile and Pyuria among Pregnant Women with Urinary Tract Symptoms in Enugu, South-Eastern Nigeria: A Cross-Sectional Study.

BACKGROUND: Urinary tract symptoms are common in pregnancy; thus, symptom-based diagnosis of urinary tract infection (UTI) might not be accurate. Such women are often exposed to antibiotics without urine culture and antibiotics sensitivity. Identification of pyuria on urine microscopy of pregnant women with urinary tract symptoms may predict significant bacteriuria and guide such women's treatment in under-resourced settings. METHODS: A cross-sectional study of 233 consecutive consenting pregnant women with UTI symptoms at theantenatal clinic of the University of Nigeria Teaching Hospital ItukuOzalla, Nigeria. Participants' mid-stream urine specimens were sent for microscopy, culture, and antibiotics sensitivity. Data analysis was descriptive and inferential at 95% confidence level. RESULTS: The prevalence of symptomatic UTI among pregnant women with urinary tract symptoms was 33.5% (78/233). Coliform bacilli were the most common isolates (82.0%) from participants' urine. Ceftriaxone and ampicillin-cloxacillin had the highest (76.9%) and least (12.8%) sensitivity, respectively. Using urine culture as the standard, pyuria on microscopy showed a sensitivity of 43.6% and a specificity of 93.5% for predicting symptomatic UTI. CONCLUSION: The prevalence of UTI among pregnant women with urinary tract symptoms was low, and the most common isolate was coliform bacilli. Though pyuria had reasonably good accuracy for diagnosing symptomatic UTI, it should not be used for this purpose because of the risks associated with misdiagnosis.

CONTEXTE: Les symptômes des voies urinaires sont fréquents pendant la grossesse; ainsi, le diagnostic basé sur les symptômes de l'infection des voies urinaires (IVU) pourrait ne pas être exact. Ces femmes sont souvent exposées à des antibiotiques sans culture d'urine ni sensibilité aux antibiotiques. L'identification de la pyurie par microscopie urinaire chez les femmes enceintes présentant des symptômes des voies urinaires peut prédire une bactériurie importante et orienter le traitement de ces femmes dans les milieux défavorisés. BUT: Déterminer la prévalence des infections urinaires chez les femmes enceintes présentant des symptômes des voies urinaires et évaluer l'exactitude de la pyurie pour prédire les infections urinaires symptomatiques pendant la grossesse à Enugu, au Nigéria. MÉTHODES: Une étude transversale de 233 femmes enceintes consentantes consécutives présentant des symptômes d'infection urinaire à la clinique prénatale de l'hôpital universitaire d'Ituku, à Ozalla, au Nigéria. Les échantillons d'urine à mi-parcours des participants ont été envoyés pour microscopie, culture et sensibilité aux antibiotiques. L'analyse des données était descriptive et inférentielle à un niveau de confiance de 95. RÉSULTATS: La prévalence des infections urinaires symptomatiques chez les femmes enceintes présentant des symptômes des voies urinaires était de 33,5% (78/233). Les bacilles coliformes étaient les isolats les plus courants (82,0%) des urines des participants. La ceftriaxone et l'ampicilline-cloxacilline avaient respectivement la sensibilité la plus élevée (76,9%) et la moins élevée (12,8%). En utilisant la culture d'urine comme norme, la pyurie à la microscopie a montré une sensibilité de 43,6% et une spécificité de 93,5% pour prédire les infections urinaires symptomatiques. CONCLUSION: La prévalence des infections urinaires chez les femmes enceintes présentant des symptômes des voies urinaires était faible et l'isolat le plus courant était les bacilles coliformes. Bien que la pyurie ait une précision raisonnablement bonne pour diagnostiquer une infection urinaire symptomatique, elle ne doit pas être utilisée à cette fin en raison des risques associés à un diagnostic erroné. MOTS CLÉS: Grossesse, infection symptomatique des voies urinaires, culture d'urine, microscopie d'urine.

Cigarette smoking and perception of its advertisement among antenatal clinic attendees in referral health facilities in Enugu, Nigeria.

BACKGROUND: The most predominant form of tobacco use is cigarette smoking, and it poses serious threats to maternal and child health. The magnitude of cigarette smoking in pregnancy in our environment is not well-known. The study aimed to determine the prevalence of cigarette smoking among pregnant women in Enugu, Nigeria as well as their exposures and perceptions of cigarette smoking advertisement. MATERIALS AND METHODS: Questionnaires were administered to a cross-section of pregnant women randomly selected from three hospitals in Enugu, South-East Nigeria, from May 2, 2012 to June 12, 2012. Analysis was both descriptive and inferential at 95% confidence levels. RESULTS: The prevalence of tobacco smoking in pregnancy was 4.5% (9/200). Over 90% of respondents admitted that cigarette smoking could harm both mother and unborn baby. In all, 79.5% (159/200) of respondents had seen or heard of advertisement for cigarette smoking as against 82.5% (165/200) that had seen or heard of antismoking advertisement (P = 0.444, odds ratio = 1.2 [95% confidence intervals: 0.74, 2.00]). CONCLUSIONS: The prevalence of cigarette smoking in pregnancy in Enugu, Nigeria was low, and there was high exposure to both pro-and anti-smoking advertisement. The awareness of harmful health effect of smoking was high but, that of the specific diseases associated with smoking in pregnancy was limited. Hence, antenatal classes and antismoking advertisement should be scaled-up to include maternal and peri-natal diseases/conditions associated with cigarette smoking.

Asymptomatic bacteriuria among pregnant women with sickle cell trait in Enugu, South Eastern Nigeria.

CONTEXT: Asymptomatic bacteriuria (ASB) in pregnancy is a major risk factor for developing acute cystitis and pyelonephritis, especially, among women with sickle cell disease. This study compared the prevalence, pattern, and microbiological characteristics of ASB in pregnancy between sickle cell trait (HbAS) and normal hemoglobin AA (HbAA) genotype subjects. MATERIALS AND METHODS: Culture and sensitivity of mid-stream urine samples were collected from 300 HbAS women and 300 matched HbAA control at the antenatal clinic of University of Nigeria Teaching Hospital Enugu, Nigeria from August 2010 to December 2011. Analysis was both descriptive and inferential at 95% confidence levels. RESULTS: Prevalence of ASB in HbAS and HbAA women were 32.7% (98/300) and 32% (96/300) respectively (odd ratio (OR) =1.03 [95% confidence interval (CI) 0.73, 1.45]). Escherichia coli was the most common organism isolated in both the HbAS group (56.1%, 55/98) and control group (61.4%, 59/96), (OR = 0.80 [95% CI 0.45, 1.42]). The antibiotics with the highest microbial sensitivity were ciprofloxacin 90.8% (89/98) and gentamicin 100% (98/98) for HbAS and HbAA women respectively. CONCLUSIONS: The prevalence of ASB in pregnant women with HbAS in Enugu, Nigeria was high and did not vary significantly from that of woman with HbAA. Therefore, pregnant women irrespective of their sickle cell status would benefit from routine screening for ASB.