Urinary tract infections (UTIs) are one of the most common bacterial infections in pregnant women, with significant implications for maternal and fetal health. The effective management of these infections relies heavily on the skills of healthcare professionals, particularly nurses, who play a key role in the screening, treatment, and prevention of associated complications. These skills are influenced by various contextual, structural, and individual factors that vary across the world [1] .

In developed countries such as the United States and Europe, nursing management is influenced by factors such as accessibility to care, the cultural diversity of patients, and social inequalities [2] . Nurses often face language or cultural barriers that can hinder communication with patients, and therefore the effectiveness of care (Hooton & Gupta, 2020) [3] . Quality of care also depends on institutional support, the availability of clinical guidelines, and collaboration with other healthcare professionals. In developing countries such as Mali and Cameroon, nursing skills are often limited by insufficient specialized training, a lack of diagnostic equipment, and weak supervision systems [4] [5] . Folefack Tsafack et al. (2016) highlighted that the lack of clear protocols and continuing education constitutes a major obstacle to effective care. Furthermore, therapeutic decisions are often hampered by antibiotic resistance and the lack of suitable drugs (Cissé, 2021) [6] .

This research is motivated by the desire to understand the factors associated with the management of urinary tract infections during pregnancy in order to strengthen nursing skills, improve clinical practices, and reduce complications related to urinary tract infections during pregnancy. By identifying training gaps, organizational barriers, and resource needs, this study will contribute to the development of concrete recommendations to improve the quality of maternal care at the local level. Furthermore, this research aims to leverage the role of nursing and improve health outcomes for pregnant women by aligning practices with international standards for the management of urinary tract infections [7] [8] .

Globally, the management of UTIs in pregnancy highlights the importance of adequate nurse training, the availability of medical resources, and adherence to care protocols. According to Hooton and Gupta (2020) [9] , continuing education in obstetric and infectious disease care allows for better symptom detection, timely treatment administration, and a reduction in complications [10] . However, challenges remain, such as a lack of interdisciplinary coordination and nursing staff overload.

Urinary tract infection is a bacterial infection that affects the urinary tract, which can present as cystitis (bladder infection) or pyelonephritis (kidney infection). In pregnant women, it can lead to serious complications for both the mother and the fetus if not properly treated [11] . The epidemiology and pathophysiology of urinary tract infections (UTIs) during pregnancy highlight the importance of systematic screening and early management [12] . Identifying risk factors and common pathogens helps better guide treatment strategies and prevent maternal-fetal complications [13] . UTIs are the most common bacterial infections in pregnant women, with a prevalence ranging from 2% to 10% (Cissé, 2021). Hormonal and anatomical changes during pregnancy promote urinary stasis, increasing the risk of infection. Escherichia coli is the most commonly implicated organism, accounting for 70% to 95% of cases (Foxman, 2014) [14] [15] .

Urinary tract infections affect approximately 2% to 10% of pregnant women worldwide, with variations depending on region and socioeconomic conditions (Foxman, 2014) [16] . A study conducted in developing countries revealed a prevalence ranging from 16% to 43%, with high rates of antibiotic resistance (Cissé, 2021; Folefack Tsafack et al., 2016) [17] . In a study conducted in the United States, asymptomatic urinary tract infections were shown to occur in 2% to 7% of pregnancies, while symptomatic cystitis and pyelonephritis affected approximately 1% to 2% of pregnant women (Gupta et al., 2019) [18] .

During pregnancy, several factors contribute to an increased risk of UTIs. Anatomical and hormonal changes play a key role, including increased progesterone levels, which cause smooth muscle relaxation in the urinary tract, promoting urinary stasis that is conducive to bacterial proliferation (Delzell & Lefevre, 2000) [19] . Furthermore, the physiological immunosuppression specific to pregnancy impairs cellular immunity, reducing the body’s ability to eliminate bacterial infections (Kass, 1960) [20] . Finally, a history of UTIs also increases the susceptibility of pregnant women to developing new UTIs (Schaeffer & Nicolle, 2016) [21] .

