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A STUDY TO DETERMINE THE EFFECTIVENESS OF
PLANNED TEACHING PROGRAMME ON KNOWLEDGE AND
PRACTICES REGARDING PREVENTION OF URINARY TRACT
INFECTION AMONG ADOLESCENT GIRLS AT SELECTED
SCHOOLS OF TUMKUR.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
Mrs JISHA T. THOMAS
OBSTETRICS AND GYNAECOLOGY
Akshaya College of Nursing,
Tumkur, Karnataka.
1
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1. Name of the Candidate : Mrs Jisha T. Thomas
M.Sc Nursing, 1st Year
And address
Akshaya College of Nursing,
Tumkur, Karnataka.
2. Name of the Institution : Akshaya College of Nursing
3. Course of Study
: M.Sc. Nursing 1st year,
And Subject
4. Date of Admission to
Obstetrics and Gynecology
:
Course
5. Title of the Topic
: “A study to determine the effectiveness of planned
teaching programme on knowledge and practices
regarding prevention of urinary tract infection among
adolescent girls at selected schools of Tumkur”
2
6. INTRODUCTION
‘Health is a wealth’, it is most essential for all people in all age group.
According to WHO ‘health is a state of complete physical, mental and social wellbeing not merely an absence of disease or infirmity.’ In recent years this statement has
amplified to include the ability to lead socially and economically productive life.1
Adolescence period is the time of transition from childhood to adulthood. The term
adolescence literally means ‘to emerge’ or ‘to achieve identity’. During this period social,
psychological and physical transformation and maturation occur in adolescence.2
Urinary tract infection is common disease affecting all age groups, from newborn to
old age.3 Among adolescent girls acute uncomplicated urinary tract infection is more
prevalent. This is the fourth main reason for out patient visit among adolescent women.4
In USA urinary tract infection causes one million hospital admissions per year. 1% of
school girls in the age group of (5-14 years) have bacteriuria which increases up to 4% in
young adulthood and then by additional 1-2% with every decade of age. Young women have
30 times more prevalence than that of young men.5
A study conducted among 1817 school going children aged 11-15 years in Mangalore
district shows that 192 (10.57%) children were affected with symptomatic bacterial infection
in which 53 (27.6%) were boys 139(72.4%) were girls. The main organism isolated was
E.coli. There was a gradual increase in incidence of asymptomatic bacteriuria in girls from 11
years (7.5%) to 15 years (13.66%) of age. The study result reveals that while age increases
incidence rate of urinary tract infection also increases.6
A syndromic approach conducted among 134 females adolescent aged 10-19 years in
Howrach district to determine reproductive tract infection shows that 64.01% were suffering
with reproductive tract infection, 3.82% with urinary tract infection and 15.92% with
3
dysmenorrhea. It is found that there was no significant association between reproductive tract
infection and religion and higher prevalence rates were found in family size of 7.7
Urinary tract infection in young children is mainly due to auto infection from
intestinal tract where as in adolescent girls often due to sexual activity.8
A Dutch National Survey of general practice to find the incidence rates and
management of urinary tract infection among 82,053 children aged 0-18 year’s shows that
1.15% were diagnosed as having urinary tract infection and the incidence rates were 19
episodes per 1000 persons per year. Incidence rate in girls were 8 times higher than boys
which gradually increased after the age of 12 years. Smaller cities and rural areas had the
incidence rate 2 times as high as in the three largest cities. The incidence rate was lowest in
summer times among children below 12 year’s.8
A midstream urine specimen collected from 787 female outpatients to determine a
frequent cause of acute urinary tract infection was analyzed by urine culture and coagulase
test. Findings revealed that 22% female were affected with S.saprophyticus, with 43%
affected in the age group of 16- 25 years. The incidence rate was found to be higher during
summer and fall. All patients were presented with complaints of dysuria and often with loin
pain and other common signs were hematuria and pyuria.9
Adolescent sexual and reproductive health programme highlights the need for
adolescent care and intersectorial approach for the improvement of the health status of the
adolescent girls.10
During adolescent period, lack of adequate knowledge and practices related to
maintenances of health leads to various genitourinary infections.
