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The prognostic value of dipstick urinalysis in children admitted to hospital with severe malnutrition
  1. Nahashon Thuo1,
  2. Eric Ohuma1,
  3. Japhet Karisa1,
  4. Alison Talbert1,
  5. James A Berkley1,2,
  6. Kathryn Maitland1,3
  1. 1Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, Kilifi, Kenya
  2. 2Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Headington, UK
  3. 3Imperial College, London, UK
  1. Correspondence to Nahashon Thuo, Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, P.O. Box 230, Kilifi 80108, Kenya; nthuo{at}kilifi.kemri-wellcome.org

Abstract

Background Children with severe malnutrition (SAM) present to hospital with an array of complications, resulting in high mortality despite adherence to WHO guidelines. Diagnostic resources in developing countries are limited and bedside tests could help identify high-risk children. Dipstick urinalysis is a bedside screening test for urinary tract infections (UTIs). UTIs are common in SAM and can lead to secondary invasive bacterial sepsis. Very few studies have examined the usefulness of dipstick screening of urine specimens in SAM and none has explored its prognostic value.

Patients and methods A 2-year prospective study on children admitted in Kilifi District Hospital, Kenya, with SAM. Freshly voided, clean catch urine samples were tested using Multistix reagent test strips. Positive samples were sent for culture.

Results Of the 667 children admitted, 498 children (75%) provided urine samples; of these, 119 (24%) were positive for either leucocyte esterase (LE) or nitrites. Culture-proven UTI was detected in 28 children (6% overall). All isolates were coliforms and were >50% were resistant to cotrimoxazole and gentamicin. There was no difference in severity signs between those with positive dipstick and those without. Case fatality was higher among children with a positive dipstick (29% vs 12%). Presence of a positive dipstick was a strong predictor of mortality (adjusted HR 2.5).

Conclusions A urine dipstick positive for either LE or nitrites is a useful predictor of death in children admitted with SAM. Prospective studies to determine the role of untreated UTI in these deaths are needed before any treatment recommendations can be made.

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Footnotes

  • Funding None.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Kenya National Ethics Review Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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