• Users Online: 128
  • Print this page
  • Email this page


 
 
Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 19  |  Issue : 1  |  Page : 50-57

Assessment of parents’ awareness about urinary tract infections in children of Babylon Province


1 Babylon Health Directorate, College of Medicine, Babylon University, Babylon Province, Iraq
2 Department of Surgery/Urology, College of Medicine, University of Babylon, Babylon Province, Iraq

Date of Submission05-Oct-2021
Date of Acceptance19-Oct-2021
Date of Web Publication20-Apr-2022

Correspondence Address:
Ola H Al-Zubaidi
College of Medicine, Babylon University, Babylon
Iraq
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/MJBL.MJBL_82_21

Rights and Permissions
  Abstract 

Background: Urinary tract infection (UTI) is one of the commonest infectious diseases in children. Early recognition and prompt treatment are vital aspects in its management to prevent complications. The major challenges for parents, clinicians, and health workers are related to the wide variation of disease presentation. So the parents must be fully informed about UTI in children. Objective: To assess parents’ awareness about UTI in their children and determine the main factors that may affect the degree of parents’ awareness. With the enhancement of parents’ awareness via correction of any wrong answers, resolving any question or confusion. Materials and Methods: This is a cross-sectional study conducted from March 2021 until the end of June 2021 and included 300 parents of children aged 2–12 years, presented with symptoms suggestive of UTI visiting teaching hospitals, primary health care centers, and urological and pediatric private clinics in Babylon province. Parents were interviewed for about 10–15 minutes by using a predesigned questionnaire. Results: Mean age was 32.20 ± 8.81 years. Females comprised the majority of study participants (77.67%), whereas males comprised the remaining (22.33%). All of the fathers were married, as were 95.71% of mothers. Most fathers had university or higher education (55.22%), whereas most mothers had below-university education (57.08%). Most of the parents had medium income (85% of fathers and 83% of mothers). About two-third of them reside in urban areas (68% of fathers and 64% of mothers). Two children account for higher rank of children number (28%). Fever was the most frequent presenting symptom (65%). Overall parents’ awareness score was medium in 50% of participants and high in 49%. Similarly, symptoms, diagnosis, and treatment scores were nearly equal between high (46.67%, 44.33%, and 44.67% respectively) and medium (45.67%, 45.67%, and 45.67% respectively), while prevention score was high in 52%, complication score was medium in 59%. Symptoms and diagnosis scores were significantly higher in residents of rural areas. Treatment and prevention scores were significantly higher in those with higher education. Complication score was significantly higher in those with higher children number, male, illiterate, and rural residents. Conclusions: Parents in Babylon province have an acceptable level of awareness about UTI in their children, with highly educated parents having more degree of awareness about UTI treatment and prevention than those with a lower level of education. Parents from rural areas have more information about UTI symptoms, diagnosis, and complications than those from urban areas, with important role of experience on the parents' awareness about UTI complications.

Keywords: Awareness, Babylon, parents, UTI


How to cite this article:
Al-Zubaidi OH, Al-Salman AR. Assessment of parents’ awareness about urinary tract infections in children of Babylon Province. Med J Babylon 2022;19:50-7

How to cite this URL:
Al-Zubaidi OH, Al-Salman AR. Assessment of parents’ awareness about urinary tract infections in children of Babylon Province. Med J Babylon [serial online] 2022 [cited 2022 May 26];19:50-7. Available from: https://www.medjbabylon.org/text.asp?2022/19/1/50/343523




  Introduction Top


One of the most common infectious diseases in children is urinary tract infection (UTI).[1] It is more frequent in girls than boys, as around 2% of boys and 8% of girls develop UTI at the age of 11 years old.[2] The major challenges for parents, clinicians, and health workers are related to the variation of disease presentation and prevalence, which depend on age, sex, race, region, and culture.[3]

UTIs are classified according to the site of infection as lower and upper UTIs; lower UTI (cystitis) is an inflammation of the bladder mucosa, presented as dysuria, frequency, urgency, enuresis, hematuria, suprapubic pain, and malodorous urine. Upper UTI (pyelonephritis) is an inflammation of the renal pelvis and parenchyma, and the patient presented with fever, chills, and flank pain and may be severe enough to cause septic shock.[4]

