Factors Associated With Recurrent Urinary Tract Infections Among Females of Reproductive Age at Kisugu Health Centre Iii, Uganda: A Cross-sectional Study

Factors Associated With Recurrent Urinary Tract Infections Among Females of Reproductive Age at Kisugu Health Centre Iii, Uganda: A Cross-sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Factors Associated With Recurrent Urinary Tract Infections Among Females of Reproductive Age at Kisugu Health Centre Iii, Uganda: A Cross-sectional Study Kavuma Sharif This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8553864/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Recurrent urinary tract infections (UTIs) remain a significant public health concern among women of reproductive age in Uganda. This study assessed factors associated with recurrent UTIs among females aged 15–49 years attending Kisugu Health Centre III, Kampala. Methods A cross-sectional study conducted on 144 randomly selected samples with the help of an interviewer-administered questionnaire to assess knowledge, attitudes and practices of recurrent UTI. The analysis of data was done in SPSS version 21. For the association, chi-square was applied at p < 0.05. Overall, 36.8% of participants reported recurrent UTIs. Results Most respondents acknowledged that UTIs can recur, indicating general awareness. However, only 53.5% demonstrated good overall knowledge, which was significantly associated with recurrence (p = 0.049). Identified risk factors included improper perineal wiping techniques, high frequency of sexual intercourse, poor medication adherence, and co-existing medical conditions such as diabetes. Although many participants sought healthcare, several reported barriers to receiving timely support, primarily due to embarrassment. Conclusions Recurrent UTIs among women in this setting are influenced by behavioral and clinical factors. Strengthening preventive strategies, improving counselling, and delivering targeted health education may help reduce recurrence and improve health-seeking practices. Recurrent urinary tract infections UTIs reproductive-age women risk factors knowledge attitudes practices Kisugu Health Centre III Uganda Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Background Urinary tract infections (UTIs) remain a serious public health problem on a worldwide basis. Annually, between 150 and 160 million people are affected (Gupta et al., 2001 ). Women in particular, carry a significantly greater burden, and the incidence estimated over their lifetime ranges from 50–60 per cent (Besty Foxman & Brown, 2003 ). Geographic variation is apparent: figures of prevalence ranging from 19.6 to 20 percent are reported throughout Europe, while prevalence figures in developing countries are closer to 24 percent (Medina & Castillo-Pino, 2019 ). In Asia, a multicounty analysis showed a prevalence of 9.8 per cent (Lee et al., 2018 ). Data from surveillance in Africa shows large variations with Algeria reporting 4.5% and Senegal only 0.7%. Recurrent UTIs (two episodes within six months or three within twelve months) are not uncommon; a study of Spanish patients found that 27% of women had recurrence within six months (Alós, 2005). Etiologically, Escherichia coli is the dominant causative agent in the majority of community acquired UTIs (Payam Behzadi, 2010 ). Other significant pathogens are Klebsiella spp, Proteus spp and Pseudomonas aeruginosa (Yilmaz et al., 2016 ). Recurrent UTIs have been widely reported in relation to risk factors such as high sexual practices (K et al. , 1999; Cai, 2021 ), spermicide use, and incorrect wiping strategies that have allowed into the urethra fecal contamination (Alós, 2005). Diabetes mellitus is highly correlated with recurrent infections due to impaired immunity, glycosuria and bladder dysfunction (De Lastours & Foxman, 2014 ; Fünfstück et al. , 2012; Nicolle, 2005 ; Gorter, et al. , 2010; Schneeberger, et al. , 2008). International studies from China, Brazil, Israel and Egypt support the importance of poor glycemic control in recurrent UTI (Wang, et al. , 2013; Truzzi et al., 2008 ; Nitzan, et al. , 2015; Aly, 2016 ). Behavioral practices such as delayed voiding, vaginal douching and use of non-cotton undergarments also contribute to susceptibility (Scholes, 2000 ; Dimetry et al., 2007 ). Knowledge and attitudes towards UTIs are considerably different in different populations. Few levels of awareness have been recorded in Nepal (Adhikari & Dhakal, 2015 ), Ethiopia (Tadesse et al., 2014 ), Kenya (Onyango et al., 2018 ), and Tanzania (Masinde et al., 2009 ). Educational attainment has a critical effect on both knowledge and preventive practices (Geerlings, 2008 ). Attitudinal barriers (such as stigma and embarrassment) often delay care-seeking (Minejima et al., 2019 ), although some research shows generally positive attitudes towards prevention in the presence of awareness program (Navarro et al., 2019 ; Santoso et al., 2017 ; Hazwell and Sichilima, 2020). In Uganda, there are already some existing studies which show a prevalence of UTIs of 13.3% (Andabati & Byamugisha, 2010 ), with E. coli being the main pathogen. Risk factors like back to front wiping and diabetes have been identified repeatedly (Andabati & Byamugisha, 2010 ; Odoki et al., 2019 ). However, the literature has generally focused on UTI and bacteriuria when discussing them in aggregate and not specifically on recurrent UTIs. No published research has looked at the relationship between knowledge, attitudes and practices and recurrence of UTIs among women of reproductive age in Uganda and no one has looked at these determinant factors in Kisugu Parish despite its urban character and high utilization of health services. This is a conspicuous evidence gap that highlights the need for context-specific research to help decipher the behavioral and clinical predictors of recurrent UTIs in this setting. Findings will guide targeted health education, fortification of preventive approaches, as well as at primary healthcare facilities. Consequently, the present study aimed at assessing the factors associated with recurrent urinary tract infections among women of reproductive age attending Kisugu Health Centre (III) Kampala, Uganda. Methods Study Aim, Design and Setting The present investigation aimed at elucidating the determinants of recurrent urinary tract infections (UTIs) in reproductive age females attending Kisugu Health Centre III, Kampala, Uganda. The study was carried out using a cross-sectional design and was conducted at this urban primary care facility located in Kisugu Parish, Makindye Division. The center provides out-patient, maternal and reproductive health services to a heterogeneous urban group. Study Population The target population was females aged 15–49 years who sought care at Kisugu Health Centre III in the study interval. Inclusion Criteria Females aged 15–49 years old capable of providing written informed consent. Exclusion Criteria Women who were unconscious or in some other way unable to participate in an interview, and those who were in active labor at the time of the data collection. Sample Size Determination The necessary size of the sample was calculated by using the formula: N = 4P (1-P)/d 2 N = 144 where P is the estimated proportion of women with recurrent UTIs (10%) and d is the error margin tolerated (5%). This calculation had a minimum sample size of 144 participants. Sampling Procedure A simple random sampling strategy was adopted. The sampling frame included eligible females aged 15–49 years that attended the facility during the study period. A lottery method was used to ensure every individual a chance of selection until the target of 144 was reached. Recruitment has been done across different service units to reduce selection bias. Study Variables Dependent Variable Recurrent UTI, defined as > = 2 episodes of UTI within 6 month or > = 3 episodes of UTI within 12 month, based on self-reported history. Independent Variables Knowledge-related factors Causes, symptoms, prevention, risk factors, recurrence. Attitudinal factors Stigma, embarrassment, Health seeking attitudes, Treatment Beliefs Practice-related factors hygiene practices, wiping technique, type of undergarments, sexual activity, voiding habits, adherence to medication, lifestyle factors, comorbidities (e.g., diabetes, hypertension). Data Collection Tools and Procedures Data were collected using a pre tested structured, interviewer administered questionnaire. The instrument gained sociodemographic data; UTI history; knowledge of causes, prevention, symptoms and recurrence; attitudes toward UTIs; and hygiene, sexual behavior, voiding habits and lifestyle practices and. Interviews were carried out privately by the principal investigator and trained research assistants, to maintain confidentiality and minimize social desirability