Diagnostic Accuracy of Urine Analysis in Diagnosis of Urinary Tract Infection in Malnourished Children Taking Urine Culture as Gold Standard

Abstract

Background: Urinary tract infection (UTI) is a frequent cause of morbidity in children, particularly in malnourished populations where immune compromise increases susceptibility and complications. Early diagnosis is essential to prevent renal damage; however, urine culture—the gold standard—is time-consuming and resource intensive. Urine analysis offers a rapid and economical alternative, but its diagnostic reliability in malnourished children in Peshawar remains insufficiently explored. Objective: To determine the diagnostic accuracy of urine analysis for detecting UTIs in malnourished children, using urine culture as the reference standard. Methods: The current cross-sectional validation study was carried out at the Department of Pediatrics, Lady reading Hospital, Peshawar, during the period between July 2024 and January 2025. The malnourished children who were aged 1-5 years and had suspected UTI were enrolled consecutively (290 in total). A urine sample was collected either in a clean-catch or suprapubic aspiration and placed under urine analysis and culture. Definitions of Pyuria were 10 or more WBC/mm 3 or 5 or more WBC/HPF. Sensitivity, specificity, predictive values, and accuracy were determined in terms of diagnostic indices. Results: UTI was established in 61 (21.0%) children by urine culture. Urine examination was affirmative in 86 (29.7) cases. The sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy of urine measure stood at 80.3, 83.8, 57.0, 94.1, and 83.1 respectively. Conclusion: The sensitivity of urine analysis is high and the negative predictive is good, thus, it is a sensitive screening tool to rule out UTI in the malnourished child. Nevertheless, a urine culture must confirm positive results in order to proceed with the series of antimicrobial therapy.