The long-term consequences of UTI in children especially if inadequately treated and followed up are chronic abdominal pain and renal scar that result in hypertension and chronic renal insufficiency in adulthood.[5] So the early recognition and prompt treatment are considered vital aspects in management of UTI in children to lessen the risk of adulthood complications.[6]

In children, it is likely to prevent infection of urinary tract and protect the child from the potential risks of the disease by improvement of health behaviors,[7] as there are many factors that can lead to the development of UTI including those related to low level of family’s health awareness about child care, such as using suitable underwear, washing methods, and gastrointestinal tract infection management.[8]

Because the symptoms of UTI in children are distinct from those that are common in adults and arise insidiously, parents’ recognition of infection is challenging. The widespread misunderstandings about the symptoms of UTI may cause delay in parents seeking medical care.[9]

The investigations required for pediatric UTI diagnosis include urinalysis and urine culture, which required urine samples collected noninvasively in sterile urine container or invasively via urethral catheterization or suprapubic aspiration for younger children.[10] The invasive procedures are preferred as urine sample contamination is more likely to occur when collected by urine container; however, invasive methods are more distressing to parents and children.[11]

Follow-up imaging tests such as ultrasound and voiding cystourethrogram may be used to identify renal abnormalities, with the former being suggested as a first step as it is less invasive.[10]

The parents must be fully informed about their child’s care, pediatric UTI symptoms, signs and complications, the diagnostic procedures options, follow-up tests, and treatment plans, and this the main aim of family-centered care by participation of parents in management decisions making, taking their preferences in account, with continuous communication about treatment steps using understandable language.[12]


  Materials and Methods Top


Study design, sample, and setting

This is an analytical cross-sectional study performed on parents of children aged 2–12 years, presented with symptoms suggestive of UTI visiting Babylon Maternity and Pediatrics Teaching Hospital, Imam Al-Sadik General Teaching Hospital, Al-Hilla General Teaching Hospital, primary health care centers, and urological and pediatric private clinics in Babylon province.

The study was performed over the course of three-month period from the first of March 2021 until the end of June 2021.

Sample size

The total number of parents who participated in the study was 300, determined according to the following equation N=Z2P(1-P)/D2. Depending on UTI prevalence (32%) reached by Hussein et al. in Baghdad in 2017.[13]

Inclusion criteria

All parents having a child aged 2–12 years presented with symptoms suggestive of UTI who visited the above-mentioned medical institutions were involved in the study.

Exclusion criteria

Reluctance to participate in the study.

Data collection tools and scoring system

Parents were interviewed for about 10–15 minutes after stabilization of their children's condition by using a predesigned questionnaire containing 35 questions divided into 5 categories (symptoms, diagnosis, treatment, complications, and prevention). Also, the questions were classified according to the quality into three levels (easy, medium, and difficult).[14]

The answer to each question was either true or false; each correct answer was given a positive score (1, 2, and 3 points for easy, medium, and difficult questions, respectively), whereas the incorrect answer was given a zero score. The final score of each participant was presented in the form of low, medium, or high for each of the following items (total, symptoms, diagnosis, treatment, complications, and prevention scores) according to scoring system shown in [Table 1].[14]
Table 1: Awareness scoring system

Click here to view


Also, the gathered information included child presenting symptoms, parents’ age, sex, marital status, education degree, family income, residence, and children number, with brief history about the current condition and any previous medical problem.

After completion of the questionnaire, any wrong answers were corrected to the parents, also any question or confusion was resolved.

Statistical analysis

SPSS® software (version 23.0 For Linux® operating system) was used to perform statistical analysis for this study. Continuous variables were represented as means ± SD, whereas categorical variables were represented as frequencies and percentages. ANOVA test was used to compare means between three or more groups, whereas chi-square test was used to assess the relationship between categorical variables. P-value of ≤ 0.05 was considered statistically significant.

Ethical approval

The study was conducted in accordance with the ethical principles that have their origin in the Declaration of Helsinki. It was carried out with patients verbal and analytical approval before sample was taken. The study protocol and the subject information and consent form were reviewed and approved by a local ethics committee according to the document number 4 (including the number and the date in 15/1/2021) to get this approval.


