ORIGINAL

Niger J Paed 2013; 40 (3) : 278 –283

Elo-Ilo JC

Iroezindu MO

Egbuonu I

Ezechukwu CC

Chukwuka JO

Prevalence of asymptomatic

bacteriuria among pre-school

children in Nnewi, South-East

Nigeria

DOI:http://dx.doi.org/10.4314/njp.v40i3,15

Accepted : 8th January 2013

Abstract Background: Early di-

agnosis and management of uri-

nary tract infection (UTI) in

young children reduces the risk of

renal scarring and chronic renal

insufficiency. We determined the

prevalence of asymptomatic bac-

teriuria (ASB) among pre-school

children in Nnewi, South-East

Nigeria.

Methodology: This was a cross-

sectional survey involving appar-

ently healthy nursery school chil-

dren aged 3-5 years. A pre-tested,

care-giver administered question-

naire was used to obtain informa-

tion about the participants includ-

ing age, sex, history of fever and

antibiotic administration in the

two weeks preceding the study.

Following a clinical examination,

a sample of mid-stream urine was

collected from each participant for

dipstick urinalysis, and urine mi-

croscopy and culture. ASB was

Results: Out of 792 children, 417

(52.3%) were females and 375

(47.4%) were males. The mean

age of the children was 4.0 ± 0.7

years. ASB was found in 31 chil-

dren (4%). The prevalence of ASB

in females (7.2%) was signifi-

cantly higher than in males (0.5%),

p<0.001. The highest prevalence

of ASB of 5.6% occurred in the 4-

year-olds and the lowest of 2.0 %

occurred in 5 year olds, p=0.09.

The commonest bacterial isolates

among the ASB cases were

Staphlococcus aureus, 13 (40.6%);

Streptococcus faecalis, 9 (28.1%)

and Escherichia coli, 5 (15.6%).

Conclusion: Asymptomatic bacte-

riuria is commoner in female pre-

school children and S. aureus is

the commonest bacterial isolate.

Routine evaluation of female pre-

school children for bacteriuria is

recommended.

(

)

Elo-Ilo JC

Department of Paediatrics,

Federal Medical Centre,

Owerri, Imo state.

Email: elochinyere@yahoo.com

Iroezindu MO

Department of Medicine,

University of Nigeria Teaching

Hospital,

Ituku/Ozalla, Enugu

Egbuonu I, Ezechukwu CC

Chukwuka JO

Department of Paediatrics,

Nnamdi Azikiwe University Teaching

Hospital, Nnewi, Anambra State.

defined as the presence of

Key words: Asymptomatic bacte-

riuria, Pre-school children, Preva-

lence

5

≥

10 CFU/ml of urine in a partici-

pant who had no symptoms of

UTI.

3

Introduction

especially if it occurs before five years of age. About

1

0-35% of children with ASB have vesico-ureteric

3

Infection of the urinary tract is among the commonest

reflux and other renal abnormalities. It has also been

shown that there is an association between renal scarring

during childhood and increased risk of hypertension and

1

causes of diseases in childhood. It affects the entire

paediatric age group, and has been shown to be a signifi-

cant cause of morbidity and long-term complications

4

chronic renal insufficiency in later life. However, early

2

especially in the tropics and subtropics. In children,

diagnosis of UTI and prompt treatment reduces the risk

of renal impairment and₃prevents deterioration of renal

function in such children.

especially the pre-school age group, urinary tract infec-

tion (UTI) could be symptomless otherwise known as

asymptomatic bacteriuria (ASB). When symptoms are

3

present, they are usually vague and non-specific, and

may not be referable to the urinary tract. It may there-

fore escape diagnosis by the primary care physician.

Urine microscopy/culture is not routinely carried out in

the evaluation of apparently healthy children especially

in resource-limited settings. This poses a challenge to

the identification of children with ASB and further com-

promises the benefits of timely intervention to prevent

possible renal damage. We carried out a cross-sectional

survey to determine the prevalence of ASB in a large

3

Asymptomatic bacteriuria may be followed by sympto-

matic UTI. Whether symptoms are present or not, renal

damage and scarring occur in a number of patients

2

79

population of pre-school children in Nnewi, South-East

Nigeria.

