Prevalence and predictors of urinary tract infections among children with cerebral palsy in Makurdi, Nigeria

Emmanuel Adémólá Anígilájé, Terkaa Terrumun Bitto

Department of Paediatrics, Benue State University, Makurdi, Nigeria.
Department of Paediatrics, Federal Medical Centre, Makurdi, Nigeria.

DOI: 10.4236/ojped.2013.34063                

Abstract

Background: Children with cerebral palsy (CP) are prone to urinary tract infection (UTI), a common cause of childhood morbidity and mortality. However, there has been no report regarding the prevalence of UTI among this group of children inNigeria. Objectives: The study aims at determining the prevalence and the possible predictors of UTI in children with CP compared to age and sex matched children without CP. Methods: A prospective cross-sectional study was carried out among consecutive children with CP at the Neurologic Clinic in the Paediatric Department of the Federal Medical Centre, Makurdi, Nigeria, from December 2011 to May 2013. Results: The age range of the studied population was between 2 and 15 years with a mean age of 8.63 ± 3.83 years including 30 males and 22 females. UTI was confirmed in 20 (38.5%) children with cerebral palsy compared to 2 children (3.8%) without CP (p value 0.000). Among children with CP, Escherichia coli was the commonest organism isolated in 9 (9/20, 45.0%), Streptococcus faecalis in 4 (20.0%), Staphylococcus aureus in 3 (15%), while both Proteus spp., and Klebsiella spp., were isolated in 2 children (10.0%) each. Escherichia coli was also found in the 2 children without CP. All the organisms were resistant to co-trimoxazole, nalidixic acid, nitrofuratoin and amoxiclav, while they were 100% sensitive to ceftriazone and the quinolones. In a univariate regression, analysis only moderate to severe gross motor dysfunction predicted the risk of UTI (OR = 54.81, 95%CI, 2.27 - 1324.00, p value 0.014). Conclusion: Efforts should be put in place to aid mobility among children with CP in order to reduce risk of UT.

