In a retrospective study of UTI among 54 pediatric patients in a tertiary hospital, a striking finding was that UTI seldom existed as a single condition. In 86 per cent of cases, UTI was part of other common diseases: gastroenteritis (in 35 per cent of UTI patients), protein energy malnutrition (in 43 per cent) and acute respiratory infection (24 per cent). Presenting symptoms were similar in children with or without UTI. Other features included infrequency of urinary tract signs (13 per cent), resistance of infecting organisms to first line antibiotics and urinary tract structural abnormalities in only two patients of 36 investigated by ultrasonograms; both the latter patients had easily diagnosable underlying diseases (TB spine, posterior urethral valves). These findings require confirmation by prospective studies as they may have implications for management of UTI in hospitals in developing countries.