Prevalence of Urinary Tract Infection among Children of Primary Schools in Nablus

Urinary Tract Infection (UTI) is a serious bacterial infection causing illness in infants and children. UTI is defined by a combination of clinical features and the presence of bacteria in urine، or it is the presence of more than 100،000 cfu/ml after doing urine culture، regardless to symptoms. Clinical symptoms of UTI usually include frequency، dysuria، abdominal pain، back pain، fever، and urgency. Diagnosis of UTI relies on both urinalysis and urine culture. Most of UTI cases are caused by gram negative bacteria such as Escherichia coli . UTI must be recognized and treated rapidly with an appropriate antibiotic to minimize any morbidity،mortality، and renal damage from acute UTI. Management of UTI in children faces the problem of the emergence of resistant of uropathogens to commonly used antibiotics for the treatment of UTI. Antibiotics are not recommended for initial empirical therapy، when their resistance rate ?10- 20%. This cross sectional study was conducted to measure the prevalence of UTI among children in primary schools in Nablus district، West Bank،Palestine، to identify microorganisms responsible for UTI، to explore sensitivity patterns of identified microorganisms to certain antibiotics used in the treatment of UTI، and to study the relation between some demographic variables and UTI. This study was conducted in the period between February and May 2009، included 1462 children in the age group from 6-12 years. This study utilized two main instruments، questionnaire and urine testing (urinalysis and urine culture). The response rate in this study was 95.35% (1394/1462)، from which 58 cases were excluded for taking antibiotics at the time of doing the test. Calculations were done on the remaining 1338 children (719 girls and 619 boys). Prevalence of UTI was calculated to be 4% (54/1338)، 7.5% among girls (54/719) and 0% among boys (0/619).Gram negative bacteria were responsible for 59.25% of UTIs in comparison to gram positive bacteria which were 40.7%.Escherichia coli was the most predominant uropathogen with 51.8% (28/54) followed by Staphylococcus aurous 29.6% (16/54). All antibiotics used in this study had a resistance rate over 20%. UTI was statistically associated with the following variables; gender (p=0.0001)، fever (p=0.012)، burning sensation while urination (p=0.0001)، nocturnal enuresis (p=0.035)، and hygienic use of toilets (p=0.046). Pupils must be allowed to go to toilets up on their request during their stay at school and they must be educated on how to use the toilets by themselves in a safe and hygienic way، Urine culture is an important diagnostic tool to confirm UTI. Rules must be put on the consumption of antibiotics to limit their abuse and misuse، Physicians are asked to go back to traditional antibiotics like Trimethoprime/Sulphamethoxazole، a cheap antibiotic that showed a low resistance rate in this study over commonly used antibiotics such as Cephalosporin’s which are more expensive.