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.





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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

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Wendy P O'Meara

Professor of Medicine

Dr. Wendy O’Meara is a Professor of Medicine and Global Health at Duke University, a visiting professor at Moi University, and the Deputy Director of the Duke Global Health Institute. She divides her time between the US and Kenya.

Dr. O’Meara has dedicated the last 20 years to community-based approaches for malaria treatment and prevention in East Africa. Her team’s work focuses on expanding access to accurate diagnosis and treatment, mapping silent reservoirs of transmission using parasite genetic signatures, and tackling emerging threats to malaria control in vulnerable populations. She serves on the Strategic Advisory Group of Experts for the Africa CDC and is an advocate for data justice and equitable data governance in global research. 

Dr. O’Meara completed her PhD in Chemical Engineering at MIT. She then joined Fogarty International Center at the NIH to apply her quantitative and modeling skills to vector borne diseases. Her collaboration with KEMRI-Wellcome Trust using hospital surveillance data to understand malaria transmission led her to Kenya in 2007. The collaborative research program built with colleagues at Moi University is based in Eldoret, Kenya with hubs in western and northern Kenya. The team works closely with county health teams and frequently advises the Division of National Malaria Control. 


Thomas Lawrence Holland

Associate Professor of Medicine

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