Escherichia coli is the main causative agent of urinary tract infections during pregnancy, accounting for 70% - 95% of cases (Foxman, 2014), we can add other pathogens agents which conduct in UTIs, as well as: Staphylococcus saprophyticus, Klebsiella pneumoniae, Proteus mirabilis. However, the emergence of antibiotic resistance is a major concern, particularly in the face of bacteria resistant to beta-lactams and fluoroquinolones (Gupta et al., 2019) [22] [23] .

Untreated UTIs during pregnancy can lead to serious complications. Approximately 20% - 40% of pregnant women with asymptomatic UTIs develop acute pyelonephritis if left untreated, which can worsen the condition and pose additional health risks to both the mother and child (Gupta et al., 2019). Furthermore, these infections are associated with an increased risk of premature rupture of membranes and preterm delivery, which can have serious consequences for the infant’s health (Smaill & Vazquez, 2019) [24] . Finally, severe maternal infection can affect fetal growth, leading to intrauterine growth restriction, and increase the risk of neonatal mortality due to infection-related complications (Delzell & Lefevre, 2000). These risks underscore the importance of appropriate treatment to prevent serious complications of UTIs during pregnancy.

Drawing on Orem’s self-care theory, nurses can educate patients on essential preventive behaviors: adequate hydration, regular bladder emptying, and proper personal hygiene (Delzell & Lefevre, 2000) [25] . These educational interventions are crucial for preventing UTIs and reducing the risk of maternal-fetal complications. Using Leininger’s model of care, which emphasizes cultural sensitivity, nurses can adapt their discourse and practices to better reflect patients’ beliefs and habits, thereby increasing adherence to preventive measures (Leininger, 2002) [26] [27] .

Early detection of UTIs relies on the clinical vigilance of nurses who, using simple tools (urine dipsticks, laboratory tests), can quickly detect signs of infection (Schneeberger et al., 2014) [28] . Peplau’s theory of the caring relationship highlights the importance of therapeutic communication, allowing nurses to effectively collect symptoms reported by patients and direct them toward appropriate care. Nurses also follow patients throughout the antibiotic treatment, monitoring side effects, treatment tolerance, and performing follow-up tests to ensure the infection has cleared (Gaitanakis et al., 2018) [29] [30] . Jean Watson’s theory of caring emphasizes the importance of the human dimension of care, emphasizing the creation of an empathic bond that promotes the patient’s overall well-being.

This is a cross-sectional study with a descriptive and analytical aim which took place over a period of one month; October 2024 at the CVN and District Hospital of Kabezi. The inclusion criteria were to be a part time or fulltime nurse in those two institutions; while, to be not a nurse or to work without a diploma was a crucial exclusion criterion.

The sample size was defined using Yamane’s formula: n = N/1 + N(e)², where signification is; n: sample size, N: population size, e: 95% accuracy level (p = 0.05). We only performed bivariate and multivariate analysis to identify trends and relationships between variables using statistical methods to analyze quantitative data and employ thematic analysis for qualitative data, also identifying recurring themes.

A multiple logistic regression was performed by calculating the adjusted odds ratio of 95% confidence interval between dependent variable and the independent variables whose p-value was p < 0.20 in bivariate analysis. Only variables whose p < 0.05 at this level was considered significantly associated with the skills of nurses in the management of urinary tract infection during pregnancy in obstetrical service of VNC (Van Norman Clinic) and Kabezi DH. The discriminatory power of the final model will be tested to assess its reliability using the ROC curve.

For qualitative variables, the number and frequency (%) of the different modalities were calculated. Second, each independent variable is cross-referenced with the dependent variable using a bivariate analysis by simple logistic regression, with a risk of error α of 5% (p = 0.05), to analyze the relationship between the dependent variable and the different independent variables, calculating the crude odds ratio (ORB) with its 95% confidence interval. Variables with a p < 0.10 were considered significantly associated with “nursing skills in the management of urinary tract infections during pregnancy.” Stata data analysis software.