4
6.1 NEED FOR THE STUDY
In healthy people, urine in the bladder is sterile. However, any part of the urinary tract can
become infected. An infection anywhere along the urinary tract is called as urinary tract
infection.11
Among bacterial infection, urinary tract infection is the second most common
infection which is seen by health care providers. This infection is affecting more than 8
million people per year. In 1997, National Ambulatory Medical Survey reported that, 7
million office visits as well as 1million emergency room visits and 100,000 hospitalizations
occur due to urinary tract infection. 12
Among adolescent girls, lower urinary tract inflections are very common. Atleast one
episode of urinary tract infection will occur in nearly 5-6% of girls during first grade to
graduation from high school. Compare to boys, the recurrence rate is 50% greater in girls.
13
Due to urinary tract infection every year nearly 6-7 million young women visits physicians.14
The life time incidence of urinary tract infection in United States is found to be one in
every five woman and eleven million per year takes medicine for urinary tract infection.15
More frequently compare to men, women have urinary tract infection, because of shorter
urethra and anatomical proximity of the urethra to rectum. 16
Among adolescent girls, urinary tract infection occurs most oftenly which is related to
nascent sexual activity and more commonly in voiding or elimination syndromes. 17
A study reported that, out of 147 women aged between 17 to 34 years, 15.6%
had urinary tract
infection caused by coagulase- negative staphylococcus. All the patients
who were having urinary tract infection due to coagulase-negative staphylococcus were
found to be more sexually active as compared to 84.7% of those who had urinary tract
infection due to other causes. Patients with urinary tract infection due to coagulase- negative
staphylococcus had increased amount of vaginal discharge and some of the patients used
tampoons and oral contraceptives for menstrual protection. 18
5
Common risk factors for urinary tract infection viz.. sexual intercourse, pregnancy,
poor hygiene, dysfunctional voiding patterns, or a history of female genital mutilation. In
women, synthetic underwear and panty hose, tight jeans, and wet bathing suits, allergens /
irritants – famine hygiene sprays, bubble baths, perfumed toilet paper, sanitary napkins, and
soaps may aid in the development of cystitis in some women.14
Among adolescent girls, Incomplete and in-coordinate voiding associated with
constipation increases the risk for urinary tract infection.19
Urinary tract infection may occur due to allergies. Allergy towards food items can
irritate the bladder wall and causes susceptibility to urinary tract infection. Allergy to latex
condom, spermicides or oral contraceptives may cause urinary tract infection after sexual
intercourse.20
Lack of adequate knowledge regarding menstrual hygiene may predispose into
urinary tract infection. 14,21,22,23
A crossectional comparative study was conducted to determine the perception and
practices regarding menstruation among 94 girls from urban schools and 74 from rural school
aged 10-19 years. Data collected by using questionnaire revealed that the adolescent girls
who are not practice taboos more in rural areas (21%) as compared to urban areas (4.3%).
Restriction of physical activities during menstruation (20.3%) and restriction in type of
clothing (35.1%) during menstruation found to be more in rural girls than in urban girls
(10.6%) and (23.4%) respectively. 24
Knowledge regarding menstrual hygiene among 65 high school girls aged 14-15 years
was assessed in Guntur district. Data collected by administering interview schedule revealed
that, 51 girls had adequate knowledge regarding the process of menstruation. Out of 64 girls,
who were using old cloth, 25 (39.06%) were reusing it, 52 (81.25%) girls were taking special
bath during menstruation. External genitalia cleaning with water was restricted by 27
(41.53%) girls where as only 3 (4.62%) girls restricted with soap and water, and 20 (31.25%)
members were restricted for taking milk and milk products during menstruation. 25
6
Silent urinary tract infection may occur among school girls which is due to inadequate
intake of water and infrequent passage of urine. The main reason for this is unhygienic school
toilets and improper teaching regarding menstrual hygiene.