effect. Clarifications were provided in the local languages where needed. Responses were systematically recorded and reviewed on a daily basis for completeness and consistency. Data Quality Control A pilot test was conducted on a small sample, external to the researchers, to refine the questionnaire. Training was given to the research assistants on study objectives, interview techniques and ethics. Completed questionnaires were inspected daily for completeness, accuracy and consistency. Double data entry and verification was done to minimize errors. Statistical Analysis Data were coded, cleaned and entered into the software (SPSS v21). Descriptive statistics (frequencies, percentages, means) summarized participant characteristics and outcome measures. Inferential analysis, using the chi-square tests, checked the association of independent variables (knowledge, attitudes, practices) and recurrent UTI. A p-value < 0.05 based on the 95% confidence level was associated with statistical significance. The fixed sample size found based on prevalence estimates eliminated the need for a separate power calculation. Results Prevalence of Recurrent UTIs The frequency of recurrent UTIs was identified by determining the number of UTI incidences in 1 year. The respondents that reported three or more episodes were considered to experience recurrent UTIs. The findings include that 36.8% of the respondents had recurrent UTIs (Fig. 2 ) and 63.2% had less than three incidences (Fig. 2 ). This proves that over a third of the women visiting the facility had experienced recurrent UTIs, which indicates that there was a high burden among this group of people. Knowledge on Recurrent UTIs The first knowledge was measured by asking the respondents to answer whether they were aware of the possibility of recurrence of UTIs. Basic awareness was high as most participants (88.9) indicated they were aware of UTI recurrence (Fig. 3 ). In addition to mere awareness, general knowledge of respondents was measured and divided into poor, average or good. More than 53.5% of the respondents represented good knowledge (Table 1 ), whereas 31.3% represented poor knowledge and 15.3% represented average knowledge. Table 1 General Knowledge on UTIs in it. The correlation between the general knowledge and the UTI recurrence was studied using a cross- tabulation. The results revealed that frequent UTIs were more prevalent among poorly knowledgeable respondents than good knowledge ones. Knowledge Level Frequency (n) Percentage (%) Poor 45 31.3 Average 22 15.3 Good 77 53.5 Total 144 100 Table 2 Cross-tabulation of Knowledge Level and UTI Recurrence Knowledge Level Recurrent UTIs (≥ 3 episodes) Non-recurrent UTIs (< 3 episodes) Total Poor 10 35 45 Average 10 12 22 Good 33 44 77 Total 53 91 144 Interpretation The relationship between knowledge level and the frequency of UTI was observed to vary between the initial and subsequent UTIs (Table 2 ). A cross-tabulation was conducted to examine the relationship between general knowledge and UTI recurrence. The findings indicated that recurrent UTIs were more common among respondents with poor knowledge compared to those with good knowledge (as shown in Fig. 4 below). A chi-square test was used to reveal the statistically significant relationship (Table 3 ) between the level of knowledge and recurrent UTIs (p = 0.049). This implies that women who have low knowledge levels will have higher chances of developing recurrent UTI cases and thus proper health education on UTI prevention is significant. Table 3 Chi-square Test of Knowledge and Recurrent UTIs Variable Tested Chi-square Value (χ²) df p-value Knowledge level vs UTI recurrence 6.035 2 0.049* Attitudes on recurrent UTIs. The attitude of the respondents towards UTIs was measured to determine how perceptions and emotional attitudes might affect the health-seeking behavior. Almost half of the respondents said that they were embarrassed to have a UTI and 41% said they felt embarrassed to consult a doctor. Nevertheless, most (93.8%) of them reported that they would consult a doctor in case they experienced the symptoms of UTI, and 97.9% of them would clearly describe their symptoms to a specialist (Table 4 ). Table 4 Attitudes Towards Recurrent UTIs Attitude Statement Response Category Frequency (n) Percentage (%) Embarrassed to have a UTI Yes 68 47.2 No 76 52.8 Embarrassed to seek medical attention Yes 59 41.0 No 85 59.0 Would seek medical attention when experiencing UTI symptoms Yes 135 93.8 No 9 6.3 Would clearly explain symptoms to the doctor Yes 141 97.9 No 3 2.1 Indeed, the majority of nurses exhibit a moderate level of disinterest in their work. As a matter of fact, most nurses are moderately disinterested in their work. These results show a general positive health-seeking attitude in spite of a feeling of embarrassment that can delay the accessibility of timely care among some individuals. Recurrent UTIs Practices. The hygiene, sexual, medical, and obstetric practices were looked into in order to determine the behavioral determinants of recurrent urinary tract infections (UTIs). Hygiene data showed that 51.4% of the respondents used a back-to-front wiping method (Fig. 5 ) and this is a factor that trans locates perianal bacteria into the urethral canal. Only 38.9% of the participants followed the suggested front-to-back method. Sexual habits were also exhibiting tendencies that were relevant to UTI recurrence. A large proportion of respondents (88.2%) reported a sexual activity with most of them reporting a sexual experience with a husband (Fig. 6 ) and 29.3% with a boyfriend. Sexual activity is a documented risk factor of UTIs, and this trend can be one of the reasons for the recurrence rates. It can be contended that the target audience consists of older adults who are sexually active and who might face certain challenges or difficulties in fulfilling their sexual desires and needs. One can argue that the target audience is that of the older adult population that is sexually active and may experience some challenges or problems in their sexual needs and desires. Medical related practices: The adherence rate to prescribed antimicrobials was at (79.9%), showing a high level of association with the recurrent UTIs. In addition, although a small proportion of the study population had uncontrolled diabetes (0.7) and hypertension (2.8), the conditions were relatively highly associated with recurrence as it has been reported that metabolic mismanagement (poorly controlled diabetes) increases predisposition to infection. Mode of delivery also showed a very strong relationship (Table 5 ), and women who had vaginal delivery were more likely to report recurrent UTIs. Other steps that were undertaken during the last UTI episode showed that a number of respondents self-medicated, used herbal remedies, or used analgesics without consulting a professional medical care- behaviors that are linked to high recurrence risks. Table 5 Practices Related to Recurrent UTIs Practice Variable Response Category Frequency (n) Percentage (%) Wiping method Back to front 74 51.4 Front to back 56 38.9 Wash with water 14 9.7 Sexual intercourse Yes 127 88.2 No 17 11.8 Sex partner Husband 85 59.0 Boyfriend 42 29.3 Not sexually active 17 11.8 Drug adherence Non-adherence 115 79.9 Adhered 29 20.1 Comorbidities Uncontrolled diabetes 1 0.7 Uncontrolled pressure 4 2.8 Mode of Delivery Vaginal delivery 88 61.1 C-section 12 8.3 No delivery history 44 30.6 Action during last UTI episode Self-medication 9 6.3 Used herbs 3 2.1 Took painkillers only 5 3.5 Went to health facility 127 88.2 Discussion Prevalence of Recurrent Urinary Tract Infections The present investigation showed that 36.8% of the subjects in this investigation reported recurrent urination tract infections (UTIs) defined operationally as three or more episodes of infection within a twelve-month period. This percentage is significantly higher than the 14.6% prevalence found in the national survey in Uganda conducted by Kabugo et al. ( 2016 ), and well above the rates recorded in other settings in Africa, such as Algeria (4.5%) and Senegal (0.7%). The marked burden observed in Kisugu, therefore, warrants consideration of local behavioral and environmental determinants, especially of personal hygiene, sexual practices and patterns of health seeking behavior which may allow for repeated episodes. International data support this trend. A Spanish cohort, for example, found a 27% recurrence rate in a six-month window (Alos, 2005 ) and highlights the importance of recurrent UTIs in women of reproductive age all over the world. Biological susceptibility due to female anatomy, combined with high amounts of sexual activity and certain hygienic practices in this cohort are likely to underlie these high recurrence rates. Knowledge on Recurrent UTIs Despite an impressive level of