1
|
Adeyemi EO, Oladele A, Ajigbotosho SO, Adaje AO, Bolaji OB, Lawal OA. A Review of Post Neonatal Paediatric Admission Pattern and Outcome in a Public Tertiary Health Facility in Nigeria. Niger Med J 2023; 64:604-611. [PMID: 38962109 PMCID: PMC11218861 DOI: 10.60787/nmj-64-5-211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2023] [Indexed: 07/05/2024] Open
Abstract
Background Admissions over the years have been largely due to preventable aetiologies and the possible outcomes are discharge, death, referral or discharge against medical advice. This study aimed to understand the patterns of postneonatal paediatric admissions and outcomes from a public tertiary health facility in South-West Nigeria. Methodology A descriptive retrospective study of paediatric admissions over a 2-year period. Information concerning age, sex, diagnosis and outcome were extracted from patients' medical records. Data was presented in numbers and percentages, Chi-square was used to compare groups and a p-value of <0.05 was accepted as significant. Results There were a total of 875 admissions, over the 24 months period, with a male-female ratio of 1.3:1. Malaria, sepsis, sickle cell crises, pneumonia, pharyngotonsilitis and acute watery diarrhoea constituted the six leading causes of all admissions. The mortality rate for all admissions was 5.0% while the under-five mortality rate was 3.9%. Seven hundred and ninety nine (91.3%) of the admitted patients were discharged, 44 (5.0%) died, 30 (3.4%) DAMA and two (0.3%) patients were referred. Conclusion A large percentage of children still die from preventable and treatable diseases. Prompt health seeking behaviour, enrollment of more citizens on insurance scheme, and adoption of the newly developed malaria vaccine will help reduce child mortality. Also, early referral of patients by private hospitals should be encouraged and paediatricians to have a high index of suspicion for the diagnosis of septicaemia.
Collapse
Affiliation(s)
| | - Ayomide Oladele
- Department of Paediatrics, Federal Teaching Hospital, Ido-Ekiti, Nigeria
| | | | - Adeline O. Adaje
- Department of Paediatrics, Federal Teaching Hospital, Ido-Ekiti, Nigeria
| | - Olufunke B. Bolaji
- Department of Paediatrics, Federal Teaching Hospital, Ido-Ekiti, Nigeria
| | - Olubunmi A. Lawal
- Department of Paediatrics, Federal Teaching Hospital, Ido-Ekiti, Nigeria
| |
Collapse
|
2
|
Abubakar Bobbo K, Ahmad U, Chau DM, Nordin N, Abdullah S. A comprehensive review of cystic fibrosis in Africa and Asia. Saudi J Biol Sci 2023; 30:103685. [PMID: 37313453 PMCID: PMC10258508 DOI: 10.1016/j.sjbs.2023.103685] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 04/30/2023] [Accepted: 05/15/2023] [Indexed: 06/15/2023] Open
Abstract
Cystic fibrosis (CF) was earlier thought to be a disease prevalent in the West among Caucasians. However, quite a number of recent studies have uncovered CF cases outside of this region, and reported hundreds of unique and novel variant forms of CFTR. Here, we discuss the evidence of CF in parts of the world earlier considered to be rare; Africa, and Asia. This review also highlighted the CFTR mutation variations and new mutations discovered in these regions. This discovery implies that the CF data from these regions were earlier underestimated. The inadequate awareness of the disease in these regions might have contributed towards the poor diagnostic facilities, under-diagnosis or/and under-reporting, and the lack of CF associated health policies. Overall, these regions have a high rate of infant, childhood and early adulthood mortality due to CF. Therefore, there is a need for a thorough investigation of CF prevalence and to identify unique and novel variant mutations within these regions in order to formulate intervention plans, create awareness, develop mutation specific screening kits and therapies to keep CF mortality at bay.