Where N = minimum sample size, Z= constant at 95%

confidence interval= 1.96, P= Prevalence of ASB from a

previous study in South-East Nigeria= 2.1% , Q = (1 –

7

P) = 1- 0.103 = 0.897, δ=precision allowed=0.05. In

consideration of a 10% attrition rate in the pilot study,

the sample size was increased to 825. The schools in

each quarter of the town were listed and two schools

were randomly selected by balloting. In each school

selected, the school register was used to stratify the

nursery school population into 3, 4 and 5 years age

strata, and each age stratum was further divided into

male and female sub-groups.

Materials and Methods

Study design and population

This was a cross-sectional study conducted in Nnewi

town, Anambra State in South-East Nigeria. The popula-

tion of the town at the time of the study was about

5

1

21,065. The inhabitants of Nnewi are predominantly

Ibos and their occupation is mainly trading and subsis-

tence farming, with few public servants. As at the time

of this study, the town had four geographical quarters

with 49 local government-approved nursery schools all

of which were privately owned. The study duration was

between February and April, 2004. Eight nursery

schools, two from each quarter of the town were

randomly selected.

The study population comprised apparently healthy

nursery school children aged 3-5 years as at their last

birthday, who met the inclusion criteria. Only children

who were toilet trained and off nappies were enrolled.

Children with fever, body swelling or symptoms sugges-

tive of genitourinary abnormalities were excluded from

the study. In addition, malnourished children and those

with history of antibiotic use in the preceding two weeks

of the study were also excluded.

Data Collection

Information obtained with the questionnaires included

date of birth/age, sex, history of fever and antibiotic

administration in the preceding two weeks. Data collec-

tion lasted for an average of 10 days in each school. This

period was used for the selection of the subjects, distri-

bution and retrieval of the questionnaires, and collection

of urine samples. The pre-tested questionnaire was ad-

ministered to the parents/guardians of the pupils as they

brought or collected their wards from school. For the

few of them that could not be directly reached by the

researchers, the questionnaires were administered

through the child’s teacher. The parents/guardians were

encouraged to complete the questionnaires at home and

to return them the subsequent day. Those who were not

literate were assisted with translation by the class teach-

ers before the questionnaires were completed.

Permission for the study was obtained from the Ethical

Committee of the Nnamdi Azikiwe University Teaching

Hospital (NAUTH), Nnewi as well as Nnewi North Lo-

cal Government School Board. The headmaster/

headmistress of each selected school also approved of

the study and the project was appropriately explained to

the teachers and parents. Informed consent was obtained

from the parents/guardians of the children.

A clinical examination was performed on each of the

participants with emphasis on anthropometry (height

and weight), axillary temperature, general physical ex-

amination, and features of renal disease such as facial

puffiness, oedema, renal angle tenderness and ballotable

0

kidneys. ₈Axillary temperature of ≥37.5 C was regarded

as fever. Weight was measured using a scale with a

sensitivity of ± 50 g. The scale was checked for zero

error and standardization was done with standard weight

before using it. The values of the weight and height were

compared with standards according to the National Cen-

tre for Health Statistics charts in order to exclude those

who were malnourished.

Pilot Study

A pilot study was conducted in December, 2003 on 30

pupils randomly selected from a nursery school in one

of the quarters of the town. Questionnaires were admin-

istered to the parents/guardians of the 30 pupils and

were self-completed at home. Another 30 randomly se-

lected pupils had their parents/guardians interviewed

using researcher-administered questionnaires. The re-

sponses were compared and there was no significant

difference between the self-completed responses and the

responses from the researcher-administered question-

naires. Based on this, it was concluded that the question-

naire was understood and could easily be completed at

home by the care-givers. Data obtained from the pilot

study were not included in the main study.

A sample of mid-stream urine was collected from each

participant with the help of the class teacher into previ-

ously labeled sterile universal bottle containing boric

acid crystals. In females, the class teachers parted the

labia during micturition and in all subjects it was en-

sured that the specimen bottle did not come in contact

with the perineum, external genitalia or adjacent skin to

avoid contamination. The urine samples were trans-

ported to the microbiology laboratory within two hours

of collection for immediate analysis. The urine speci-

mens were divided into two aliquots. One aliquot was

used for dipstick urinalysis while the second aliquot was

used for microscopy and culture.

