Predictive Validity and Reliability of Dipstick and Microscopy in Diagnosis of Urinary Tract Infections Among Febrile Under-Fives in Nsambya Hospital, Uganda
[1]
Robert Anguyo DDM Onzima, Department of International Public Health, Liverpool School of Tropical Medicine, Kampala, Uganda.
[2]
Christine Ocokoru, Moyo Hospital, Moyo District Local Government, Moyo, Uganda.
[3]
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
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