A study of the prevalence and clinical features of urinary tract infection in children aged between 0-5 years admitted to A-Block paediatric wings of the University Teaching Hospital, Lusaka, Zambia

Abstract

Urinary tract infection (UTI) is a common paediatric problem that has not been seriously addressed in Zambia as evidenced by lack of documentation. UTI causes significant morbidity and mortality in the affected children and their families. UTI has subtle symptoms and signs that are easily overlooked and only a high index of suspicion will allow for a urine sample to be collected from a patient for analysis. Simple urine analysis and microscopic examination of fresh urine samples can give preliminary results which would be confirmed by the culture of a single organism with a colony count of more than lO/ml. Pathogens isolated from urine samples and their antibiotic sensitivity pattern differ from area to area. It is important to monitor the prevailing uropathogens and their antibiotic sensitivity pattern on a regular basis. Due to constraint on resources, the Paediatric wing in the University Teaching Hospital (UTH), does not allow for urine to be cultured routinely. The aims of this cross section study were: 1.To examine whether UTIs are commonly under diagnosed problem in this environment 2.To determine which sceening methods best predicts which urine samples should be sent for culture; 3.To identify the prevailing uropathogens and their antibiotic sensitivity pattern in this environment. From the study resuUs: 1.The prevalence of UTIs was found to be 33%. 2.The infants had a higher prevalence of UTIs as compared to the older children. 3.The prevalence in the females was higher than in the males. 4.Being underweight (as defined by Wellcome classification) per se was not associated with having a UTI. 5.The clinical feature most associated with UTI was fever and gastro-intestinal upsets. 6.The diagnosis commonly associated with UTI were pyrexia without focus of infection and pneumonia. 7.Presence of WBC and nitrites were good predictors of infection. 8.Commonest uropathogens isolated in urine were Klebsiella (35.5%) and E. coli (29.4%). 9.Most of the organisms isolated are still sensitive to nalidixic acid and nitrofurantoin. From the study findings, the young child with a fever or gastro-intestinal upsets, should be screened for a UTI with a simple urinalysis and microscopic examination of the urine sample. Those urine samples that have WBC, nitrites or pus cells of more than 1/HPF should be sent for culture. The recommended drugs for treatment of suspected UTI should be nalidixic acid and nitrofurantoin until the culture and sensitivity results are available, when the antibiotic can be changed appropriately. There should be regular studies to check on the prevailing pathogens and their antibiotic sensitivity pattern. Studies to show associated abnormalities of urinary tract in children with UTI should be carried out.A Paediatric Nephrology clinic should be set up with proper guidelines for further management of patients with proven UTI.