Collapse
Affiliation(s)
- Khadijat Abubakar Bobbo
- UPM-MAKNA Cancer Research Laboratory, Institute of Bioscience, Universiti Putra Malaysia, 43400 UPM Selangor, Malaysia
- Department of Human Anatomy College of Medical Sciences, Faculty of Medicine, Gombe State University, 760253 Gombe State, Nigeria
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Selangor, Malaysia
| | - Umar Ahmad
- Molecular Genetics Informatics, Department of Anatomy, Faculty of Basic Medical Sciences, Bauchi State University, 751105 Gadau, Nigeria
- Institute of Pathogen Genomics, Africa Centres for Disease Control and Prevention (Africa CDC), African Union Commission, P.O.Box 3243, Addis Ababa, Ethiopia
| | - De-Ming Chau
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Selangor, Malaysia
- Genetics & Regenerative Medicine Research Group, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Selangor, Malaysia
| | - Norshariza Nordin
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Selangor, Malaysia
- Genetics & Regenerative Medicine Research Group, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Selangor, Malaysia
| | - Syahril Abdullah
- UPM-MAKNA Cancer Research Laboratory, Institute of Bioscience, Universiti Putra Malaysia, 43400 UPM Selangor, Malaysia
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Selangor, Malaysia
- Genetics & Regenerative Medicine Research Group, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Selangor, Malaysia
| |
Collapse
|
3
|
Agbesanwa TA, Babatola AO, Fatunla OA, Ibrahim A, Aina FO, Ogundare EO, Adeniyi AT, Egbedi F, Olubamiwa T, Olanipekun B, Olatunya OS. Pattern of admissions and outcome in the children emergency department of a tertiary health institution in Southwestern Nigeria: A four-year review. Afr J Emerg Med 2023; 13:45-51. [PMID: 36864888 PMCID: PMC9970896 DOI: 10.1016/j.afjem.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 01/26/2023] [Accepted: 02/03/2023] [Indexed: 02/19/2023] Open
Abstract
Introduction Pediatrics and adolescents are susceptible to illnesses that often necessitate emergency attention. Morbidity and mortality from illnesses in these ages have attracted much interest globally, particularly in Africa. Knowledge of pattern and outcomes of admissions may guide policy and interventions especially in resource constrained settings. The study aimed to determine the pattern of admissions, outcomes and seasonal variations of conditions that presented at the children emergency of a tertiary health institution over a four-year period. Methods A retrospective descriptive study of children emergency admissions from January 2016 to December 2019. Information obtained included age, diagnosis, month and year of admission, and outcome. Descriptive statistics were used to describe the demographic characteristics and Chi-squared test to assess their associations with the diagnoses made. Results There were 3,223 admissions. There were more males (1866; 57.9%) and more toddlers (1181; 36.6%). The highest number of admissions were observed in the year 2018 (951; 29.6%) and during the wet season (1962; 60.9%). There was an overall mortality rate of 7%; complicated malaria, gastroenteritis and meningitis were the leading causes of death. Malaria (χ2 = 135.522, p value < 0.001), and gastroenteritis (χ2 = 130.883, p value < 0.001) were predominant among the toddlers while sepsis (χ2 = 71.530, p value < 0.001) and pneumonia (χ2 = 133.739, p value < 0.001) were more among the infants. Typhoid enteritis (χ2 = 26.629, p value < 0.001) and HIV (χ2 = 16.419, p value = 0.012) were commoner among the early adolescents. Conclusion The major causes of death in the study area are preventable with more of these amongst the children under the age of 5 years. There are seasonal and age-related patterns to admissions and the need for policy formulations and emergency preparations to be tailored towards these observed patterns through the year.
Collapse
Affiliation(s)
- Tosin Anthony Agbesanwa
- Department of Family Medicine, Ekiti State University/ Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti, Nigeria
| | - Adefunke Olarinre Babatola
- Department of Paediatrics and Child Health, Ekiti State University/Ekiti State Universty Teaching Hospital, Ado-Ekiti, Ekiti, Nigeria,Corresponding author.