Findings of our research show that 48% of nurses in two health structures had a baccalaureate level of education; Nurses who had received training in maternal health were 62% of cases; 87% of cases did not receive training on urinary tract infections during pregnancy; 45% of nurses had 6 - 11 years of work experience in the two selected HCFs (VNC & Kabezi DH). Inadequate hygiene is the most cited cause of urinary tract infections during pregnancy (95%). The symptoms most recognized by nurses are burning during urination (88.33%). Urinalysis (96.67%) is clearly identified as a key diagnostic test. A history of urinary tract infections is a major risk factor (73.33%). Finally, poor hygiene habits (95%) and urinary retention (50%) are aggravating factors, while frequent sexual intercourse (55%) is also mentioned. The results also showed that 63.33% of nurses were familiar with the common causes of urinary tract infections during pregnancy in both health facilities. 63.33% of nurses received more useful training in the management of urinary tract infection.

Findings of our study show that a high number of nurses has been trained on urinary tract infections (53.33%), a big number of nurses was able to establish one treatment of that disease (63.33%); low number of nurses knew one to three practices (25%); only 25% of interviewed had a behavior of integration in management of urinary tract infections; a low number of nurses was able to describe one to three associated factors (11.67%); also among sixty interviewed, a significant number of nurses knew one exam to diagnosing urinary tract infections (41.67%); and among a tested number of nurses, some of them were able to tell one to four symptoms of urinary tract infections (13.33%); and then a small number of nurses has been able to describe one to three causes of that disease higher talked (3.33%). Those results showed that nurses in Health Care Facilities were not competent in knowledge and skills to combatting urinary tract infections fluently as it is presented in Figure 1 .

Bivariate analysis shows that professional experience and training significantly influence the level of nursing competence in the management of urinary tract infections during pregnancy. Nurses with more experience (p < 0.05) and those with a higher level of education, including a Masters degree (p = 0.026), show greater competence. Frequent use of standardized treatment protocols is also a key factor, with a progressive improvement in skills depending on the frequency of application (p < 0.05). On the other hand, participation in specific training on urinary tract infections does not show a significant association with the level of competence (p = 0.001). Finally, neither marital status nor the possession of educational resources seem to significantly influence nursing competence.

Table 1 shows that many interviewed (nurses) had an age range of 26 to 33 years, or 50% (p = 0.064); a big number of nurses was married, or 66.7% (p = 0.092); low number had masters’ degree, or 5% (only 3; or p = 0.026); only eight interviewed had an experience of over eleven years, or 13.3% (p = 0.002); a significant number had not participate in maternal health training, or 61.7% (p = 0.099); a low number of nurses accepted that it didn’t participate in specific training on urinary tract infections during pregnancy, or 86.7% (p = 0.032); however, a significant number of interviewed was able to identify potential complications of untreated urinary tract infections, 73.3% (p = 0.073); in addition, a big number of nurses had not tools or resources to assist and compains in patient education, 76.7% (p = 0.066); only two nurses implemented a standardized treatment protocol for urinary tract infections, 3.3% (p = 0.01); and then, a significant number nurses accessed to standardized treatment protocols for urinary tract infections, 61.7% (p = 0.008).

Multivariate analysis reveals that several factors significantly influence the level of competence of nurses in the management of urinary tract infections during pregnancy. Older nurses (34 - 41 years, p = 0.021) and those with a Masters degree (p = 0.026) show better competence. Professional experience of more than one year also significantly improves competence (p ≤ 0.010). Specific training (p = 0.000) and frequent application of standardized protocols (p ≤ 0.045) are positive predictors of high level of competence.

