Urinary tract infection and malaria co-morbidity in febrile children with sickle-cell anaemia in Sokoto, Nigeria

Abstract

BACKGROUND: Urinary tract infection (UTI) accounts for 10% to 30% of end-stage renal failure in 
children. Sickle –cell anaemia (SCA) is one of the predisposing conditions for UTI in Nigerian children. 
OBJECTIVES: The objectives of this study were to determine the prevalence of UTI and malaria co
morbidity in febrile children with SCA and to determine renal ultrasound findings in them. METHODS: 
This was a prospective cross-sectional and descriptive study conducted amongst febrile children with 
SCA (Haemoglobin SS) that presented at the sickle-cell clinic, Department of Paediatrics, Usmanu 
Danfodiyo University Teaching Hospital, Sokoto, Nigeria over a one-year period (1st July 2008 to 30th 
June 2009). The results of urine microscopy, culture and sensitivity, blood smears for malaria parasite 
and abdominal ultrasounds were analyzed, and p-value < 0.05 was considered statistically significant. 
RESULTS: Of the 259 febrile children with SCA that were studied, 72(27.8%) of them had UTI giving a 
prevalence rate of 27.8%. Uncomplicated malaria was present in 112(43.2%) of the 259 febrile children 
with SCA. Forty-five (40.2%) out of 112 that had malaria also had UTI. That is, 4 out of 10 febrile children 
with SCA with malaria may have UTI. Escherichia coli were the commonest cause of UTI in febrile 
children with SCA, in 37(51.4%). Normal renal ultrasound scans were in 228/259(88%) patients. 
Abnormal renal scans were more in those with UTI, 22/72(30.6%) compared to 4/112(3.6%) in those with 
malaria (p < 0.001). CONCLUSION: The prevalence of UTI and malaria were very high in febrile children 
with SCA. It is therefore, recommended that every febrile child with SCA and malaria should be 
investigated for UTI.