  Results Top


This study included a total of 300 parents; age of participants ranged from 18 to 55 years with a mean age of 32.20 ± 8.81 years and a median of 30 years. Age group distribution of study participants is illustrated in [Figure 1]. Females comprised the majority of study participants (77.67%), whereas males comprised the remaining (22.33%), as illustrated in [Figure 2]. Demographic characteristics for mothers are detailed in [Table 2] and fathers are detailed in [Table 3]. Number of children for each parent is presented in [Table 4].
Figure 1: Age group distribution among study participants (n = 300)

Click here to view
Figure 2: Gender distribution among study participants (n = 300)

Click here to view
Table 2: Demographic characteristics of mothers (n = 233)

Click here to view
Table 3: Demographic characteristics of fathers (n = 67)

Click here to view
Table 4: Number of children for each parent

Click here to view


The most frequent presenting symptoms were fever in 65.0% and abdominal pain in 56.7%, followed by irritation of perineal area (39.7%), bad odor of urine (38.0%), dysuria (36.7%), and frequency (36%). Other symptoms include nocturia, anorexia, vomiting, diarrhea, involuntary urination, and hematuria as shown in [Figure 3].
Figure 3: Proportions of presenting symptoms (n = 300)

Click here to view


Awareness scores among study participants were summarized in [Table 5]. Awareness scores were compared with certain variables of study participants after being divided into five distinct scores: symptoms score, diagnosis score, treatment score, complications score, and prevention score, as in [Table 6][Table 7][Table 8][Table 9][Table 10], respectively. The total score was also compared with those variables in [Table 11].
Table 5: Awareness scores among study participants (n = 300)

Click here to view
Table 6: Symptoms score

Click here to view
Table 7: Diagnosis score

Click here to view
Table 8: Treatment score

Click here to view
Table 9: Complication score

Click here to view
Table 10: Prevention score

Click here to view
Table 11: Total score

Click here to view



  Discussion Top


The mean age of the studied parents was 32.20 ± 8.81 years, ranging from 18 to 55 years. Females account for the majority of study participants (77.67%), as a mother is considered as the primary caregiver to her children, whereas males comprised the remaining (22.33%). These results were comparable to other Iraqi studies done by Hasan.[15] in 2020 and Shibeeb et al.[16] in 2019 that assess parental knowledge about autism spectrum disorder and febrile Seizure in their children, respectively, at Babylon province; they were also compatible with results obtained by Fazel et al.[17] in their study about parents' knowledge, attitude, and practice regarding UTI prevention in children at Tehran, Iran.

All of the fathers were married, as were the majority of mothers; only 3% and 1.29% of mothers were divorced and widowed, respectively. These results were consistent with that reached by Hasan.[15] but slightly differ from results gained by Seyezadeh et al.[14] in Iran, which show 8.1% of parents were divorced; this might be explained by difference in population and possible effect of the societal norms that assume divorce as a stigma, leading to parents hiding their real marital status.

Most fathers had university or higher education, with only less than 5% of them being illiterate, whereas most mothers had below-university education, with nearly 10% of them being illiterate. These differences might be related to social restriction that sometimes prevents women from completing their education, especially after marriage. Comparable finding regarding the level of education and gender difference was reported by Hasan.[15] and Mohammed et al.,[18] respectively. Whereas lower level of education and less gender difference were reported by both Seyezadeh et al.[14] and Fazel et al.,[17] which might be explained by the difference in population trend to complete education and more opportunity for women to complete an education.

Most of the parents had medium income (85% of fathers and 83% of mothers), which was similar to the finding reported by Qasem et al.[19] About two-third of them reside in urban areas; this result was consistent with that obtained by Hasan,[15] Shibeeb et al.,[16] Fazel et al.,[17] and Alkhazrajy and Aldeen.[20]

Number of children for each parent is highly variable between families, with two children accounting for higher rank, as was reported similarly in Seyezadeh et al.[14]

Presenting symptoms of UTI are also highly variable between children, but most frequent presenting symptom was fever in 65.0%. This finding was in agreement with the study done by Al Rikabi and Raghif[21] and Giri et al.[22]

Overall parents’ awareness score was medium in half of participants, slightly less percent of parents achieved high score, whereas only 1% got low score. These findings were in agreement with the study done by Hashemiparast et al.[23] But slightly lower results were obtained by Seyezadeh et al.[14] where 63% of parents got high score, and the remaining achieved moderate score. These discrepancies might be related to difference in studied population, sample size, or study design.

