A Comparative Study of Knowledge, Attitude and Practice among Pediatricians and General Practitioners toward Urinary Tract Infection in Children

Document Type : Original Article (s)

Authors

1 Associate Professor, Department of Pediatrics, Child Health Promotion Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Associate Professor, Behavioral Sciences Research Center, Medical Education Research Center (MERC), Isfahan University of Medical Sciences, Isfahan, Iran

3 Student of Medicine, Student Research Committee, Child Health Promotion Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

4 Lecturer, Medical Education Research Center, Department of Medical Education, Isfahan University of Medical Sciences, Iran

5 Assistant Professor, Department of Pediatrics, Child Health Promotion Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Urinary tract infection (UTI) is not uncommon in infants and children. Delayed initiation of empiric therapy may be accompanied with severity of infection and high likelihood of kidney scars leading to hypertension and chronic kidney disease. However, correct management could prevent these complications. There is scarce published data on knowledge, attitude and practice (KAP) of pediatricians and general practitioners (GPs) about UTI. In this survey, we aimed to compare KAP of GPs (as the first level of health system) and pediatricians (the second level of health system) considering different aspects of managing patients with UTI.Methods: In this KAP study, a 15-item questionnaire was designed by pediatric nephrologists and statisticians. The questionnaires were distributed among GPs and pediatricians who attended the continuous medical education (CME). Finally, 70 pediatricians and 149 GPs were included in our study.Findings: Mean knowledge score of GPs and pediatricians were 2.7 ± 1.2 and 3.6 ± 1.2, respectively. Mean scores of practice among GPs was and pediatricians were 2.1 ± 1.2 and 2.9 ± 1.1, respectively. There were significant differences in scores of knowledge and practice between the two groups. However, mean scores of attitude were not significantly different between GPs and pediatricians (15.1 ± 2.1 vs. 15.2 ± 1.9).  Conclusion: Controversies in UTI management, accepted references for education of GPs and pediatricians in CME courses, and patients' feedback received by pediatricians who work for higher levels of health systems make differences in KAP between pediatricians and GPs. 