Sample size and Sampling

A minimum sample size of 750 subjects was calculated

using the formula for cross-sectional surveys:

6

N =

2

80

Laboratory investigations

Statistical analysis

Dipstick urinalysis

Data analysis was carried out using the Statistical Prod-

uct and Service Solutions (SPSS) version 15. Means (±

SD) and proportions were used to describe continuous

and categorical variables respectively. Differences be-

tween proportions were tested using Yates’s corrected

chi square test or Fisher’s exact test. Statistical signifi-

cance was set at p <0.05.

Dipstick urinalysis was done on one aliquot of uncentri-

fuged urine using multistix 10SG (Bayer incorporations,

USA) which is capable of testing for ten different

parameters including protein, pH, glucose, specific

gravity, leucocytes, urobilinogen, bilirubin, ketones,

nitrites and blood.

Urine microscopy

Ten milliliters of urine specimen from each participant

was centrifuged in a test tube at 3,000 revolutions per

minute (rpm) for five minutes. The supernatant fluid

was decanted and the remaining contents were shaken to

mix and a wet preparation made with one or two drops

of the sediment. The slide was examined under high

power objective of a microscope for white blood cells,

red blood cells, bacteria debris and casts. The leucocyte

count per high power field was taken as the average

value from at least four high power fields.

Results

Age and sex distribution of the children

Table 1 shows the age and sex distribution of the study

participants. Out of 825 children enrolled, 33 had inade-

quate data for analysis leaving a total of 792 children.

Out of 792 children, 417 (52.3%) were females and 375

(47.4%) were males. The ages of the children ranged

from 3 to 5 years, with a mean age of 4.0 ± 0.7 years.

Across all ages, there were more females than males but

the difference was not statistically significant, p=0.62.

Urine culture, colony count and bacterial identification

Urine culture was carried out by simultaneous plating of

blood agar and MacConkey agar plates. Before inocula-

tion of the urine, there was prior incubation of the plates

Table1: Age and Sex distribution of all the children studied

Age (years) Male n (%) Female n (%)

Total n (%)

0

at 37 C for 30 minutes to dry the surface and eliminate

3

108 (28.8)

155 (41.3)

112(29.9)

375(100)

114 (27.3)

165(39.6)

138(30.1)

417(100)

222(28.0)

320(40.4)

250(31.6)

792(100)

contamination. The inoculated plates were incubated

0

aerobically at 37 C for 18-24 hours, after which the

4

9

colonies were counted using the Kass criteria. Bacterial

5

identification was done using various methods including

the appearance of the colonies, gram staining and stan-

dard biochemical methods. The Biochemical methods

included triple sugar iron, oxidase, coagulase, urease

and indole tests. Gram staining was used to classify the

bacteria into gram positives and gram negatives.

Total

2

χ =0.96, p=0.62

Prevalence of asymptomatic bacteriuria and colony

counts

The prevalence of ASB and colony counts is shown in

Table 2. Thirty two of the 792 urine samples had colony

counts ≥ 10 CFU/ml and all qualified as ASB giving a

Case definitions

5

9

The following case definitions were applicable:

prevalence of 4.0%. Fourteen urine samples had bacte-

4

5

rial growth between 10 and 10 CFU/ml while 62 urine

•

Significant pyuria was defined as the presence of

five or more leucocytes per high power field

4

samples had colony count of <10 CFU/ml. Six hundred

and eighty four urine samples (86.4%) were sterile.

(

≥5 WBC/hpf).

Significant bacteriuria was regarded as bacteria

5

counts of ≥10 colony forming units per ml

Table 2: Urine colony counts in the study population

(

CFU/ml).

Colony count (CFU/ml)

N=792 n (%)

32(4.0)

•

Negative culture was defined as bacteria counts of

<

Asymptomatic bacteriuria was said to be present

5

4

10 CFU/ml.

>10 (ASB)

4

5

1

0 -₄10

14(1.8)

62(7.8)

5

<10

when a urine sample contained ≥10 CFU/ml of

urine in a participant who had no symptoms of UTI.