Similarly, symptoms, diagnosis, and treatment parents’ awareness scores were nearly equal between high (46.67%, 44.33%, and 44.67%, respectively) and medium (45.67%, 45.67%, and 45.67%, respectively). Also Seyezadeh et al’s.[14] results were slightly higher regarding diagnosis and treatment, but lower in relation to symptoms. Individual variation and difference in study population might explain this diversity.

Symptoms and diagnosis parents’ awareness scores were found to be significantly affected by the residence of parents, the opposite of expected, which were higher in residents of rural area. This might be related to high prevalence of UTI in children of rural population,[24] leading to more encounters and so more experience of rural parents to identify UTI symptoms and ways to diagnosis, in addition to higher level of community communication between members of rural area than those in urban cites, leading to sharing their stories and experiences about childrens’ sickness and raising the level of their awareness regarding corresponding illness.

Treatment parents’ awareness score was not significantly affected by the residence of parents but with their level of education; higher degree of score correlated with higher level of education. Most of the parents with university and higher education obtained high scores; similar finding was obtained by Seyezadeh et al.[14]

Complication parents’ awareness score was medium in about 60% of participants, low in only 2%, and high in the remaining. The score is significantly affected by number of children, gender, education level, and residency, with high score related to higher number of children, male gender, lower level of education, and rural residency; these results might be explained by high association between these factors and childrens’ UTI complication, secondary to UTI complication exposure by parents or their relative, ending with improvement in their awareness about UTI complication. This score is also lower than that obtained by Seyezadeh et al.,[14] which failed to demonstrate such statistical correlation.

Prevention parents’ awareness score was high in more than half of participants, low in 10%, and medium in the remaining. With positive significant correlation with educational attainment, higher degree of score is associated with higher educational level. This finding was consistent with that obtained by Seyezadeh et al.[14] regarding both score degree and educational attainment significant correlation.


  Conclusions Top


The study concludes that parents in Babylon province have acceptable level (medium to high) of awareness about UTI in their children in both overall score and score of the five components of UTI knowledge (symptoms, diagnosis, treatment, complications, and prevention). Parents with higher educational attainment have more awareness about UTI treatment and prevention than those with lower level of education. The parents from rural areas have more information about UTI symptoms, diagnosis, and complications than those from urban areas. And experience plays an important role in development of parents’ awareness about UTI complications.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Karmazyn B, Alazraki A, Anupindi S, Dempsey M, Dillman J, Dorfman S et al. ACR appropriateness criteria® urinary tract infection - child. J Am Coll Radiol 2017;14:S362-71.  Back to cited text no. 1
    
2.
Kronman MP, Smith S Urinary tract infection. In: Marcdante KJ, Kliegman RM, editors. Nelson Essentials of Pediatrics. 7th ed. Philadelphia: Elsevier/Saunders; 2015. p. 372-4.  Back to cited text no. 2
    
3.
Schmidt B, Copp HL Work-up of pediatric urinary tract infection. Urol Clin North Am 2015;42:519-26.  Back to cited text no. 3
    
4.
A‘t Hoen L, Bogaert G, Radmayr C, Dogan H, Nijman R, Quaedackers J, et al. Update of the EAU/ESPU guidelines on urinary tract infections in children. J Pediatr Urol 2021;17:200-7.  Back to cited text no. 4
    
5.
Montini G, Tullus K, Hewitt I Febrile urinary tract infections in children. N Engl J Med 2011;365:239-50.  Back to cited text no. 5
    
6.
Coulthard MG, Lambert HJ, Vernon SJ, Hunter EW, Keir MJ, Matthews JN Does prompt treatment of urinary tract infection in preschool children prevent renal scarring: Mixed retrospective and prospective audits. Arch Dis Child 2014;99:342-7.  Back to cited text no. 6
    
7.
Keren R, Shaikh N, Pohl H, Gravens-Mueller L, Ivanova A, Zaoutis L, et al. Risk factors for recurrent urinary tract infection and renal scarring. Pediatrics 2015;136:e13-21.  Back to cited text no. 7
    
8.
Hashemi Parast M, Shojaizade D, Dehdari T, Gohari MR Design and evaluation of educational interventions on the health belief model to promote preventivebehaviors of urinary tract infection in mothers with children less than 6 years. Razi J Med Sci 2013;20:22-28.  Back to cited text no. 8
    
