Assessment of Knowledge for Urinary Tract Infections Among Pregnant Women in Jordan: A Cross-Sectional Study

This cross-sectional study of 500 pregnant women in Jordan reveals that nearly half possess inadequate knowledge about urinary tract infections, with significantly lower awareness observed among older, rural, less-educated, and unemployed women, highlighting the need for targeted health education within antenatal care.

The Gist

Imagine pregnancy as a long, exciting road trip. The mother is the driver, the baby is the precious cargo, and the car (her body) needs to be in perfect shape to get everyone to the destination safely.

This research paper is like a mechanic's report checking one specific part of that car: the "plumbing" system (the urinary tract). The authors, Sara and Zeinab from Jordan, wanted to see if the drivers (pregnant women) knew enough about how to keep this plumbing clean and working, or if they were flying blind.

Here is the breakdown of their findings, translated into everyday language:

1. The Problem: A Hidden Leak

During pregnancy, the body changes a lot. Think of the growing baby like a heavy suitcase sitting right on top of the car's fuel lines. This pressure, combined with hormonal changes, makes it easier for "bad guys" (bacteria) to sneak into the urinary system and cause an infection (a UTI).

If these infections aren't caught early, they can cause the car to break down early (premature birth) or damage the cargo (low birth weight). It's a common problem, affecting nearly 1 in 4 pregnant women worldwide.

2. The Investigation: The Knowledge Test

The researchers went to four major hospitals in Jordan (like checking garages in different cities) and asked 500 pregnant women a simple quiz.

• The Quiz: 20 questions about what causes UTIs, how to stop them, and what to do if you feel sick.
• The Score: They gave points for correct answers. If you scored above the middle line, you had "Adequate Knowledge." If you were below, you had "Inadequate Knowledge."

3. The Results: The "Knowledge Gap"

The results were a bit worrying, like finding out half the drivers don't know how to check their oil.

• The Scorecard: 51.4% of the women (more than half!) didn't know enough about UTIs. Only 48.6% had the right info.
• The Pattern: Who knew the most?
  • Younger drivers (ages 21–30).
  • City dwellers (living in urban areas).
  • Highly educated drivers (university grads).
  • Working women and those with higher incomes.

Basically, if you lived in the city, had a degree, and a job, you were much more likely to know how to protect your plumbing. If you lived in the countryside, had less education, or less money, you were more likely to be in the dark.

4. Why Does This Matter? (The Analogy)

Imagine you are driving and your "Check Engine" light comes on.

• If you know your car: You know it might be low on oil, so you pull over and fix it before the engine blows.
• If you don't know your car: You might think the light is just a glitch, keep driving, and end up with a broken engine on the side of the road.

For pregnant women, not knowing the symptoms of a UTI (like burning when you pee or needing to go all the time) means they might ignore it until it becomes a serious emergency for both mom and baby.

5. The Solution: Better Maps and Signposts

The authors conclude that the problem isn't that the women can't learn; it's that the instruction manual (the healthcare system) isn't being handed out clearly enough.

• The Fix: Doctors and nurses need to stop just handing out vitamins and start teaching specific "plumbing safety" lessons during every check-up.
• Targeted Help: They need to make sure these lessons reach the women who need them most: those in rural areas and those with less education.
• The Goal: If we teach the drivers how to spot the warning lights early, we can prevent the breakdowns, ensuring a smooth, safe journey for both mother and baby.

In short: Half of the pregnant women in this study didn't know enough about a very common infection. By teaching them better, especially those with fewer resources, we can prevent serious health problems and keep the "road trip" of pregnancy safe for everyone.

Technical Summary

1. Problem Statement

Urinary Tract Infections (UTIs) are a prevalent health issue during pregnancy, affecting up to 23.9% of pregnant women globally. If left untreated, UTIs can lead to severe adverse outcomes, including preterm birth, low birth weight, and preeclampsia. Despite the high prevalence in low- and middle-income countries (LMICs), there is a significant lack of data regarding the specific knowledge levels of pregnant women in Jordan concerning UTI etiology, prevention, and symptoms. The study addresses the gap in understanding how socio-demographic factors influence health literacy regarding UTIs in this specific population, aiming to inform targeted antenatal care interventions.