awareness about the possibility of recurrence (88.9%), only 53.5% of the respondents showed a good knowledge base, and 31.3% showed poor knowledge. Importantly, low knowledge was statistically related to recurrent UTIs (p = 0.049), which attests to the fact that it is not enough to be aware, but rather to comprehend how one can be effective in preventing recurrence. These findings are similar to those from studies in Nepal (Adhikari & Dhakal, 2015 ) and Kenya (Onyango et al., 2018 ), where high awareness was accompanied by limited knowledge of etiological factors, risk determinants and preventive behaviors. Geerlings ( 2008 ) similarly noted that lower education attainment is predictive of poor comprehension of UTIs. In this cohort, those with deficient knowledge also practiced maladaptive practices (such as inappropriate wiping, failing to adhere to medication and delaying health-seeking) that are consistent with theoretical models specifying that knowledge influences attitudes and actions. As such, knowledge deficiencies are a direct risk factor for recurrence. Attitudes About Recurrent UTIs The study identified a dual attitude pattern. About half of the participants (47.2%) reported embarrassment relating to the presence of a UTI, and 41.0% felt shame relating to care seeking. Notwithstanding, majority (93.8%) respondents reported a plan to visit a doctor in case of symptoms and 97.9% said they were happy to communicate their symptoms openly. Embarrassment is a recognized psychosocial barrier, which delays the initiation of treatment (Minejima et al., 2019 ). However, the dominance of positive health seeking intentions found here is similar to those in Indonesia (Santoso et al., 2017 ) and the Philippines (Navarro et al., 2019 ), in which women showed high preparedness to prevent and manage UTIs despite knowledge gaps. Thus, stigma may delay, but does not completely inhibit, treatment; such delays may compromise bacterial clearance and increase risk of recurrence. Recurrent UTI Practices Hygiene Practices More than half of respondents (51.4%) reported wiping from back to front, a well-documented risk factor for UTIs because of the possibility of the migration of perianal flora, especially Escherichia coli, into the urethra. These observations are in line with studies in the United States, Egypt and Uganda identifying improper wiping as a major contributor to UTI recurrence (Alos, 2005 , Dimetry et al., 2007 , Andabati and Byamugisha 2010 ). Anatomically, the proximity of the anus and urethra in females increases sensitivity when the use of non-optimal hygiene. Practices for Sexual and Reproductive A large number of the participants (88.2%) were sexually active, with a proportion of these reporting multiple partners (which are strongly correlated with UTI recurrence in multiple studies; K et al. , 1999; Foster, 2008 . Comparable associations have been reported in Australia, Spain and North America, strengthening the concept of sexual activity as an important risk factor. Delivery mode was also a strong predictor of recurrence: women who had given birth by vaginal delivery were more likely to have recurrent UTIs. Previous evidence indicates that obstetric trauma and pelvic floor alterations could be a predisposing factor for women developing incomplete bladder emptying, a known risk factor for infection (Franco, 2005 ). Practices Relating to the Medical and Treatment Noncompliance with antimicrobial therapy was strikingly high (79.9%). Poor adherence promotes bacterial persistence and increases risk of recurrence which accords with the results of Canadian studies (Nicolle, 2005 ) and Kuwaiti studies involving diabetic women (Sewify et al., 2016 ). Although the number of participants with uncontrolled diabetes or hypertension was low, there was a strong correlation between these comorbidities and recurrence. This finding is consistent with reports from the Netherlands and Israel suggesting that suboptimum glycemic control negatively affects immune competence and favors bacterial growth (Gorter et al., 2010 ; Nitzan et al., 2015 ). Self-medication, herbal usage and dependence on analgesics alone during UTI episodes were observed with few but it is a major contributor of inadequate therapy. Such behaviors reflect both knowledge deficits as well as access barriers and, eventually, increase the risk of recurrence. Integration to the Conceptual Framework The results strongly endorse this conceptual framework, which states that knowledge, attitudes, and practices together affect the recurrence of UTIs. Knowledge gaps catalyze improper hygiene, non- adherence and delayed care. Attitudes (notably, embarrassment) modulate health seeking behaviors. Practices are the nearest determinants of recurrence in terms of direct biological effect on the risk of infection. The interaction between cognitive, behavioral and psychosocial factors is therefore indicative that recurrent UTIs in this population are the result of a multifactorial process that correlates with international research suggesting that recurrence is influenced by lifestyle, hygiene, sexual behavior, comorbidities and psychological factors. Study Limitations A number of limitations should be acknowledged. First of all, the self-reported history of UTI may cause recall bias. Second, the cross-sectional design does not allow a definite causally effect, as exposures and outcomes were measured at the same time. Third, the study was carried out at one health facility, and this may affect generalizability to the other Ugandan contexts. Lastly, the data on comorbidities were based on participant self-reporting rather than clinical verification which may underestimate the prevalence of metabolic or chronic conditions. Conclusion This study identified a high burden of recurrent urinary tract infections among females of reproductive age attending Kisugu Health Centre III, with more than one-third reporting three or more episodes annually. Upon conducting this investigation, I found a high burden of recurrent urinary tract infections among women of reproductive age attending Kisugu Health Centre III with more than one-third reporting 3 or more episodes a year. Such a prevalence implies a multifactorial interaction of behavioral, cognitive and clinical determinants that together increase susceptibility to repeated infections. The data indicate that the knowledge, attitudes and practices have a strong impact on the recurrence of UTI. Although general awareness of recurrence of UTI was high, some significant gaps were noted in a deeper understanding of causative factors, risk profiles and preventive measures. These gaps were found to be highly correlated with recurrence and manifested in inappropriate behaviors such as improper wiping techniques, non-adherence to prescribed regimens and self-medication. Attitudinal barriers, specifically embarrassment, further delayed seeking care, or resulted in less-than-optimal management. Clinical factors such as uncontrolled diabetes, hypertension, and history of vaginal delivery significantly contributed to the risk of recurrence, adding to the known information about metabolic and obstetric factors. Sexual activity, especially among participants with multiple partners, was a factor that contributed to high risk, suggesting patterns seen in epidemiological studies that have been done in other situations. Overall, the study helps to confirm that in this population, recurrent UTIs are caused by a combination of knowledge deficit, behavior practices, psychosocial factors, and underlying health conditions. These findings highlight the need for formal health education, improved counselling at the facility level and the need for specific interventions around modifiable risk factors. A holistic approach to these determinants offers potential for reduction in the recurrence rate and quality of life of women in this community. Abbreviations AMR Antimicrobial Resistance AST Antimicrobial Susceptibility Testing CTX Cotrimoxazole CDC Centre for Disease Control CA-UTI Community Acquired Urinary Tract Infections E. coli Escherichia coli ESBL Extended spectrum Beta Lactamase HA-UTI Hospital Acquired Urinary Tract Infection MHA Muller Hinton Agar MIC Minimum Inhibitory Concentration S. Aureus Staphylococcus aureus UTI Urinary tract infections WHO World Health Organization XDR Extensively Drug-resistant Declarations Ethics approval and consent to participate This study was carried out in accordance with the Declaration of Helsinki and all pertinent ethical guidelines for conducting research involving human participants. Ethic approval was secured from the Clarke International University Research Ethics Committee (CIU-REC): Reference No. CLARKE-2021-21. Written informed consent was obtained from all the participants before data collection. Consent for publication Not applicable. The manuscript does not contain any individual person's data in any form. Competing interests The authors declare that they have no competing interests. Funding This study did not receive any specific funding from public, commercial, or not-for-profit sectors. Author Contribution Kavuma Sharif: conceived the study, designed the proposal including questionnaire, data collection, performed data analysis, collected data and drafted the manuscript, contributed to literature review and interpretation of results and manuscript finalizations. Acknowledgements The author would like to acknowledge Clarke International University (CIU) for providing ethical approval and support for this study. Also, thanks to the supervisor, Mrs. Nakayi Marthae, for their guidance and mentorship throughout the study. Data Availability The datasets generated during the current study are available from the corresponding author on reasonable request. **Mail:** [email protected] References Adhikari S, Dhakal R. 