Frequency of Urinary Tract Infection in children presenting with Protein Calorie Malnutrition to Hayatabad Medical Complex, Peshawar

Abstract

Background: Urinary tract infection (UTI) is among the most common bacterial infections in childhood and can lead to serious complications such as renal scarring and chronic kidney disease if not detected early. Children suffering from protein calorie malnutrition (PCM) are at higher risk due to impaired immune defenses, including reduced cell-mediated and humoral immunity. In resource-limited settings like Pakistan, where malnutrition and poor hygiene coexist, the coexistence of PCM and UTI further increases morbidity and mortality. However, local data on the prevalence and bacterial pattern of UTI in malnourished children are limited. This study was conducted to determine the frequency of UTI in children with PCM presenting to Hayatabad Medical Complex, Peshawar. Methodology: This cross-sectional descriptive study was conducted in the Department of Pediatrics, Hayatabad Medical Complex, Peshawar, from November 2024 to May 2025. A total of 121 children up to 12 years of age with protein calorie malnutrition were included through non-probability consecutive sampling. Protein calorie malnutrition was defined according to the Wellcome classification as weight less than 80% of the expected for age. Urine samples were collected aseptically by suprapubic aspiration in non–toilet-trained children and by midstream clean-catch in toilet-trained children. Samples were cultured in the hospital laboratory, and a pure growth of a single organism ≥10⁵ CFU/mL was considered diagnostic of UTI. Data were analyzed using SPSS version 22. Quantitative variables were described as mean ± standard deviation (SD), and categorical variables as frequencies and percentages. Chi-square test was applied with p ≤ 0.05 considered statistically significant. Results: Out of 121 children, 68 (56.2%) were males and 53 (43.8%) were females, with a mean age of 26.8 ± 14.7 months. Urinary tract infection was confirmed in 14 (11.6%) children. Escherichia coli was the most common pathogen, isolated in 8 (57.1%) cases, followed by Klebsiella species (21.4%) and others including Proteus, Staphylococcus aureus, and Pseudomonas. A significant association was observed between UTI and poor socioeconomic status (p = 0.03) as well as incomplete vaccination (p = 0.04). The mean birth weight was significantly lower among children with UTI compared to those without infection (p = 0.05). Conclusion: Urinary tract infection is a frequent comorbidity among children suffering from protein calorie malnutrition. Escherichia coli remains the leading causative organism. Poor socioeconomic conditions, incomplete vaccination, and low birth weight are significant risk factors associated with infection. Routine screening and prompt management of UTI should be incorporated into the care of malnourished children to prevent complications and improve outcomes.