Abstract
ObjectiveUrinary tract infection (UTI) is the most common non-intestinal infection worldwide. In the developed world, incidence and prevalence of UTI would be similar owing to the relatively short duration of illness experienced by women with ready access to healthcare services. We hypothesize that, in the developing world, factors limiting access to care and those which may increase the likelihood of developing UTI, result in increased morbidity. This difference is reflected in an increased prevalence of UTI in regions where women suffer the effects of UTI for extended periods of time.MethodsThis study represents a cross sectional analysis of UTI prevalence in rural western Panama conducted over the course of a 3-day medical mission. All women 18–45 years of age reporting to the medical brigade clinic were tested for UTI by dipstick urinalysis and a brief history regardless of whether they themselves were presenting with a complaint.ResultsUTI was diagnosed clinically by providers in 29.8% of the women tested although only 21.15% of these same women met the evidence-based study criteria. This prevalence of 21.15% is seven times greater than reported by the Panamanian Ministry of Health. When comparing the effectiveness of clinical diagnosis relative to urinalysis by dipstick, a Kappa coefficient revealed only low moderate agreement (0.42; SE 0.0955).ConclusionsThe prevalence of UTI in rural western Panama is greater than would be expected based on prevalence data from either the US or Panamanian Ministry of Health and may represent an opportunity for targeted interventions, including educational programming about UTI prevention.
Highlights
This study represents a cross sectional analysis of the prevalence of urinary tract infections (UTI) among women of reproductive age in two rural communities of western Panama
The prevalence of UTI in rural western Panama is greater than would be expected based on prevalence data from either the US or Panamanian Ministry of Health and may represent an opportunity for targeted interventions, including educational programming about UTI prevention
As a result of our informal findings on previous trips and our inability to conduct confirmatory urine cultures, a medical decision was made to test all females of reproductive age by dipstick urinalysis allowing for the study of UTI in women presenting to the clinic
Summary
This study was exempted from review by the Samuel Merritt University Institutional Review Board, because it does not involve human subjects, but rather a post hoc review of clinical data without patient-identifying information. Clinical encounters were conducted by Panamanian Ministry of Health physicians and nurse practitioner students This provided the opportunity to assess UTI prevalence in women seeking care. Definition of UTI For the purposes of this study, positive UTI was defined as the presence of two of the following three criteria on presentation or urinalysis: leukocyte esterase, nitrites or a documented complaint of dysuria [15]. These criteria are consistent with clinical findings associated with a high predictive value for UTI with each additional criterion making UTI more likely [16]. Data from these clinical indicators were compared to clinical diagnoses of UTI including pyelonephritis by the clinical team
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