| | - Odunayo Adebukola Fatunla
- Department of Paediatrics, Afe Babalola University/ Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti, Nigeria
| | - Azeez Ibrahim
- Department of Family Medicine, Federal Teaching Hospital, Ido-Ekiti, Ekiti, Nigeria
| | - Felix O Aina
- Department of Family Medicine, Ekiti State University/ Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti, Nigeria
| | - Ezra Olatunde Ogundare
- Department of Paediatrics and Child Health, Ekiti State University/Ekiti State Universty Teaching Hospital, Ado-Ekiti, Ekiti, Nigeria
| | - Adewuyi Temidayo Adeniyi
- Department of Paediatrics and Child Health, Ekiti State University/Ekiti State Universty Teaching Hospital, Ado-Ekiti, Ekiti, Nigeria
| | - Funmilayo Egbedi
- Department of Family Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti, Nigeria
| | - Tinu Olubamiwa
- Department of Family Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti, Nigeria
| | - Bolanle Olanipekun
- Department of Family Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti, Nigeria
| | - Oladele Simeon Olatunya
- Department of Paediatrics and Child Health, Ekiti State University/Ekiti State Universty Teaching Hospital, Ado-Ekiti, Ekiti, Nigeria
| |
Collapse
|
4
|
Eghomwanre AF, Oguntoke O, Taiwo AM. Levels of indoor particulate matter and association with asthma in children in Benin City, Nigeria. ENVIRONMENTAL MONITORING AND ASSESSMENT 2022; 194:467. [PMID: 35648237 DOI: 10.1007/s10661-022-10135-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/23/2022] [Indexed: 06/15/2023]
Abstract
The relationship between indoor particulate matter and asthma in children was assessed in this study. Forty-five (45) locations were randomly selected across the five local government areas in Benin City, Edo State, for air quality assessment. Indoor and outdoor particulates (PM1.0, PM2.5, and PM10) were monitored monthly using a handheld BLATN particulate sampler (Br-Smart-126S series). Reported clinical cases of asthma in children from 2008 to 2017 were collected from two major hospitals in the metropolis. The data obtained were analysed with SPSS for Windows version 21.0. The average concentrations of indoor and ambient PM ranged between 10.7-26.2 and 19.0-49.4 µg/m3 (PM1.0), 27.4-59.6 and 45.6-93.0 µg/m3 (PM2.5), and 33.5-67.9 and 60.9-106.1 µg/m3 (PM10) in the wet and dry seasons. PM2.5 and PM10 concentrations were observed above the WHO standards. Indoor particulate concentration was significantly (p = 0.001-0.012) higher in the dry season across the locations. Outdoor PM correlated positively (R = 0.568-0.855, p < 0.05; R2 = 0.322-0.724, p < 0.001) with their corresponding indoor PM concentration. The hazard ratio (HR) values of PM2.5 and PM10 exceeded 1 in all the sampling locations during the dry season, while the mean total hazard ratio (THR) of both PM metrics was considerably higher during the dry season than in the wet season. Indoor PM concentrations showed a significant positive correlation with reported cases of asthma (R = 0.498-0.542, p < 0.001) and accounted for 40.6% of the asthma cases during the dry season. The study showed that children in the selected households are at risk of increased asthma exacerbation due to exposure to particulate matter pollution.
Collapse
Affiliation(s)
- A F Eghomwanre
- Department of Environmental Management and Toxicology, Faculty of Life Sciences, University of Benin, Benin City, Nigeria.
- Department of Environmental Management and Toxicology, College of Environmental Resources Management, Federal University of Agriculture, Abeokuta, Nigeria.
| | - O Oguntoke
- Department of Environmental Management and Toxicology, College of Environmental Resources Management, Federal University of Agriculture, Abeokuta, Nigeria
| | - A M Taiwo
- Department of Environmental Management and Toxicology, College of Environmental Resources Management, Federal University of Agriculture, Abeokuta, Nigeria
| |
Collapse
|
5
|
Borkar NA, Ambhore NS, Kalidhindi RSR, Pabelick CM, Prakash YS, Sathish V. Kisspeptins inhibit human airway smooth muscle proliferation. JCI Insight 2022; 7:152762. [PMID: 35420998 DOI: 10.1172/jci.insight.152762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 04/12/2022] [Indexed: 11/17/2022] Open
Abstract
Sex/gender disparity in asthma is recognized, and suggests a modulatory role for sex-steroids, particularly estrogen. However, studies including our own show a dichotomous role for estrogen in airway remodeling, making it unclear whether sex hormones are protective or detrimental in asthma, and suggesting a need to explore mechanisms upstream or independent of estrogen. We hypothesize that Kisspeptin (Kp)/KISS1R signaling serves this role. Airway smooth muscle (ASM) is a key structural cell type that contributes to remodeling in asthma. We explored the role of Kp/KISS1R in regulating ASM proliferation. We report novel data that Kp and KISS1R are expressed in human airways, especially ASM, with lower expression in ASM from females compared to males, and asthmatics showing lowest expression compared to non-asthmatics. Proliferation studies showed that cleaved forms of Kp, particularly Kp-10 mitigates PDGF-induced ASM proliferation. Pharmacological inhibition and shRNA knockdown of KISS1R increased basal ASM proliferation, further amplified by PDGF. The anti-proliferative effect of Kp-10 in ASM was found to be mediated by inhibition of MAPK-ERK-Akt pathways, with altered expression of PCNA, C/EBP-alpha, Ki-67, Cyclin-D1, and Cyclin-E leading to cell-cycle arrest at G0/G1 phase. Overall, we demonstrate the importance of Kp/KISS1R signaling in regulating ASM proliferation and a potentially novel therapeutic avenue to blunt remodeling in asthma.
