An Assessment of Urine Analysis, Trichomonas vaginalis and Schistosoma haematobium Infections in Women Attending Out-patient Clinics in Southeastern Nigeria
C Uneke, E Ugwuja, N Isiogu, R Iloegbunam, M Elom
infection, urine analysis
C Uneke, E Ugwuja, N Isiogu, R Iloegbunam, M Elom. An Assessment of Urine Analysis, Trichomonas vaginalis and Schistosoma haematobium Infections in Women Attending Out-patient Clinics in Southeastern Nigeria. The Internet Journal of Laboratory Medicine. 2006 Volume 2 Number 1.
Urine analysis can detect a wide variety of disorders of urinary system and may give earliest warning of significant pathology. An assessment of urine analysis using rapid dipstick and infections with
Urine analysis, the first of all laboratory tests, began as and still remains a most valuable and highly important means of diagnosis in clinical medicine . The recognition of the importance of urine in diagnosis was made over 6000 years ago by several of the earliest civilizations, and a few of their clay tablets have been found that give us some insight into their observations and conclusions. Urine analysis can be used to detect a wide variety of disease states, particularly disorders of the urineary system. Although routine urine analysis is common, the results are important in management of only certain diseases . However it is a very useful tool in establishing a baseline status in each patient. This has two important benefits. First, if a patient can acidify and concentrate urine, this establishes that renal function was normal at one point in time; secondly, if at some future date an abnormality is detected, such as hematuria, it will be of great help to know if this is an acute abnormality (eg, poststreptococcal glomerulonephritis), or a chronic abnormality (eg, hypercalciuria) .
There is considerable information on the prevalence of urinary abnormalities in outpatient clinics, in hospitals [4,5,6], in a- symptomatic children [7,8,9] and in healthy adults . The detection of proteinuria and/or haematuria is useful in selecting patients who require long-term surveillance . Haematuria, after exclusion of serious urinary tract infection, renal calculi and malignancy may follow a benign course and have a good prognosis . Glycosuria has significant correlation with blood glucose level [10,13], while pyuria is a common problem, mainly in women and has been reported that as many as a quarter may experience an acute dysuric episode each year [14,15]. It is often customary to perform the microscopic examination of urinary sediment with all routine urine analysis tests, if transparency, glucose, protein, blood, nitrite, or leukocyte esterase is abnormal. Microscopic examination of urine sediment is necessary as it can establish the existence of trichomoniasis caused by
Although infection with
The purpose of this study was to provide baseline data on routine urine analysis and prevalence of
Materials and Methods
The study location was Abakaliki the capital city of Ebonyi State, South-eastern Nigeria. The study was conducted at the two major hospitals in the city which run the largest out-patient clinics. The hospitals were Ebonyi State University Teaching Hospital (EBSUTH) and Federal Medical Centre (FMC). The study area is defined by longitude 8o61611E and latitude 6o2212811N, elevated at 380ft above sea level. The vegetation characteristic is that of the tropical rain forest with an average annual rainfall of about 1,600mm and an average atmospheric temperature of 30oC. There are two distinct seasons, the wet and the dry seasons, the former takes place between April and October, while the latter occurs from November to March.
The study protocol was approved by the Infectious Diseases Research Division, Department of Medical Microbiology, Faculty of Clinical Medicine, Ebonyi State University, Abakaliki and from the authorities of EBSUTH and FMC Abakaliki. The approval was on the agreement that patient anonymity must be maintained, good laboratory practice/quality control ensured, and that every finding would be treated with utmost confidentiality and for the purpose of this research only. All work was performed according to the international guidelines for human experimentation in clinical research .
Study Population /Sampling Technique
The study was conducted from October 2005 to April 2006. The study population consisted of 218 women attending the out-patient clinic of the selected hospitals and were referred to the laboratory units of the hospital for urinee collection. After obtaining informed consent from each patient, a clean leak-proof sterile container was given to each participant and instructed on the urinee collection. For example, the women were told to cleanse the area around the urethral opening with water, dry the area and collect the mid-stream urinee with the labia held apart, they were advised not to touch the inside or rim of the container. The samples were collected between the hours of 10am to 12noon and were transported immediately to the Medical Microbiology Laboratory, Ebonyi State University, Abakaliki for analysis. All samples were analysed within 60minutes of collection.