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Prevalence of Urinary Tract Infection and Antimicrobial Susceptibility among Diabetic Patients with Controlled and Uncontrolled Glycemia in Kuwait. J Diabetes Res. 2016;2016:6573215. 10.1155/2016/6573215 . Seyeded M. Evaluation of Knowledge, Attitude and Behavior in the Field of Urinary Tract Infection among the Pregnant Women Consulted in Health Centers Zahedan City, Iran, Based on the Health Belief Model (HBM). J Health Syst Res. 2014;12(1):114–8. Simmering JE, et al. The Increase in Hospitalizations for Urinary Tract Infections and the Associated Costs in the United States, 1998–2011. Open Forum Infect Dis. 2017;4(1). 10.1093/OFID/OFW281 . Subramaniam. Association of urinary tract infection in married women presenting with urinary incontinence in a hospital based population. J Diagn Res. 2016;10(3):DC10–3. 10.7860/JCDR/2016/16547.7390 . Tadesse E et al. Asymptomatic urinary tract infection among pregnant women attending the antenatal clinic of Hawassa Referral Hospital, Southern Ethiopia. BMC Res Notes. 2014;7:155. Available from: http://dx.doi.org/10.1186/1756-0500-7-155 Truzzi JC, et al. Residual urinary volume and urinary tract infection–when are they linked? J Urol. 2008;180(1):182–5. 10.1016/J.JURO.2008.03.044 . Wang J, et al. Bacterial characteristics and glycemic control in diabetic patients with Escherichia coli urinary tract infection. J Microbiol Immunol Infect. 2013;46(1):24–9. 10.1016/J.JMII.2011.12.024 . Yilmaz Y, et al. Bacterial uropathogens causing urinary tract infection and their resistance patterns among children in Turkey. Iran Red Crescent Med J. 2016;18(6):e26610. 10.5812/ircmj.26610 . Additional Declarations No competing interests reported. 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Sharif","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABB0lEQVRIie2PQUrEMBSGn3iJSrE5gZAhUDfSY7j+w0CzyYAgiODCgpcodGCuMMPAiLtAYbxCwVnUTdcFQbo0Kc5qaNWdMPkWySP8H38ekcfzD2G5PXBliIJ+oMi9mnpE4ZVLpnslJdErGFNckvYKpSQzd48q4VPT1tjJZzvUNRK1uC7fbUsSXWQDu8y3Igca+TLfXnJgOlu9pdwqUxGbgZoKgmRXymWFOJDd6WxVwClGbgYV9UGAU9RnADyqSaHaHxQtvhUdW6UEC/V4C6/0rVUaYZU7q7xOlqG+MeDDu7BcrU867M7txzZnHR4YK9S6be+TaHD9w94+yX8b73uzv6Q9Ho/nGPgCx7ptL1JGoB8AAAAASUVORK5CYII=","orcid":"","institution":"Clarke International University","correspondingAuthor":true,"prefix":"","firstName":"Kavuma","middleName":"","lastName":"Sharif","suffix":""}],"badges":[],"createdAt":"2026-01-08 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1","display":"","copyAsset":false,"role":"figure","size":44876,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 2: Proportion of UTIs in a Year\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"image1.png","url":"https://assets-eu.researchsquare.com/files/rs-8553864/v1/46bd96202dca84a76c85b7ee.png"},{"id":100367129,"identity":"7a36ea01-4024-4126-94f0-464681917944","added_by":"auto","created_at":"2026-01-16 07:56:47","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":55547,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 3: Knowledge on Recurrent UTIs in proportions\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"image2.png","url":"https://assets-eu.researchsquare.com/files/rs-8553864/v1/baefc27bcf29053f7c222685.png"},{"id":100366330,"identity":"7cb4f9da-0a16-4626-a17c-55de5f6f3650","added_by":"auto","created_at":"2026-01-16 07:56:13","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":49459,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 4: Knowledge level\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"image3.png","url":"https://assets-eu.researchsquare.com/files/rs-8553864/v1/6b426f588e3bb064ce943133.png"},{"id":100366583,"identity":"f203bc3e-410d-42ec-978d-4c7afe4c6fa8","added_by":"auto","created_at":"2026-01-16 07:56:22","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":109376,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 5: Hygiene-related Practices\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"image4.png","url":"https://assets-eu.researchsquare.com/files/rs-8553864/v1/0dc505b6a1f3f1017fce9223.png"},{"id":100136391,"identity":"4b6c0805-f448-4e4d-998b-8a838af494f3","added_by":"auto","created_at":"2026-01-13 10:45:30","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":101687,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 6: Sexual and reproductive practices\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"image5.png","url":"https://assets-eu.researchsquare.com/files/rs-8553864/v1/fb5ae37fe8b47163f54970a5.png"},{"id":100819392,"identity":"fb4adfaa-d110-4d46-bced-b437c6db63eb","added_by":"auto","created_at":"2026-01-21 17:25:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1370856,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8553864/v1/f9422715-8be5-49ae-a969-a0b7657c9332.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eFactors Associated With Recurrent Urinary Tract Infections Among Females of Reproductive Age at Kisugu Health Centre Iii, Uganda: A Cross-sectional Study\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eUrinary tract infections (UTIs) remain a serious public health problem on a worldwide basis. Annually, between 150 and 160\u0026nbsp;million people are affected (Gupta et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2001\u003c/span\u003e). Women in particular, carry a significantly greater burden, and the incidence estimated over their lifetime ranges from 50\u0026ndash;60 per cent (Besty Foxman \u0026amp; Brown, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2003\u003c/span\u003e). Geographic variation is apparent: figures of prevalence ranging from 19.6 to 20 percent are reported throughout Europe, while prevalence figures in developing countries are closer to 24 percent (Medina \u0026amp; Castillo-Pino, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). In Asia, a multicounty analysis showed a prevalence of 9.8 per cent (Lee et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Data from surveillance in Africa shows large variations with Algeria reporting 4.5% and Senegal only 0.7%. Recurrent UTIs (two episodes within six months or three within twelve months) are not uncommon; a study of Spanish patients found that 27% of women had recurrence within six months (Al\u0026oacute;s, 2005).\u003c/p\u003e \u003cp\u003eEtiologically, Escherichia coli is the dominant causative agent in the majority of community acquired UTIs (Payam Behzadi, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Other significant pathogens are Klebsiella spp, Proteus spp and Pseudomonas aeruginosa (Yilmaz et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Recurrent UTIs have been widely reported in relation to risk factors such as high sexual practices (K \u003cem\u003eet al.\u003c/em\u003e, 1999; Cai, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), spermicide use, and incorrect wiping strategies that have allowed into the urethra fecal contamination (Al\u0026oacute;s, 2005). Diabetes mellitus is highly correlated with recurrent infections due to impaired immunity, glycosuria and bladder dysfunction (De Lastours \u0026amp; Foxman, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; F\u0026uuml;nfst\u0026uuml;ck \u003cem\u003eet al.\u003c/em\u003e, 2012; Nicolle, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2005\u003c/span\u003e; Gorter, \u003cem\u003eet al.\u003c/em\u003e, 2010; Schneeberger, \u003cem\u003eet al.\u003c/em\u003e, 2008). International studies from China, Brazil, Israel and Egypt support the importance of poor glycemic control in recurrent UTI (Wang, \u003cem\u003eet al.\u003c/em\u003e, 2013; Truzzi et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Nitzan, \u003cem\u003eet al.