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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Urinary Tract Infection- Knowledge and Habitual Practices among Adolescent Girls Residing in College Hostel of Mangaluru, India: A Cross-sectional Study
Correspondence Address :
Dr. Sonia Karen Liz Sequera,
Associate Professor, Department of Community Health Nursing, Father Muller College of Nursing, FMCI, Kankanady, Mangalore-575002, Karnataka, India.
E-mail: soniakaren@fathermuller.in
Introduction: Urinary Tract Infection (UTI) is a common infection among female adolescents, causing significant distress in the hospital or community settings. Most of the issues related to UTI could be prevented by adequate knowledge and safe habitual practices. Within the context of reproductive health services, nurses or nursing students being healthcare providers are typically expected to have knowledge on the causes of UTI, methods of preventing and managing such conditions and teaching the same to young girls and women. Education provided to women, particularly adolescents, by nurses and by trainers who have relevant experience and knowledge may ensure proper hygiene practices.
Aim: To determine the level of knowledge, expressed habitual practice among 82 adolescent girls of a selected nursing college hostel.
Materials and Methods: This was a descriptive cross-sectional study conducted between June 2019 and December 2019. Tools included structured questionnaire on knowledge of UTI and a rating scale on expressed habitual practice on UTI prevention. All the 82 students of 1st BSc Nursing from the study institute were recruited. Adolescent girls who have undergone training on prevention of UTI in nursing curriculum and who had congenital defects of urinary system were excluded from the study.
Results: The mean age of the subjects was 18.69±0.46 years. Total 13.4% experienced UTI in their life time. In terms of overall knowledge score, out of 82 subjects, around 40.2% had average (scoring between 8-10 out of 14) and few (28%) had good knowledge (≥11) on UTI prevention. In terms of overall expressed habitual practice, majority (53.7%) had average practice (score between 26-33 out of 46) whereas, 4.9% had unsafe practice (score ≤25). The Karl Pearson correlation coefficient was 0.1 and showed weak positive correlation between knowledge and expressed habitual practice. Association was found between experience of UTI p-value<0.001 and expressed habitual practice.
Conclusion: Pooled results showed overall knowledge and expressed habitual practice was average and safe. Healthcare professionals, especially primary care givers such as nurses and nursing students, have the responsibility to broadcast proper information about UTI so that women/adolescents can identify the causes, risk factors, symptoms of UTI in early stages thereby preventing the mortality and morbidity related to UTI.
Healthcare professionals, Morbidity, Nursing students
The UTI is a common infection that can upset any part of the urinary system (1). This causes distress in the hospital or community settings that result in high healthcare and financial cost (2),(3). UTI has been the major cause of morbidity and mortality among Indian population (4).
Urinary Tract Infection (UTI) most commonly occurs in adolescent age group (5). Lower UTIs are considered as the most common adolescent girl’s infection. Atleast one episode of UTI occurs in nearly 5-6% of girls during their entry from high schools to graduation. Compared to boys, the recurrence rate is 50% greater in girls (4). The vagina and anus are positioned close to the urinary opening which makes females more prone for the development of UTI (6). Due to UTI, every year nearly 6-7 million young women visit physicians and therefore it is a major concern for the parents and healthcare providers (1),(4). Any delay in the treatment leads to permanent kidney damage, bacterial endocarditis and infertility (4),(7).
Among adolescent girls, poor hygiene and dysfunctional voiding pattern increases the risk for UTI. Silent UTI may occur among adolescent girls due to inadequate intake of water and infrequent passage of urine. The possible link between the prevalence of UTI among students residing in the hostel includes the use of western toilets, unhygienic mass toilets; improper menstrual hygiene and toileting habits (7). A study also reveal that nursing students confessed an indiscriminate consumption of antibiotics whenever they fell sick or difficulty while micturition is noticed (8).
Early identification of the disease by proper diagnostic measures and management will help to prevent the complications of UTI. Proper preventive measures like maintenance of good hygienic measures during menstruation, intake of more amount of water etc., also will help to reduce the incidence of UTIs (5).