Sterile

684 (86.4)

ASB= Asymptomatic bacteriuria, CFU= Colony forming units

•

Contaminated sample: culture plates with colony

4

5

counts of > 10 but <10 CFU/ml growing two or

more organisms. For contaminated samples, the

urine culture was repeated with a fresh specimen

collected from the pupil concerned within 48 hours.

Table 3 shows the sex and age distribution of

participants with ASB. Of the 32 children with ASB; 30

(

93.7%) were females and 2 (6.3%) were males. The

prevalence of ASB in females (7.2%) was significantly

higher than in males (0.5%), p<0.001. The highest

prevalence of ASB of 5.6% occurred in the 4-year-olds

2

81

and the lowest of 2.0 % occurred in 5 year olds but the

difference in the prevalence of ASB across the ages was

not statistically significant as p=0.09.

Escherichia coli, 5(16.7%), Klebsiella species, 3(10%),

and Pseudomonas aeruginosa, 2 (6.7%).

Fig 2: Frequency of the bacterial isolates from the 32 children

Table 3: Distribution of asymptomatic bacteriuria by age and

with ASB

sex

Asymptomatic bacteriuria

Yes

n (%)

No

n (%)

2

Variable

Total

χ

p-value

<0.001

Sex

Female

Male

Total

Age (years)

3

4

5

30 (7.2)

2 (0.5)

32

387 (92.8)

373 (99.5)

760

417

375

792

21.1

4.8

9 (0.04)

18 (0.06) 302 (0.94)

5 (0.02)

32

213 (0.96)

222

320

250

792

0.09

245 (0.98)

760

Total

Bacterial isolates from children with ASB

Gram positive organisms were the predominant bacterial

isolates, responsible for 22 (68.8%) of the cases of ASB

while gram negatives were responsible for 10 (31.2%) of

the cases. The two (100%) males with ASB had

gram-positive organisms while 20 (62.5%) out of the 30

females with ASB had gram positive organisms.

The remaining 10 (31.3%) females had gram negative

organisms.

Urinalysis and microscopy result of children with ASB

The dipstick urinalysis showed that 26 (81.3%) of the

children with ASB had an acidic urine; 4 (12.5%) had

alkaline urine while 2 (6.2%) had neutral urine. Tests for

nitrites and leucocytes esterase were negative in all the

subjects with ASB. There was neither blood nor glucose

in their urine. Two (6.2%) of the bacteriuric children had

Figure1 shows the Gram staining distribution of the

organisms according to age. Gram positive organisms

were predominant across all ages, 80% in children aged

1

+ of protein while 3 (9.4%) had trace of protein. Only

5

years, 66.7% in the 4 year olds and 66.7% in the 3

one child (3.1%) had protein of 2++. Pyuria (≥5 WBC/

hpf) was seen in only one female subject (3.1%) who

had 7 WBC/hpf. The majority of the children with ASB

had between 1-3 WBC/hpf while the remaining subjects

had no white cells at all. There was no cast in all the

cases but uric acid crystal was demonstrated in 2

year olds. The difference in the rate of gram positive

organisms was not statistically significant across the

2

ages, χ =4.76, p=0.09.

Fig 1: Gram staining distribution of the organisms according

to age

(

2

6.25%) subjects and calcium oxalate crystal in another

subject (6.25%).

Discussion

In this cross-sectional survey, we determined the preva-

lence of ASB in pre-school children in Nnewi, South-

East Nigeria. The prevalence of ASB was found to be

+

_

4

%. The prevalence of ASB in this study agrees with

previous reports of about 3-6% in studies carrie₁₀d_-₁₂out

both outside Nigeria and within the country. In

Europe, Nebigel et al documented a prevalence of

1

0

11

.8% amongst pre-school children while Oner et al

12

5

reported a prevalence of 3.3%. Eyong et al studied pre

-school children in Calabar, Nigeria and found a preva-

lence of 5.6%. Similarly, an₁A₃ SB prevalence of 7.3%

was reported by Jombo et al in a study of pre-school

children in Calabar, Nigeria.