Keywords

References

  1. Eckman K, Walker R. Knowledge, attitudes and practice (KAP) survey. Available from http://www.phmed.umu.se/digitalAssets/50/50461_malange-ernest-njoh---revised.pdf. 2008.
  2. Hooton TM, Stam WE. Management of acute uncomplicated urinary tract infection in adults. Med Clin North Am 1991; 75(2): 339-57.
  3. Powers RD. New directions in the diagnosis and therapy of urinary tract infections. Am J Obstet Gynecol 1991; 164(5 Pt 2): 1387-9.
  4. Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J 2008; 27(4): 302-8.
  5. Elder JS. Urinary tract infection. In: Behrman RE, Kliegman RM, Jenson HB, Stanton BF, editors. Nelson Textbook of Pediatrics. 18th ed. Philadelphia: Saunders; 2007.
  6. Roberts JA, Kaack MB, Baskin G. Treatment of experimental pyelonephritis in the monkey. J Urol 1990; 143(1): 150-4.
  7. Smellie JM, Poulton A, Prescod NP. Retrospective study of children with renal scarring associated with reflux and urinary infection. BMJ 1994; 308(6938): 1193-6.
  8. Smellie JM, Ransley PG, Normand IC, Prescod N, Edwards D. Development of new renal scars: a collaborative study. Br Med J (Clin Res Ed) 1985; 290(6486): 1957-60.
  9. Hiraoka M, Hashimoto G, Tsuchida S, Tsukahara H, Ohshima Y, Mayumi M. Early treatment of urinary infection prevents renal damage on cortical scintigraphy. Pediatr Nephrol 2003; 18(2): 115-8.
  10. Hoberman A, Charron M, Hickey RW, Baskin M, Kearney DH, Wald ER. Imaging studies after a first febrile urinary tract infection in young children. N Engl J Med 2003; 348(3): 195-202.
  11. Whiting P, Westwood M, Bojke L, Palmer S, Richardson G, Cooper J, et al. Clinical effectiveness and cost-effectiveness of tests for the diagnosis and investigation of urinary tract infection in children: a systematic review and economic model. Health Technol Assess 2006; 10(36): iii-xiii, 1.
  12. van d, V, Edwards A, Roberts R, Verrier JK. The struggle to diagnose UTI in children under two in primary care. Fam Pract 1997; 14(1): 44-8.
  13. dos Santos JC, Weber LP, Perez LR. Evaluation of urinalysis parameters to predict urinary-tract infection. Braz J Infect Dis 2007; 11(5): 479-81.
  14. Gheissari A. The place of ultrasound in renal medicine. Saudi J Kidney Dis Transpl 2006; 17(4): 540-8.
  15. Westwood ME, Whiting PF, Cooper J, Watt IS, Kleijnen J. Further investigation of confirmed urinary tract infection (UTI) in children under five years: a systematic review. BMC Pediatr 2005; 5(1): 2.
  16. Martinell J, Lidin-Janson G, Jagenburg R, Sivertsson R, Claesson I, Jodal U. Girls prone to urinary infections followed into adulthood. Indices of renal disease. Pediatr Nephrol 1996; 10(2): 139-42.
  17. Wennerstrom M, Hansson S, Hedner T, Himmelmann A, Jodal U. Ambulatory blood pressure 16-26 years after the first urinary tract infection in childhood. J Hypertens 2000; 18(4): 485-91.
  18. Wennerstrom M, Hansson S, Jodal U, Sixt R, Stokland E. Renal function 16 to 26 years after the first urinary tract infection in childhood. Arch Pediatr Adolesc Med 2000; 154(4): 339-45.
  19. Hoberman A, Charron M, Hickey RW, Baskin M, Kearney DH, Wald ER. Imaging studies after a first febrile urinary tract infection in young children. N Engl J Med 2003; 348(3): 195-202.
  20. Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. American Academy of Pediatrics. Committee on Quality Improvement. Subcommittee on Urinary Tract Infection. Pediatrics 1999; 103(4 Pt 1): 843-52.
  21. Stapleton FB. Imaging studies for childhood urinary infections. N Engl J Med 2003; 348(3): 251-2.
  22. Al-Eisa A, Al-Mosawi M, Gupta R, D'Souza TM, Sharma PN. Attitudes of General Practitioners and Pediatricians to Management of Acute Pyelonephritis in Children. Med Principles Pract 2000; 9(2): 119-24.
  23. Williams G, Sureshkumar P, Chan SF, Macaskill P, Craig JC. Ordering of renal tract imaging by paediatricians after urinary tract infection. J Paediatr Child Health 2007; 43(4): 271-9.
  24. Jadresic L, Cartwright K, Cowie N, Witcombe B, Stevens D. Investigation of urinary tract infection in childhood. BMJ 1993; 307: 761-4.
  25. Craig JC, Simpson JM, Williams GJ, Lowe A, Reynolds GJ, McTaggart SJ, et al. for the Prevention of Recurrent Urinary Tract Infection in Children with Vesicoureteric Reflux and Normal Renal Tracts (PRIVENT) Investigators - Antibiotic Prophylaxis and Recurrent Urinary Tract Infection in Children. N Engl J Med 2009; 361: 1748-59.
  26. Williams GJ, Lee A, Craig JC. Long-term antibiotics for preventing recurrent urinary tract infection in children. Cochrane Database Syst Rev 2001; (4): CD001534.
  27. Conway PH, Cnaan A, Zaoutis T, Henry BV, Grundmeier RW, Keren R. Recurrent urinary tract infections in children: risk factors and association with prophylactic antimicrobials. JAMA 2007; 298(2): 179-86.
  28. Roussey-Kesler G, Gadjos V, Idres N, Horen B, Ichay L, Leclair MD, et al. Antibiotic prophylaxis for the prevention of recurrent urinary tract infection in children with low grade vesicoureteral reflux: results from a prospective randomized study. J Urol 2008; 179(2): 674-9.
  29. Montini G, Rigon L, Zucchetta P, Fregonese F, Toffolo A, Gobber D, et al. Prophylaxis after first febrile urinary tract infection in children? A multicenter, randomized, controlled, noninferiority trial. Pediatrics 2008; 122(5): 1064-71.
  30. Garin EH, Olavarria F, Garcia N, V, Valenciano B, Campos A, Young L. Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: a multicenter, randomized, controlled study. Pediatrics 2006; 117(3): 626-32.
  31. Mattoo TK. Are prophylactic antibiotics indicated after a urinary tract infection? Curr Opin Pediatr 2009; 21(2): 203-6.
Journal of Isfahan Medical School
Volume 29, Issue 168 - Serial Number 168
November and December 2012
Pages 2457-2467

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History

  • Receive Date: 13 May 2011
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

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