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Predictive Validity and Reliability of Dipstick and Microscopy in Diagnosis of Urinary Tract Infections Among Febrile Under-Fives in Nsambya Hospital, Uganda
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Volume 3, 2015
Issue 3 (June)
Pages: 107-111   |   Vol. 3, No. 3, June 2015   |   Follow on         
Paper in PDF Downloads: 17   Since Aug. 28, 2015 Views: 1634   Since Aug. 28, 2015
Robert Anguyo DDM Onzima, Department of International Public Health, Liverpool School of Tropical Medicine, Kampala, Uganda.
Christine Ocokoru, Moyo Hospital, Moyo District Local Government, Moyo, Uganda.
Philip Govule, Faculty of Health Sciences, Uganda Martyrs University, Kampala, Uganda.
The non-specific presentation of urinary tract infections amongst children poses a challenge in its diagnosis. Given the lower-relative frequency of urinary tract infections, more commonly occurring causes of fever have to be ruled out before considering it hence delayed diagnosis and treatment. Tests exist to aid clinicians timely-diagnose urinary tract infections. In this study we assessed if such tests could produce accurate and reliable results in diagnosing urinary tract infections among febrile children below 5 years (0-59 months) of age. Objectives: To determine predictive validity and reliability of urine dipstick, microscopy and their combination in diagnosing urinary tract infections among children 0-59 months of age. Methods: We conducted a descriptive cross-sectional study at the pediatric out patients’ department of Nsambya Hospital from December 2013 to April 2014; and enrolled 302 febrile children aged 0-59 months with no antibiotic therapy 48 hours preceding hospital visit. We subjected urine samples from the eligible children to dipstick, microscopy and urine culture. We analyzed the data for predictive validity by computing the sensitivity, specificity and predictive values and employed the kappa statistic to assess for reliability using urine culture as our gold standard. Results: The combined urine dipstick and microscopy had sensitivity, specificity, positive predictive and negative predictive values of 98.8%, 95.0%, 87.9% and 99.5% respectively. Urine dipstick had 46.9% sensitivity, 95.5% specificity, 79.2% positive predictive value and negative predictive value of 83.1%. The sensitivity, specificity; positive and negative predictive values of microscopy were 95.1%, 98.2%, 95.1% and 98.2% respectively. Urine microscopy and culture; and combined dipstick-microscopy and culture showed close to perfect agreement (kappa=0.933 and 0.903 respectively). Conclusions: Urine microscopy is accurate and reliable in diagnosing urinary tract infections among children aged 0-59 months. Its use in screening for urinary tract infections among febrile under-fives in Ugandan hospitals could improve early diagnosis and treatment.
Predictive Validity, Reliability, Urinary Tract infections, Febrile Under-Fives
The World Health Organization. Pocket book of hospital care for children: guidelines for the management of common childhood illnesses. Geneva: World Health Organization, 2013.
Uganda Bureau of Statistics and ICF Macro. Uganda malaria Indicator Survey 2009 . Calverton, Maryland, USA : Uganda Bureau of Statistics and ICF Macro, 2010.
Zorc JJ, Kiddoo DA & Shaw KN. Diagnosis and management of pediatric urinary tract infections. Clinical Microbiology Reviews. 2005; 18: 417-422.
VanDeVoorde R. Is it appropriate to treat a suspected urinary tract infection based on an in office urine dipstick result or should the specimen be sent for culture? Does the age of the patient have anything to do with the decision? In Myers LM, editor. Curbside consultation in pediatric infectious disease: 49 clinical questions (curbside Consultation In Pediatrics). NewJersey: SLACK Inc, 2012.
Gopal CS, Rao D, Hedge P & Soans S. Routine urine culture in febrile young children. Journal of Clinical and Diagnostic Research. 2010; 5. 452-455.
Msaki BP, Mshana SE, Hokororo A, Mazigo HD & Morona D. Prevalence and predictors of urinary tract infection and severe malaria among febrile children attending makongoro health centre in mwanza city, North-Western Tanzania. Arch Public Health. 2012; 70: 4.
Cheesbrough M. District laboratory practice in tropical countries, part 1, 2nd ed . New York : Cambridge University Press, 2006.
Katz HM. Study design and statistical analysis: a practical guide for clinicians. New York: Cambridge University Press, 2006.
Petrie A & Sabin C. Medical statistics at a glance. Oxford: Malden MA : Blackwell Science., 2000.
Taylor HA. Medical statistics made easy. 2nd ed. UK: Scion, Oxfordshire, 2008.
Armitage PBG & Mathews J. Statistical methods in medical research. $th ed.. Blackwells : Oxford University Press, 2002.
Di Eugenio BN. On the usage of kappa to evaluate agreement on coding tasks. USA: University of Illinois, 2000.
Landis JR & Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977; 33: 159-174.
Wu S & Wong S.Auditing the management of childhood urinary tract infections in a regional hospital. HK J Paediatr (New Series). 2005; 10: 180-188.
Glissmeyer EW, Korgenski EK, Wilkes J, Schunk JE, Sheng X, Blaschke AJ et al. Dipstick screening for urinary tract infection in febrile infants. Pediatrics. 2014; 133: e1121-e1127.
Othman S, Chia YC & Ng CJ. Accuracy of urinalysis in detection of urinary tract infection in a primary care setting. Asia Pacific Family Medicine. 2003; 2. 206-212.
Kleinbaum GD, Sullivan MK & Barker DN. A pocket guide to epidemiology. New York : Springer Science+Business Media, LLC, 2007.
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