A condition marked by headaches, respiratory problems, etc affecting office workers, attributed to factors such as poor ventilation in the work environment The C oncise Oxford Dictionary.

APPENDIX II

EXTENSION OF APPROVAL DATE

APPENDIX III

INFORMED CONSENT FORM

URINARY TRACT INFECTION IN FEBRILE UNDER-FIVES SEEN AT THE UNIVERSITY OF CALABAR TEACHING HOSPITAL, CALABAR, NIGERIA TO PARENT/GUARDIAN

Dear Sir/Madam,

I am a Resident Paediatrician (a doctor that cares for and treats children) working in UCTH.

I wish to let you know that your child/ward has been selected to participate in a study entitled, “Urinary tract infection in febrile under-five children attending the Children Emergency Unit of University of Calabar Teaching Hospital Calabar, Nigeria”

The urinary tract is a common site of infection in infants and young children. Urinary tract infections (UTIs) can damage the kidney and lead to problems like hypertension and chronic renal failure later in life. Children below five years of age are more at risk of this problem.

Prompt detection and treatment of UTI in these children will prevent these complications.

Hence this study is aimed at providing useful knowledge towards detection, treatment and prevention of UTI in children.

Every child selected to participate in this exercise shall be examined by a doctor and urine samples taken for analysis. The procedure shall be harmless and at no extra cost to the parents. You are free to decide whether your child/ward should participate in this exercise or not after reading/understanding the information provided in this sheet or the verbal explanation if you are unable to read. If you are unable to sign; your thumbprint will be obtained in lieu of your signature.

Refusal to allow your child or ward participate in this exercise will not have any negative effect on the child whatsoever and will not affect treatment.

APPENDIX IV

VOLUNTARY PARTICIPATION:

URINARY TRACT INFECTION IN FEBRILE UNDER-FIVES SEEN AT THE UNIVERSITY OF CALABAR TEACHING HOSPITAL, CALABAR, NIGERIA I ---parent/guardian of ---have carefully read the information provided to me and fully understand all the points. I hereby consent to my child’s/ ward’s participation in the exercise.

Residential Address: ---

Patient/Parent’s Consent: Written Not obtained Withdrew consent

Parent/Guardian’s signature: ---Doctor’s signature: ---

Parent/Guardian’s thumbprint:

Name of witness: --- Witness’s signature: --- APPENDIX V

Questionnaire on Urinary tract infection in febrile Under-fives seen at the UCTH, Calabar Nigeria

SECTION A: BIODATA & SOCIODEMOGRAPHIC FACTORS - To be completed by parent of children (Please tick or write as appropriate)

1. Name:----Phone No: ---

2. Age at last birthday: --- Gender: a) Male b) Female 3. Father’s Occupation: a) Civil servant b) Public servant c) Businessman

d) Company Staff e) Student f) Unemployed g) Others: ---

4. Mother’s Occupation: a) Civil servant b) Public servant c) Businesswoman

d) Company Staff e) Student f) Unemployed g) Others: ---

5. Highest education level attained by father: a)None b) Primary c) Secondary d) Tertiary

6. Highest education level attained by mother: a) None b) Primary c) Secondary d) Tertiary

7. What is your average monthly income? a)<N50,000 b) 51,000 – 100,000 c) N101,000 – 300,000 d) >N300,000

8. Which Ethnic group do you belong to? a) Efik b) Ejagam c) Ibibio

d) Ibo e)

Others:………

9. What is your Religion? a) Roman Catholics b) Pentecostal c)Protestant

d) Muslims e) Others………

10. What is your housing type? a) Self-content b) Rented flat c) Owned house

SECTION B: SYMPTOMS (To be completed by parents) 11. Does your child have fever? Yes No

12. Is your child vomiting? Yes No

13. Does he or she complain of abdominal pains (Stomach pains)? Yes No 14. Does he or she have pain or cry while passing urine? Yes No

15. Does your child pass bloody urine? Yes No

16. Does he/she rush to the toilet each time he/she wants to urinate and sometimes wets the pants before getting to the toilet? Yes No

17. Does he/she still bed wet? (For children that have stopped bed wetting) Yes No 18. How frequent does he/she urinate? Day 1 2 3 4 >4

Night 1 2 3 4 > 4 19. Has he/she received Antibiotics within the past one week? Yes No

20. If yes, which one. a) Ampiclox b) Septrin c) Augumentin d) Erythromycin Others: ---

21. Is his/her face or legs swollen now or in the past? Yes No

22. Others symptoms (Specify):---

SECTION C:CLINICAL SIGNS (To be completed by the author)

23. Weight: ---kg. a) Normal for age b) Abnormal for age 24. Length/Height: ---cm. a) Normal for age b) Abnormal for age

25. Blood pressure: ---mmHg .a) Normal for age b) Abnormal for age

26. Oedema: Present Absent

27. Suprapubic tenderness: Yes No 28. Liver: a) Normal span b) Enlarged

29. Spleen: a) Normal size b) Enlarged

30. Kidneys: Left: a) Normal size b) Abnormal size Right: a) Normal size b) Abnormal size

SECTION D: LABORATORY TEST RESULT (To be completed by the candidate)

31. Leukocytes esterase assay (LE): a) Positive b) Negative

32. Nitrite: a) Positive b) Negative

33. Urine Culture: a) Positive b) Negative 34. Urine Culture:

a) Colony count/ml: --- b) Organism isolated: ---

35. Antibiotics Sensitivity

ANTIBIOTIC SENSITIVITY TO

ANTIBIOTIC RESISTANCE TO

APPENDIX VI

Scoring Indices For Social Class Determination

Father’s Occupation (A) Mother’s Education (B) Score 1: Professional, top civil servant,

politician and businessmen.

Score 2: Middle class bureaucrats, technicians, skilled artisans and well- to- do traders

Score 3: Unskilled workers and those in general whose income is below the national minimum wage.

Score 0: Education to university level

Score 1: Secondary or tertiary below university example; college of education,

school of nursing

Score 2: No school or schooling up to primary level only.

The scores obtained from A and B was added to arrive at the social class for each subject. For example a subject whose father is a technician (score 2) and the mother has secondary education (score 1) gets a total score of 3 which corresponds to social class III. A total score of I or 2 indicates an upper social class, a total score of 3 indicates a middle social class while a total score of 4 or 5 indicates a lower social class.

APPENDIX VII

PICTURE OF MICROBACT IDENTIFICATION SYSTEM

APPENDIX VIII

Picture of ESBL “Keyhole effect”