Authors: Antwi, Sampson¹; Bates, Imelda²; Baffoe-Bonnie, Ben¹; Critchley, Julia³

Source: Annals of Tropical Paediatrics: International Child Health, Volume 28, Number 2, June 2008 , pp. 117-122(6)

Publisher: Maney Publishing

Abstract:

Background: Febrile illnesses are common among children in Ghana and are often diagnosed as malaria, thus overlooking urinary tract infection (UTI) as a possible cause of fever.

Aims: To determine the prevalence of UTI among febrile children <5 years and to estimate the sensitivity, specificity and positive and negative predictive values of urine dipstick as a screening test.

Methods: From March to July 2004, children aged 3–60 months attending an outpatient clinic at Komfo Anokye Teaching Hospital, Kumasi were systematically screened for UTI using Combi 10 dipstick (CyBow TM). All dipstick-positive and a sample of dipstick-negative urines underwent microscopy and culture (i.e. gold standard) from clean-catch or catheterised urine.

Results: Of 1393 children (median age 20 months), 112 (8%) had a positive dipstick and 29 of these (25.9%) had UTIs; 118/1278 (9.2%) children with a negative dipstick had urine cultured, one of whom (0.8%) had a UTI. The prevalence of UTIs was 2.1% (30/1393) and was higher among females (RR 3.99, 95% CI 1.76–9.04). 70% of UTIs were in children <2 years of age (p=0.08). The sensitivity, specificity and positive and negative predictive values of dipstick were 96.7%, 58.8%, 26.1% and 99.2%, respectively. Use of dipstick as a screening test for UTI was comparable to microscopic analysis for pyuria. 90% of all UTIs were clinically misdiagnosed (70% as malaria). Escherichia coli was the predominant isolate (60%). Co-trimoxazole and ampicillin, commonly used to treat uncomplicated UTIs at first level in Ghana, showed 0% and 8.3% in-vitro sensitivities, respectively. Ciprofloxacin and cefuroxime (widely used at regional/tertiary level) showed good sensitivities, 99.0% and 86.2%, respectively.

Conclusions: Urine dipstick should be promoted as a screening test for UTI. First-line use of cotrimoxazole and ampicillin for UTI should be reviewed.

Document Type: Research Article

DOI: http://dx.doi.org/10.1179/146532808X302134

Affiliations: 1: Department of Child Health, School of Medical Sciences, Kwame Nkrumah University of Science & Technology and Komfo Anokye Teaching Hospital, Kumasi, Ghana 2: The Liverpool School of Tropical Medicine, Liverpool, UK 3: Institute of Health & Society, Newcastle-upon-Tyne, UK

Publication date: 2008-06-01

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• In 2012 Annals of Tropical Paediatrics changed its name to Paediatrics and International Child Health to reflect changes and developments in the subject area. View the issues of Paediatrics and International Child Health available online.
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