Predictive value of dipstick and microscopy in diagnosis of urinary tract infections among under-fives presenting with fever to Nsambya hospital

Abstract

Background: Urinary tract infection (UTI) is a common paediatric problem with the potential to cause long-term complications, globally. Children < 5 years often present with non-specific symptoms and signs making the diagnosis of urinary infection challenging. Fever may be the only sign of UTI in under-fives. Effective treatment depends on clinicians’ high index of suspicion and laboratory urine test results. Early diagnosis of UTI is essential to institute prompt treatment and reduce lifelong morbidity. Urine dipstick for nitrites and leucocyte esterase, and microscopy for leucocytes and bacteriuria are good screening tests to select urine specimens for culture which is the gold standard for UTI diagnosis. The screening tests provide more rapid information than urine culture, which could be utilized as decision-making tool for initiating treatment of UTI. Objective: To determine the predictive value of a combination of urine dipstick and microscopy in diagnosing UTI in children. Methodology: A cross-sectional study was conducted at the paediatric out patients’ department of Nsambya Hospital from December 2013 to April 2014.Children <5 years presenting with fever were approached and inquiries made about their prior antibiotic use. All children with temperatures ≥37.5⁰C and aged ≤59 months who had not been on antibiotic therapy 48 hours prior to hospital visit were enrolled into the study upon obtaining consent from their parents/caretakers. Basic information was filled in a data collection form. Two urine samples were collected from every participant-one for urine dipstick and microscopy and the other for urine culture. Data was entered in a computer using Epidata version 3.1 and analyzed using SPSS version 19 software. Findings: The sensitivity, specificity, positive predictive value and negative predictive value of combined urine dipstick and microscopy were 98.8%, 95%, 87.9% and 99.5% respectively. Urine dipstick alone had sensitivity of 46.9%, specificity 95.5%, positive predictive value of 79.2% and negative predictive value of 83.1%.Urine microscopy used alone had sensitivity of 95.1%, specificity 98.2%, positive predictive value 95.1% and negative predictive value of 98.2%. Conclusions: A combination of urine dipstick and microscopy is reliable in the diagnosis of UTI Recommendation: The MoH of Uganda should continue prioritizing the use of microscopy for the diagnosis of UTI among children under-five years of age.