\u003c/em\u003e, 2015; Aly, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Behavioral practices such as delayed voiding, vaginal douching and use of non-cotton undergarments also contribute to susceptibility (Scholes, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2000\u003c/span\u003e; Dimetry et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2007\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eKnowledge and attitudes towards UTIs are considerably different in different populations. Few levels of awareness have been recorded in Nepal (Adhikari \u0026amp; Dhakal, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), Ethiopia (Tadesse et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2014\u003c/span\u003e), Kenya (Onyango et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), and Tanzania (Masinde et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Educational attainment has a critical effect on both knowledge and preventive practices (Geerlings, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Attitudinal barriers (such as stigma and embarrassment) often delay care-seeking (Minejima et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), although some research shows generally positive attitudes towards prevention in the presence of awareness program (Navarro et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Santoso et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Hazwell and Sichilima, 2020).\u003c/p\u003e \u003cp\u003eIn Uganda, there are already some existing studies which show a prevalence of UTIs of 13.3% (Andabati \u0026amp; Byamugisha, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2010\u003c/span\u003e), with E. coli being the main pathogen. Risk factors like back to front wiping and diabetes have been identified repeatedly (Andabati \u0026amp; Byamugisha, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Odoki et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). However, the literature has generally focused on UTI and bacteriuria when discussing them in aggregate and not specifically on recurrent UTIs. No published research has looked at the relationship between knowledge, attitudes and practices and recurrence of UTIs among women of reproductive age in Uganda and no one has looked at these determinant factors in Kisugu Parish despite its urban character and high utilization of health services.\u003c/p\u003e \u003cp\u003eThis is a conspicuous evidence gap that highlights the need for context-specific research to help decipher the behavioral and clinical predictors of recurrent UTIs in this setting. Findings will guide targeted health education, fortification of preventive approaches, as well as at primary healthcare facilities.\u003c/p\u003e \u003cp\u003eConsequently, the present study aimed at assessing the factors associated with recurrent urinary tract infections among women of reproductive age attending Kisugu Health Centre (III) Kampala, Uganda.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Aim, Design and Setting\u003c/h2\u003e \u003cp\u003eThe present investigation aimed at elucidating the determinants of recurrent urinary tract infections (UTIs) in reproductive age females attending Kisugu Health Centre III, Kampala, Uganda. The study was carried out using a cross-sectional design and was conducted at this urban primary care facility located in Kisugu Parish, Makindye Division. The center provides out-patient, maternal and reproductive health services to a heterogeneous urban group.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003eThe target population was females aged 15\u0026ndash;49 years who sought care at Kisugu Health Centre III in the study interval.\u003c/p\u003e\n\u003ch3\u003eInclusion Criteria\u003c/h3\u003e\n\u003cp\u003eFemales aged 15\u0026ndash;49 years old capable of providing written informed consent.\u003c/p\u003e\n\u003ch3\u003eExclusion Criteria\u003c/h3\u003e\n\u003cp\u003eWomen who were unconscious or in some other way unable to participate in an interview, and those who were in active labor at the time of the data collection.\u003c/p\u003e\n\u003ch3\u003eSample Size Determination\u003c/h3\u003e\n\u003cp\u003eThe necessary size of the sample was calculated by using the formula:\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;4P (1-P)/d\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;144\u003c/p\u003e \u003cp\u003ewhere P is the estimated proportion of women with recurrent UTIs (10%) and d is the error margin tolerated (5%). This calculation had a minimum sample size of 144 participants.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSampling Procedure\u003c/h3\u003e\n\u003cp\u003eA simple random sampling strategy was adopted. The sampling frame included eligible females aged 15\u0026ndash;49 years that attended the facility during the study period. A lottery method was used to ensure every individual a chance of selection until the target of 144 was reached. Recruitment has been done across different service units to reduce selection bias.\u003c/p\u003e\n\u003ch3\u003eStudy Variables\u003c/h3\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDependent Variable\u003c/h2\u003e \u003cp\u003eRecurrent UTI, defined as \u0026gt;\u0026thinsp;=\u0026thinsp;2 episodes of UTI within 6 month or \u0026gt;\u0026thinsp;=\u0026thinsp;3 episodes of UTI within 12 month, based on self-reported history.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eIndependent Variables\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eKnowledge-related factors\u003c/strong\u003e \u003cp\u003eCauses, symptoms, prevention, risk factors, recurrence.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eAttitudinal factors\u003c/strong\u003e \u003cp\u003eStigma, embarrassment, Health seeking attitudes, Treatment Beliefs\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePractice-related factors\u003c/strong\u003e \u003cp\u003ehygiene practices, wiping technique, type of undergarments, sexual activity, voiding habits, adherence to medication, lifestyle factors, comorbidities (e.g., diabetes, hypertension).\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eData Collection Tools and Procedures\u003c/h2\u003e \u003cp\u003eData were collected using a pre tested structured, interviewer administered questionnaire. The instrument gained sociodemographic data; UTI history; knowledge of causes, prevention, symptoms and recurrence; attitudes toward UTIs; and hygiene, sexual behavior, voiding habits and lifestyle practices and.\u003c/p\u003e \u003cp\u003eInterviews were carried out privately by the principal investigator and trained research assistants, to maintain confidentiality and minimize social desirability effect. Clarifications were provided in the local languages where needed. Responses were systematically recorded and reviewed on a daily basis for completeness and consistency.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eData Quality Control\u003c/h2\u003e \u003cp\u003eA pilot test was conducted on a small sample, external to the researchers, to refine the questionnaire. Training was given to the research assistants on study objectives, interview techniques and ethics. Completed questionnaires were inspected daily for completeness, accuracy and consistency. Double data entry and verification was done to minimize errors.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData were coded, cleaned and entered into the software (SPSS v21). Descriptive statistics (frequencies, percentages, means) summarized participant characteristics and outcome measures. Inferential analysis, using the chi-square tests, checked the association of independent variables (knowledge, attitudes, practices) and recurrent UTI. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 based on the 95% confidence level was associated with statistical significance. The fixed sample size found based on prevalence estimates eliminated the need for a separate power calculation.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003ePrevalence of Recurrent UTIs\u003c/h2\u003e \u003cp\u003eThe frequency of recurrent UTIs was identified by determining the number of UTI incidences in 1 year. The respondents that reported three or more episodes were considered to experience recurrent UTIs. The findings include that 36.8% of the respondents had recurrent UTIs (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003e) and 63.2% had less than three incidences (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This proves that over a third of the women visiting the facility had experienced recurrent UTIs, which indicates that there was a high burden among this group of people.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eKnowledge on Recurrent UTIs\u003c/h2\u003e \u003cp\u003eThe first knowledge was measured by asking the respondents to answer whether they were aware of the possibility of recurrence of UTIs. Basic awareness was high as most participants (88.9) indicated they were aware of UTI recurrence (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn addition to mere awareness, general knowledge of respondents was measured and divided into poor, average or good. More than 53.5% of the respondents represented good knowledge (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), whereas 31.3% represented poor knowledge and 15.3% represented average knowledge.