Study selection
Articles were identified through electronic database search where PubMed provided the largest number of records (n = 317), followed by Science Direct (n = 286), African Index Medicus provided 103 records, and AJOL provided the least number of records (n = 88) (Fig. 1).
The initial database search yielded 794 records. Of these, 10 records were excluded on the basis of being duplicates. Further, on screening the titles and abstracts for relevance, 717 records were removed for being irrelevant. 20 records were excluded for being reviews and short communications as they could not provide adequate data for this study, while 16 more records were not included in this study due to irretrievability or their language not being English. Finally, 31 studies met inclusion criteria and were thus included in the final analysis (Fig. 2).
Characteristics of included studies
Studies included in this review were distributed in 9 countries, Ethiopia leading with 38.7% (n = 12), Nigeria followed with 25.8% (n = 8), Uganda 9.7% (n = 3), Cameroon and Kenya each contributed 6.5% (n = 2), and Ghana, Tanzania, Burkina Faso and Zambia each contributed 3.2% (n = 1). The sample size in the studies included varied greatly. The minimum sample size was 53 in the study by Wondimeneh et al.[15] and the maximum sample size was 1254 in the study by Melaku et al. [16]. This review included recent studies, with the earliest study by Odetoyin et al.[17] published in 2008 and the latest is of 2023 by Mekonnen et al.[18]. All the studies included in this review adopted a cross-sectional study design except for the study by Che Pantalius Nji et al.[19]which employed mixed methods. Table 1 presents a summary of characteristics of included studies.
Table 1
Characteristics of studies included in the review.
Author and citation | Year of study | Country | Study design | Study population | Sample size | Study aims |
AK Labi et al.[20] | 2015 | Ghana | Cross-sectional | Pregnant women | 274 | To measure the prevalence of asymptomatic bacteriuria among ante-natal clients at the Korle-Bu Teaching Hospital in Ghana and its’ associated risk factors. |
Ali et al.[21] | 2022 | Ethiopia | Cross-sectional | Pregnant women | 422 | To determine the prevalence, antimicrobial susceptibility pattern and associated factors of urinary tract infection (UTI) among pregnant women attending Hargeisa Group Hospital (HGH), Hargeisa, Somaliland. |
Awonunga et al.[22] | 2010 | Nigeria | Cross-sectional | Pregnant women | 205 | To determine the pattern as well as possible predictors of asymptomatic bacteriuria at the University College Hospital, Ibadan. |
Bashir et al.[23] | 2022 | Nigeria | Cross-sectional | General public | 150 | To determine the prevalence of UTIs among in-patients in Murtala Muhammad Specialist Hospital, Kano using a cross-sectional study |
Che Pantalius Nji et al.[19] | 2020 | Cameroon | Cross-sectional | Children | 405 | To identify the risk factors of UTI, etiologic agents, and their antibiotic susceptibility. |
Dereje et al.[24] | 2017 | Ethiopia | Cross-sectional | Women | 210 | To determine the etiologic agents, drug resistance pattern of the isolates and associated risk factor for urinary tract infection among fistula patients in Addis Ababa fistula hospital, Ethiopia |
Elikwu et al.[25] | 2017 | Nigeria | Cross-sectional | General public | 200 | To determine the etiology of UTI at BUTH and obtain data on their susceptibility and resistance patterns |
Emiru et al.[26] | 2013 | Ethiopia | Cross-sectional | Pregnant women | 367 | To assess associated risk factors of UTI among pregnant women in Felege Hiwot Referral Hospital, Bahir Dar, North West Ethiopia |
Fenta et al.[27] | 2020 | Ethiopia | Cross-sectional | Children | 299 | To assess the bacterial profile of urinary tract infection, their antimicrobial susceptibility pattern and associated factors among clinically suspected children attending Felege-Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia. |
Gebremariam et al.[28] | 2019 | Ethiopia | Cross-sectional | Students | 341 | To assess bacteriological profile, risk factors and antimicrobial susceptibility patterns of symptomatic Urinary tract infection among students of Mekelle University, northern Ethiopia. |
Gessese et al.[29] | 2017 | Ethiopia | Cross-sectional | Pregnant women | 300 | To isolate and identify the predominant pathogenic bacteria causing UTI, evaluation of the antimicrobial susceptibility pattern of the isolates and identification of potential risk factors of UTI. |
Iwang et al.[30] | 2021 | Nigeria | Cross-sectional | Pregnant women | 320 | To determine the ASB prevalence, the causative microorganisms, their drug sensitivity patterns, and the factors associated with its occurrence in pregnant women in the Uyo, Nigeria. |