The investigators have come across many nursing students residing in hostel and suffering from recurrent UTI. Another reason to conduct study among nursing students is that, they would be the primary care givers who can undertake the role of health educator through proper approaches in identifying and resolving issues, particularly in a country like India, where these problems are considered strictly private. So, understanding their own issues being an adolescent girl will further motivate them in using adequate knowledge and skills for themselves and also in identifying various symptoms, which may assist in preventing urinary infections, as well as in ensuring that the women comply with the recommended hygienic practices. Education provided to women, particularly adolescents, by nurses and by trainers who have relevant experience and knowledge may ensure proper hygiene practices (9).
Hence the above mentioned factors motivated the investigator to undertake this study. The primary aim of this study was to assess the knowledge and expressed habitual practices among adolescent girls towards prevention of UTI.
A cross-sectional descriptive survey approach was employed to study 82 adolescent girls’ knowledge and expressed habitual practice towards the prevention of UTI. Ethical clearance was obtained from Institutional Review Committee (IRC/FMCON/2018/FAC-28) and Father Muller Institutional Ethics Committee (FMIEC/CCM/44/2019). The study has been registered under CTRI-Ref/2019/06/026318. Permission for data collection was obtained from the principal of Nursing College and the chief warden of the hostel. Written informed consent was obtained from all the subjects.
The investigator conducted pilot study from 15th June 2019 to 30th June 2019, among eight adolescent girls of 1st year diploma in General Nursing and Midwifery (GNM) residing in the nursing hostel located in Mangaluru, Dakshina Kannada District, Karnataka, India and the main study was conducted from 1st November 2019 to 30th December 2019, as per the duration assigned for data collection.
Inclusion criteria: The nursing students of 1st year BSc nursing residing in the selected hostel of a nursing college were chosen for the study (2018 batch-entry level). Sampling technique and size was not applicable, as all the students of 1st BSc Nursing were recruited.
Exclusion criteria: Adolescent girls who had undergone training on prevention of UTI in the nursing curriculum and who had congenital defects of urinary system were excluded. Therefore, the students who just entered into the profession (freshers) were recruited for the study and no students met the exclusion criteria.
Data Collection
The tool was developed after an intensive review of literature, consultation and discussion with experts (9),(10). A blue print was prepared, which showed the distribution of items according to the content areas. Tools of data collection consisted of baseline proforma, structured knowledge questionnaire covering two domains- basics of UTI comprising questions from 1-7 and preventive aspects towards UTI from questions 8 to 14. Total knowledge questionnaire comprised of 14 multiple choice questions. The maximum possible score was 14. The scores ≥11 (80%) was considered as good knowledge, scores between 8 to 10 (61-79%) as average and scores ≤8 (60%) was considered as poor knowledge. The mean percentage knowledge score ≥80% would be considered as good knowledge level and the mean percentage knowledge score ≤60 would be considered as poor knowledge (for all domains and overall knowledge score).
To assess the expressed habitual practice, a three-point rating scale (with score 0, 1 and 2) was used which covered two domains- the hygienic practices from question 1-14 and fluid and dietary habits from questions 15-21. The maximum score was 42. The scores ≥34 (74%) was considered as safe practice, scores between 26-33 (55-73%) was average and scores ≤25 (54%) was considered as unsafe practice. The mean percentage practice score ≥80% would be considered as safe practice level and the mean percentage practice score ≤60 would be considered as unsafe practice (for all domains and overall practice score).
All the tools of data collection were validated by experts from the field of medicine and nursing and the Content Validity Index (CVI) and Scale Content Validity (SVI) was calculated. To find the reliability of the tool, the Stability (intra class correlation coefficient) and internal consistency (Cronbach’s alpha) was used. The stability (intra class correlation coefficient) of the knowledge questionnaire was 0.963 and internal consistency (Cronbach’s alpha) was 0.762. For the rating scale on expressed habitual practice, the stability (intra class correlation coefficient) of the tool was 0.995 and the internal consistency (Cronbach’s alpha) was 0.809. Self-reported technique was used for data collection.
Statistical Analysis
The data was analysed using Statistical Package for Social Sciences (SPSS) version 16.0. Descriptive statistics such as frequency, percentage, mean and standard deviation was used. For inferential statistics, Karl Pearson correlation test and Chi-square test was used to find the association with selected demographic variables.