26
Dehydration can cause urinary
tract infection. 27
A study conducted among 107 people with symptoms of urinary tract infection and
250 non infected people selected randomly with in the community. Among infected members
27.85% were men and 72.2% were women. The study showed that, there was a highly
significant difference between fluid intake among noninfected (4 pints/day) and infected
2pints/day) persons. 28
Different medical and nursing text books have mentioned that the urination habits,
clothing, diet, menstrual protection and sexual intercourse are the risk factors for the urinary
tract infection in women. But sound studies related to these aspects are few. 29
A case control study conducted among the students aged 16-39 years, of the
University of California at Los Angels. Using questionnaire collected the data and found that
19 of the 44 cases had prior urinary tract infection. There was strong positive association
between having urinary tract infection, consumption of tea and cola soft drinks, but a slight to
moderate association with cranberry juice, vitamin c, soda pop, orange juice and citrus juice,
coffee and milk. Negative association with vegetarian diet, garlic, ginger, chili peppers and
alcoholic beverages. Moderately positive association between primary urinary tract infection
and using tampons sanitary napkins with deodorant and non-deodorant. Slight association
using bubble bath and spermicide foam. Cotton panties showed a strong positive association
and wearing synthetic panties a mild positive association with secondary urinary tract
infection. Wearing tight jeans as compare to loose and very loose one was strongly associated
with primary urinary tract infection and moderately with secondary urinary tract infection.
Some times frequently or always urinating before sexual intercourse was moderately
associated with primary and secondary urinary tract infection. 29
80% of UTI in adults are due to E-coli which present around the anus or vagina,
which may enter into the urethra while wiping from back to front. 30
7
Urinary tract infection may progress into renal damage, renal failure, and sepsis. Early
recognition and prompt treatment help to prevent occurrence of recurrent urinary tract
infection and possibility of complication.31, 12, and 32
Based on 2001 census among 33% of Indian population belongs to age group between
10 to 24 years. 20% of adolescents have sexual workers. It is important to provide education
and involvement of both medical and health professionals to improve the health status of the
adolescents.33
Personal experience of the investigator and review of literature revealed that lack of
adequate knowledge and hygienic practices are most common causes for urinary tract
infection among adolescent girls. Nurses being the part of health team have responsibility to
educate the adolescent girls and show correct pathway to prevent urinary tract infection.
Hence, the above-mentioned factors motivated the investigator to undertake the study.
6.2 REVIEW OF LITERATURE
Literature review is a critical summary of research on a topic of interest, often
prepared to put a research problem in context. A literature review helps to lay foundation for
the study, shows current knowledge on the topic and illuminates the significance of the new
study.
For the present study the researcher done an extensive review of textbooks, journals
and internet to collect the information related to prevention of urinary tract infection.
Reviewing literature is important in broadening the understanding and gaining an
insight necessary for development of broad conceptual context into which a problem fix.
8
Review of literature helps in selecting methodology, developing a tool and also analyzing the
data.
The content of the literature is divided into

Incidence and prevalence of urinary tract infection

Causes and risk factors of urinary tract infection

Prevention and management of urinary tract infection
INCIDENCE AND PREVALENCE OF UTI:
An article regarding urinary tract infections shows that, 8-10 million people world
wide are affected with UTI.
31
A report regarding urinary tract infection shows that, by the
age of 11, 3% of girls will suffer from urinary tract infection. Kidney and Urology foundation
of America reported that in America one in every 5 women will develop urinary tract
infection in their life time.32 According to National Ambulatory Medical Care Survey and
National Hospital Ambulatory Medical Care Survey, one in every 3 women by the age of 24
years will have one episode of urinary tract infection which requires antimicrobial therapy.33
Recent statistics reveals that, symptomatic urinary tract infection will be present in 8% girls
during their childhood.34
National Family Health Survey 1998- 1999 reported that, in India 16.1% of
adolescent girls (15- 19 years) presented with symptoms of urinary tact infection. In
Karnataka state, 7.2% of women reported regarding symptoms of urinary tract infection.35
9
A one-year morbidity survey was conducted among 796 patients aged 16 years and
above with an objective to find the prevalence of urinary tract disease in general practice.
Urine bacteriological and microscopic study revealed that 54% women had symptoms of
urinary tract infection and prevalence rate were 6 to 7 times higher in females than males.
Urinary tract infection in females with out symptoms of bacteriuria was peak in the month of
February. The prevalence of recurrent or chronic urinary tract infection were found five in
1000 women per year.36
A prospective study was conducted among 796 sexually active non-pregnant women
aged 18 to 40 years to find the prevalence of asymptomatic bacteriuria at university of
Washington student health centre and at a health maintenance organization (HMO) in Seattle.