2. Methodology

• Study Design: A descriptive cross-sectional study conducted between October 2023 and July 2024.
• Setting & Population: The study was conducted across four major governmental hospitals in Jordan (Al-Bashir in Amman, Al-Karak, Princess Badea in Irbid, and Al-Zarqa).
• Sample: A convenience sample of 500 pregnant women aged 18–50 years attending antenatal and gynecology clinics.
  • Inclusion Criteria: Currently pregnant, attending selected clinics.
  • Exclusion Criteria: Chronic renal conditions or congenital urinary anomalies.
• Instrument: A validated questionnaire based on the Theory of Planned Behavior (TPB).
  • Structure: 25 questions total (5 socio-demographic, 20 knowledge-based).
  • Scoring: Knowledge questions were scored (Correct = 2, Incorrect/No Answer = 0), yielding a total score range of 0–40.
  • Classification: Scores were dichotomized based on the median (33/40): "Inadequate" (below median) and "Adequate" (at or above median).
  • Validation: The tool was translated from Persian to Arabic, culturally adapted, and validated by a panel of experts (Content Validity Index = 0.82). Reliability was confirmed via Cronbach's alpha (0.964 for knowledge).
• Data Analysis: Data were analyzed using SPSS version 25. Descriptive statistics were used for demographics. Associations between socio-demographic variables and knowledge levels were tested using Chi-square tests (for categorical variables) and t-tests/ANOVA (for continuous variables).

3. Key Contributions

• Contextual Baseline: Provides the first comprehensive baseline data on UTI knowledge specifically among pregnant women in Jordan, a region with limited prior research on this specific intersection.
• Socio-Demographic Correlation: Identifies specific demographic predictors of health literacy, highlighting that knowledge is not uniformly distributed but is heavily stratified by education, income, and residence.
• Theoretical Application: Successfully adapts the Theory of Planned Behavior (TPB) to assess health knowledge in a Middle Eastern cultural context, validating the instrument's reliability for future studies in the region.
• Policy Implication: Offers evidence-based recommendations for integrating specific UTI education modules into routine antenatal care, particularly for vulnerable subgroups.

4. Results

• Overall Knowledge Levels:
  • 51.4% (n=257) of participants demonstrated inadequate knowledge.
  • 48.6% (n=243) demonstrated adequate knowledge.
• Significant Associations: Statistical analysis revealed strong correlations between higher knowledge levels and specific socio-demographic factors:
  • Age: Younger women (21–30 years) had significantly higher knowledge ($p < 0.01$).
  • Education: University and postgraduate education levels were strongly associated with adequate knowledge ($p < 0.001$).
  • Residence: Urban residents possessed significantly better knowledge than rural residents ($p < 0.001$).
  • Employment: Employed women scored higher than unemployed women ($p = 0.02$).
  • Income: Higher income groups showed the greatest proportion of adequate knowledge ($p < 0.001$).

5. Significance and Conclusion

The study concludes that a critical knowledge gap exists regarding UTIs among pregnant women in Jordan, with over half of the sample lacking sufficient understanding of the condition. This gap is exacerbated by socio-economic disparities, particularly affecting rural populations, those with lower educational attainment, and lower-income groups.

Significance:

• Clinical Impact: The findings suggest that current antenatal care in Jordan may be insufficient in addressing specific infection risks, potentially contributing to preventable maternal and neonatal complications.
• Intervention Strategy: The authors recommend a multifaceted approach to bridge this gap, including:
  1. Standardizing UTI education within antenatal protocols.
  2. Developing targeted health literacy programs for rural and low-income communities.
  3. Addressing cultural barriers that may hinder open discussion of urinary health.
• Future Directions: The study underscores the need for further research into the efficacy of educational interventions in improving UTI outcomes in Jordan and similar LMIC settings.

Note: As this is a preprint (medRxiv), the findings have not yet undergone peer review and should not be used to guide immediate clinical practice without further validation.