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eGeneral Knowledge on UTIs in it.\u003c/b\u003e The correlation between the general knowledge and the UTI recurrence was studied using a cross- tabulation. The results revealed that frequent UTIs were more prevalent among poorly knowledgeable respondents than good knowledge ones.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge Level\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCross-tabulation of Knowledge Level and UTI Recurrence\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge Level\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRecurrent UTIs (\u0026ge;\u0026thinsp;3 episodes)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-recurrent UTIs (\u0026lt;\u0026thinsp;3 episodes)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e144\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eInterpretation\u003c/strong\u003e \u003cp\u003eThe relationship between knowledge level and the frequency of UTI was observed to vary between the initial and subsequent UTIs (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/p\u003e \u003cp\u003eA cross-tabulation was conducted to examine the relationship between general knowledge and UTI recurrence. The findings indicated that recurrent UTIs were more common among respondents with poor knowledge compared to those with good knowledge (as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e4\u003c/span\u003e below).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eA chi-square test was used to reveal the statistically significant relationship (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) between the level of knowledge and recurrent UTIs (p\u0026thinsp;=\u0026thinsp;0.049). This implies that women who have low knowledge levels will have higher chances of developing recurrent UTI cases and thus proper health education on UTI prevention is significant.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eChi-square Test of Knowledge and Recurrent UTIs\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable Tested\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChi-square Value (χ\u0026sup2;)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge level vs UTI recurrence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.049*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eAttitudes on recurrent UTIs.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe attitude of the respondents towards UTIs was measured to determine how perceptions and emotional attitudes might affect the health-seeking behavior. Almost half of the respondents said that they were embarrassed to have a UTI and 41% said they felt embarrassed to consult a doctor. Nevertheless, most (93.8%) of them reported that they would consult a doctor in case they experienced the symptoms of UTI, and 97.9% of them would clearly describe their symptoms to a specialist (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAttitudes Towards Recurrent UTIs\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttitude Statement\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResponse Category\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmbarrassed to have a UTI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e47.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e52.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmbarrassed to seek medical attention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWould seek medical attention when experiencing UTI symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e93.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWould clearly explain symptoms to the doctor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e97.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIndeed, the majority of nurses exhibit a moderate level of disinterest in their work. As a matter of fact, most nurses are moderately disinterested in their work.\u003c/p\u003e \u003cp\u003eThese results show a general positive health-seeking attitude in spite of a feeling of embarrassment that can delay the accessibility of timely care among some individuals.\u003c/p\u003e \u003cp\u003e \u003cb\u003eRecurrent UTIs Practices.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe hygiene, sexual, medical, and obstetric practices were looked into in order to determine the behavioral determinants of recurrent urinary tract infections (UTIs). Hygiene data showed that 51.4% of the respondents used a back-to-front wiping method (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e5\u003c/span\u003e) and this is a factor that trans locates perianal bacteria into the urethral canal. Only 38.9% of the participants followed the suggested front-to-back method.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eSexual habits were also exhibiting tendencies that were relevant to UTI recurrence. A large proportion of respondents (88.2%) reported a sexual activity with most of them reporting a sexual experience with a husband (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e6\u003c/span\u003e) and 29.3% with a boyfriend. Sexual activity is a documented risk factor of UTIs, and this trend can be one of the reasons for the recurrence rates.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIt can be contended that the target audience consists of older adults who are sexually active and who might face certain challenges or difficulties in fulfilling their sexual desires and needs. One can argue that the target audience is that of the older adult population that is sexually active and may experience some challenges or problems in their sexual needs and desires.\u003c/p\u003e \u003cp\u003eMedical related practices: The adherence rate to prescribed antimicrobials was at (79.9%), showing a high level of association with the recurrent UTIs. In addition, although a small proportion of the study population had uncontrolled diabetes (0.7) and hypertension (2.8), the conditions were relatively highly associated with recurrence as it has been reported that metabolic mismanagement (poorly controlled diabetes) increases predisposition to infection. Mode of delivery also showed a very strong relationship (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e), and women who had vaginal delivery were more likely to report recurrent UTIs.\u003c/p\u003e \u003cp\u003e Other steps that were undertaken during the last UTI episode showed that a number of respondents self-medicated, used herbal remedies, or used analgesics without consulting a professional medical care- behaviors that are linked to high recurrence risks.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePractices Related to Recurrent UTIs\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractice Variable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResponse Category\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWiping method\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBack to front\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFront to back\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWash with water\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSexual intercourse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e88.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex partner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHusband\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBoyfriend\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot sexually active\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrug adherence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-adherence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e79.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdhered\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUncontrolled diabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUncontrolled pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMode of Delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVaginal delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e61.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eC-section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo delivery history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAction during last UTI episode\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf-medication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUsed herbs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTook painkillers only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWent to health facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e88.