Jamiu et al.[31] | 2021 | Nigeria | Cross-sectional | Pregnant women | 206 | To determine the prevalence of and factors associated with significant bacteriuria among pregnant women attending the antenatal clinic (ANC) of Adeoyo Maternity Hospital, Yemetu, Ibadan, Nigeria, as well as determine the bacterial etiology and antimicrobial susceptibility patterns of the isolates. |
Odoki et al.[32] | 2019 | Uganda | Cross-sectional | General public | 267 | To determine the prevalence of UTI by isolating and characterizing the different bacterial etiological agents and to evaluate the factors associated with UTI. |
Kabugo et al.[4] | 2016 | Uganda | Cross-sectional | General public | 139 | To identify factors associated with CA-UTIs, the common uropathogens and the drug sensitivity patterns of the common uropathogens cultured. |
Kidenya et al.[33] | 2022 | Tanzania | Cross-sectional | General public | 227 | To establish the pattern of urogenital pathogens and factors associated with PCR positive urogenital pathogens in urine samples of patient with sterile pyuria. |
Marami et al.[34] | 2022 | Ethiopia | Cross-sectional | Women | 146 | To determine the prevalence, antimicrobial susceptibility pattern, and associated factors of urinary tract infections among women with post-fistula attending public health facilities, Harar, eastern Ethiopia. |
Mekonnen et al.[18] | 2023 | Ethiopia | Cross-sectional | Children | 332 | To assess the bacterial profile of urinary tract infections, their susceptibility to antimicrobial agents, and associated factors in under-five children at Hiwot Fana Specialized University Hospital, eastern Ethiopia. |
Melaku et al.[16] | 2012 | Ethiopia | Cross-sectional | General public | 1254 | To determine the prevalence and antibiogram of nosocomial UTIs from a referral hospital. |
Nabaigwa et al.[35] | 2017 | Uganda | Cross-sectional | General public | 210 | To establish which UTI aetiological agents are most common among diabetic patients attending the diabetes clinic at Jinja Regional Referral Hospital. Risk factors for UTIs by these pathogens were also evaluated. |
Ngong et al.[36] | 2021 | Cameroon | Cross-sectional | Pregnant women | 287 | Prevalence and risk factors for UTIs, diagnostic potential of dipstick analyses and antimicrobial susceptibility of uropathogens from pregnant women attending ANC in some Integrated Health Centers (IHCs) in Buea Health District (BHD). |
Nigusse et al.[37] | 2020 | Ethiopia | Cross-sectional | General public | 224 | To determine the prevalence, risk factors of UTI, and drug susceptibility pattern of bacteria isolated among peoples infected with HIV. |
Odetoyin et al.[17] | 2008 | Nigeria | Cross-sectional | General public | 192 | To investigate the prevalence and associates of associates of asymptomatic bacteriuria (ASB) in a sample of Nigerian diabetic patients. |
Okechukwu and Thairu[38] | 2019 | Nigeria | Cross-sectional | Children | 166 | To determine the prevalence and causative bacteria of UTI in HIV infected children and adolescents on antiretroviral medications in our health institution. |
Ramalan et al.[39] | 2020 | Nigeria | Cross-sectional | General public | 202 | Determining the prevalence and AR profiles of S. aureus and E. coli strains from patients with UTIs attending Dalhatu Araf Specialist Hospital (DASH) Lafia, Nasarawa State, Nigeria. |
Sanou et al.[40] | 2015 | Burkina Faso | Cross-sectional | General public | 75 | To identify the risk factors and the microorganisms susceptibilities of nosocomial urinary infections at the urology unit of the national university hospital of Ouagadougou in Burkina Faso. |
Seifu and Gebisa.[41] | 2018 | Ethiopia | Cross-sectional | General public | 384 | To assess the prevalence of bacterial uropathogens and their invitro susceptibility patterns to commonly used antibiotic agents amongst outpatients with complaints of UTI in Shashemene referral hospital. |
Wondimeneh et al.[15] | 2014 | Ethiopia | Cross-sectional | women | 53 | To determine the prevalence, drug susceptibility pattern and associated risk factors of UTI among obstetric fistula patients at Gondar University Hospital, Northwest Ethiopia. |
Moses Mukosha et al.[42] | 2020 | Zambia | Cross-sectional | Pregnant women | 380 | Investigating the prevalence of UTIs and associated factors among HIV infected pregnant women attending antenatal care at a tertiary hospital in Zambia. |
F. Wanja et al.[43] | 2021 | Kenya | Cross-sectional | General public | 206 | To investigate and determine the prevalence of bacterial urinary tract infection, antimicrobial susceptibility profiles, and UTI associated risk factors among adults attending Kiambu level 5 Hospital. |
H. A. Onyango et al.[44] | 2018 | Kenya | Cross-sectional | Pregnant women | 210 | Identifying associated risk factors for UTI amongst pregnant women attending antenatal clinic at Pumwani Maternity Hospital (The largest antenatal clinic in Kenya) |
Risk factors for UTIs.
