Prevalence and factors associated with urinary tract infections among children aged 6-59 months with severe acute malnutrition at mulago hospital.

Abstract

Background: Severe Acute Malnutrition (SAM) is one of the leading causes of mortality among children under five in the developing countries. The burden of Urinary Tract Infections (UTI) among children with SAM is high and is associated with increased morbidity and mortality. Children with SAM are more susceptible to UTI than the well-nourished children. Despite the known risk of UTI among children with complicated SAM, the burden of UTI among children with SAM at Mulago hospital and Uganda remains scanty. Findings from this study will provide an insight into the burden of UTI among children admitted with SAM in our setting. It will also provide knowledge on the antimicrobial susceptibility patterns of common UTI causative agents among children with severe acute malnutrition.Objective: To determine the prevalence and factors associated with urinary tract infections among children aged 6-59 months with severe acute malnutrition at Mulago national referral hospital Materials and Methods: The study was conducted at the Acute Care Unit of Mulago National Referral Hospital. A cross-sectional study design was used and a total of 194 children with SAM aged 6-59 months who met the inclusion criteria were consecutively enrolled. A urine sample was obtained from each study participant by urethral catheterization and transported to the microbiology laboratory for analysis using urine dipstick, microscopy, and urine culture. All culture-positive urine samples were subjected to antimicrobial drug susceptibility testing according to Clinical Laboratory Standards International guidelines. Data was analyzed using STATA version 15.0 Software. Variables were summarized in forms of proportions. Logistic regression analysis was to assess the strength of associations between the independent and outcome variable, and a p-value of 0.05 was considered as statistically significant. The culture results were used to calculate prevalence of urinary tract infection, characterize the type of microbial growth and test for antimicrobial susceptibility. Approval was obtained from the Department of Pediatrics and Child Health and Makerere School of Medicine Research and Ethics Committee and administrative clearance from Mulago Hospital. Results: The overall prevalence of urinary tract infections was 10.8%, and the factors found to be significantly associated with urinary tract infections among children with severe acute malnutrition aged 6-59 months were loss of appetite, positive leucocyte esterase test and lymphocytosis. Bacterial isolates identified were all gram-negative bacteria predominantly Escherichia coli. Bacterial isolates displayed sensitivity to meropenem, piperacillin-tazobactam and nitrofurantoin while resistance patterns were to Ampicillin, Ceftriaxone, Trimethoprim-sulfamethoxazole, and Gentamycin. Conclusion and Recommendation: The burden of urinary tract among children with severe acute malnutrition in Mulago hospital is high, therefore, there is need to strengthen existing guidelines on screening for urinary tract infections among these children.