The mean age and SD of the subjects was 18.69±0.46 years. Out of 82 subjects, a few 16 (13.4%) have experienced UTI at least once in their life time. Less than half had received information about UTI from friends/relatives 56 (46.3%) and health personnel 52 (42.7%). None had the history of any other illness.
In terms of knowledge about prevention of UTI, results showed that, majority of the subjects had average knowledge on prevention of UTI {33 (40.2%)}, whereas a few had good knowledge {23 (28%)}.
(Table/Fig 1) shows the areawise mean, standard deviation and mean percentage of knowledge on prevention of UTI. The mean knowledge score was higher in the domain of knowledge on basics of UTI (66.71%) than in the domain of knowledge on preventive aspects of UTI (62.85%). The overall mean knowledge score was considered average (64.78%). (Table/Fig 2) shows knowledge towards UTI prevention related questions with frequency and percentage.
In terms of expressed habitual practice, results also showed that, less than half of the subjects had safe practices {34 (41.5%)} whereas majority {44 (53.7%)} had average practice towards prevention of UTI.
(Table/Fig 3) shows the mean, standard deviation and mean percentage of expressed habitual practice. The mean percentage of the practice score was highest in the domain of hygienic practice (73.12%) whereas, in the domain of fluid and dietary habits the mean percentage score was 63%. The overall mean percentage of the practice score was 70.10% indicating average practice.
(Table/Fig 4) shows expressed habitual practice related questions towards UTI prevention in frequency and percentage and the (Table/Fig 5), (Table/Fig 6) show distribution of subjects according to the level of knowledge and practice score.
Furthermore, result showed, there was a weak positive relationship between knowledge and expressed habitual practice as depicted by the Karl Pearson correlation coefficient (r=0.1). The computed p-value was 0.37 (>0.05).
The p-value computed between experience of UTI and expressed habitual practice (<0.001) was <0.05. This shows that expressed habitual practice had a significant association with experience of UTI among adolescents.
The present study throws light on the knowledge of adolescent girls towards UTI prevention and the application of this knowledge in their habitual practices. Adolescent girls (17-18 years) were chosen for the study as UTI is more prevalent in adolescent girls and young females, than in male population. In India, the National Family Health Survey (NFHS) 2000 reported the prevalence of UTI among adolescent girls (10-19 years) as 16.6% and the risk of bacteraemia developing in adolescent girls as 5-10% (6).
In the present study, majority of the respondents age was of 19 years {57 (69.5%)} and very few {11 (13.4%)} experienced UTI in their life time. Out of 11, {1 (9.1%)} experienced UTI more than 3 times, {6 (54.5%)} have experienced 2-3 times UTI and {4 (36.4%)} experienced UTI only once. A similar study was conducted at the medical university of Jos (Nigeria) among the 185 female students residing in the hostel, and the results revealed that majority of the students were between 18-22 years (62.5%) and most (62.5%) of the respondents have never experienced UTI, 34.9% experienced it at some point while 1.3% had no response (10).
In this present study, in terms of knowledge on prevention of UTI, results showed that, majority of the subjects had average knowledge 33 (40.2%), whereas a few had good knowledge 23 (28%). The results were congruent to the similar study conducted among nursing students at Sri Guru Ram Das Institute (SGRD) Nursing hostel, Vallah, Amritsar, revealed that 83.3% have moderate knowledge, 9.3% of students have inadequate knowledge and 7.7% of students have adequate knowledge (3).
In the present study, 74 (90%) respondents knew that holding urine for long time causes UTI, 44 (54%) responded that regular intake of water leads to flushing of bacteria from the urinary tract through voiding. This results were similar to the study conducted at medical Jos University among 185 female students, where {108 (71.1%)} responded that emptying the bladder frequently helps to prevents UTI (10).
In terms on preventive practices of UTI, the present study showed majority of the students maintained an average level of practice. This study also showed that 49 (60%) adolescents passed urine at least six times in 24 hours and majority (70%) drank minimum seven glass of water per/day. The findings of this study are congruent to the study conducted in the University of Jos which also showed that 52.6% students drink plenty of water and 53.3% empty their bladder when full (10). The above results show that nursing students follow healthy and safe practices which aids in the prevention of UTI.
