Predicting Urinary Tract Infection in Malaria Co-morbidity among Under Fives

Abstract

Fever presenting in children less than 5 years of age in malaria endemic areas will almost always be treated as cases of malaria. However fever is a common feature to other childhood illnesses including ARI and UTI. Besides, malaria is known to co-exist with these other morbidities including UTI. Undiagnosed and poorly treated UTI can lead to immediate and long term sequelae. Reliance on clinical features for the identification of presence of the co-morbidity could be quite tasking in the absence of discriminatory features. This work was meant to evaluate children less than 5 years of age presenting with fever (without localising signs) for discriminatory features (if any) for malaria, UTI co-morbidity. This was a prospective and cross sectional study carried out between June and August 2006. The study involved well nourished under fives with parasitologically proven malaria seen at the Children's Emergency Room (CHER) of the University of Benin Teaching Hospital (UBTH) Benin City. The presence of UTI was evaluated in this cohort using urinalyses, microscopy and culture. Of the 300 children evaluated, 27(9%) had UTI-malaria co-morbidity. There was paucity of known symptoms or signs of UTI in those with the co-morbidity. The clinical features of abdominal pain, vomiting, irritability, showed very low sensitivity while the same features had high negative predictive values with respect to the presence of the co-morbidity (>67.40%). Tachycardia and tachypnoea also had very low sensitivity with regard to detecting the child with the co-morbidity. However, the features occurred significantly more in children without the co-morbidity. In conclusion, malaria-UTI co-morbidity occur frequently (in 1 out of every 10 children under 5 years of age with presumed sole diagnosis of malaria) to warrant the evaluation of such children, if the long term sequelae of undiagnosed and poorly treated UTI are to be minimized.

Key words: Predicting, Malaria, UTI, Co-morbidity, Under fives.