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Untreated asymptomatic bacteriuria can lead to urinary tract infection (UTI) in pregnancy with devastating maternal and neonatal effects such as prematurity and low birth weight, higher fetal mortality rates and significant maternal morbidity. We carried out a two year (April 2007 to March 2009) cross-sectional epidemiological study to determine the prevalence of significant bacteriuria among asymptomatic antenatal clinic attendees at two antenatal clinics (ANCs) in University College Hospital and Adeoyo Maternity Hospital, both in Ibadan, Nigeria. All consenting ANC attendees without UTI were enrolled in the study. Urine specimens of 5 to 10 ml collected from each subject were examined microscopically for white blood cells, red blood cells and bacteria. The specimens were further cultured on MacConkey agar using a sterile bacteriological loop that delivered 0.002 ml of urine. Colony counts yielding bacterial growth of more than 105/ml of pure isolates were considered significant. Of the 473 subjects studied, 136 had significant bacteriuria, giving a prevalence rate of 28.8%. The highest age specific prevalence (47.8%) was found in the 25-29 year olds while only one (0.7%) was found in the teenage group. A large percentage (64.0%) of subjects with significant bacteriuria had tertiary education, compared with 4.4% who had no formal education but the association was not statistically significant (X2 = 0.47, p = 0.79). The majority (75.8%) of subjects with significant bacteriuria had no previous history of abortion, while 20 (14.7%) had one previous abortion and only three (2.1%) admitted to three previous abortions (X2 = 5.16, p = 0.16). The majority (69.8%) of those with significant bacteriuria presented at second trimester while 38 (28.0%) presented at third trimester (X2 = 6.5, p = 37). Only 22 (4.6%) of the studied subjects presented at first trimester, and 3 (13.7%) of these had significant bacteriuria. The prevalence of asymptomatic bacteriuria is high among this study population. Hence we suggest that advocacy programs be initiated to urge pregnant women to access ANC services early in pregnancy. © 2011 by The Japanese Society of Tropical Medicine.
This two-year (April 2007 to March 2009) cross-sectional epidemiological study was carried out at two ANCs in Ibadan, Nigeria. These ANCs were the University College Hospital (UCH), a tertiary health care centre, and Adeoyo Maternity Hospital (AMH), a secondary health care facility. The two hospitals serve as health care facilities for middle and upper class patients in the population. Ethical approval was obtained from the University of Ibadan/UCH Joint Ethical Committee prior to recruitment of participants. Ante Natal Clinic attendees without dysuria, frequency and urgency of urination or other clinical symptoms of UTI were interviewed. Subjects who gave informed consent were enrolled into the study while those who refused participation were excluded. A standardized questionnaire was used to obtain demographic data, medical and social information as well as the gynaecological and obstetric history of the subjects. Subjects with gestational diabetes were excluded from the study because they are more prone to UTI, especially significant bacteriuria without pyuria [2]. A well-labelled sterile universal container was given to each participant to collect about 5–10 ml of mid-stream urine. The specimen was promptly transported to the Department of Medical Microbiology and Parasitology, UCH, Ibadan for immediate processing. One drop of un-centrifuged urine was aseptically placed on a clean grease- free well- labelled frosted slide and covered with a slip. It was then examined under a microscope using ×10 eye objective lens looking for white blood cells, red blood cells, yeast cells and various types of casts. This procedure was repeated using sediment obtained from about 10 ml of centrifuged urine. All the urine specimens were cultured on MacConkey agar to test for significant bacteriuria. The approximate number of bacteria per ml of un-centrifuged urine was estimated using a sterile special calibrated wire loop (that can hold 1/500 ml i.e 0.002 ml of urine) for inoculation on sterile culture medium and incubated aerobically at 35°C to 37°C for 24–48 hours. The number of isolated colonies (colony forming units) on MacConkey medium was counted using a counting chamber and was then multiplied by a factor of 500 to estimate significant bacteriuria. A count more than 105 per ml of urine was taken as significant bacteriuria; less than 104 per ml was taken as not significant while counts between 104–105 per ml were considered doubtful and the urine samples were re-examined. The computer data were studied using the statistical software SPSS version 10.0 (SPSS InC, Chicago, IL). Data exploration was done by examining the frequency of distribution of all the variables. Results were presented in the form of tables and charts. Chi square test was applied where necessary. Statistical significance was set at p < 0.05.
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