Collapse
Affiliation(s)
- Niyati A Borkar
- Department of Pharmaceutical Sciences, North Dakota State University, Fargo, United States of America
| | - Nilesh Sudhakar Ambhore
- Department of Pharmaceutical Sciences, North Dakota State University, Fargo, United States of America
| | | | - Christina M Pabelick
- Department of Anesthesiology and Physiology, Mayo Clinic, Rochester, United States of America
| | - Y S Prakash
- Department of Anesthesiology and Physiology, Mayo Clinic, Rochester, United States of America
| | - Venkatachalem Sathish
- Department of Pharmaceutical Sciences, North Dakota State University, Fargo, United States of America
| |
Collapse
|
6
|
Ibraheem RM, Aderemi JA, Abdulkadir MB, Johnson WBR. Burden and spectrum of paediatric respiratory diseases at a referral hospital in North-Central Nigeria - A five year review. Afr J Emerg Med 2020; 10:3-7. [PMID: 32161704 PMCID: PMC7058886 DOI: 10.1016/j.afjem.2019.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/01/2019] [Accepted: 09/04/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction Globally respiratory diseases, comprising a broad range of disease conditions due to infectious and non-infectious causes, are a major cause of childhood morbidity and mortality. Thus, identification of the burden of respiratory illness will ensure appropriate interventions towards reducing its attendant morbidity and mortality. The study was conducted to identify the burden, spectrum and outcome of respiratory diseases in hospitalized children at University of Ilorin Teaching Hospital, North-Central Nigeria. Methods A retrospective descriptive cross-sectional study involving children admitted through the emergency paediatric unit over five years (January 2013-December 2017) was conducted. Data on demography, diagnosis, co-morbidities and complications, duration of admission, and outcome were collected and analyzed using SPSS 20. Results Of the total 7012 children admitted, 1939(27.7%) were due to respiratory diseases with a median age of 16 (interquartile range {IQR} 7-36) months. Males were 994(51.3%) and 945(48.7%) females. Infectious diseases were the most common cause of admission. Pneumonia (50.1%) and aspiration pneumonitis (5.1%) accounted for the highest admissions due to infective and non-infective respiratory diseases respectively. Overall, respiratory diseases accounted for 20.7% (119/574) of the overall mortality among all admissions while the all-respiratory disease mortality was 6.1% (119/1939). The major contributors to mortality were pneumonia, aspiration pneumonitis and tuberculosis accounting for 81(68.1%), 12(10.1%) and nine (7.6%) deaths respectively. The median duration of hospital stay was four days [IQR: 2 to 6 days]. A significantly higher proportion of the deaths occurred with four days of admission and 82.4% of the deaths occurred among those aged less than five years. A higher number of females (70, 58.8%) died compared to males (49, 41.2%), p=0.05. Conclusion Pneumonia and aspiration pneumonitis are major contributors to morbidity and mortality due to respiratory diseases for which interventions towards improving childhood health indices should be prioritized.