Twenty six risk factors were identified and were classified into four groups for the purposes of this review, namely socioeconomic factors, factors concerning medical history, risk factors on hospitalization, and HIV associated factors. Socioeconomic factors were age, gender, residence, occupation, family income, education, marital status and religion. Medical history factors were history of UTIS, history of catheterization, recurrent UTIs, underlying disease, poor glycemic control, gestational period, parity and gravidity. Hospitalization factors were indwelling catheter, anemia, pyuria, Flank pain, fistula, diabetes mellitus and admission status. HIV associated factors were CD4 counts, viral loads and on HIV medication. Practices including being not circumcised in males, eating raw foods and frequency of sexual intercourses were studied by majority of the articles included (Table 2).
Table 2
Summary presentation of risk factors and the studies investigating them.
Category | Risk Factor | Studies investigating risk factor |
Socioeconomic | Age | [20][21][22][19][24][25][43][27][28][29][30][31][33][34][16][42][36] [37][32][15]. |
| Gender | [23][19][25][43][27][28][18][16][35][37][17][32][38][39][40][41]. |
| Residence | [21][24][27][28][29][33][34][18][37][32][41][15]. |
| Occupation | [21][22][24][43][29][44][31][4][34][42][37][15]. |
| Family income | [21][26][29]. |
| Education | [21][22][24][26][43][29][44][30][31][4][34][42][36][37][32][15]. |
| Marital status | [20][21][43][44][30][4][33][42][36][37][17][32][15][24]. |
| Religion | [22][23][38]. |
Medical history | History of UTI | [21][19][24][26][27][29][29][31][4][18][36][37]. |
| History of Catheterization | [21][24][26][27][28][34][18][37][32][41][15]. |
| Gestational period | [20][21][22][26][29][44][30][31][42][36]. |
| Parity | [20][22][26][44][30][34][42][36]. |
| Gravidity | [20][21][36]. |
Hospitalization status | Indwelling Catheter | [23][19][25][18][16][32][39][40]. |
| Flank pain | [28]. |
| Fistula | [24][34]. |
| Pyuria | [31]. |
| Diabetes Mellitus | [23][25][27][18][35][37][17][32]. |
HIV associated factors | On HIV medication | [38]. |
| CD4 count | [38]. |
| Viral load | [38]. |
Practices | Uncircumcision | [19][27][28][18][32]. |
| Eating raw meat | [29]. |
| Coital Frequency | [20][26][43][28][44][36][32]. |
Age
Twenty studies[19], [20], [34], [43], [21], [22], [24], [25], [27]–[29], [33][30][31][15], [16], [32], [36], [37], [42] reported the mean age of their study subjects. The lowest mean age was 6 years reported by Fenta et al.[27] while the highest mean age was 39 years reported in the study by Nigusse et al.[37]. Of these, four studies[4], [32], [35], [41]found significant association between age and occurrence of urinary tract infections.
Gender
Among studies that investigated gender, ten studies[4], [16], [25], [28], [32], [33], [35], [37], [38], [41] reported significant association between gender and occurrence of urinary tract infections. High prevalence was observed in female participants and all the above studies reported that females had increased odds of acquiring urinary tract infections compared with their male counterparts.
Residence
Twelve studies[21][24][27][28][29][18], [33], [34][37][32], [41][15] investigated residence as a factor for urinary tract infections. None of the above studies found significant association between residence and occurrence of UTIs.
Occupation
Occupation of participants was investigated by twelve studies[21][22][24][43][29][44][31][4][34][42][37][15]. None of these studies found any significant relationship between occupation and occurrence of urinary tract infections. Odds ratios revealed contrasting and inconclusive conclusions. Notably, while the odds were high in some studies for employed participants, other studies reported reduced odds in unemployed participants and those in informal jobs.
