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- JOURNAL OF SCIENCE, Hue University, N0 61, 2010
SOME DETERMINANTS OF URINARY TRACT INFECTION IN CHILDREN
FROM 2 MONTHS TO 6 YEARS OLD IN HAI PHONG VIETNAM IN 2008
Dang Van Chuc, Nguyen Ngoc Sang, Dang Viet Linh
SUMMARY
This research was conducted to establish some determinants of urinary tract infections
(UTI) in children from 2 months to 6 years old in some areas of Haiphong in 2008. Method:
Cross-sectional study. Results and Conclusions: “Poverty”, “Underweight weight
malnutrition”, “Phimosis” and incorrect washing method after children have passed stools
were statistically significant with the presence of UTI using a logistic regression analysis. There
was a relationship between UTI development, poverty and poor knowledge of child hygiene.
Keyword: Urinary Tract Infection, Determinant.
1. Introduction
Urinary Tract Infections (UTI) are of interest to scientists because they can lead
to renal scarring, which causes dangerous complications when children grow up such
as: anemia, hypertension (7-17%), preeclampsia, eclampsia, renal failure and end stage
nephropathologies. Most research has been conducted in hospitals to determine the
incidence of UTI, type of bacteria and treatment effectiveness. In Vietnam, no studies
have been conducted in the community to evaluate the Prevalence rate, In particular, to
determine some risk factors of UTI. Therefore, this study was conducted with the
following objectives:
Determine some risk factors of UTI in children from 2 months to 6 years old in
some areas of Haiphong, Vietnam.
2. Methodology
2.1. Population and study time
All children from 2 months to 6 years old in some areas of Haiphong.
Study duration: 7/2007-10/2007.
Criteria of UTI: Leucocyturia ≥ 30/mm3 and bacteriuria ≥ 105/ml urine.
2.2. Method
Study location
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- 3 districts representative of Haiphong district, which were coastal, rural and
urban.
Study design
Cross-sectional and descriptive study.
Sample size was calculated according to the following formula:
p 1 p
n Z 12 /2
d2
n: Sample size
Z21-α/2 = (1, 96)2 (confidence 95%)
p = 0, 04 (UTI rate in children of Haiphong after Nguyen Ngoc Sang et al in one
commune in 2005)
d= (p*) or 20% of p
So approximately 4610 children were needed for the study.
Sampling process: Multistage sampling was used.
The 3 districts chosen were Kien An (urban), Kien Thuy (coastal) and Thuy
Nguyen (rural). The 9 communes/ quarters selected were Nam son, Trang Minh and Van
Dau (Kien An), Dai Ha, Tan Trao and Ngu Doan (Kien Thuy), Phuc Le, Lap Le and Pha
Le (Thuy Nguyen).
Data collection:
+ Identification of UTI:
We carried out screening of midstream urine of children in the morning to detect
UTIs. In the previous night and in the morning the child’s genitals were cleaned using
safe water and soap. The first urine was eliminated and 5 ml of midstream urine was
collected in a neutral tube. If the urine sample has leucocyturia ≥ 30/mm3, it was
cultured to identify bacteriuria. A UTI was identified if urine sample had both
leucocyturia ≥ 30/mm3 and bacteriuria ≥105/ml.
+ Parental interview:
Parental interview of socio-economic conditions, and the child’s history of
disease.
+ Complete examination:
Pediatricians examined children for diseases, particularly genitor-urinary
diseases. Anthropometry was completed to evaluate children’s nutritional status.
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- Data treatment:
SPSS version 13.0 was used for entering and analyzing data, determining UTI
rate and risk factors.
Cases were dependent variables and socio-economic conditions, child’s diseases
were independent variables. UTI and risk factors were associated when OR>1, p
- care of paternal
child care of
child*
Direct care 44 1.9
Remarks: Significant factors with asterisk included “maternal education level
less than secondary school”, “poverty”, “indirect paternal care of the child”. With
multivariable analysis, only “poverty” remained significant .
Table 2. The relationship of socio-economic conditions and UTIs (continued).
OR
OR Bi
Risk Multi
Exposure n Rate % 95%CI 95%CI
factors variables
variables
Indirect
Maternal 71 3.9
maternal care
1.9 1.4-2.8
care of of child*
child
Direct care 57 2.0
Stable 73 2.5
House 0.7 0.5-1.1
Unstable 55 3.3
Unhygienic
58 2.3
lavatory
Lavatory 0.65 0.4-0.9
Hygienic
70 3.4
lavatory
< 20 m2 98 2.5
House’s
0.5 0.3-0.8
square ≥ 20 m2 30 4.3
Remarks: “Indirect maternal care of the child” had a statistically significant
association with UTI in bivariate analysis but it was not significant in multivariable
analysis. Others were not significantly associated with UTI.
Table 3. The relationship between hygienic factors and UTI.
