Prevalence of Urinary Tract Infection among Secondary School Students in Urban and Rural in Erbil: Comparative Study

Urinary tract infection (UTI) is a common condition in children. Approximately 1 in 10 girls and 1 in 30 boys will have a UTI by the age of 16 years . Renal scarring as a result of UTI may lead to hypertension, decreased renal function, provsteinuria and end-stage renal disease. This is especially true if the condition is not diagnosed, investigated and managed appropria tely. However, UTI in children is a most challenging condition to treat in primary care because symptoms can be minimal in the early stages objectives: The aim of the study was to determining the prevalence of UTI's among the secondary schools students in urban and rural areas in Erbil . Subjects and methods: A descriptive study were carried out at two public secondary schools in Erbil city. During 1 st Oct. 2010 to 30 th June. 2011. A randomly sample size of 200 students was selected from urban and rural areas in Erbil ,the data was collected by special form and analyzed through the use of statistical package sciences (Spss 15) Results: The present study found that the prevalence of UTI among female were higher (76.1%) in urban than in rural area (57%) in reversely to UTI among males students which is higher in rural area (45.3%) than males in urban area (23.9%),while roles of prevention in urban and rural area found that the large numbers of students in urban area were preventing themselves by hand washing (68.5%). Conclusions: Significant difference was found between rural and urban area, age factors were initially to be responsible for the difference in prevalence. Recommendation: Secondary school's students need for greater education and healthcare providers regarding the prevention of UTI .

estimated that at least 8% of girl's and 2% boys have UTI in childhood (3,5) .Urinary tract infections (UTIs) are of the most frequent infectious diseases in children, with a prevalence strongly influenced by gender and age (1).Knowledge of the prevalence of UTI among different subgroups of children can assist clinicians in selecting children who would benefit from further diagnostic testing.Using prevalence rates as an estimate of the prior probability of disease is the first step in evidence-based practice (6).The aim of the study was to determining the prevalence of UTIs between the secondary schools students in urban and rural areas in Erbil city and to identify the association between the demographic characteristic with (symptoms, prevention of UTI and urinalysis) of study sample and residence areas.

METHODS AND SUBJECTS:
Descriptive study was carried out at two public secondary schools in urban and rural areas in Erbil.A randomly sample size of 200 students were selected during the period of the 1st /October/ 2010 to 30th / June / 2011.Before data collection, official permissions were obtained from the Ministry of Education and schools.These schools agreed to take part in the study.Within the schools, all students were invited to take part in this study.Among 914 respondents, 200 (74 males and 126 females) of students were participants.A questionnaire was designed that composed of four parts (I, II, III, and IV) to deal with this study.During collection of urine from students the following exclusion criteria were used: -students who have been on antibiotics for at least three days; students who took large quantities of fluids less than an hour before coming collected the sample and clean voided mid-stream urine samples were collected in sterile universal bottles transported to the laboratory immediately in ice pack bags for urinalysis, detailed history was obtained.The data were gathered by the researchers using direct interview with the students, the data analyzed through the use of statistical package sciences (Spss 15), P-value ≤ 0.01, High significant(HS), ≤0.05 significant (S) and > 0.05 non significant (N.S).Table (1) shows prevalence of urinary tract infection in urban and rural area in relation with sociodemographic data.Ages ranges 11-14 years old for both gender, large numbers of students were among ages 12 (43.5%)and 14 (57.8%) years old in each rural and urban area respectively.The prevalence of UTI among female were higher (76.1%) in urban than in rural area (57%) in reversely to UTI among males students which is higher in rural area (45.3%) than males in urban area (23.9%).High percentages of students father (41.3%) and (54.7%) were governmental employed and unemployed for each urban and rural area respectively.(69.6%) and (81.3%) of their mothers were house wife in urban and rural area.This table shows that there were significant difference (P=0.10) between UTI in urban and rural area.

DISCUSSION :
In present study the incidence of UTI among female higher in urban area 76.1% than rural area (54.7%), contrarily to the males percentages which is higher in rural area (45.3%) than in urban area (23.9%).The higher incidence of UTI female than male might be as a result of variety of factors, such as the close proximity of the female urethral meatus to the anus (6) and incomplete and in coordinate voiding of urine in school girls which is often associated with constipation and encourages infection of the urinary tract (7).Alternatively, vaginal microbial flora also play a critical role in encouraging vaginal colonization with coliforms and this can lead to urinary tract infection (6).Female anatomic feature also contributes to higher prevalence among the female subject.This finding is agreed with earlier studies (8,9).While the high prevalence of UTI among males in rural than urban area due to the fact that susceptible males to UTI having different urethral flora from that in males not susceptible to UTI.Most Symptoms noted in the majority of the patients were note indicative of UTI, referable to the renal system, this due to their strategies of UTI prevention which primarily include proper hygienic practice such as hand washing, wiping from front to back, frequent urination were obvious rules of prevention in both areas as similar reported studies ( 10,11).There were predominant numbers of negative urinalysis test among students whose mothers were house wife; they might have effective roles in educating their children.

CONCLUSIONS:
Significant difference was found between rural and urban area, age factors were initially to be responsible for the difference in prevalence.

RECOMMENDATION:
Further research is needed to optimize the evaluation phase following the diagnosis of UTI in order to improve quality of care and decrease cost.In addition, there is a need for greater education among parents and healthcare providers regarding the prevention of UTI .