Pediatric otorhinolaryngology emergencies at the Jos University Teaching Hospital: Study of frequency, management, and outcomes

Trends and patterns in urgent pediatric otolaryngology inter-hospital referrals in Saudi Arabia

OBJECTIVES

To assess trends in otolaryngology-head and neck surgery (ORL-HNS) referrals among pediatric patients, and to address common urgent causes of ORL-HNS referrals in this population. Additionally, to give recommendations regarding these causes, and assessing the impacts of coronavirus desease-19 on such referrals.

METHODS

A retrospective descriptive study were the data was extracted from the referral system of the Saudi Ministry of Health (Ehalati), from 2019-2020. Pediatric patients from all hospitals across Saudi Arabia with problems related to ORL-HNS who have been referred urgently to other hospitals were included.

RESULTS

A total of 1318 urgent ORL-HNS referrals were collected. The average age of the sample was 6.5 years, with the unavailability of specialty being the major cause for referrals. Foreign bodies, recurrent epistaxis, and tracheostomy were also common clinical causes. The average time for accepting referrals was 21 hours. Most cases had medical or surgical intervention prior to referral. The Western region of Saudi Arabia was the most common sender and receiver of all referrals. In 2020, referrals decreased by 18.4%.

CONCLUSION

Maternity and pediatric hospitals make up the largest number of referring hospitals for ORL-HNS urgent cases. Expanding ORL-HNS services has been recommended in highly demanding areas. standards for urgent ORL-HNS referrals may limit inappropriate urgent referrals.

Direct and Indirect Costs of Non-surgical Treatment for Acute Tonsillitis in Children in Southeast Nigeria

BACKGROUND

Acute tonsillitis has become one of the main reasons why children visit healthcare facilities in Nigeria. Presently, there is no information on the costs of its treatment, and this study aimed at determining these costs.

METHODS

The study was conducted in two hospitals located in southeast Nigeria. The information was obtained in two ways: (1) retrospectively from the medical records of children treated for acute tonsillitis over a period of 5 years and (2) cross-sectionally from children who presented with complaints of acute tonsillitis over a period of 7 months. The information obtained was the costs of self-medication and hospital treatment, and the payment mechanisms used to settle these costs. The human capital method approach was used to estimate the indirect cost (loss in productivity) from the caregivers' absenteeism from work.

RESULTS

The mean costs of self-medication and hospital treatment for acute tonsillitis in children were €3.85 and €13.48, respectively. The indirect cost was €11.31. The mean total cost of treatment of acute tonsillitis was €23.80. The proportion of households that suffered catastrophic health expenditure (CHE) from the treatment of acute tonsillitis was 55 (55%). CHE was highest [22 (91.7%)] in the lowest socio-economic quartile compared to households in the highest quartile [4 (16.7%)], and the difference was statistically significant (p = 0.02). Of the 72 participants whose payment mechanisms were documented, the proportion who paid out of pocket was 53 (73.6%), and 19 (26.4%) used the National Health Insurance Scheme.

CONCLUSION

The costs of treatment for children with acute tonsillitis were high, and most of these costs were settled out-of-pocket. The costs for laboratory investigations, drugs, and productivity loss contributed to these high costs. There is a need to cover the costs of non-surgical treatment of acute tonsillitis in social health insurance and improve efforts to increase the coverage of the health insurance scheme.