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003ePrevalence of Recurrent Urinary Tract Infections\u003c/h2\u003e \u003cp\u003eThe present investigation showed that 36.8% of the subjects in this investigation reported recurrent urination tract infections (UTIs) defined operationally as three or more episodes of infection within a twelve-month period. This percentage is significantly higher than the 14.6% prevalence found in the national survey in Uganda conducted by Kabugo et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), and well above the rates recorded in other settings in Africa, such as Algeria (4.5%) and Senegal (0.7%). The marked burden observed in Kisugu, therefore, warrants consideration of local behavioral and environmental determinants, especially of personal hygiene, sexual practices and patterns of health seeking behavior which may allow for repeated episodes.\u003c/p\u003e \u003cp\u003eInternational data support this trend. A Spanish cohort, for example, found a 27% recurrence rate in a six-month window (Alos, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2005\u003c/span\u003e) and highlights the importance of recurrent UTIs in women of reproductive age all over the world. Biological susceptibility due to female anatomy, combined with high amounts of sexual activity and certain hygienic practices in this cohort are likely to underlie these high recurrence rates.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eKnowledge on Recurrent UTIs\u003c/h2\u003e \u003cp\u003eDespite an impressive level of awareness about the possibility of recurrence (88.9%), only 53.5% of the respondents showed a good knowledge base, and 31.3% showed poor knowledge. Importantly, low knowledge was statistically related to recurrent UTIs (p\u0026thinsp;=\u0026thinsp;0.049), which attests to the fact that it is not enough to be aware, but rather to comprehend how one can be effective in preventing recurrence.\u003c/p\u003e \u003cp\u003eThese findings are similar to those from studies in Nepal (Adhikari \u0026amp; Dhakal, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) and Kenya (Onyango et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), where high awareness was accompanied by limited knowledge of etiological factors, risk determinants and preventive behaviors. Geerlings (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2008\u003c/span\u003e) similarly noted that lower education attainment is predictive of poor comprehension of UTIs.\u003c/p\u003e \u003cp\u003eIn this cohort, those with deficient knowledge also practiced maladaptive practices (such as inappropriate wiping, failing to adhere to medication and delaying health-seeking) that are consistent with theoretical models specifying that knowledge influences attitudes and actions. As such, knowledge deficiencies are a direct risk factor for recurrence.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eAttitudes About Recurrent UTIs\u003c/h2\u003e \u003cp\u003eThe study identified a dual attitude pattern. About half of the participants (47.2%) reported embarrassment relating to the presence of a UTI, and 41.0% felt shame relating to care seeking. Notwithstanding, majority (93.8%) respondents reported a plan to visit a doctor in case of symptoms and 97.9% said they were happy to communicate their symptoms openly.\u003c/p\u003e \u003cp\u003eEmbarrassment is a recognized psychosocial barrier, which delays the initiation of treatment (Minejima et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). However, the dominance of positive health seeking intentions found here is similar to those in Indonesia (Santoso et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) and the Philippines (Navarro et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), in which women showed high preparedness to prevent and manage UTIs despite knowledge gaps.\u003c/p\u003e \u003cp\u003eThus, stigma may delay, but does not completely inhibit, treatment; such delays may compromise bacterial clearance and increase risk of recurrence.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eRecurrent UTI Practices\u003c/h2\u003e \u003cdiv id=\"Sec24\" class=\"Section4\"\u003e \u003ch2\u003eHygiene Practices\u003c/h2\u003e \u003cp\u003eMore than half of respondents (51.4%) reported wiping from back to front, a well-documented risk factor for UTIs because of the possibility of the migration of perianal flora, especially Escherichia coli, into the urethra. These observations are in line with studies in the United States, Egypt and Uganda identifying improper wiping as a major contributor to UTI recurrence (Alos, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2005\u003c/span\u003e, Dimetry et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2007\u003c/span\u003e, Andabati and Byamugisha \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Anatomically, the proximity of the anus and urethra in females increases sensitivity when the use of non-optimal hygiene.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003ePractices for Sexual and Reproductive\u003c/h2\u003e \u003cp\u003eA large number of the participants (88.2%) were sexually active, with a proportion of these reporting multiple partners (which are strongly correlated with UTI recurrence in multiple studies; K \u003cem\u003eet al.\u003c/em\u003e, 1999; Foster, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2008\u003c/span\u003e. Comparable associations have been reported in Australia, Spain and North America, strengthening the concept of sexual activity as an important risk factor.\u003c/p\u003e \u003cp\u003eDelivery mode was also a strong predictor of recurrence: women who had given birth by vaginal delivery were more likely to have recurrent UTIs. Previous evidence indicates that obstetric trauma and pelvic floor alterations could be a predisposing factor for women developing incomplete bladder emptying, a known risk factor for infection (Franco, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2005\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003ePractices Relating to the Medical and Treatment\u003c/h2\u003e \u003cp\u003eNoncompliance with antimicrobial therapy was strikingly high (79.9%). Poor adherence promotes bacterial persistence and increases risk of recurrence which accords with the results of Canadian studies (Nicolle, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2005\u003c/span\u003e) and Kuwaiti studies involving diabetic women (Sewify et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough the number of participants with uncontrolled diabetes or hypertension was low, there was a strong correlation between these comorbidities and recurrence. This finding is consistent with reports from the Netherlands and Israel suggesting that suboptimum glycemic control negatively affects immune competence and favors bacterial growth (Gorter et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Nitzan et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSelf-medication, herbal usage and dependence on analgesics alone during UTI episodes were observed with few but it is a major contributor of inadequate therapy. Such behaviors reflect both knowledge deficits as well as access barriers and, eventually, increase the risk of recurrence.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003eIntegration to the Conceptual Framework\u003c/h2\u003e \u003cp\u003eThe results strongly endorse this conceptual framework, which states that knowledge, attitudes, and practices together affect the recurrence of UTIs. Knowledge gaps catalyze improper hygiene, non- adherence and delayed care. Attitudes (notably, embarrassment) modulate health seeking behaviors. Practices are the nearest determinants of recurrence in terms of direct biological effect on the risk of infection.\u003c/p\u003e \u003cp\u003eThe interaction between cognitive, behavioral and psychosocial factors is therefore indicative that recurrent UTIs in this population are the result of a multifactorial process that correlates with international research suggesting that recurrence is influenced by lifestyle, hygiene, sexual behavior, comorbidities and psychological factors.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eStudy Limitations\u003c/h2\u003e \u003cp\u003eA number of limitations should be acknowledged. First of all, the self-reported history of UTI may cause recall bias. Second, the cross-sectional design does not allow a definite causally effect, as exposures and outcomes were measured at the same time. Third, the study was carried out at one health facility, and this may affect generalizability to the other Ugandan contexts. Lastly, the data on comorbidities were based on participant self-reporting rather than clinical verification which may underestimate the prevalence of metabolic or chronic conditions.