Collapse
Affiliation(s)
- Rasheedat Mobolaji Ibraheem
- Department of Paediatrics & Child Health, University of Ilorin and University of Ilorin Teaching Hospital, PMB 1515, Ilorin, Kwara State, Nigeria
- Corresponding author at: PMB 1515 Ilorin, Kwara State, Nigeria
| | | | - Mohammed Baba Abdulkadir
- Department of Paediatrics & Child Health, University of Ilorin and University of Ilorin Teaching Hospital, PMB 1515, Ilorin, Kwara State, Nigeria
| | - Wahab Babatunde Rotimi Johnson
- Department of Paediatrics & Child Health, University of Ilorin and University of Ilorin Teaching Hospital, PMB 1515, Ilorin, Kwara State, Nigeria
| |
Collapse
|
7
|
Gurupadaswamy S, Gowda G, Athani S. A study on respiratory morbidities among school children post Diwali in Bangalore city. INDIAN JOURNAL OF ALLERGY, ASTHMA AND IMMUNOLOGY 2020. [DOI: 10.4103/ijaai.ijaai_21_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
8
|
Muhanuzi B, Sawe HR, Kilindimo SS, Mfinanga JA, Weber EJ. Respiratory compromise in children presenting to an urban emergency department of a tertiary hospital in Tanzania: a descriptive cohort study. BMC Emerg Med 2019; 19:21. [PMID: 30819093 PMCID: PMC6393970 DOI: 10.1186/s12873-019-0235-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 02/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Respiratory compromise is the leading cause of cardiac arrest and death among paediatric patients. Emergency medicine is a new field in low-income countries (LICs); the presentation, treatment and outcomes of paediatric patients with respiratory compromise is not well studied. We describe the clinical epidemiology, management and outcomes of paediatric patients with respiratory compromise presenting to the first full-capacity Emergency Department in Tanzania. METHODS This was a prospective cohort study of paediatric patients (< 18 years) with respiratory compromise (respiratory distress, respiratory failure or respiratory arrest) presenting to the Emergency Medicine Department of Muhimibili National Hospital (EMD-MNH) in Dar es Salaam, from July-November 2017. A standardized case report form was used to record demographics, presenting clinical characteristics, management and outcomes. Primary outcomes were hospital mortality and secondary outcomes were EMD mortality, 24-h mortality, incidence of cardiac arrest in the EMD, length of stay, ICU admission, and risk factors for mortality. RESULTS We enrolled 165 children; their median age was 12 months [IQR: 4-36 months], and 90 (54.4%) were male. At presentation 92 (55.8%) children were in respiratory failure. Oxygen therapy was initiated for 143 (86.7%) children, among which 21 (14.7%) were intubated. The most common aetiologies were pneumonia followed by congenital heart disease and sepsis. The majority 147 (89.1%) of children were admitted to the hospital, with 20 (12%) going to ICU. Four (2%) children were discharged from EMD and 14 (8.5%) died in the EMD. In the EMD, 18 children developed cardiac arrest, with two surviving to hospital discharge. Overall 51 (30.9%) children died; 84% of deaths were in children under five years. Risk of mortality was increased in children presenting with decreased consciousness (RR = 2.2 (1.4-3.4)), hypoxia RR = 2.6 (1.6-4.4)) or bradypnoea (RR = 3.9 (2.9-5.0)), and those who received CPR (RR = 3.7 (2.7-5.2)) and intubation (RR = 3.1 (2.1-4.5)). CONCLUSIONS In this EMD of a LICs, respiratory compromise in children carries high mortality, with children of young age being the most vulnerable. Many children arrived in respiratory failure and few children received ICU care. Outcomes can be improved by earlier recognition to prevent cardiac arrest, and more intensive treatment, including ICU and assisted ventilation.
Collapse
Affiliation(s)
- Biita Muhanuzi
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Hendry R Sawe
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania. .,Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania.