In this study, 79(96%) students expressed that they take bath as well as change their undergarments every day, majority (71%) dried undergarments under sunlight after washing, 76% changed pads during menstruation every four hours and 72% used sanitary napkins instead of cloths during menstruation. A similar study was conducted among unmarried nursing students of a medical college hospital of northern India, to find the role of behavioural risk factors in symptoms related to UTI, showed that 54.29% student changed the innerwear satisfactorily, 42.86% dried innerwear under sunlight and 42.86% took bath once a day; while 20% took bath on alternative day (11). Although the proportion of girls using cloth were quite low (8.47%), around 35 students out of 177, have experienced symptomatic UTI in the last three months (9). But in the present study only 11 (13.4%) had experienced UTI at least once in their life time. The studies above conclude that life style and behavioural modification play a vital role in the prevention of UTI.
The present study identified significant association between experiences of UTI with expressed habitual practice. A similar study in northern India also showed significant association between the menstrual absorbent and frequency of infections (9).
Nursing students being a part of healthcare team must be educated and self-motivated to follow the preventive techniques and this could also be instrumental in providing health promotional activities to their peer groups. Peer support and good relationship among adolescent groups are considered as factors contributing to a positive learning attitude.
Various studies prove that an effective strategy on prevention of UTI would help the adolescents to overcome this issue. Results of a quasi-experimental study conducted at Egypt to evaluate preventive programme on knowledge and habitual practices regarding prevention of UTI, conducted among 462 female adolescents, revealed a general pattern of improved knowledge and hygienic practices related to habit score level after programme implementation. Knowledge regarding menstrual hygiene shifted from 80.5% (unsatisfactory) to 100% after programme implementation. Hygienic practice regarding clean perennial area was shifted to 89% from 53.9%. There was reduction in health complaints after the implementation programme. Burning sensation during urination reduced from 50.6% to 6.1% (12).
This study yielded very useful information to initiate health intervention measures for the prevention and control of UTI among young nursing females. Based on the findings of this study, it is recommended that, there should be an awareness campaign, designing and implementation of educational programs to increase the awareness and susceptibility about chances of getting UTI.
The investigator of the study designed an educational programme Structured Counselling And Preventive Strategies (SCAPS) to sensitise the women of reproductive age group, towards the improvement of knowledge and prevention of UTI. The programme includes various components such as therapeutic counselling at the initial opening and throughout the process to build rapport and trust, open communication and mutual understanding - snake and ladder game as a motivational factor to change life style, educational video on UTI and its prevention to deliver the instructions effectively, case scenarios and discussion to learn with real life situation.
Healthcare professionals, especially nurses, have the obligation to disseminate proper information about UTI so that females become aware of the causes, risk factors, symptoms and prevention practices of this infection (10). Adolescents must be encouraged to inculcate health promotional behaviour, and student nurses have a responsibility to motivate their peer adolescent groups towards the prevention of UTI.
Limitation(s)
The findings need external validation, since it was limited to a small population. The data were not compared between the students who experienced UTI and those who did not. Study results could be influenced by the information girls obtained from various sources such as media, relative/friends or by a healthcare professional.
To conclude, though this study is not uncommon, it yielded enough and very useful information to initiate and develop health intervention measures for the prevention and control of UTI among young nursing adolescent girls. Although the students were aware regarding UTI and its prevention, appropriate training to maintain adequate hygienic practices, food and life style modification was the need highlighted from this study. Educational talks on UTIs and its risk factors should be held periodically amongst the nursing students to improve knowledge and improve their preventive practices towards UTI.
The authors would like to acknowledge the support of Father Muller Charitable Institutions, Mangaluru, Karnataka, India. The Principal, Father Muller college of Nursing, teaching faculty, experts for their guidance and participants of the study for their whole-hearted participation.
10.7860/JCDR/2021/45707.15152
Date of Submission: Dec 12, 2020
Date of Peer Review: Mar 22, 2021
Date of Acceptance: May 27, 2021
Date of Publishing: Jul 01, 2021
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
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