Data were collected by using a standard questionnaire, interview technique, periodic culture
and a dairy regarding frequency of sexual intercourse, type of contraceptive method, vaginal
and urinary symptoms. The result found that the incident rate of asymptomatic bacteriuria
among women in university group was 0.39 episodes per person and was 0.53 episodes per
person in HMO group. Both in university and in HMO group, 8% asymptomatic bacteriuria
became symptomatic urinary tract infection within one week. There was significant
association found with use of diaphragm, spermicide and sexual intercourse, with
asymptomatic bacteiruria.37
A study was conducted among 181prison inmates in Nigeria aged 7 to 60 years to
detect prevalence and anti biogram of urinary tract infections from June to August 2005.
Midstream urine was collected from the participants to identify the bacterial count and for
antibiotic susceptibility testing. The findings revealed that 77.9% of the urine samples shown
bacterial growth. Among this 68.1% were female urine sample. E-coli was isolated from
33.3% samples followed by Klebsella [19.9%]. Prevalence of urinary tract infection among
females was 66.7% in an age group of 7 to 15 years. The prevalence rate was 86.4% in
females, whereas in males it was 57.1%. 38
By using random sampling method, 300 asymptomatic undergraduate female students
of Nigeria University aged 16 to 26 years were selected, to identify asymptomatic bacteiruria.
Midstream urine samples were collected and cultured. Results revealed that, 10% had
significant bacteriuria. E-Coli [50%] was, the most predominant bacteria found in urine
10
followed by Staphylococcus Aureus [20%]. E-Coli were most resistant to Ampicillin and
Tetracycline, but sensitive to Co-trimaxazole and Cefuroxin.39
A study was conducted on incidence of UTI among children and adolescent in
Nigeria. Clean voided mid stream urine specimen was collected from children and adolescent
and cultured and gram staining was done. The study revealed that out of 301 patients 11.96%
had significant bacteriuria and out of 124 females, 22.4 % presented positive urine culture,
while, 4.56% of the 177 males had significant bacteiruria. E-Coli was the most common
organism isolated, then Klebsiella. A large portion of isolates were sensitive to Ofloxacin,
Ciprofloxacin, Gentamycin and Nalidixic acid.19
A cross sectional survey on sample of 296 sexually active females aged 14-22 years,
attending a hospital based team health center of emergency department , determined no
association of urinary symptoms or urinary tract infection with sexually transmitted infection
among the prevalence of 17% and 33% of urinary tract infection and sexually transmitted
infection respectively.40
CAUSES AND RISK FACTORS OF UTI
Urinary tract infection occurs, when parts of the urinary tract become inflamed/
contaminated. UTI includes cystitis, urethritis and pyelonephritis. Alteratation in
physiological and mechanical defenses like normal voiding with complete emptying of the
bladder, normal antibacterial ability of the bladder mucosa and urine, ureterovesical junction
competence and peristaltic activity that propels urine towards the bladder, increases the risk
of urinary tract infection.
41
80% of the urinary tract infection is caused by E.Coli, a gram
negative bacteria, found in the intestine. 14
Females are more likely to develop urinary tract infection because of the shorter
length of the urethra and its proximity to anal orifice. Stasis of urine may result in incomplete
bladder emptying and over distended bladder, which decreases the blood supply to the wall of
bladder, and alter the function of WBCs from fighting any contamination that may have
entered in the bladder. 42
11
Other risk factors for urinary tract infection includes bacteria from the anus, wearing
tight jeans, bicycling, use of scented perfume soaps, powders, and cleansers in the genital
area, spicy foods, drinking excessive carbonated beverages and alcohol. The symptoms
associated with UTI are frequent and painful urination, fever, pelvic pain and nausea and
management is drinking plenty of water and juices, frequently urinating, taking ibuprofen /
aspirin for pain.47
Sexual intercourse promotes ‘milking’ of bacteria from the vagina and perineum and
may causes minor trauma that predispose women into urinary tract infections. Poor personal
and menstrual hygiene may increase the risk of urinary tract infection in adolescent girls.14
Urinary tract infection may occur due to constipation, which causes pressure on the
bladder and urethra and not allow the bladder to empty completely, which predispose into
urinary stasis and infection.43
The usual causes of UTI among women are bacteria that live on the skin near the
rectum or the vagina. Waiting too long time to urinate can cause the bladder muscle to stretch
too much that, not all the urine is pushed out, which increase the risk for urinary tract
infections. UTI at childhood can also put a person at risk for UTI in adolescent age.44
A report regarding urinary tract infection shows that, high intake of zinc increases the
risk for urinary tract infection. Recommended daily average doses for the zinc in women is
8mg /day and 11mg/day for men. One study in the journal of urology shows that people who
take very high doses of zinc supplements may have an increased risk for UTI and urological
problems. This study also shows that, patients who took 80mg /day of zinc were more likely
to be hospitalized than those who do not take.45
A study was conducted in Kerala regarding menstrual hygiene practices and
reproductive morbidity among 360 rural females aged aged 12-45 years, selected through
multistage cluster sampling technique. Data regarding symptoms of UTI, RTI and skin
problems, were collected by using structured questionnaire, interviews and group discussion.
