Clinical presentation, risk factors and pathogens involved in bacteriuria of pregnant women attending antenatal clinic of 3 hospitals in a developing country: a cross sectional analytic study.

BACKGROUND: Pregnancy increases the risk of recurrent bacteriuria and acute pyelonephritis which is associated with significant maternal and fetal risks. The prevalence of bacteriuria varies worldwide. Clinical diagnosis is challenging since it is usually mistaken for normal physiological changes during pregnancy. This study aims to determine the prevalence, clinical presentation, risk factors and microorganism responsible for bacteriuria in pregnant women of Douala city, Cameroun. METHODS: A cross-sectional study was conducted in 3 hospitals of Douala from January to April 2015. We consecutively recruited all consented pregnant women aged 18 years and above attending antenatal clinics. Socio-demographic characteristics, medical and obstetrical past history, clinical signs and obstetric characteristics of the index pregnancy were collected. Thereafter, urine were collected aseptically and subjected to routine macroscopy, microscopy examination and culture. The culture was obtained by inoculation of 10 µl of urine on the appropriate medium. Identification of pathogens was done automatically using the VITEK2™ (BioMérieux- France). Data were processed using the Statistical Package for the Social Sciences (SPSS) 18. Statistics were descriptive and analytic; Odds ratios were calculated. Associations between variables and bacteriuria were conducted using the Chi squared test and the fisher exact probability. Associations with p-values < 0.05 were considered statistically significant. RESULTS: Overall, 354 pregnant women were enrolled with mean of age 28.18 ± 4.4. The prevalence of significant bacteriuria was 9.9% (35 out of 354). The prevalence of bacteriuria in women who were asymptomatic was 5.7%. Cystitis and pyelo-nephritis were observed in 3.6 and 0.6% respectively. The most commonly isolated organism was Escherichia coli (E. coli): 48.6%. History of Urinary Tract Infection (UTI) (p = 0.035, OR = 2.183, CI = 1.055-4.518) was significantly associated with bacteriuria. High level of education was protective. CONCLUSIONS: Bacteriuria was frequent in pregnant women and significantly increased with the past history of UTI and low level of education. Asymptomatic bacteriuria was more common. E coli was the most frequent uropathogen. Education and proper treatment of UTI should be provided to reduce the burden of this pathology in order to prevent its severe complications.

Knowledge, practices and attitudes on antibiotics use in Cameroon: Self-medication and prescription survey among children, adolescents and adults in private pharmacies.

Benefits of antibiotics are threatened by the self-medication, people's lack of knowledge and inappropriate use of antibiotics, especially in developing countries. This study was designed to determine knowledge; attitudes and practices toward antibiotics use in an urban community, and evaluate the factors that are associated with antibiotic use. Between January and March 2015, a cross sectional and prospective study was conducted in all pharmacies within the Douala IV health district, Cameroon. Anonymous interviews including both open and closed ended questions were conducted in participants selected by convenience sampling Descriptive and logistic regression analysis were performed using StataSE11 software (version 11 SE) and R software (version 3.1.1) in data analysis. Overall 402 (33.7%) of 1,192 customers purchased antibiotics and of these, 47% bought antibiotics without a prescription. 60.7% of purchased antibiotics was for adult 'patients and around 60% of parents carried out self-medication on their children. The vast majority reported that all microbes can be treated with antibiotics (88.3%). The belief that antibiotics are appropriate for bacterial infections was more common among those with a higher level education (OR = 4.03, 95%CI:1.89-8.57, p<0.0001) and among public/private servants (OR = 2.47, 95%CI:1.21-5.08, p = 0.013). Physicians provide less explanations about antibiotics are and their potential side effects than the pharmacy auxiliaries (OR = 0.205, 95%CI = 0.09-0.46, p<0.0001), but more than pharmacists (OR = 3.692, 95%CI:1.44-9.25, p = 0.005). Indications on antibiotics use were 7 times more given to customers with a prescription compared to those without a prescription (OR = 7.37, 95% CI = 2.13-25.43, p = 0.002). Adult male (OR = 2.32, 95%CI:1.24-4.34, p = 0.009) and higher education (OR = 2.05, 95%CI:1.08-3.89, p = 0.027) were significantly associated with self-medication. Misuse, little "practical knowledge" and high self-medication confirm the unsatisfactory prescription and dispensing practices of the antibiotics in our country. These results highlight the important of the development and implementation appropriate guidelines for the responsible use of antibiotics for health care providers and health education targeting community members themselves.