URINARY TRACT INFECTION IN CHILDREN WITH PROTEIN ENERGY MALNUTRITION SEEN AT AMINU KANO TEACHING HOSPITAL KANO

Abstract

Urinary Tract Infection is the second most common bacterial infection in children, and
perhaps the commonest disease of the urogenital tract. UTI may lead to substantial morbidity
that may not be limited to the acute period of illness.
This study was aimed at determining the prevalence of UTI in children with Protein Energy
Malnutrition (PEM). A descriptive comparative study was conducted from July to November
2011 at the Aminu Kano Teaching Hospital (AKTH), Kano to determine the prevalence of
UTI in children with PEM aged six months to 5 years. To identify the bacterial aetiologic
agents and antimicrobial sensitivity pattern of the isolated urinary pathogens.
One hundred and sixty nine children with PEM and 169 age and sex matched controls whose
parents or guardian gave consent, were consecutively recruited. The controls were children
with minor ailments but without obvious malnutrition. Their bio-data, socio-demographic
characteristics and physical examination including anthropometry were done. From each
subject, urine sample was obtained for urinalysis, urine microscopy, culture and sensitivity.
There were 105 (62.1%) males and 64 (37.9%) females, giving a male: female ratio of 1.6:1
in each group. The mean age was 20.6 ± 9.2 months for both subjects and controls. Sixty four
percent of the children with PEM were in the 13-24 months age bracket. Eighty seven
(51.5%) of the children with PEM had marasmus, 27(15.9%) had marasmic kwashiorkor,
26(15.4%) had underweight kwashiorkor, 23(13.6%) were underweight while 6(3.6%) had
kwashiorkor.
The prevalence of UTI in PEM was 16.0% which was significantly higher than in the control
with 2.4% (χ2=17.19, p=0.001). The prevalence of UTI in kwashiorkor, marasmus,
underweight kwashiorkor, marasmic kwashiorkor was 33.3%, 19.5%, 15.4%, and 14.8%
respectively. There was an apparently higher trend for UTI in children with Kwashiorkor.
Escherichia.coli was the predominant organism isolated in 51.9% of the cases in children
with PEM and in 75.0% of the control subjects. There was no statistically significant
difference in the bacterial aetiologic agents and the type of malnutrition (p= 1.00).
All the bacterial isolates in PEM were highly sensitive to gentamicin and ciprofloxacin while
in the control subjects all the isolates were highly sensitive to gentamicin, Ceftazidime and
ciprofloxacin. However the isolates showed poor sensitivity to Amoxicillin, Cotrimoxazole,
Nitrofurantoin, Cefuroxime and chloramphenicol in children with PEM, while poor
sensitivity to amoxicillin, cotrimoxazole and chloramphenicol was observed in the control
group.
This study showed a high prevalence of UTI in children with PEM. Prompt recognition and
treatment of UTI is thus of public health importance, not only in reducing the morbidity of
infection and risk of renal scarring but also facilitating nutritional rehabilitation. It is
therefore recommended that routine screening for UTI be done as part of evaluation of any
child with PEM. Regular update on antimicrobial sensitivity pattern of commonly used
antimicrobial drugs is strongly advocated.

URINARY TRACT INFECTION IN CHILDREN WITH PROTEIN ENERGY MALNUTRITION SEEN AT AMINU KANO TEACHING HOSPITAL KANO