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study identified a high burden of recurrent urinary tract infections among females of reproductive age attending Kisugu Health Centre III, with more than one-third reporting three or more episodes annually. Upon conducting this investigation, I found a high burden of recurrent urinary tract infections among women of reproductive age attending Kisugu Health Centre III with more than one-third reporting 3 or more episodes a year. Such a prevalence implies a multifactorial interaction of behavioral, cognitive and clinical determinants that together increase susceptibility to repeated infections.\u003c/p\u003e \u003cp\u003eThe data indicate that the knowledge, attitudes and practices have a strong impact on the recurrence of UTI. Although general awareness of recurrence of UTI was high, some significant gaps were noted in a deeper understanding of causative factors, risk profiles and preventive measures. These gaps were found to be highly correlated with recurrence and manifested in inappropriate behaviors such as improper wiping techniques, non-adherence to prescribed regimens and self-medication. Attitudinal barriers, specifically embarrassment, further delayed seeking care, or resulted in less-than-optimal management.\u003c/p\u003e \u003cp\u003eClinical factors such as uncontrolled diabetes, hypertension, and history of vaginal delivery significantly contributed to the risk of recurrence, adding to the known information about metabolic and obstetric factors. Sexual activity, especially among participants with multiple partners, was a factor that contributed to high risk, suggesting patterns seen in epidemiological studies that have been done in other situations.\u003c/p\u003e \u003cp\u003eOverall, the study helps to confirm that in this population, recurrent UTIs are caused by a combination of knowledge deficit, behavior practices, psychosocial factors, and underlying health conditions. These findings highlight the need for formal health education, improved counselling at the facility level and the need for specific interventions around modifiable risk factors. A holistic approach to these determinants offers potential for reduction in the recurrence rate and quality of life of women in this community.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAMR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAntimicrobial Resistance\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAST\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAntimicrobial Susceptibility Testing\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCTX\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCotrimoxazole\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCDC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCentre for Disease Control\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCA-UTI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCommunity Acquired Urinary Tract Infections\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eE. coli\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEscherichia coli\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eESBL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eExtended spectrum Beta Lactamase\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHA-UTI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHospital Acquired Urinary Tract Infection\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMHA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMuller Hinton Agar\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMIC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMinimum Inhibitory Concentration\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eS. Aureus\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStaphylococcus aureus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUTI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUrinary tract infections\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eXDR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eExtensively Drug-resistant\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e This study was carried out in accordance with the Declaration of Helsinki and all pertinent ethical guidelines for conducting research involving human participants. Ethic approval was secured from the Clarke International University Research Ethics Committee (CIU-REC): Reference No. CLARKE-2021-21. Written informed consent was obtained from all the participants before data collection.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable. The manuscript does not contain any individual person's data in any form.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study did not receive any specific funding from public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eKavuma Sharif: conceived the study, designed the proposal including questionnaire, data collection, performed data analysis, collected data and drafted the manuscript, contributed to literature review and interpretation of results and manuscript finalizations.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003e The author would like to acknowledge Clarke International University (CIU) for providing ethical approval and support for this study. Also, thanks to the supervisor, Mrs. Nakayi Marthae, for their guidance and mentorship throughout the study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated during the current study are available from the corresponding author on reasonable request. **Mail:** [email protected]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAdhikari S, Dhakal R. Knowledge on Urinary Tract Infection among Primigravida Women. 2015.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlos JI. [Epidemiology and etiology of urinary tract infections in the community. Antimicrobial susceptibility of the main pathogens and clinical significance of resistance]. 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Iran Red Crescent Med J. 2016;18(6):e26610. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5812/ircmj.26610\u003c/span\u003e\u003cspan address=\"10.5812/ircmj.26610\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Recurrent urinary tract infections, UTIs, reproductive-age women, risk factors, knowledge, attitudes, practices, Kisugu Health Centre III, Uganda","lastPublishedDoi":"10.21203/rs.3.rs-8553864/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8553864/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eRecurrent urinary tract infections (UTIs) remain a significant public health concern among women of reproductive age in Uganda. This study assessed factors associated with recurrent UTIs among females aged 15\u0026ndash;49 years attending Kisugu Health Centre III, Kampala.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional study conducted on 144 randomly selected samples with the help of an interviewer-administered questionnaire to assess knowledge, attitudes and practices of recurrent UTI. The analysis of data was done in SPSS version 21. For the association, chi-square was applied at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Overall, 36.8% of participants reported recurrent UTIs.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eMost respondents acknowledged that UTIs can recur, indicating general awareness. However, only 53.5% demonstrated good overall knowledge, which was significantly associated with recurrence (p\u0026thinsp;=\u0026thinsp;0.049). Identified risk factors included improper perineal wiping techniques, high frequency of sexual intercourse, poor medication adherence, and co-existing medical conditions such as diabetes. Although many participants sought healthcare, several reported barriers to receiving timely support, primarily due to embarrassment.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eRecurrent UTIs among women in this setting are influenced by behavioral and clinical factors. Strengthening preventive strategies, improving counselling, and delivering targeted health education may help reduce recurrence and improve health-seeking practices.\u003c/p\u003e","manuscriptTitle":"Factors Associated With Recurrent Urinary Tract Infections Among Females of Reproductive Age at Kisugu Health Centre Iii, Uganda: A Cross-sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-13 10:45:25","doi":"10.21203/rs.3.rs-8553864/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"19391943-f123-480f-9e50-4b5fbbc53864","owner":[],"postedDate":"January 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-21T17:24:24+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-13 10:45:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8553864","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8553864","identity":"rs-8553864","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}