Urinary Tract Infections are prevalent among febrile under-five children presenting to the University Teaching Hospital - Children's Hospital

Background: Urinary tract infections (UTIs) account for a significant proportion of fevers in paediatric patients. In low resource settings where diagnostic testing for fever is not readily available, children with UTIs may be left at risk of adverse outcomes due to inadequate treatment. This study investigated the burden of UTIs in under-five children presenting with fever to the outpatient department of the University Teaching Hospital, Children's Hospital in Lusaka, Zambia. Method: This cross-sectional study was conducted between October 2019 and March 2020, in children with an axillary temperature greater than 37.5 degrees celsius. Clinical data were collected, and urine specimens were obtained for analysis by dipstick, microscopy, culture and sensitivity testing as per standard protocols. Ultrasonography was performed on all children with culture positive UTIs. Data was analysed using IBMTM-SPSSTM version 29 (IBM Corp., Arming, NY, USA) and a p-value of <0.05 was considered significant. Results: Out of 146 children, majority 79 (54%) were males and the median age was 26.5 months (IQR, 11.3 - 42.0). The prevalence of UTIs was 28.8% (42/146) and a history of diarrhoea (p=0.031) and presence of leucocytes in urine (p=0.016) were associated with culture-positive UTIs. Escherichia coli 12(26%) and Enterococcus species 10(22%) were the commonest uropathogens and were most susceptible to co-amoxiclav 19(83%) and ciprofloxacin 15(83%) but 15(83%) were resistant to co-trimoxazole. Conclusion: UTIs occurred in almost a third of febrile under-five children with most uropathogens remaining susceptible to commonly used antibiotics. Clinicians should have a high index of suspicion for UTI among children presenting with fever in this setting.