Awareness, Knowledge, and Attitude Towards Urinary Tract Infections: An Appraisal From Saudi Arabia

Introduction Urinary tract infections (UTIs) are a common global health issue, yet awareness and knowledge about UTIs among the general population can vary widely. This study aimed to assess the awareness, knowledge, and attitudes regarding UTIs among Saudi Arabian citizens residing in Al-Ahsa, Saudi Arabia. Methods A descriptive cross-sectional study was conducted among Saudi Arabian citizens aged 18 and above residing in Alhassa. A structured questionnaire was used to collect data on participants' awareness, knowledge, attitudes, and experiences related to UTIs. Data were analyzed using IBM® SPSS® Statistics. Results The study included 445 participants, predominantly males, with 279 (62.7%) and a range of educational backgrounds. Approximately 302 (70.1%) of the participants were aware of UTIs. However, misconceptions about the definition of UTI and its risk factors were common. Most participants recognized bacteria as the primary cause of UTIs, with 261 (58.7%) identifying this factor. Symptoms such as painful urination were recognized by 390 participants, which is a significant proportion. When experiencing UTI symptoms, 285 (66.1%) indicated they would go to the hospital. Significant associations were found between awareness, knowledge, and socio-demographic factors. Conclusion This study highlights the need for increased awareness and knowledge about UTIs among Saudi Arabian citizens in Alhassa. Tailored educational interventions are essential to correct misconceptions, promote accurate risk factor awareness, and encourage appropriate management strategies. Public health campaigns can contribute to reducing the burden of UTIs in the community.


Introduction
Urinary tract infections (UTIs) are a common health problem worldwide, affecting individuals of all ages and genders.They often result from the invasion and multiplication of pathogenic bacteria in the urinary system [1].UTIs can lead to significant morbidity and healthcare burden and, if left untreated, may progress to severe complications such as pyelonephritis and septicemia [2].In the United States, approximately 25% to 40% of women in the age group 20-40 have had a UTI.UTIs account for over six million patient visits to physicians annually in the United States [3].UTIs are a significant burden on the healthcare system in the Kingdom of Saudi Arabia (KSA).They account for 10% of all infections in the country and are the second most common reason for ED admissions [4][5].A study conducted in Malaysia revealed a moderate level of awareness and knowledge about UTIs among its participants [6].Similarly, another study in Saudi Arabia focusing on parents also reported a moderate level of UTI knowledge [7].Additionally, a study among pregnant women in Saudi Arabia found that 66% were aware and knowledgeable about UTIs [8].Assessing the knowledge, awareness, and attitudes toward UTIs in the general population is crucial for developing effective prevention strategies and ensuring early detection and prompt treatment.In our study, we aim to investigate these factors regarding UTIs among Saudi Arabian citizens residing in Al-Ahsa.

Study design
A descriptive cross-sectional study was conducted to assess the level of knowledge, awareness, and attitudes toward UTIs among Saudi Arabian citizens residing in Al-Ahsa, a city located in the Eastern Province of Saudi Arabia.

Inclusion and exclusion criteria
Inclusion criteria were as follows: Saudi Arabian citizens residing in Alhassa, a city in the Eastern Province of Saudi Arabia, aged 18 years or older, and willing to provide informed consent.Exclusion criteria included individuals who were unable or unwilling to provide informed consent, non-Saudi Arabian citizens or those not residing in Al-Ahsa, and individuals with cognitive impairments or language barriers that could hinder their ability to accurately complete the surveys or questionnaires.

Data collection methods and tools
The data for this study was collected through questionnaires administered to the participants.The questionnaires were designed specifically for this study to assess the level of knowledge, awareness, and attitudes toward UTIs among the target population.The questions were developed based on current literature, guidelines, and expert opinions in the field.The questionnaires were distributed in electronic formats via social media platforms.The questionnaire was divided into three sections: The first section included informed consent, followed by the second section, which included questions regarding sociodemographic factors such as age, gender, education level, occupation, and income.The third section asked about knowledge, awareness, and attitudes regarding UTIs.