Urine analysis rapid dipstick test was performed using the Medi-Test Combi 9 (MACHERY-NAGEL GmbH, Duren) strictly according to procedure specified by manufacturer. Microscopic examination of wet mount preparations of the urine samples was also done to detect pus cells and epithelial cells.
Differences in proportion were evaluated using the chi-square test. Statistical significant was achieved if
The urine analysis result showed that a total of 89(40.8%) and 27(12.4%) women had acidic and alkaline urine respectively, the remaining 102(46.8%) had normal urinee pH of 7. Protein was found among 43(19.7%) of the women while nitrite and blood were detected in 14(6.4%) and 18(8.3%) of them respectively (Table 1).
Epithelial cells were detected among 103(47.2%) women and pus cells were identified in 126(57.8%) of them. Moderate to many pus cells were observed among 33(15.1%) of the women. Individuals of the ≤20 and 21-30 years age categories were more likely to have protein, nitrite, blood and epithelial cells in their urine (Table 1).
Of the 218 females screened, 4 (1.8%, 95% CI, 0.0 – 4.0%) were infected with
Statistically, there was neither a significant difference in the association between age with the
Although urine analysis is a simple semiquantative test, it can detect various types of illness and may give the earliest warning of unexpected and significant pathology . Because of its routine nature, substantial abnormalities may be overlooked and this is with the possible consequences of missing serious curable conditions. In this study a high percentage (40.8%) of the women had acidic urinee, which may indicate a high protein diet, acidosis, uncontrolled diabetes mellitus, and renal tubular acidosis . About 12.4% of the women screened had alkaline urinee which might be an indication of urinary tract infection . These findings demonstrate a clear need for further patient evaluation. Even though pH varies with a person's diet, tending to be acidic in people who eat meat but more alkaline in vegetarians, pH measurements are useful in determining metabolic or respiratory disturbances in acid-base balance. For example, kidney disease often results in retention of H+ (reduced acid excretion) [26,27].
A relatively high rate of proteinuria (19.7%) was observed among the women in this study and was comparatively higher than those observed in a similar study in Ramat Aviv, Israel (3.9%) . The rate of hematuria observed in this study (8.3%) is similar to that observed in the study in Israel (8.1%). The presence of protein in the urine may be an indication of glomerular disease and may develop into a protein losing nephropathy . However, a weakly positive test for urinary protein in a symptomless woman is often due to contamination of the urine from the perineum . It is important that menstruation be always excluded as a cause of apparent haematuria and proteinuria. Slight proteinuria is a non-specific finding of no diagnostic importance that may be found in most pyrexial illnesses and in congestive heart failure while gross proteinuria is rarely an unexpected finding; it may occur in pre-eclampsia or in the nephrotic syndrome, which is often suggested by the clinical picture or the finding of hypoalbuminaemia . The urine must be examined by microscopy and microbiological methods if urinary infection is suspected; this is much more useful than testing for protein.
Nitrite was detected in 6.4% of the women screened and this signified possible infection with bacterial agents such as
The prevalence of
Our result showed that only six persons (2.8%) had
In conclusion, it is important to note that urine analysis is a vital tool for disease surveillance and still remains an accepted and well established component of many screening programmes. However the need for additional laboratory analysis for proper patient evaluation cannot be over-emphasised. This is to avoid the underestimation or overestimation of abnormal urine analysis and the attendant consequences.
C.J. Uneke Department of Medical Microbiology/Parasitology, Faculty of Clinical Medicine, Ebonyi State University, P.M.B 053 Abakaliki, Nigeria,Telephone: 234-08038928597, Fax number: 234-04300222, E-mail: email@example.com