9.
Schulz L, Hoffman RJ, Pothof J, Fox B Top ten myths regarding the diagnosis and treatment of urinary tract infections. J Emerg Med 2016;51:25-30.  Back to cited text no. 9
    
10.
Robinson JL, Finlay JC, Lang ME, Bortolussi R; Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Community Paediatrics Committee. Urinary tract infections in infants and children: Diagnosis and management. Paediatr Child Health 2014;19:315-25.  Back to cited text no. 10
    
11.
Stevens BJ, Abbott LK, Yamada J, Harrison D, Stinson J, Taddio A, et al; CIHR Team in Children’s Pain. Epidemiology and management of painful procedures in children in canadian hospitals. CMAJ 2011;183:E403-10.  Back to cited text no. 11
    
12.
Byczkowski TL, Gillespie GL, Kennebeck SS, Fitzgerald MR, Downing KA, Alessandrini EA Family-centered pediatric emergency care: A framework for measuring what parents want and value. Acad Pediatr 2016;16:327-35.  Back to cited text no. 12
    
13.
Hussein NH, Rasool KH, Taha BM, Hussein JD Prevalence and antimicrobial susceptibility patterns of bacteria isolated from urinary tract infections (UTIs) in children at children hospital in Baghdad. AL-Kindy College Med J 2017;13:102-7.  Back to cited text no. 13
    
14.
Seyezadeh A, Tohidi MR, Sameni M, Seyedzadeh MS, Hookari S Assessment of parents’ awareness of urinary tract infections (UTIs) in infants and children and related demographic factors: A cross-sectional study. J Compr Ped 2021;12:e107529.  Back to cited text no. 14
    
15.
Hasan AA Assessment of family knowledge toward their children with autism spectrum disorder at al-hilla city, Iraq. Indian J Forensic Med Toxicol 2020;14:1801.  Back to cited text no. 15
    
16.
Shibeeb N, Altufaily YS Parental knowledge and practice regarding febrile seizure in their children. Medical Journal of Babylon 2019;16:58.  Back to cited text no. 16
    
17.
Fazel M, Tefagh G, Mohammadi-Vajari MA, Meysamie A, Larijani FJ, Nourbakhsh SM, et al. Evaluation of knowledge, attitude, and practice of mothers presenting to pediatric clinic regarding urinary tract infection prevention in children. J. Pediatr Nephrol 2019;7:1-6.  Back to cited text no. 17
    
18.
Mohammed MM, Abbas AN, Rashid AA Estimating the knowledge and attitude of parents about their children’s asthma and evaluating the impact of their education status in Baghdad/Iraq. Syst Rev Pharm 2020;11:265-9.  Back to cited text no. 18
    
19.
Qasem AO, Abas LA, Hussein BA, Qadir MS, Salih FA Assessment the knowledge of mothers toward home accident among children less than five years in Polytechnic University of Sulaimani. Kurd J Appl Res 2017;2:21-6.  Back to cited text no. 19
    
20.
Alkhazrajy LA, Aldeen ER Assessment of mothers knowledge regarding the developmental milestone among children under two years in Iraq. Am J Appl Sci 2017;14:869-77.  Back to cited text no. 20
    
21.
Al Rikabi AA, Raghif LF Screening program for urinary tract infection of prepubertal children at al nasiriya city primary schools. Iraqi National Journal of Nursing Specialties 2016;29:35-44.  Back to cited text no. 21
    
22.
Giri A, Kafle R, Singh GK, Niraula N Prevalence of escherichia coli in urinary tract infection of children aged 1–15 years in a medical college of eastern Nepal. J Nepal Med Assoc 2020;58:11-4.  Back to cited text no. 22
    
23.
Hashemiparast MS, Shojaeizadeh D, Aezam, K, Tol A Effective factors in urinary tract infection prevention among children: Application of health belief model. Open J Prev Med 2015;5:72-7.  Back to cited text no. 23
    
24.
Muhsin M, Sarhat AR, Ghani MF Urinary tract infection in malnourished children under 5 years in Tikrit-Iraq. Indian J Public Health Res Dev 2019;10:653-7.  Back to cited text no. 24
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusions
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed184    
    Printed8    
    Emailed0    
    PDF Downloaded15    
    Comments [Add]    

Recommend this journal