Data analysis
The data collected from the questionnaires were analyzed and stored using IBM® SPSS® Statistics, a powerful statistical software platform.

Research ethics approval
The research proposal was submitted to the King Faisal University committee for approval with code number KFU-REC-2022-SEP-ETHICS1,322.The study was conducted in accordance with applicable national and international ethical guidelines and regulations.It was essential to uphold these ethical considerations to ensure the well-being, autonomy, and confidentiality of the study participants, as well as the integrity and credibility of the research findings.

Results
The study involved 445 participants.Among them, the majority, 279 (62.7%), were male, while 166 (37.3%) were female.Results showed that a higher percentage of males, 206 (74%), were aware of UTIs compared to females, 106 (64%), and this difference was statistically significant (p-value = 0.026).Among healthcare workers, 63 (90%) were knowledgeable about UTIs, which was significantly higher than the awareness level among nonhealthcare workers, 249 (66%), with a p-value of less than 0.001.However, no significant associations were observed between UTI awareness and marital status, education level, residence, or monthly income (Table 5).Findings revealed that among the participants, 8 (80%) with primary education, 11 (100%) with intermediate education, 79 (89%) with high school education, 133 (70%) with university education, and 90 (75%) with postgraduate education believed that UTIs are a serious condition.This association was found to be statistically significant, with a p-value of less than 0.001.However, no significant associations were observed between the perception of UTIs as a serious condition and factors such as gender, marital status, residence, occupation, or monthly income (Table 6).Results indicated that the percentage of males, 131 (47%), who had experienced UTIs was higher than that of females, 56 (34%), and this difference was statistically significant (p-value = 0.006).The highest percentage of individuals reporting UTI experiences were widowed, 3 (60%), followed by married, 123 (54%), divorced, 3 (50%), and single individuals, 58 (28%).This association also showed statistical significance (pvalue < 0.001).In terms of education levels, the highest percentage of individuals who had experienced a UTI had intermediate education, 10 (83%), followed by those with primary and high school education, 50 (50%), university education, 77 (39%), and postgraduate education, 45 (35%).This association was statistically significant, with a p-value of 0.006.Non-healthcare workers, 167 (45%), were more likely to have experienced a UTI compared to healthcare workers, 20 (29%), and this difference was statistically significant (p-value = 0.013).However, no significant association was found between individuals who had ever experienced a UTI and their residence or monthly income (Table 7).

Discussion
UTIs are a significant global health concern [1].Our study aimed to assess the awareness, knowledge, and attitudes regarding UTIs among Saudi Arabian citizens residing in Al-Ahsa.The results reveal several significant findings and implications.Our study found that most participants displayed a reasonable level of knowledge regarding UTIs.Specifically, more than two-thirds of participants correctly identified what a UTI is, and when defining UTIs, half of them associated them with inflammation of both the urethra and bladder.Almost two-thirds of participants recognized bacteria as the leading cause of UTIs.Common UTI symptoms reported included "painful urination," "urgency," and "red urine."Factors contributing to increased UTI risk included behaviors like "delaying urination," "drinking a small amount of water," and "neglecting perineum hygiene."Additionally, almost two-thirds believed that seeking hospital care was the best response to UTIs, contrasted with prior research.Furthermore, a notable proportion considered UTIs to be common, and most participants acknowledged the seriousness of UTIs.The most expected complications were "recurrent UTIs" and "affecting the quality of life." We found that most participants demonstrated a reasonable level of knowledge regarding UTIs.Specifically, more than two-thirds correctly identified what a UTI is, aligning with previous studies conducted by Al-Mutairi NZ and Amara FM in 2015 in the Hail region, Saudi Arabia, and Badran YA et al. in 2016 among Saudi women [9,10].
When defining UTIs, almost half of the participants associated UTIs with inflammation of both the urethra and bladder.This differs from the findings of Badran YA et al. [10], where only around a third of participants provided the same response.These variations may be attributed to differences in cultural and educational backgrounds, as well as sample size and demographics.
In terms of the most common cause of UTIs, almost two-thirds of participants identified bacteria, consistent