Keywords

Urinary Tract Infection; Cerebral Palsy Children; Prevalence; Predictors

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Taft, L.T. (1995) Cerebral palsy. Pediatrics in Review, 16, 411-418.
[2]	Reid, C.J. and Borzyskowski, M. (1993) lower urinary tract dysfunction in cerebral palsy. Archives of Disease in Childhood, 68, 739-742. http://dx.doi.org/10.1136/adc.68.6.739
[3]	Drigo, P., Seren, F., Artibani, W., Laverda, A.M., Battistella, P.A. and Zacchello, G. (1988) Neurogenic vesicoureteral dysfunction in children with cerebral palsy. The Italian Journal of Neurological Sciences, 9, 151-154. http://dx.doi.org/10.1007/BF02337462
[4]	Mayo, M.E. (1992) Lower urinary tract dysfunction in cerebral palsy. Journal of Urology, 142, 419-420.
[5]	Bross, S., Pomer, S., D?derlein, L., Knoll, T., Michel, M.S., Staehler, G., Gerner, H.J. and Alken, P. (2004) Urodynamic findings in patients with infantile cerebral palsy. Aktuelle Urologie, 35, 54-57. http://dx.doi.org/10.1055/s-2003-812521
[6]	Fahimzad, A., Babaied, D., Ghoroubi, J., Zahed, G.H. and Rafiei, T. (2013) Common infections among disabled children admitted to hospital. Archives of Pediatric Infectious Diseases, 1, 71-74. http://dx.doi.org/10.5812/pedinfect.9075
[7]	Hellquist, J.M., McKinney Jr, R.E. and Worley, G. (1985) Urinary tract infections in cerebral patients. Pediatric Research, 5, 295. http://dx.doi.org/10.1203/00006450-198504000-01140
[8]	Ozturk, M., Oktem, F., Kisioglu, N., Demirci, M., Altuntas, I., Kutluhan, S. and Dogan, M. (2006) Bladder and bowel control in children with cerebral palsy: Case-control study. Croatian Medical Journal, 47, 264-270.
[9]	Palisano, R., Rosenbaum, P., Walter, S., Russell, D., Wood, E. and Galuppi, B. (1997) Development and reliability of a system to classify gross motor function in children with cerebral palsy. Developmental Medicine and Child Neurology, 39, 214-223. http://dx.doi.org/10.1111/j.1469-8749. 1997.tb07414.x
[10]	Njokanma, O.F. and Nkanginieme, K.E.O. (2007) Growth and development. In: Azubuike, J.C. and Nkanginieme, K.E.O., Eds., Paediatrics and Child Health in a Tropical Region, African Educational Services, Owerri, 56-69.
[11]	Benninga, M., Candy, D.C., Catto-Smith, A.G., Clauden, G., Loening-Baucke, V., DiLorenzo, C., Nurko, S. and Staiano, A. (2005) The Paris Consensus on Childhood Constipation Terminology (PACCT) Group. Journal of Pediatric Gastroenterology and Nutrition, 40, 273-275. http://dx.doi.org/10.1097/ 01.MPG.0000158071.24327.88
[12]	American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders. A.P.A., Washington DC, 1.
[13]	Cheesebrough, M. (2002) Examination of urine. District laboratory practice in tropical countries. Cambridge University Press, Cambridge.
[14]	Ajasin, M.A. and Adegbola, R.A. (1998) Asymptomatic bacteriuria in children with sickle cell anaemia. Nigerian Journal of Paediatrics, 15, 19-25.
[15]	Chukwu, B.F., Okafor, H.U. and Ikefuna, A.N. (2009) Asymptomatic bacteriuria in children with sickle cell anemia at The University of Nigeria teaching hospital, Enugu, South East, Nigeria. Italian Journal of Pediatrics, 9, 45.
[16]	Asinobi, A.O., Fatunde, O.J., Brown, B.J., Osinusi, K. and Fasina, N.A. (2003) Urinary tract infection in febrile children with sickle cell anaemia in Ibadan, Nigeria. Annals of Tropical Paediatrics, 23, 129-134. http://dx.doi.org/10.1179/027249303235002198
[17]	Okunola, P.O., Ibadin, M.O., Ofovwe, G.E. and Ukoh, G. (2012) Co-existence of urinary tract infection and malaria among under five years old: A report from Benin city, Nigeria. Saudi Journal of Kidney Disease and Transplantation, 23, 629-634.
[18]	Musa-Aisien, A.S., Ibadin, M.O., Ukoh, G. and Akpede, G.O. (2003) Prevalence and antimicrobial sensitivity pattern in urinary tract infection in febrile under-5s at a children’s emergency unit in Nigeria. Annals of Tropical Paediatrics, 23, 39-45. http://dx.doi.org/10.1179/000349803125002850
[19]	Iduoriyekemwen, N.J., Sadoh, W.E. and Sadoh, A.E. (2012) Asymptomatic bacteriuria in HIV positive Nigerian children. Journal of Medicine and Biomedical Research, 11, 88-94.
[20]	Oyedeji, G.A. (1989) The pattern of infections in children with severe protein energy malnutrition. Nigerian Journal of Paediatrics, 16, 55-61.
[21]	Rabasa, A. and Shattima, D. (2002) Urinary tract infection in severely malnourished children at the University of Maiduguri Teaching Hospital. Journal of Tropical Pediatrics, 48, 359-361. http://dx.doi.org/10.1093/tropej/48.6.359
[22]	Foxman, B. (2002) Epidemiology of urinary tract infections: Incidence, morbidity, and economic costs. American Journal of Medicine, 113, 5S-13S. http://dx.doi.org/10.1016/S0002-9343(02)01054-9
[23]	Elder, J.S. (2004) Urinary tract infections. In: Behrman, R.E., Vaughan, V.C. and Jensen, H.B., Eds., Nelson Textbook of Paediatrics, W.B., Saunders, Philadelphia, 1785-1790.