OR
OR Bi
Risk 95% Multi
Exposure n Rate % 95%CI
factors CI
variables
variables
Clean* 102 3.3
Hygiene
1.3-
after 1.9
3.0
26 1.8
Clean and
urination
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- washing
Yes* 23 5.8 1.5-
Diaper 2.4
3.8
No 105 2.5
Clean * 99 3.2
Hygiene 1.1-
1.7
Clean and
after stool 2.6
29 1.9
washing
Remark: Factors such as “Incorrect washing method after urination and Passing
stools”, and “diapers”, were significantly associated with UTI in bivariate analysis but
they were not significantly associated in the multivariable one.
Table 4. The relationship of hygienic factors with UTI (continued).
OR
OR Bi
Risk Multi
Exposure n Rate % 95%CI 95%CI
factors variables
variables
Back-
123 2.9
ward*
Way of
2.6 1.1-6.3 1.9 1.2-3.9
washing Back-
after stool ward, in 5 1.2
place
Yes 94 2.6
Kinder-
0.9 0.5-1.1
garten No 34 3.3
Yes 16 2.5
Preschool 0.8 0.5-1.4
No 112 2.8
Remark: Factors such as “incorrect washing method after urination and passing
stools” were statistically significant in bivariate and multivariable analysis. Others were
not significant.
Table 5. The relationship of child’s diseases and UTIS.
OR
OR Bi
Risk Multi
Exposure n Rate % 95%CI 95%CI
factors variables
variables
Stunting Yes * 49 3.5 1.4 1.0-2.1
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- No 79 2.4
Yes * 41 4.0
Under
1.6 1.1-2.4 1.7 1.1-3.3
weight
No 87 2.4
Yes * 26 4.7
Wasting 1.97 1.3-3.3
No 102 2.5
Yes * 30 6.6 3.7- 3.7-
Phimosis 6.6 6.7
11.9 12.2
No 19 1.0
Yes * 44 4.6
Consti
2.0 1.4-2.9
pation No 84 2.3
Yes * 81 3.3
Enuresis 1.5 1.1-2.3
No 45 2.1
Remark: Factors marked with an asterisk were significant in bivariate analysis,
including “Malnutrition of all kinds”, “phimosis”, “constipation” and “enuresis”. In
multivariable analysis, only “phimosis and “low weight malnutrition” were significantly
associated with UTIS.
4. Discussion
4.1. Socio-economic conditions and maternal education level:
Table 1, 2 showed that “poverty”, paternal education level under secondary
school”, and “indirect paternal care of child” were significantly associated with UTI.
The results revealed the relationship between poverty, ignorance and disease. People
with low education levels generally do not earn a high income later in life. Once being
poor, parents have to work hard and so they do not have enough time to take care of
their child, they are not able to get access to medical services and their child’s disease
makes them become poorer. In multivariable analysis, only “poverty” remained
significantly associated with UTI (OR = 2, 9).
4.2. Paternal practice for UTI prevention:
Table 3, 4 showed that “incorrect method of cleaning after urination”, “diapers”,
“clean after stool”, and “incorrect washing methods after stools” were risk factors of
UTIs. According to Gal and Steven Use of an incorrect hygiene method after urination
and stools helps bacteria colonize on the perineal surface and then penetrate into urinary
tract and cause UTI. In multivariable analysis, “incorrect washing method after stool
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- was significantly associated with UTI” OR =1.9.
4.3. Other accompanied diseases and genitor-urinary abnormalies:
Table 5 indicated that “malnutrition of all kinds”, “phimosis”, “constipation” and
“enuresis” was risk factors. When a child was malnourished, his immune status was
reduced so they were more susceptible to bacterial infection. Phimosis was an anchor of
bacteria that penetrated into the urinaty tract in favorable conditions. According to Gal
and Steven, when children have constipation, the urinary tract is suppressed and this
causes urinary stagnation contributing to bacterial development leading to UTI.
Enuresis contributes to good colonization of bacteria on the perineal surface and then
penetrates into the urinary tract. In multivariable analysis, “phimosis” with OR=6.7 and
“low weight malnutrition” with OR=1.7 were associated with UTI.
5. Conclusion
Risk factors such as “poverty”, “Under weight malnutrition”, “phimosis” and
“incorrect washing method” were associated with UTI using multivariable analyze. The
model revealed the relationship between UTI, poverty and a Poor knowledge of child
hygiene.
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2. Le Nam Tra et al. Malnutrition in children. Pediatric book, volume I. Hanoi Publish
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3. Braslavsky et al. Recurrence risk in infants with urinary tract infections and a negative
radiographic evaluation. J Urol 172. 2004; (4 Pt2): 1610-3.
4. Yan A et al. Adequacy of urinary tract infections management among minority
underserved children. Pediatric Nephrol 19.2004; (12): 1375-8.
5. Gal Finer et al. Pathogenesis of urinary tract infection with normal female anatomy.
The Lancet Infect Dis 4. 2004; 631-635.
6. Le Nam Tra et al. Urinary tract infection in children. Pediatric book, volume II. Hanoi
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