The bacterial isolates in the children with ASB is shown

in Fig. 2. The commonest organisms were Staphlococ-

cus aureus, 13 (40.6%); Streptococcus faecalis,

Contrarily, some authors have reported ASB prevalence

rat₁e₄s much higher than what we found. Kondapaneni et

al reported ASB prevalence of 16.5% among 200

9

(28.1%) and Escherichia coli, 5(15.6%). The two

males with ASB had either of Streptococcus faecalis and

Staphylococcus aureus isolated from their samples. The

organisms isolated in the females were Staphlococcus

aureus 12 (40%), Streptococcus faecalis, 8 (26.7%),

15

school children in India while Salem et al documented

a rate of 30% in Egyptian children. In Nigeria, reports of

higher ASB rates include 10.3% by Iduoriyekemwen et

2

82

1

6

17

al and 15% by Wogu et al both in Benin City, and 48

matter. Conversely, some studies in Nigeria involving

pre-school children reported no gender difference in the

prevalence of ASB despite the₁₃_,s₁l₈ight female preponder-

ance in their study population.

18

by Alo et al in rural primary school children in

%

Ebonyi State.

The higher ASB prevalence in the above studies can be

explained by a number of reasons. Some of the studies

In this study, Staphylococcus aureus (40.6%) was found

to be the most predominant bacterial isolate, followed

by Streptococcus faecalis (28.1%), Escherichia coli

(15.6%), and Klebsiella spp (9.4%). Staphylococcus

aureus has been reported as the predominant organism

among children with ASB by some authors inclu₁d₈ing

1

4-17

involved relatively lower sample siz₁₅es of 100-200.

In addition; Iduoriyekemwen et al included a large

number of infants who are known to have a hig₅her pre-

1

disposition to UTI. The fact that Salem et al studied

children with typ₆e 1 diabetes and the subjects of Iduori-

1

23

yekemwen et al were all HIV-infected children could

Frank-Peterside in Port Harcourt and Alo et al in

have also contributed to the high values they found.

While our study was carried out in the community, those

Ebonyi State, Nigeria where it was isolated in 30% and

43.6% of cases respectively. The Predominance of S.

aureus among the bacterial isolates in this study is in

contrast with most reports from outside and within Nige-

ria where gram negative organisms dominated with Es-

1

5

16

of Salem et al and Iduoriyekemwen et al were hospi-

tal-based studies and as such the children are considered

to have a higher risk of UTI or sample contamination.

Th₈e very high ASB rate of 48% documented by Alo et

1

1, 12,

c₁₆h_,e₂₂richia coli being the most prevalent organisms.

1

al could be attributed to the fact that the study was

carried out among children in a rural area who are

known to have a low level of hygiene and poor health

consciousness. Although most of the authors did not

indicate the time between urine collection and its analy-

sis, time lag between the two processes may also ac-

count for higher ASB rates in some of the studies due to

higher false positive results. On the other hand, some

other authors documented ASB prevalence rates much

lowe₁r₉than what we found; 0.1₂2₀% and 0.37% by Joseph

et al in India and Yayli et al in Turkey respectively.

Decline in the predominance of Escherichia coli as the

causative agent of UTI has been attributed to improve-

2

4

ment in the use of culture media such as MacConkey.

This culture medium acts as a selective and differential

medium for gram negative bacilli. This greatly enhances

the separation of groups of organisms into their respec-

tive genera and their appropriate species. MacConkey

and nutrient agar media were employed in this study and

they would have enhanced better differentiation and

identification of the organisms isolated. Furthermore,

decline in E. coli predominance with a shift to S. aureus

has been attributed to the indiscriminate use and mi₂s₅use

of antibiotics and emergence of resistant organisms.

2

0

Compared to our study, Yayli et al screened a much

larger population of 10,289. In addition, the participants

in both studies were older children of 5-14 years who

are known to be less predisposed to UTI. While it can be

argued that the better level of hygiene in developed

countries such as Turkey may be contributory to the low

Significant pyuria defined as the presence of at least 5

WBC/hpf of centrifuged urine in this studywas found in

one bacteriuric female child. This suggests the unreli-

ability of pyuria alone as an indicator of ASB_,₂₆. In agree-

2

0

ASB rates among the participants of Yayli et al , the

same cannot be said for India which is a developing

country. A number of studies in Nigeria including those

involving older children have also₇r_,e₂p₁orted lower

prevalence of ASB of about 1-2%.

