Utility of dipstick urinalysis in the diagnosis of urinary tract infections among outpatients in Mwanza and Dar es Salaam regions in Tanzania

Abstract

Abstract Background Globally, urinary tract infections (UTIs) are the leading cause of hospital visits, especially among women. In many developing countries, especially in lower health facilities, the dipstick urinalysis is the most commonly requested test, as urine culture is not routinely performed. The dipstick test can potentially reduce the number of patients who could be treated with empirical antibiotics and reduce the burden of antibiotic resistance. The current study determined the utility of dipstick urinalysis in diagnosing UTIs using urine culture as a gold standard method. Methods A cross-sectional study was conducted between July and November 2021. The study involved 1327 outpatients attending lower health centres in Mwanza (n = 678) and Dar es Salaam (n = 649) regions. The samples were subjected to dipstick urinalysis (nitrite and leucocytes) and quantitative bacterial culture. Results Of all 1326 patient samples, 808(60.9%) and 48(3.6%) were positive for urinary leucocyte and nitrite, respectively, while significant urine culture was found in 364(27.4%). leucocyte test correctly diagnosed UTI in 283 (77.75%) and nitrite test in 36 (9.89%). The leucocytes and nitrites, in combination, exhibited a sensitivity of 79.40% and NPV of 85.24% but a lower specificity of 44.96% and a lower PPV of 35.29%. Urinary leucocyte test had a higher discrimination ability to detect urinary tract infection than urinary nitrite test (AUC = 0.073, 95% CI 0.043–0.103, p < 0.001); likewise, combined results of urinary nitrite and leucocytes tests had higher discrimination ability to detect UTI than nitrite only (AUC = − 0.079, 95% CI − 0.107–0.050, p < 0.001). Conclusions In settings where culture is available, dipstick urinalysis can be a helpful screening method for reducing unnecessary urine cultures and related expenses because of its higher negative predictive value. In most low-resource settings where patients' diagnosis solely depends on clinical diagnosis and culture is not easily available, urine dipstick can decrease the risk of overuse of antibiotics. However, the combined (leucocytes and nitrites) dipstick urinalysis has a rather low positive predictive value, with approximately one-third of cases giving positive test results being truly UTI, subjecting over 65% of cases to unnecessary antibiotic treatment.