Access to sanitation and risk of developing urinary tract infections among women from low socio-economic settings
Keywords:Urban slums, Risk factors for urinary tract infections, Place of urination, Access to toilet
Background: Poor sanitation facilities are root cause of many health problems of people residing in slums. The present study estimates the prevalence of urinary tract infections (UTI) and identifies factors associated with an increased risk of UTI among women.
Methods: A cross-sectional study was conducted among 616 women aged between 18 to 60 years residing in 33 slums across four cities in Maharashtra, India. Data related to individual characteristics of women, housing condition, access to sanitation facilities, behaviors adopted by the women that could lead to UTI and an episode of symptomatic UTI in the previous one month were recorded through structured questionnaire. Logistic regression analysis was performed to find out risk factors for UTI among women.
Results: The prevalence of UTI was found to be 19.6%. The prevalence was higher among young women aged upto 30 years (23.2%). In absence of individual toilet, women had adopted certain behaviors such as urine holding (21.3%), modify dinner to avoid toilet use at night (26.6%) and avoid intake of liquids (10.7%) to reduce frequency of visits to toilet. All these behaviors were significantly associated with UTI. Multiple logistic regression indicated that UTI was strongly and independently associated with age (OR=1.64, 95%CI: 1.08, 2.47), no access to bathroom (OR=2.21, 95%CI: 1.08, 4.49) and avoid intake of liquids (OR=2.70, 95%CI: 1.53, 4.75) (p<0.05).Conclusions:Behavior modifications by women to adjust with restricted use of place of urination may affect their health and increase the likelihood of developing UTI. Younger women are more at risk of developing UTI.
Sallem M, Burdett T, Heaslip V. Health and social impacts of open defecation on women: a systematic review. BMC Public Health. 2019;19:158.
Out of Order – The State of the World’s Toilets 2017. Available at: https://www.wateraid.org/uk/ sites/g/files/jkxoof211/files/Out%20of%20Order%20report%202017_0.pdf. Accessed on 12 March 2019.
Brocklehurst C. Water, Sanitation and hygiene: Foundations for development. Prepared for the High Level Expert Group Meeting The Global Water Crisis: Addressing Urgent Security Issues, Inter Action Council, Toronto, Canada, 2011. Available at: https://www.interactioncouncil.org/sites/default/ files/Clarissa%20Brocklehurst%20paper.pdf. Accessed on 12 March 2019.
Foxman B, Barlow R, D’Arcy H, Gillespie B, Sobel JD. Urinary tract infection: self-reported incidence and associated costs. Ann Epidemiol. 2000;10:509–15.
Litwin M, Saigal C. Urologic Diseases in America. US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Washington, DC: US Government Printing Office, NIH Publication No. 07–5512, 2007. Available at: https://www.niddk.nih.gov/ about-niddk/strategic-plans-reports/urologic-diseases-in-america. Accessed on 12 March 2019.
Liao Y, Yang C, Kao C, Dougherty M, Lai Y. Prevalence and impact on quality of life of lower urinary tract symptoms among a sample of employed women in Taipei: A questionnaire survey. Int J Nurs Stud 2009;46:633–44.
Srivastava S. Analytical study of urinary tract infection in adolescent girls. Int J Reprod Contracept Obstet Gynecol. 2018;4:1385-8.
Ahmed A, Zaky N. Health Care-Seeking Behaviors among Women Suffering from Urinary Incontinence. J Nurs Care. 2016;5:319.
International Institute for Population Sciences (IIPS) and ORC Macro, National Family Health Survey (NFHS-2), 1998-99: India, 2000.
Dash M, Padhi S, Mohanty I, Panda P, Parida B. Antimicrobial resistance in pathogens causing urinary tract infections in a rural community of Odisha, India. J Family Community Med. 2013;20:20.
Vyas S, Varshney D, Sharma P, Juyal R, Nautiyal V, Shrotriya V. An Overview of the Predictors of Symptomatic Urinary Tract Infection Among Nursing Students. Annals Med Health Sci Res. 2015;5(1):54-8.
August S, Rosa M. Evaluation of the prevalence of urinary tract infection in rural Panamanian women. PLoS ONE. 2012;7(10):e47752.
Das P, Baker K, Dutta A, Swain T, Sahoo S, Das B, et al. Menstrual Hygiene Practices, WASH Access and the Risk of Urogenital Infection in Women from Odisha, India. PLoS ONE. 2015;10(6):e0130777.
Fitzgerald S, Palmer M, Kirkland V, Robinson L. The Impact of Urinary Incontinence in Working Women: A Study in a Production Facility. Women Health. 2002;35(1):1-16.
Nygaard I, Linder M. Thirst at work – An occupational hazard? Int Urogynecol J Pelvic Floor Dysfunct. 1997;8:340-3.