Urinary tract infections among under-five children with congenital anomalies of kidney and urinary tract in hospitalized patients in Addis Ababa.

Abstract

Background: Congenital anomalies of the kidney and urinary tract (CAKUT) and urinary tract infections (UTIs) are significant clinical concerns in children. Children who have UTIs are also at risk of developing long-term complications, notably kidney disease and scarring UTIs. The purpose of this study was to assess the prevalence of urinary tract infection and its determinants among under-five children with congenital anomalies of kidney and urinary tract in Addis Ababa.

Methods: A health institution-based retrospective cross-sectional study was employed on 389 randomly selected medical records of children with CAKUT, out of a total of 850 cases. The children were admitted to Tikur Anbesa and Menelik II Hospitals between January 1, 2018, and December 31, 2022. The study hospitals were purposively selected as they were the only referrals in the nation for CAKUT cases. Sociodemographic, clinical, and laboratory characteristics were captured using a data extraction sheet created in the Kobo Toolbox and transferred to SPSS for analysis. Binary logistic regression analysis was used to evaluate the associations of variables with a p-value of ≤ 0.05 and a confidence interval of 95%.

Results: The majority of the study participants (336 [86.4%]) were males. A total of 194 (49.8%) children were older than 25 months, with a median age of 23 (95% CI: 22-27) months, and 117 (30.1%) (95% CI = 25.4-35.2) participants were positive for urinary tract infection (UTI). Forty were culture-positive out of 103 urine specimens tested, where, Escherichia coli (60%) was the most frequently isolated bacteria followed by Klebsiella pneumonia (20%), Enterobacter spp, (12.5%), and Staphylococci spp. (7.5%). Factors associated with UTI among CAKUT children were found to be being female (AOR = 4.3, 95% CI = (1.4-13.07), children having Posterior Ureteral Valve (PUV) (AOR = 4.8, 95% CI = (2.32-9.93), duration of hospitalization (> 4 days) (AOR = 3.08, 95% CI = (1.52-6.24), and children having fever (AOR = 5.8, 95% CI = (2.81-11.97).

Conclusion: In this study, almost one-third of the children developed UTIs, and female sex, longer hospitalization, PUV, and fever were identified as independent risk factors of UTIs. This emphasizes special attention should be given to high-risk children.