Prevalence of Urinary Tract Infection in Malnourished Children

Abstract

BACKGROUND Malnutrition involves hundreds of millions of children in the developing world. Malnutrition and infection is a vicious cycle. Malnourished children suffer from many infections like respiratory tract infection, UTI, diarrhoea. UTI is more common in malnourished children, and risk of UTI is related to severity of malnutrition. Severe acute malnutrition (SAM) is associated with immune deficiency, because of which they are more vulnerable to severe infection. Risk factors for urinary tract infection include female gender, uncircumcised male, vesicoureteral reflux, poor toilet training, voiding dysfunction, obstructive uropathy, urethral instrumentation, wiping from back to front in girls, bubble bath, tight clothing (underwear), pinworm infestation, constipation, sexually activity, neuropathy bladder, anatomic abnormality (labial adhesion), bacteria with P fimbriae and under nutrition. Urinary tract infection (UTI) is more common in malnourished children, and risk of UTI is related to severity of malnutrition. Severe acute malnutrition (SAM) is associated with immunodeficiency, for which they are more vulnerable to severe infection. We wanted to study the prevalence of UTI in malnourished children. METHODS 72 malnourished children (WHO classification) who met the inclusion criteria were included in this study from June 2017 to Ma y 2018. Detailed anthropometric measurements were done and grading of malnutrition was done according to WHO classification. Urine for routine examination and culture and sensitivity was done for each case. Early morning urine was collected. In children below 3 years of age urine was collected by catheterization and in toilet trained children (> 3 years of age) midstream clean catch urine sample under strict asepsis was collected in a sterile container. After collecting urine sample was sent within one hour to the laboratory. RESULTS UTI was found in 16.67% cases, mostly in female and more frequently in 6-12 months age group and most common organisms was gram negative bacilli. CONCLUSIONS Among the various risk factors of urinary tract infection, malnutrition especially under-nutrition itself is a risk factor for UTI or sometimes urinary tract infection also can lead to malnutrition. UTI is common in malnourished children and most common causative organisms are gram negative bacilli.

Prevalence of Urinary Tract Infection in Children With Severe Acute Malnutrition Aged Between Six Months and Five Years and Their Antibiotic Sensitivity Pattern

“…However, this association was not statistically significant (p value=0.102). This was similar to previous studies [ 18 , 20 , 21 ] where a significant association of UTI with female gender was seen. The female predominance of UTI in malnourished children is in accordance with female preponderance of UTI in general.…”

“…The presenting complaint was burning micturition in only one out of 140 patients (0.71%). Fever was present as the most common presenting complaint in other studies by Sharma et al [ 15 ] (84.7%), Kumar et al [ 19 ] (59.3%) and Dangayach et al [ 20 ] (33.84%), whereas respiratory symptoms were found to be most common in studies by Dey et al [ 21 ] and Banapurmath et al [ 17 ]. Among all these clinical presentations studied, only loose stool was found to have a statistically significant association with UTI in our study (p value 0.0239).…”

“…In malnutrition, urinary tract infection is very common which is 6-37% in literature reviews [1]. Not much information is available from developing countries, but some studies from Africa report it to be 9-11.4% [13,14] and few from India found it to be 15.2-22.3% [15][16][17][18][19][20][21]. Since there are limited studies available, hence this study was planned to determine the prevalence of urinary tract infection in children with severe acute malnutrition aged between six months and five years and to identify the causative organisms and their antibiotic sensitivity pattern.…”