1

ment with our observation, some authors share the

same opinion that pyuria is a poor indicator of bacteri-

uria, and that the absence of pus cells does not rule out

2

6

There was no statistically significant difference in the

prevalence of ASB across various ages in this study.

However, the highest rate of ASB occurred amongst the

significant bacteriuria. Dogunro in Port Harcourt noted

that only 1.7% of school children aged 4-15 years had

both significant bacteriuria and significant pyuria.

The clinical importance of ASB in children goes beyond

its prevalence. It is its predisposition to renal scarring

that makes it a critical issue. In one of the studies where

ASB prevalence was found to be low, detailed investiga-

tions showed that a reasonable propor₁t₉ion of affected

children had evidence of renal damage. In developing

countries with poor hygienic conditions, ASB remains a

big challenge amongst pre-school children. Incidentally,

diagnostic facilities are inadequate in these settings and

children with ASB who later develop renal damage may

not be identified early enough for appropriate interven-

tions aimed at halting or reversing renal damage. This

means that health education on improved hygiene and

screening for ASB in young children remains the eco-

nomically viable option.

4

year olds (5.6%), followed by the 3 year olds (4.1%).

The 5 year olds recorded the lowest rate of 2.0%. This is

1

0

similar to the findings of Nebigil el al who recorded

the highest prevalence of ASB in the pre-school age

group among the 2,591 children aged 1 day to 16 years.

The relatively higher prevalence of ASB in younger

children can be explained by the fact that this age coin-

cides with the period of toilet training when the child is

more predisposed to urinary tract infection from faecal

contamination.

In this study, the prevalence of ASB was significantly

higher in females (7.2%) than in males (0.5%) giving a

male to female ratio of 1:15. The female predominance

was consistent across all ages. Similarly, other authors

have recor₁d₆e_,₁d₇_,₂f₂e_. male predominance among children

with ASB.

This observation is attributed to the

short female urethra, which is in close proximity to the

anus from which it can be easily contaminated by faecal

Our study had some limitations. We were unable to

carry out radiological investigations for children with

2

83

significant bacteriuria. This would have helped in deter-

mining the presence and extent of renal pathology as

well as the co-existence of congenital or structural

urogenital abnormalities in these children.

unwanted consequences of bacteriuria and its higher

prevalence in females, all female pre-school children

should be routinely evaluated for bacteriuria as part of

the school health programme.

Conflict of Interest: None.

Funding: None.

Conclusion

In conclusion, ASB remains an important problem in pre

-school children. The prevalence of ASB was signifi-

cantly higher in females, being 15 times that of their

male counterparts. Gram positive organisms were the

predominant isolates among children with ASB with S.

aureus and S. faecalis accounting for over 68% of the

cases. Escherichia coli which has been widely reported

to be the predominant isolate in many studies was

Acknowledgement

We are grateful to the pupils and their parents/guardians

for participating in this study. The headmasters/

headmistresses and the teachers of the eight Nursery

schools where the study was carried out are deeply

appreciated for their contributions.

responsible for only 15.6% of the cases. In view of the

References

1

.

Brkic S, Mustafic S, Nuhbegovic

S, Ljuca F, Gavran L. Clinical and

epidemiology characteristics of

urinary tract infections in child-

hood. Med Arh 2010; 64(3): 135-

11. Oner YA, Ahangari T, Artinyan E,

18. Alo M, Elom M, Anyim C, Okeh

EN. Asymptomatic urinary tract

infection among school children in

rural area of Ebonyi State. Annals

of Bio Res 2012; 3(5): 2353-6.

19. Joseph TP, Streekumaran MI. As-

ymptomatic bacteriuria in school

children. India J Pediatr 1989; 56:

121 – 3.

20. Yayli G, Yaman H, Demirdal T.

Asymptomatic bacteriuria rates in

schoolchildren: Results from a

rural city in Turkey. J Trop Pediatr

2003; 49(4): 228-30.

21. Onifade EU, Grange AO. Preva-

lence of asymptomatic proteinuria

among a rural and healthy child-

hood population. Nig J Paediatr

1997; 24: 14-9.