The result showed that, 60.8% of females were practicing poor menstrual hygiene, 36.1% had
12
symptoms of RTI, 45.8% had symptoms of skin problems and 13.1% had symptoms related
to UTI. 46
A descriptive study was conducted in Tehran, to assess knowledge, attitude and
behaviour of 250 female students between the age of 15 – 18 years regarding dysmenorrhea
and menstrual hygiene. The result revealed that, 77% of female students had adequate
knowledge of dysmenorrhea. Only 32% females were practicing personal hygiene like
hygienic material (sterile pad), taking bath and taking appropriate diet. 51.5% of students
were not taking bath for 8 days, after the onset of their menstruation. The study findings
concluded that majority (68%) of girls were don’t have appropriate knowledge regarding
personal hygiene and did not practicing positive health behaviour during menstruation.47
A prospective clinical study was conducted on association between idiopathic
hypercalcemia and UTI among 75 children with UTI and control group of 30 healthy children
revealed that 21% children with UTI had Idiopathic hypercalcemia and recurrent UTI
affected 33% of patients and in 67% UTI was diagnosed for the first time.48
E.Coli bind specifically to epithelial cell receptors, which are glycolipids of the
globoseries and also antigen in the P blood group system. The P blood group affects the
binding of bacteria to leucocytes, and helps in the clearance of bacteria from urinary tract.49
A case control study was conducted to find the correlation between P1 blood group,
vesico urethral reflex and bacterial attachment in patients with recurrent pyelonephritis. 68
girls aged 6 to 18 years as case and 84 girls as control were selected. Findings revealed that,
among case group, 36 girls who did not have vesico urethral reflex, bacterial attachment was
very common and 97% had P1blood group, where as 32 girls who had reflex, bacterial
attachment were rare and 82% had P1 blood group, as compared to control group. The
findings suggested that in the absence of vesico urethral reflex, the PI blood group contribute
to risk for recurrent pyelonephritis, because of the bacterial attachment to glycolipid receptors
of epithelial layer.49
To determine the causes of the acute urethral syndrome in women a study was
conducted among 59 women with dysuria and 35 women with typical cystitis as case and 66
13
women with no symptoms of urinary tract infection as control of the university of
Washington students health center and United State Public Health Service in Clinics. Data
were collected by using questionnaire and midstream urine. The study findings showed that,
out of 59 women, 42 and, out of 35 women with cystitis 31 had pyuria and urethral and
vaginal colonization with E-coli was found to be associated with symptomatic infection
among women with bacteriuria.50
An article reported that, women with urethral syndrome often have bacteiruria but
fewer than 105 bacteria. Frequent hematuria and suprapubic pain indicates that bladder wall
inflammation. Chlamydial infection is associated with pyuria. An external dysuria (pain felt
in the inflamed vagina as stream of urine passes) indicate vaginal infection, where as an
internal dysuria (pain felt to be inside the body) indicates urinary tract infection. 51
Anemia, malnutrition and decreased acidity of urine are the age related risk factors
associated with development of urinary tract infection. 52
Due to infection of bladder and urinary tract by Schistosome Haematobium,
hematuria will occur, which predispose into anemia among school aged children adolescents
and adults.53
PREVENTION AND MANAGEMENT OF UTI
Prevention is most important goal in both primary and recurrent urinary tract
infection. Cleaning the perineum from front to back after urination and defecation will
minimize the contamination of periuretheral area from bacteria. Avoid external irritants such
as bubble bath, talcum powder and deodorants. Frequently voiding every 2 to4 hours
enhances the bacterial clearance and reduces the stasis of urine. 54
Reduce intake of bladder irritants like carbonated beverages, alcohol, coffee, spicy
food items and chocolates. Taking fluids 3 to 4 lit/day helps to flush the urinary system.
