Abstract
BACKGROUND: Pediatric urinary tract infections (UTIs) are a major source of morbidity, often leading to severe complications like renal scarring, hypertension, and chronic kidney disease if not treated promptly. In Ethiopia, current data remains sparse and fragmented across single-institution studies. This synthesis pools existing evidence to provide a comprehensive national estimate of bacterial UTI prevalence and its primary determinants. METHODS: This systematic review and meta-analysis followed PRISMA guidelines and involved a comprehensive search of PubMed, Medline, HINARI, ScienceDirect, Scopus and Google Scholar for literature published through August 15, 2025. The inclusion criteria focused on non-randomized studies reporting the prevalence of UTIs and/or associated factors among children (age < 18 years) in Ethiopia. Data were extracted using a standardized template encompassing the author, publication year, study area/setting, prevalence, study population, participant count and reported factors. Risk of bias was appraised using the Newcastle-Ottawa Scale. Statistical analysis was conducted in STATA version 17. A random-effects meta-analysis was employed to calculate pooled prevalence and Odds Ratios with 95% Confidence Intervals. Heterogeneity was quantified using the I(2) statistic, while the robustness of the findings was evaluated through subgroup and leave-one-out sensitivity analyses. To address publication bias funnel plot and a non-parametric trim-and-fill analysis was applied. Forest plots were utilized to visualize results. RESULTS: A total of 13 studies involving 3,951 children met the inclusion criteria. The pooled prevalence of bacterial UTI was found to be 23.17% (95% CI: 18.40%-27.93%). The meta-analysis of associated factors was identified history of previous UTI (OR = 2.47, 95% CI: 1.66 - 3.68), history of catheterization (OR = 2.95, 95% CI: 1.78 - 4.91) and hospital stay longer than four days (OR = 2.65, 95% CI: 1.75 - 4.00) as significant predictors of UTI. CONCLUSION: Urinary tract infections (UTIs) represent a significant clinical burden driven primarily by a history of previous infections, prior catheterization and prolonged hospital stays exceeding four days. To mitigate this risk, implementation of targeted screening protocols and evidence-based preventive measures: minimizing unnecessary catheterization and reducing hospital length of stay whenever medically feasible, is recommended to proactively lower infection rates. CLINICAL TRIAL: Not applicable.