| | - Said S Kilindimo
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania.,Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Juma A Mfinanga
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania.,Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Ellen J Weber
- Department of Emergency Medicine, University of California, San Francisco, CA, USA
| |
Collapse
|
9
|
Yore MA, Strehlow MC, Yan LD, Pirrotta EA, Woods JL, Somontha K, Sovannra Y, Auerbach L, Backer R, Grundmann C, Mahadevan SV. Characteristics and outcomes of pediatric patients presenting at Cambodian referral hospitals without appointments: an observational study. Int J Emerg Med 2018. [PMID: 29536212 PMCID: PMC5849596 DOI: 10.1186/s12245-018-0172-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emergency medicine is a young specialty in many low- and middle-income countries (LMICs). Although many patients seeking emergency or acute care are children, little information is available about the needs and current treatment of this group in LMICs. In this observational study, we sought to describe characteristics, chief complaints, management, and outcomes of children presenting for unscheduled visits to two Cambodian public hospitals. METHODS Children enrolled in the study presented without appointment for treatment at one of two Cambodian public referral hospitals during a 4-week period in 2012. Researchers used standardized questionnaires and hospital records to collect demographic and clinical data. Patients were followed up at 48 h and 14 days after initial presentation. Multivariate logistic regression identified factors associated with hospital admission. RESULTS This study included 867 unscheduled visits. Mean patient age was 5.7 years (standard deviation 4.8 years). Of the 35 different presenting complaints, fever (63%), respiratory problems (25%), and skin complaints (24%) were most common. The majority of patients were admitted (51%), while 1% were transferred to another facility. Seven patients (1%) died within 14 days. Follow-up rates were 83% at 48 h and 75% at 14 days. Predictors of admission included transfer or referral from another health provider, seeking prior care for the presenting problem, low socioeconomic status, onset of symptoms within 24 h of seeking care, abnormal vital signs or temperature, and chief complaint of abdominal pain or fever. CONCLUSIONS While the admission rate in this study was high, mortality was low. More effective identification and management of children who can be treated and released may free up scarce inpatient resources for children who warrant admission.
Collapse
Affiliation(s)
- Mackensie A Yore
- Department of Emergency Medicine, UCSF Fresno Center for Medical Education and Research, 155 N Fresno St, Fresno, CA, 93701, USA.
| | - Matthew C Strehlow
- Department of Emergency Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Lily D Yan
- Department of Internal Medicine, Boston University Medical Center, Boston, MA, USA
| | - Elizabeth A Pirrotta
- Department of Emergency Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | | | - Koy Somontha
- University Research Co., LLC, Centre for Human Services, Phnom Penh, Cambodia
| | - Yim Sovannra
- GIZ-Social Health Protection Program Cambodia, Phnom Penh, Cambodia
| | - Lauren Auerbach
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Rebecca Backer
- UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | | | - Swaminatha V Mahadevan
- Department of Emergency Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| |
Collapse
|
10
|
Awotidebe TO, Awopeju OF, Bisiriyu LA, Ativie RN, Oke KI, Adedoyin RA, Olusola OD, Erhabor GE. Relationships between respiratory parameters, exercise capacity and psychosocial factors in people with chronic obstructive pulmonary disease. Ann Phys Rehabil Med 2017; 60:387-392. [PMID: 28797622 DOI: 10.1016/j.rehab.2017.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 06/22/2017] [Accepted: 06/23/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) affects respiratory functioning and psychosocial factors. However, little is known about perceived ability of people with COPD to engage in a regular exercise program. This study assessed respiratory parameters, exercise capacity, psychosocial factors and their relations in people with COPD. METHODS This cross-sectional study involved patients with COPD recruited from a Nigerian university teaching hospital. Respiratory parameters including forced expiratory volume in 1sec (FEV1) and forced vital capacity (FVC) were assessed by using a spirometer and FEV1/FVC ratio was calculated. Participants were sitting upright in a comfortable chair and wearing a nose clip for measurements. The procedure was performed in accordance with the American Thoracic Society criteria. Exercise capacity was assessed by the 6-min walk test (6MWT). Gait speed was assessed by the distance covered in 6min. Perceived exercise self-efficacy (PESE) and rating of perceived exertion (RPE) were assessed by exercise self-efficacy and Borg scales, respectively. Data were analysed using descriptive and inferential statistics. Alpha level was set at P<0.05. RESULTS The mean age of the 125 participants was 62.0±7.1years (60% male). The mean values for FEV1, FVC and FEV1/FVC were 1.8±0.6L, 2.4±0.5L and 58.0±8.8%, respectively, and the mean 6MWT and PESE values were 291.1±41.6m 63.1±11.2%. Exercise capacity was correlated with mean values for the respiratory parameters FEV1 (r=0.29; P=0.035), FVC (r=0.32; P=0.045) and FEV1/FVC ratio (r=0.37; P=0.007), and both exercise capacity and PESE were correlated with gait speed (r=0.96, P=0.001 and r=0.57; P=0.042) and RPE (r=0.42, P=0.050 and r=-0.44; P=0.032), but PESE was not correlated with respiratory parameter values (P>0.05). CONCLUSION Participants with COPD demonstrated reduced respiratory parameter values and low exercise capacity but moderate PESE. We found significant correlations between exercise capacity and respiratory parameter values, but PESE was correlated with only gait speed and RPE. The study has implications for respiratory health promotion and exercise adherence.