Family income
Family income was investigated by three studies[21][26][29], of which two of them reported significant association. Ali et al. reported those earning below 100USD per month were five times at risk compared with those earning more than 100 dollars [AOR = 5.225, 95%CI: 1.270–21.500, P = 0.002][21]. Gessese et al. reported those receiving a monthly salary of ≤ 500 Ethiopian Birr (≤ 21.18 USD) were 4.78 times at risk of acquiring a UTI[OR = 4.87, 95% CI: 1.03–22.21, P = 0.046][29].
Education
Of the sixteen studies that investigated education, two found it to be positively correlated with occurrence of UTIs. While Ali et al. observed that occurrence of UTI was most likely to those who had no formal education as compared to those with formal education [AOR = 3.183, 95%CI: 1.027–9.866, P = 0.045][21], Inwang et al. reported increased prevalence of asymptomatic bacteriuria among participants with secondary education (P = 0.037)[30].
Marital status
Marital status was investigated by fourteen studies[20][21][43][44][30][4][33][42][36][37][17][32][15][24], and of these, only 3 studies found significant association between this risk factor and occurrence of UTIs. Kabugo et al.[4]reported that being married [AOR = 0.45; 95%CI: 0.22–0.92, P = 0.004] was significantly associated with UTIs. Similarly, Odoki et al.[32] and Wondimeneh et al.[15]found that the risk of acquiring UTIs was higher in married participants compared to unmarried ones {[COR = 2.204, 95%CI: 1.203–4.037, P = 0.011] and [P = 0.032] respectively}.
History of UTIs
Out of the twelve studies that investigated history of UTIs among its participants, eight studies[21][29][26][27][28][29][31][18] reported significant relationship between UTI occurrence and having a previous infection.
History of catheterization
Eleven studies investigated association between having been catheterized in the past and occurrence of UTIs. Among these studies, six of them[21][24][28][34][18][32] found significant association between this risk factor and occurrence of UTIs.
Gestational period, parity and Gravidity
Studies conducted among expectant women investigated gestational period, parity and gravidity and their association with occurrence of UTIs. Particularly, ten studies investigated the factor gestational period, with two finding significant association with UTI occurrence. While Awunonga et al.[22]predicted an increase in urinary bacterial isolates in the second trimester [P = 0.013], Mukosha et al.[42]reported a lower probability of UTI occurrence in late stages of pregnancy [AOR = 0.96 95%CI: 0.91–0.99, P < 0.0001].
Parity was investigated by eight studies, with only Marami et al.[34]reporting significant association [AOR = 0.3, 95%CI: 0.1–0.8], where they found nulliparous participants to have reduced chances of getting UTIs. Gravidity was investigated by three studies and none of them reported significant association.
Indwelling catheter
Of the eight studies reporting on patients with an indwelling catheter, two predicted positive correlation between having an indwelling catheter and the likelihood of acquiring a UTI. Melaku et al.[16]found the risk of developing a UTI among catheterized patients was 2.6 times higher compared to those without a catheter [p = 0.001]. Also, Odoki et al.[32]reported that patients with an indwelling catheter of more than 6 days were 3.761 times at risk of acquiring a UTI [AOR = 3.761, 95%CI: 1.077–13.128, P = 0.038].
HIV associated factors
Four studies[42][37][32][38] investigated prevalence of UTIs in HIV positive participants. Surprisingly, the study by Okechukwu and Thairu[38] stood out by reporting significant relationship in three aspects. Firstly, the prevalence of bacterial isolates was higher in participants receiving first line Anti-Retroviral Therapy (ARVT) compared to those receiving second line ARVT[P = 0.024]. Secondly, this study predicted a reduced number of CD4 cells/µl of urine in subjects with bacterial isolates [P = 0.02], and that there were high chances of isolating urinary bacteria in patients with an higher viral load (copies/ml)[P = 0.003].
Practices associated with occurrence of UTIs
Uncircumcision
Two studies[18], [27] found significant association between being uncircumcised and acquiring UTIs, out of the four studies that investigated this factor. Fenta et al.[27] reported uncircumcised subjects were more than eighteen times at risk of acquiring an infection compared to circumcised subjects [AOR = 18.99, 95%CI: 5.5-65.35, P = 0.00]. Mekonnen et al.[18]reported the high risk of UTIs among uncircumcised subjects [AOR = 3.523 95%CI: 1.328–9.348, P = 0.011].
Eating raw foods
Only Gessese et al.[29]investigated this practice and found no significant association.
Coital frequency
With seven studies investigating frequency of sexual intercourse, only two reported significant association. Specifically, Gebremariam et al.[28]concluded those having sexual intercourse more than three times in a week were more than two times at risk of acquiring a UTIs[AOR = 2.16, 95%CI: 1.149–3.69, P = 0.012].