Predictors of Urinary Tract Infection and Their Diagnostic Performances among Cameroonian Under-five

Abstract

Objective: Urinary tract infection (UTIs) in child is a serious public health problem especially in developing countries. This study aimed at identifying factors associated with urinary tract infection and determining their diagnosis performances as well as resulting algorithms among Cameroonian under-five. Methods: A descriptive and analytical cross sectional study took place from May 2013 to March 2014 at Pediatrics Department of the Bonassama District hospital in the town of Douala. Urine samples were collected dependent on the age of children and its aptitude to micturate. Ten microliters (10 µL) of urine specimen were cultured at 37°C for 24-48 hours. In addition, sociodemographic, anthropometric, clinic and biological information of each child were documented. Results: The prevalence of UTI was 32.2% (129/400) which was mainly caused by Escherichia coli (41.1%). A total of four risk factors for UTI were found after adjustment for all pertinent characteristics of children. These included female gender (ARR= 0.55; p= 0.0046), presence of fever (ARR = 1.83; p= 0.0426), trouble urine (ARR = 1.36; p= 0.0063) and presence of nitrites in urine (ARR = 1.09; p= 0.0001). Presence of nitrites was the most discriminant parameter based on specificity (98.1%), positive predictive value (95.4%) and negative predictive value (90.1%). The diagnosis performances have gradually improved with the increasing number of parameters. Conclusion: This study reported four factors associated with increased risk for UTI. This also outlined that the presence of nitrites in urine had best diagnosis performances and different predictors-based clinical algorithms could be helpful especially in the identification of UTI-negative children.

Predictors of Urinary Tract Infections in Children and Antibiotic Susceptibility Pattern in the Buea Health District, South West Region, Cameroon

“…Contrary to the report from Douala [ 8 ] and elsewhere [ 21 , 28 ] in which females were more at risk than males, our study observed a higher prevalence in males than in females though the difference was not significant. Poor hygiene generally observed with male children must have accounted for this observation.…”

“…Therefore, 24 out of 200 test cases (12%) had UTIs by microscopy, giving a UTI prevalence of 12%. Our prevalence is higher than 11% recently reported in children under 5 in Nigeria [ 21 ] but lower than 32.2% reported in a recent study of children under 5 in Douala, Cameroon [ 8 ], and 65.9% reported in Buea [ 17 ]. Though the prevalence of UTI in our study is relatively low, it is still a cause for concern given that if not promptly diagnosed and adequately treated, it could result in chronic ill health and long-term renal damage.…”

“…Parasitic diseases such as schistosomiasis and trichomoniasis give rise to renal and lower urinary tract diseases [ 7 ]. Most UTIs in children are monomicrobic, with E. coli being the most frequently isolated pathogen [ 8 , 9 ]. Other members of the Enterobacteriaceae as well as Pseudomonas aeruginosa and species of Staphylococcus have also been isolated from UTI cases.…”

“…Several risk factors including age, gender, fever, constipation, uncircumcision, lack of toilet training, bladder instability, infrequent voiding of urine, previous antibiotic use, vesicoureteral reflux, and presence of nitrates in urine have been associated with UTIs in the pediatric population [ 8 , 12 – 14 ]. In addition to these factors, studies in developing countries have also reported poor hygiene, thread worm infections, and immunocompromised state as other risk factors [ 15 ].…”

“…Very few studies in Cameroon have addressed UTI in the pediatric population. Motse et al [ 8 ] identified factors associated with UTI and their diagnostic performances in children under 5 in Douala, Cameroon. Akoachere et al [ 17 ] investigated the etiologic profile and antibiotic susceptibility of community-acquired UTI in participants of all groups.…”