The febrile child: how frequent should we investigate for urinary tract infection

Abstract

Background: Febrile illness in children remains the most common cause of emergency room visit. In many tropical countries where malaria is en-demic, children presenting with fever are treated for malaria presumptuously. Current evidence suggests however that malarial parasitaemia in febrile children is declining and the prevalence of other causes of fever apparently on the increase. Therefore, highlighting such causes of fever as urinary tract infection (UTI) is indispensable. This is much so as UTI not only is common in younger children and often neglected but also associated with long term complications Methods: Children aged 6-59months with fever of less than 2weeks were consecutively recruited. Each child had both clinical evaluation and preliminary laboratory assessment such as dipstick urinalysis. Further micro-biological and radiological evaluations were performed where necessary: blood film for malarial parasite identification and count, cerebrospinal fluid (CSF) analysis and chest X-ray. Results: Of the 303 children 180 (59.4%) were males and 123 were females (40.6%). The mean age was 21.7±14.0months, 54.5% were less than 24months. ARI accounted for 44.6% (mainly tonsillitis, 61%, pneumonia, 27% and otitis media, 12%), while malaria and UTI were observed in 38.3% and 4.6% respectively. Five (35.7%) patients with UTI were males while 9 (64.3%) were females. Their combined mean age was 25.4±18.6months, 57% of these children were less than 24 months old. In 3(21.4%), UTI co-existed with malaria. Conclusions: Acute respiratory infection, malaria and UTI are the three leading causes of fever in children under 5 years.