Collapse
Affiliation(s)
- T O Awotidebe
- Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.
| | - O F Awopeju
- Chest Unit, Obafemi Awolowo University Teaching Hospitals Complex, P.M.B. 5538, Ile-Ife, Nigeria; Department of Medicine, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - L A Bisiriyu
- Department of Demography and Social Statistics, Faculty of Social Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - R N Ativie
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, University of Nigeria, Enugu Campus, Enugu State, Nigeria
| | - K I Oke
- Department of Physiotherapy, School of Medical Sciences, University of Benin, Benin City, Edo State, Nigeria
| | - R A Adedoyin
- Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - O D Olusola
- Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - G E Erhabor
- Chest Unit, Obafemi Awolowo University Teaching Hospitals Complex, P.M.B. 5538, Ile-Ife, Nigeria; Department of Medicine, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| |
Collapse
|
11
|
Tabbal AOA, Humedi SSA. Surveillance of the Most Prevalent Medical Diseases among Pediatric Age Groups and Evaluation of the Control Measures Used At Tabuk Hospitals, Saudi Arabia. Open Access Maced J Med Sci 2017; 5:182-187. [PMID: 28507625 PMCID: PMC5420771 DOI: 10.3889/oamjms.2017.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND During the last decades, medical recordings has increased dramatically leading to more awareness of the diseases commonly affecting paediatric age groups opening a wide entrance to the prevention of possible complications and decrease its incidence. AIM This article aims to assess the prevalence of the commonly encountered paediatric medical diseases by affected system among admitted paediatric patients of different age groups in Tabuk and to identify their burden. METHODS This is a retrospective research studying disease pattern according to age, gender, nationality, admission status and length of stay. RESULTS Admissions due to respiratory system disorders were the most common among children under the age of six years (39.7%). Acute gastroenteritis was the most common disease leading to hospitalisation of children below the age of three years and cast a financial burden heavily on family and society. CONCLUSIONS Respiratory diseases and acute gastroenteritis constitute a significant burden of childhood illnesses in Tabuk City. Efforts are required to reduce the impact to achieve the Saudi ministry of health (SMOH) Goal. Even though Rota vaccine is added to the national Saudi program of vaccination schedule, other causes should be looked for, and preventive measures are important as a part of public education.
Collapse
|
12
|
Baumann P, Baer G, Bonhoeffer J, Fuchs A, Gotta V, Heininger U, Ritz N, Szinnai G, Bonhoeffer J. Procalcitonin for Diagnostics and Treatment Decisions in Pediatric Lower Respiratory Tract Infections. Front Pediatr 2017; 5:183. [PMID: 28894729 PMCID: PMC5581362 DOI: 10.3389/fped.2017.00183] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 08/11/2017] [Indexed: 12/12/2022] Open
Abstract
Mortality and morbidity remain high in pediatric lower respiratory tract infections (LRTIs) despite progress in research and implementation of global diagnostic and treatment strategies in the last decade. Still, 120 million annual episodes of pneumonia affect children younger than 5 years each year leading to 1.3 million fatalities with the major burden of disease carried by low- and middle-income countries (95%). The definition of pneumonia is still challenging. Traditional diagnostic measures (i.e., chest radiographs, C-reactive protein) are unable to distinguish viral and from bacterial etiology. As a result, common antibiotic overuse contributes to growing antibiotic resistance. We present an overview of current evidence from observational and randomized controlled trials on a procalcitonin (PCT)-based diagnosis of pediatric LRTIs and discuss the need for an adequate PCT threshold for antibiotic treatment decision-making.
Collapse
Affiliation(s)
- Philipp Baumann
- Department of Pediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - Gurli Baer
- Department of Pediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | | | - Aline Fuchs
- Department of Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland
| | - Verena Gotta
- Department of Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland
| | - Ulrich Heininger
- Department of Pediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - Nicole Ritz
- Department of Pediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland.,Department of Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland
| | - Gabor Szinnai
- Department of Pediatric Endocrinology and Diabetology, University of Basel Children's Hospital, Basel, Switzerland
| | - Jan Bonhoeffer
- Department of Pediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| |
Collapse
|