22. Kumar CSV, Jairam A, Chetan S,

Sudesh P, Kapur Srikaramallya.

Asymptomatic bacteriuria in

school going children. India J Med

Microbiol 2002; 20: 29 – 32.

23. Frank-Peterside N, Wokoma EC.

Prevalence of asymptomatic bacte-

riuria in students of university of

Port Harcourt demonstration sec-

ondary school. J Applied Sci and

Env Management 2009; 13: 55-8.

24. Eliegbe IA. Bacteriuria in some

Nigerian pediatric population. J

Trop Pediatr 1986; 32: 69-71.

25. Ibadin MO. Childhood urinary

tract infection in Benin City:

Pathogens and antimicrobial sensi-

tivity pattern. J Med and Biomed

Res 2002; 1: 22-8.

26. Dongunro AS. A comparative

study of pyuria and asymptomatic

bacteriuria in school children. Trop

Doct 1991; 1: 26-8.

Oz V, Kocazeybek B. A research

on asymptomatic bacteriuria in 14-

to 17-year-old female students.

Urol Int 2004; 73: 325-8.

12. Eyong KI, Anah MU, Udo JJ,

Jombo GTA, Ewa AU, Etuk IS,

Asindi AA. An evaluation of leu-

kocyte esterase activity as a rapid

screening test for significant bacte-

riuria in children. J Clin Med Res

2011; 3(2): 23-7.

13. Jombo GTA, Odey F, Ibor S, Bo-

larin DM, Ejezie GC, Egah DZ,

Okwori EE, Enenebeaku MNO,

Alao OO. Subclinical significant

bacteriuria among pre-school chil-

dren in Calabar municipality: A

survey. J Med Med Sci 2010; 1(4):

134-40.

14. Kondapaneni SL, Surpam R, Mohd

Azaruddin, Devi G. Screening for

asymptomatic bacteriuria in school

-going children. Indian J Pub

Health 2012; 56(2): 169-70.

15. Salem MA, Matter RM, Abdel-

maksoud AA, El Masry SA. Preva-

lence of asymptomatic bacteriuria

in Egyptian children and adoles-

cents with type 1 diabetes mellitus.

J Egypt Soc Parasitol 2009; 39(3):

951-62.

8

.

2

.

Taneja N, Chatterjee SS, Singh M,

Singh S, Sharma M. Pediatric uri-

nary tract infections in a tertiary

care center from North India. In-

dian J Med Res 2010; 131: 101-5.

Bartowski DP. Recognizing UTIs

in infants and children: early treat-

ment prevents permanent damage.

Post Grad Med 2001; 109: 171-81.

Park YS. Renal scar formation

after urinary tract infection in chil-

dren. Korean J Pediatr 2012; 55

3

4

.

(

10): 367-70.

National Population Commission

001 (Nnewi North Local Govern-

5

6

.

2

ment Area).

Araoye MO. Sample size determi-

nation. In: Research Methodology

with statistics for health and social

workers. Nathadex Publishers

Ilorin 2004; 115-21.

Okafor HU, Ibe BC, Njoku–Obi

ANC, Okoro BA. Bacteriology of

asymptomatic bacteriuria in pre-

school children in Enugu. Orient Jour-

nal of Medicine 2005; 17: 37-42.

Mava Y, Ambe JP, Bello M,

Watila I, Pius S. Evaluation of the

nitrite test in screening for urinary

tract infection in febrile children

with sickle cell anaemia in

7

.

8

.

16. Iduoriyekemwen NJ, Sadoh WE,

Sadoh AE. Asymptomatic bacteri-

uria in HIV positive Nigerian chil-

dren. J Med and Biomed Res 2012;

11: 88-94

17. Wogu MD, Ogbebor NE. Preva-

lence of Asymptomatic bacteriuria

in secondary school students in

Benin City. Afr Res Rev 2011; 5

(4): 145-51.

Maiduguri- Nigeria. Niger Med J

2

011; 52(1): 45-8.

9

1

.

Kass EH. Asymptomatic infections

of the urinary tract. Trans Assoc

Am Phy 1956; 69:56-64.

0. Nebigil I, Tumer N. Asymptomatic

urinary tract infection in childhood. Am

J med 1983; 75: 53-5.