Cranberry juice and ascorbic acid (vitamin c) helps in acidification of urine. (17). Animal
protein also helps in acidification of urine. 13
14
Taking shower bath rather tub bath prevents entry of micro organism into the urethral
meatus. Voiding before and after sexual intercourse, flush out the bacteria from the urinary
tract and prevents risk for urinary tract infection. 14
Epicatechin is present in apple, cherry and plum, which prevents E.Coli from
attaching to the bladder wall. D-Mannose present in peaches, apples and berries, which is
effective in relieving mild urinary tract infection.50
An article reported that, E.Coli binds tightly to human kidney cells, using an
‘adhesive protein’ secreted by the cell membrane. 55
Scientist may develop oral or injectable vaccine that can prevent urinary tract
infection, because many studies found that urinary tract infection repeatedly occurs among
women and children who were lacking immunoglobulins. Researchers are also working on
vaccine which can keep as a suppository in the vagina.56
One can prevent the urinary tract infections by practicing the proper health habits like
good personnel hygiene, drinking plenty of water which flush out the bacteria out of the
urinary tract, empting bladder completely as soon as we feel the urge or at least once in 3
hours, by taking vit-c which make urine acidic and helps to keep bacteria down, wear cotton
underwear which does not trap moisture and changing sanitary pads and tampons frequently
during menstruation. 45
Researchers had identified that the compounds in blueberries and cranberries prevent
E-coli from adhering to the wall of bladder and kidneys. Avoiding synthetic underwear and
tight pants which can trap heat and moisture in the crotch are also preventive measures for
preventing urinary tract infection. 48
A case control study was conducted regarding dietary factors protecting women from
UTI, among 139 women in Oulu university of Hospital, with mean age of 30.5 + 10.5 years.
A questionnaire was used to collect the data regarding women’s dietary and life style habits.
The results showed that increased consumption of fresh fruit or berry juice reduces the risk
for UTI. 58
15
An intervention study was conducted in Tainan Science Based Park to find the
effectiveness of health education programme on prevention of urinary tract infection among
166 females’ workers aged <20 years >30 years. Data were collected by using urine
examination and standard questionnaire. The results revealed that, after the health education
programme, the prevalence of urinary tract infection was reduced from 9.8% to 1.6%, urine
voiding and water intake, three times or more during each shift were increased from 12.8% to
39.6% and 27.6% to 51.5% respectively. The study found that, a significant association
between decrease in the prevalence of urinary tract infection and increase in the prevalence of
water intake and urine voiding three times or more in a day.59
An experimental study was conducted in Norway to evaluate the effectiveness of
acupuncture treatment in prevention of uncomplicated recurrent lower urinary tract
infections, among 94 women aged 18 to 60 years. 67 members as experimental group and 27
members as control group were selected. The results revealed that, with in 6 months 73% of
women in the experimental group were free from urinary tract infection as compared to 52%
of women in control group. 76
An open randomized controlled 12 months follow up trial was conducted to find the
effectiveness of cranberry-lingo berry and lactobacillus GG drink for prevention of urinary
tract infection.150 symptomatic women were selected from university of Oulu and Oulu
university hospital, where the participants were divided into three group. Where 1st group was
provided with 50ml cranberry juice, 2nd group with 50ml of lactobacillus GG drink and
control group with no intervention. Mid stream clean catched urine were collected at 3rd
month and at 12th month. The findings shown that, after 6 months, at least one episode of
urinary tract infection, was present in 16% of women in cranberry group, 39% in
lactobacillus GG drink group and 36% in control group and at 12 months the findings were,
12, 21 and 19 in above mentioned group respectively. 98 episodes of urinary tract infection
occurred in follow up period, out of which 80% had causative organism E.Coli.61
Trimethoprim- Sulfamethaxazole or Nitrofurantoin is often used to treat
uncomplicated or initial urinary tract infection. Before sexual intercourse, to prevent
recurrent urinary tract infection a single dose of antibiotic is advisable.41
16
Herbs like asparagus, couch grass, birch, parsley and spiny rest harrow are approved
in Germany as a treatment for urinary tract infection. These herbs will increases urinary
volume and flush the bacteria out of the urinary tract. Gold seal contains berberine, an
alkaloid which inhibits bacteria from adhering into the bladder wall. In North America an
extract of Uvaursi using for treatment for urinary tract infection which kills bacteria.
