Screening for urinary tract infection in children with cancer.

Neutropaenia and immunosuppression place children on treatment for malignancies at a high risk for infections. We undertook to determine the prevalence of urinary tract infection (UTI) in children on treatment for cancer at the Kenyatta National Teaching and Referral hospital. With the understanding that many laboratories in the rural areas of the country lack appropriate facilities for confirmation of UTI, it was also important to evaluate simple and inexpensive screening methods against a "gold standard" in this cross sectional study. One hundred and eighty six children between the ages of five and 14 years admitted in Kenyatta hospital with leukaemia or lymphoma were enrolled. Besides clinical evaluation, urinalysis and culture and sensitivity were performed on all the subjects. Urine culture was considered the "gold standard" for diagnosis for UTI. The prevalence of UTI was 8.1% (CI = 6.1, 10.1). Only five out of 15 patients were symptomatic. E. coli and klebsiella spp. were responsible for 93.4% of the infections. Presence of pyuria, defined as five or more pus cells per high power field, had a sensitivity of 80.0%, specificity of 97.1% and a positive predictive value of 70.6% while comparative values associated with a positive nitrite test were 60%, 97.7% and 96%. Other clinical and laboratory tests had low sensitivity. UTI is a relatively frequent infection in children on cancer treatment. Screening for pyuria is simple, inexpensive and an accurate method of diagnosing UTI in children on treatment for lymphohaematopoietic malignancies in situations where facilities for urine culture are unavailable.

The effect of protein energy malnutrition on morbidity and mortality due to measles at Kenyatta National Hospital, Nairobi (Kenya).

In a study of 7,631 cases referred to the infectious diseases hospital, Nairobi with a diagnosis of measles, 7,447 cases had the diagnosis confirmed. The overall mortality was 17.5 per 1000 cases with 43.51 of all the deaths occurring in all children less than 12 months of age. A nutritional analysis revealed that children whose weight were below 80 of the Harvard median of weight for age stayed in hospital longest and had the highest mortality rate. Measles continues to offer increasing challenge in spite of the intensive vaccination programme presently being carried out.

PIP: In a study of 7631 children referred to the infectious diseases hospital in Nairobi, Kenya, between April 1982 and April 1985 with a diagnosis of measles, 7447 cases had the diagnosis confirmed clinically. Only children with some secondary complications were admitted. An attempt was made to record the age, weight, and sex of every patient. Children were then divided into age groups and their nutritional status was rated according to the Wellcome classification. The youngest child was a 2-week old neonate whose 20-year old mother had measles. The peak age was 7-12 months accounting for 39% of all children, while 9.8% were aged under 6 months. The highest morality was recorded in children aged 12 months and below who accounted for 43.5% of the deaths. The weight of 5961 (80%) children were obtained. 4872 (82%) had weight for age less than 80% of the Harvard median. 46% of 2697 children were actually marasmic (they had weight for age less than 60% of the Harvard median) and 2175 (36%) children were underweight with some having overt kwashiorkor. Patients whose weight for age was less than 60% of the Harvard median had the highest duration of hospital stay with total patient days of 4997 and a mean duration of stay of 4.0 days. The overall mortality rate was 17.5/1000 admissions. The mortality rate was highest among marasmic children with 39.6/1000 admissions. Children who were underweight had an overall mortality of 14.3/1000 admissions, while those whose weight for age was normal had a mortality rate of only 7.4/1000. The incidence of measles is still very frequent, and overcrowding in developing countries only worsens the severity of this disease. There is a need for revision of vaccination programs to provide early protection and equally as great a need to eliminate protein energy malnutrition.