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Suprapubic aspiration (SPA) was compared with midstream urine collection (MSU) in the diagnosis of urinary tract infection (UTI) in a busy paediatric out-patient department in Northern Nigeria, where usually only one specimen can be taken before starting antimicrobial therapy. SPA in 287 children was compared with 175 MSU collections. Urine was obtained at the first attempt in 260 (91%) SPA's which were easy to perform and safe. MSU collections were more difficult, particularly in the younger child. In 51 cases MSUs were compared with SPAs taken immediately before, and gave an accurate indication of urine infection with no false negative or positive cultures. It is concluded that when only one urine specimen can be collected before starting antimicrobial therapy, a single MSU specimen gives an adequate result if correctly collected and plated out. When accuracy of diagnosis is essential or if a MSU cannot be obtained, SPA is indicated. A white cell count on unspun urine proved to be the most successful sideroom test for urinary tract. Counts in excess of ten cells per mm3 were found in 62% of patients with positive cultures.

A survey of urinary tract infections (UTI) was conducted in a paediatric out-patient department in Northern Nigeria over six months. The most common presenting complaints of UTI were pyrexia of unknown origin (PUO) and mild diarrhoea. The frequency of symptomatic UTI in out-patients was estimated at 0.4%. Asymptomatic UTI was common in children with nephrotic syndrome (16%) and severe malnutrition (23%). Abnormalities of the urinary tract were found on I.V.P. in four out of twelve boys and one out of nine girls with symptomatic infection. Micturating cystograms (MCUG) were of less value because even if severe ureteric reflux was found, long term follow-up was not practical. Follow-up could be maintained with greater success from local clinics.