Another study was conducted to find the result of chemotherapy in urinary tract
infection, from September 1952 to august 1953. 1,022 incidents of urinary tract infection
occurred in 686 patients among that 726 incidence were treated with chemotherapy viz.
Streptomycin, Penicillin, Chlortetracycline, Chloramphenicol. The infection was highly due
to bacterial coli, which was more predominant in females. The cocal infection responded to
chemotherapy in best way. The prognosis was high in patients without urinary tract
abnormality and no history of previous urinary tract infection (16/20 in males and157/178 in
females). 62
A survey was conducted by the National Ambulatory Medical Care to find the
national patterns in treatment of urinary tract infections in women by Ambulatory Care
Physicians from 1989-1998. 1478 women aged 18 to 45 years with urinary tract infection
were selected, among that 55% women were younger than 45 years and 32% had prior
urinary tract infection and 15%
had complicated urinary tract infection. The findings
analyzed and found that, the ordering of urine analysis decreased from 90% to 81% of the
visits from1989 to 1990 and prescription of trimethoprim, Trimethprim-Sulfamethaxazole
declined from 49% in 1990 to 24% in 1997 to 1998.63
An article has mentioned the importance of probiotics for prevention and treatment
urinary tract infection, which causes resistance to bacteria and destruction of beneficial
bacterial flora. Many research have shown the importance of use of live microorganism to
prevent and treat recurrent urinary tract infection, which can be administered orally or applied
to the genital area. 64
Home remedies are helpful for treating urinary tract infection and preventing
recurrent urinary tract infection. Home remedies can use while first sign of urinary tract
infection appears. A mixture of ½ teaspoon baking soda in 8 ounce glass water helps for
17
acidification of urine. Drinking water or fluids which dilute the urine and flush out the
unwanted substance from the body. Mixture of cranberry juice and apple juice will helps in
acidification of urine. Aroma therapy which includes massage with the oil prepared from
sandal wood, bergamot, tea tree, frankincense and juniper over the bladder area for 3-4 days
will relive pain due to bladder infection. Consuming 2capsule of Echinacea and Oregon grape
root 3times in day prevent recurrence of urinary tract infection. In acute urinary tract
infection have ½ teaspoon of tincture every hour. Have blended mixture of Pipsissewa,
Buchu, Echinacea, and Uvaursi 20 drops for every 2 hours in a day followed by 1 teaspoon
four times in a day, until symptoms are completely recovered. Hot compression pad placed
on the lower abdomen relieves pain. Reflexology working on the bladder or kidney point can
provide relief from urinary tract infection.65
6.3. STATEMENT OF PROBLEM
A study to determine the effectiveness of planned teaching programme
on knowledge and practices regarding prevention of urinary tract infection among
adolescent girls at selected schools of Tumkur.
6.4. OBJECTIVES
1. To assess knowledge regarding prevention of urinary tract infection among adolescent
girls in experimental and control group before and after the administration of planned
teaching programme.
2. To assess the practices regarding prevention of urinary tract infection among
adolescent girls in experimental and control group before and after the administration
of planned teaching programme.
18
3. To find the relationship between knowledge and practice scores of adolescent girls
regarding prevention of urinary tract infection.
4. To determine the effectiveness of planned teaching programme regarding prevention
of urinary tract infection in terms of gain in knowledge and practice scores of
adolescent girls.
5. To find the association of pretest level of knowledge and practices of adolescent girls
with their selected personal variables viz. age, religion,
place of residence,
occupation and education of their parents, female senior siblings and their education
,exposure to mass media , previously suffered from urinary tract infection, related
educative seminar attended previously at school or elsewhere.
6.6. OPERATIONAL DEFINITION
 Effectiveness: Refers to the gain in knowledge and practice scores after
administration of planned teaching programme on prevention of urinary tract infection
among adolescent girls.
