Contribution of urinary tract infection to the burden of febrile illnesses in young children in rural Kenya.
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INTRODUCTION: The clinical features of UTI in young children may not localize to the urinary tract and closely resemble other febrile illnesses. In malaria endemic areas, a child presenting with fever is often treated presumptively for malaria without investigation for UTI. Delayed or inadequate treatment of UTI increases the risk of bacteremia and renal scarring in young children and subsequently complications as hypertension and end stage renal disease in adulthood. METHODS: A cross-sectional study was carried out in a hospital in western Kenya. Inpatients and outpatients 2 months to five years with axillary temperature ≥37.5°C and no antibiotic use in the previous week were enrolled between September 2012 and April 2013. Urine dipstick tests, microscopy, and cultures were done and susceptibility patterns to commonly prescribed antibiotics established. UTI was defined as presence of pyuria (a positive urine dipstick or microscopy test) plus a positive urine culture. RESULTS: A total of 260 subjects were recruited; 45.8% were female and the median age was 25months (IQR: 13, 43.5). The overall prevalence of UTI was 11.9%. Inpatients had a higher prevalence compared to outpatients (17.9% v 7.8%, p = 0.027). UTI co-existed with malaria but the association was not significant (OR 0.80, p = 0.570). The most common organisms isolated were Escherichia coli (64.5%) and Staphylococcus aureus (12.9%) and were sensitive to ciproflaxin, cefuroxime, ceftriaxone, gentamycin and nitrofurantoin but largely resistant to more commonly used antibiotics such as ampicillin (0%), amoxicillin (16.7%), cotrimoxazole (16.7%) and amoxicillin-clavulinate (25%). CONCLUSION: Our study demonstrates UTI contributes significantly to the burden of febrile illness in young children and often co-exists with other infections. Multi-drug resistant organisms are common therefore choice of antimicrobial therapy should be based on local sensitivity pattern.
Published Version (Please cite this version)
Masika, Wechuli Geoffrey, Wendy Prudhomme O'Meara, Thomas L Holland and Janice Armstrong (2017). Contribution of urinary tract infection to the burden of febrile illnesses in young children in rural Kenya. PLoS One, 12(3). p. e0174199. 10.1371/journal.pone.0174199 Retrieved from https://hdl.handle.net/10161/15688.
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Dr. Wendy O’Meara is an Associate Professor at Duke University School of Medicine in the Division of Infectious Diseases, visiting professor at Moi University, and the Associate Director for Research of the Duke Global Health Institute. She has been based full-time in Kenya since 2007.
Dr. O’Meara’s team is interested in improving rational drug use for suspected malaria fevers through expanding the use of diagnostic tools in the community and in health facilities. As many as 90% of fevers that seek treatment in the formal sector receive antimalarials, and it is estimated that only 20% of those buying antimalarials over-the-counter in the retail sector actually have malaria. Such overuse poses a significant threat to the continued efficacy of first-line antimalarials. Dr. O’Meara has conducted several randomized controlled trials in western Kenya to test interventions designed to improve the use of information from malaria diagnostic testing in order to target antimalarials to those with confirmed infection. In 2005, she helped to establish the Malaria Diagnostic Centre of Excellence in Kisumu, Kenya.
Dr. O’Meara is also working towards elucidating malaria transmission networks by identifying individual human-to-mosquito and mosquito-human transmission events through leveraging variability in key parasite genes (collaboration with Steve Taylor’s lab). By tracking generations of infections from humans to mosquitoes, a clearer understanding of the reservoir of infection will be possible and interventions such as ivermectin and transmission blocking vaccines can be targeted to maximizes their effectiveness.
Dr. O’Meara also has experience in marrying innovative spatial techniques with epidemiologic outcomes. Recent work includes an analysis of health systems factors that contribute to early childhood mortality in sub-Saharan Africa and the impact of malaria prevention on birth outcomes.
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