Bivariate analysis confirms the significant influence of professional experience and educational level (p = 0.026) on nursing skills, in agreement with Benner (1984) and Aiken et al. (2014), who highlight the impact of experience and advanced training on the quality of care. Frequent application of standardized treatment protocols also improves skills (p < 0.05), as demonstrated by Cabana et al. (1999). However, specific training on urinary tract infections does not show a significant association (p = 0.001), concurring with the findings of Forsetlund et al. (2009) on the importance of post-training follow-up. In addition, marital status and access to educational resources do not significantly influence skills, corroborating the results of McHugh and Lake (2010) [30] [31] .

Multivariate analysis revealed a significant association between educational attainment and nursing skill level, with a notable improvement among nurses with a master’s degree (p = 0.026). These results confirm the findings of Aiken et al. (2014), who demonstrated that nurses with an advanced university degree are better prepared to apply evidence-based best practices. Indeed, a study conducted by Tourangeau et al. (2007) in Canada showed that nurses with a university degree had better critical analysis skills and a higher rate of compliance with care protocols. Furthermore, research such as that of Blegen et al. (2013) has highlighted that educational attainment is correlated with better clinical outcomes, due to greater mastery of therapeutic protocols and better decision-making in complex clinical situations [32] .

The study highlights that regular application of standardized protocols significantly improves nursing competence (p ≤ 0.045). Nurses who apply these protocols “often” (p = 0.020) or “always” (p = 0.001) demonstrate significantly higher competence than those who rarely or never use them. This finding is consistent with the work of Cabana et al. (1999), who demonstrated that adherence to clinical guidelines reduces practice variability and improves the quality of care. In a study conducted in France by Vincent et al. (2018), it was observed that healthcare facilities that had implemented standardized treatment protocols for urinary tract infections in obstetrics had better clinical outcomes and a reduction in maternal-fetal complications. Reason why results highlight the importance of integrating protocols into nursing training and encouraging their systematic application [33] [34] .

Nurses are key players in maternal care, intervening at multiple levels to ensure the health of pregnant women. In the management of urinary tract infections (UTIs) during pregnancy, they play a critical role in prevention, early detection, and patient follow-up to avoid serious maternal-fetal complications (Schneeberger et al., 2014). This section explores these different roles in depth, drawing on recent research and evidence-based recommendations. Despite their central role, nurses may face challenges such as a lack of continuing education, limited access to diagnostic resources, or care protocols that are sometimes unsuitable for specific contexts (Gaitanakis et al., 2018). Strengthening skills through specialized training and integrating nurses into clinical decision-making appear to be essential levers for optimizing the management of UTIs during pregnancy.

Recommendations are addressed to the following stakeholders:

Ministry of Public Health and the Fight against AIDS: Strengthening continuing education; Integrating standardized protocols; Encouraging academic training; Supervision and evaluation.

Authorities in Northen District of Bujumbura and all Head of District Hospitals of Burundi: to enhance an organization of local training; a logistical and material support; training nurses in urinary tract infections and other phenomenon, Supervision and mentoring and Performance evaluation.

Authorities of HCFs (Health Care Facilities) from Burundi: Capacity building; Implementation of standardized protocols; Availability of resources; Staff motivation.

Nurses who worked in the obstetrics’ department: Self-training and updating of knowledge; Rigorous application of protocols; Collaboration and sharing of experience; Case monitoring and documentation.

This study provides the associated factors to urinary tract infections during pregnancy in two health district of Bujumbura province including CVN and Kabezi DH. It does not represent the entire Burundian population and could not be generalized. Moreover, this study was conducted in short term of two months (October to November 2024). Authors did not test the reliability and validity of the questionnaire.

The Ministry of Public Health and the Fight against AIDS for its facility to carry out research in public hospitals; The authorities of Hope Africa University, and the representation of HCFs for the technical and administrative support throughout our research, Nurses for their contribution and suggestions during participation towards our mission.