 Planned teaching programme: refers to systematically developed instructions
designed to provide information and improve practices of adolescent girls regarding
prevention of urinary tract infection consisting of objectives, meaning, causes, sign
and symptoms, diagnostic measures, management and preventive measures of urinary
tract infection.
 Knowledge: Refers to the level of information regarding urinary tract infection
among adolescent girls
measured through the correct response to the test items in
structured knowledge questionnaire regarding prevention of urinary tract infection
and expressed in terms of scores.
19
 Practices: refers to the habitual performance of activities of adolescent girls related
to prevention of urinary tract infection, which is measured in terms of self-reported
practice questionnaire and expressed in terms of scores.
 Adolescent girls: Girl student who are aged between 14 to 17 years and studying in
selected schools.
6.7. HYPOTHESIS
H1: The mean post test knowledge scores of adolescent girls on prevention of urinary tract
infection, who have undergone the planned teaching programme will be significantly
higher than their mean pre-test knowledge scores.
H2: The mean post test practices scores of adolescent girls on prevention of urinary tract
infection, who have undergone the planned teaching programme will be significantly
higher than their mean pre test practice scores.
H3:
The mean post test knowledge scores of adolescent girls on prevention of urinary tract
infection, who have undergone the planned teaching programme will be significantly
higher than the mean post knowledge scores of adolescent girls who are not exposed
to planned teaching programme.
H4: The mean posttest practices scores of adolescent girls on prevention of urinary tract
infection, who have undergone the planned teaching programme will be significantly
higher than the mean posttest practices scores of adolescent girls who are not exposed
to planned teaching programme.
H5:
There will be significant relationship between knowledge and practices scores of
adolescent girls regarding prevention of urinary tract infection.
20
H6: The levels of knowledge and practices of adolescent girls regarding prevention of
urinary tract infection will be significantly associated with their selected personal
variables viz. age, religion, place of residence, occupation and education of their
parents, female senior siblings and their education, exposure to mass media,
previously suffered from urinary tract infection, related educative seminar attended
previously at school or elsewhere.
7. MATERIALS AND METHODS
7.1 SOURCES OF DATA
Research Design
: True experimental pretest -posttest control group design.
Setting of the study : Selected schools of Tumkur
Population
: School adolescent girls
Sampling technique : Two stage cluster sampling technique
Sample size
: 100(50 in each group control and experimental)
Sampling Criteria:
Inclusive criteria:
o Adolescent girls who can understand, comprehend, and respond in English.
o Adolescent girls who are willing to take part in the study.
21
o Adolescent girls within the age of 14-18 years.
Exclusive criteria:
o Adolescent girls having any behavioral problems as reported by their teachers.
7.2 METHODS OF DATA COLLECTION
After obtaining the permission from the concerned authorities the investigator data
will be collected by using structured questionnaire.
Description of the tool
: Structured questionnaire
Tool-1
Part-A
: Performa for collecting demographic data
Part-B
: structured questionnaire to assess the knowledge and practice
regarding urinary tract infection among adolescent girls.
Tool-2
: Structured teaching programme regarding management of
urinary tract infection among adolescents girls
Methods of Data analysis and interpretation
Pre and post test scores of knowledge will be analyzed through the following
technique.
22
Descriptive statistics: Mean, standard deviation, range and mean score percentage
will be used to quantify the level of knowledge before and after structured teaching
programme.
Inferential statistics: Paired t-test will be use to examine the effectiveness of
structured teaching programme by comparing the pre- test and post- test score.
The effectiveness of planned teaching will be assessed using paired‘t’ test and Chisquare to find out the association between pretest , level of knowledge and practices on
prevention of urinary tract infection among adolescent girls and their selected personal
variables.
Duration of the study
: 6 weeks.
7.3 Does the study require any investigation or intervention to be conducted on the
patients or other human being or animals? If so please describe briefly.
No
7.4Has Ethical Clearance been obtained from your institution in case of the above?
Yes enclosed in the end
23
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9. Signature of candidate
:
10. Remarks of the guide
:
11. Name and designation (in block letters)
11.1 Guide
:
11.2 Signature
:
11.3 Co-guide (if any)
:
11.4 Signature
:
11.5 Head of the Department
:
11.6 Signature
:
12. Remarks of the Chairman or Principal
:
12.1 Signature
:
31