Intervenção educacional para prevenção de infecções urinárias em mulheres em privação de liberdade: ensaio clínico randomizado

Abstract

Introduction: Urinary tract infections (UTIs) are characterized by the presence and multiplication of microorganisms in the urinary tract, which can lead to tissue invasion in structures such as the bladder and kidneys, starting from the distal end of the urethra. Women are biologically more susceptible to this type of infection due to anatomical and physiological factors, such as a shorter urethra and its proximity to the perineal region, facilitating bacterial ascent. This vulnerability is even more pronounced in women deprived of liberty, who often face inadequate hygiene conditions, limited access to basic supplies, restricted water consumption, and prison overcrowding, factors that favor the development and recurrence of UTIs. This study seeks to fill the gap in the literature on the prevention of urinary tract infections in the prison system, since, as identified in a systematic review and scoping review, clinical trials and systematic reviews specifically targeting this population are still scarce. Objective: To evaluate the effectiveness of an educational intervention on urinary tract infection prevention on the knowledge, attitudes, and practices of women deprived of liberty. Methodology: This is a randomized controlled trial (RCT) conducted in women's prisons in the state of Ceará, from July to November 2022. Two randomized groups (CG and IG) were organized. The sample consisted of 387 women deprived of liberty. The IG underwent an educational intervention conducted in an expository and dialogical format, using audiovisual resources, including a PowerPoint slide presentation and an educational video. Meanwhile, the CG continued to receive conventional healthcare. Both groups were administered the General Social and Health Status Assessment Questionnaire and the Knowledge, Attitudes, and Practices Survey (KAP Survey) on urinary tract infection prevention. Data were compared using Pearson's chi-squared, Fisher's exact, or Mann-Whitney U tests, with a 5% significance level and 95% confidence interval. The study was approved by the Research Ethics Committee under CAAE 57107722.6.0000.5054 and registered in the Brazilian Clinical Trials Registry database with the primary identifier RBR-9ndj8xs. Results: The final sample consisted of 387 women, 208 (53.75%) in the Control Group (CG) and 179 (46.25%) in the Intervention Group (IG). The majority (219; 56.6%) were between 32 and 34 years old, lived in inland cities of Ceará, and self-identified as brown (303; 78.3%). The median education level was eight years in the CG and nine years in the IG. The majority were cisgender (372; 96.1%), heterosexual (248; 64.1%), single (257; 66.4%), and with children (319; 82.9%), with a predominance of Catholic religion (340; 87.9%). Regarding housing, 184 (47.5%) owned their own home and 179 (46.3%) rented a residence. After the intervention, an increase in the KAP level of women regarding the adoption of healthy hygiene habits to prevent urinary tract infections was identified in both groups. However, the level of knowledge and practice showed a more significant increase in the intervention group. There was a significant association with being "single" being a risk factor for developing an inadequate practice, "having participated in intimate hygiene guidance," "having a health professional as a source of guidance on intimate hygiene," and "shared faucet or water tank" were the factors that showed an increase in the level of adequate knowledge. Infrastructure and personal hygiene data were identified: the variable "availability of water for hand hygiene" increases by 3 (CI: 1.56 - 5.79) < p 0.001 the likelihood of an inmate having an appropriate attitude. Another variable, "sufficient water for hand hygiene," increases by 2.74 (CI: 1.4 - 5.34) the likelihood of inmates having an appropriate attitude. Conclusion: The intragroup analysis demonstrated that the educational intervention significantly increased knowledge about urinary tract infections and preventive practices in the intervention group, while the control group showed little variation, with continued inappropriate behaviors. The results suggest that the educational intervention is effective in promoting behavioral changes and preventing urinary tract infections among women deprived of liberty.