The Spectrum of Gastroenteritis at the Pediatric Outpatient Clinic,. Department of Child Health, School of Medicine, University of North Sumatera in 1982

The number of children attending the Pediatric Outpatient Clinic of Pirngadi Hospital, Medan, during 1982 was 15.375. Out of these, 1246 (8.1%) had gastroenteritis. Most of the patients (1046 or 83.94%) were under two years old. The male to female ratio was 1.6: I. The peak incidence for allendance was in January, April, and May. Of 1057 patients under  five years old, 383 (36.2%) also had malnutrition. The highest percentage (70. 75%) of those who had malnutrition was found in the I to 2 years age group. Of 370 patients whose Hb level was examined, 185 (50%) had anemia. The highest percentage (67.02%) was in the below 1 year group. Only 360 (28.8%) of gastroenteritis cases received oral rehydration solution. There were 23 (1.85%) cases in which diarrhea lasted longer than 7 days. The number of patients admitted to the ward was 213 (17.07%), and the highest percentage was in the above 3 years age group. The largest number of hospitalized patients was in January (43), February (21), and April (28); while the highest percentage was in April (20.40%), June (21.42%) and August (31.42%). Peak rainfall in Medan during 1982 was in October, November, and December, i.e. much 322.2 mmm,  366.4 and 382 mm, respectively.

Gastroenteritis in Patients Hospitalized at the Pediatric Ward of Dr. Pirngadi Hospital Medan

In 1989, oj2350 patients hospitalized in the paediatric ward of Dr. Pirngadi Hospital, Medan, 829 (35.3%) were gastroenteritis cases, with male more than female. Most of the patients with gastroenteritis were found in the age group of under 1 years (521 cases = 62.8%). The highest prevalence was found in january, February and March. Mild, moderate and severe dehydration were encountered in 2. 7%, 83.1% and 14.2% cases respectively. Eighty for (10.1%) cases had been treated with oralit before admission. Only 49. 1% of those patients with gastroenteritis under two years of age were breastfed. The patients of under five year old were 791 (95. 4%) cases; 259 (32. 7%) cases were malnourished. The overall mortality rate of these patients with gastroenteritis was 5.9% ( 49 cases). The age specific mortality rate was highest in the age group of 6- 12 months. Usually patients died with gastroenteritis had complications or associated diseases.

Parents' Knowledge on Diarrhea in a Plantation Area

The parents' knowledge on diarrhea was evaluated by a cross sectional study in Balirnbingan plantation PTP Vlll Kabupaten Simalungunon December 18-19, 1992. The study was conducted by providing questionnaires to 216 parents of infants and children with diarrhea. Most parents (97.2%) knew that diarrhea was a disease, wbile six of them (2.SOA>) thought that diarrhea was not a disease but was associated with the increase level of intelligence or teeth eruption. Seventy-five percent of parents thought that fluid and electrolyte ought to be given to children with diarrhea, and 16.5 % thought to give anti-diarrheal drugs or traditional medicaments. Fluid and electrolytes were given as an initial treatment for diarrhea by most of the parents (69%). Eight per cent of parents gave diarrheal drugs and 12% used traditional medicaments. They got oral electrolyte solution (OES) from the health workers (63.3%) or from the dispensaries or drug stores (36.7%). Most of the parents (53.7%) thought that OES was useful to stop diarrhea. Only 30.3% knew that OES was used as the substitute of fluid loss, 16% thought it was to cure for stomach ache. As many as 57.4% parents knew diarrhea as an infectious disease and 57.4 % knew how to prevent it. Most of them knew that environmental sanitation could prevent the disease (23.3%). Food and beverages were known as vehicle of infections by 37.5% parents.

Steatocrit Value in New-Born Babies

A prospective study on steatocrit value in full-term or preterm newborn babies of~ 2 days of age in Dr. Pimgadi Hospital, Medan is reported. This study was conducted from December 7, 1992, to February 7, 1993; there were 72 newborn babies (37 males and 35 females). The body weight was> 2500 gin 60 babies and s. 2500 gin 12 babies. The median steatocrit value in babies with body weight of> 2500 g was 9%, and it was 32% in babies less than 2500 g of body weight. The proportion of babies with > 25% steatocrit value was larger in babies less than 2500 g than that in 2500 g by the diet patterns of breast milk, breast milk and milk formula, milk formula. The proportion of babies with < 25% steatocrit value was higher in babies with body weight of< 2500 g than that in babies > 2500 g for those who had either breast milk, breast milk and milk formula or milk formula. There was significant difference (p<0,05) in the steatocrit levels between babies with the body weight of > 2500 g and those who had body weight of ≤ 2500 g.

Measles enteritis in infants and children

The incidence, mortality and clinical features of measles enteritis were reported among 6484 infants and children admitted to the Pediatric Ward Dr. Pirngadi General Hospital Medan from 1st January 1987 until 31st December 1988. Of these 6484 children, 2685 suffered from gastroenteritis and 82 from measles. There were 31 cases of measles enteritis (1.2% of all gastroenteritis cases or 37.8% of measles cases). Most of measles enteritis cases (74.2%) were in the age group of 6-24 months and no case was found under six months old. The mortality of measles enteritis with bronchopneumonia and encephalitis was 25.0% while the mortality of measles enteritis with bronchopneumonia was 13.3%. There were no deaths in children just with measles enteritis alone. The overall mortality of measles enteritis with or without accompanying disease was 12.9%. The age specific death rate of measles enteritis was highest (23.1%) in the 13-24 month age group.

Intestinal parasitic infestation in pediatric gastroenterology outpatient clinic Dr. Pirngadi Hospital Medan

A retrospective study had been done at the outpatient clinic sub division of Pediatric Gastroenterology, Dr. Pirngcdi Hospital Medan, comprising patients from 1 January 1985-31 December 1987. There were 874 patients. Three hundred seventy eight (43.25%) patients consisting of 210 (55.56%) males and 168 (44.44%) females had intestinal parasitic infestations. The youngest patient was 5 months and the oldest was 14 years and 3 months. Ascaris lumbricoides was found in 215 patients (24.60%) while Trichuris trichiura, hookworm, Oxyuris vermicularis, Hymenolepis nana, and Taenia were in 152 (17.39%), 13 (1.49%), 4 (0.46%), 15 (1.72%) and 4 (0.46%) cases respectively. Entamoeba histolytica was found in 121 (13.84%) and Giardia lamblia in 16 (1.83%) patients. The highest age specific attack rate was found in the age group of 5-10 years (65.67%). Ascaris lumbricoides was most frequently found namely in 100 children (26.46%), followed by Entameba histolytica in 73 (19.31%) and mixed infestation of Ascaris lumbricoides and Trichuris trichiura in 68 (17.99%) patients. One hundred seventy three (66.28%) under five patients with intestinal parasitic infestation had malnutrition while of the 433 under fives without intestinal parasitic infestation only 201 (46.42%) suffered from malnutrition (P less than 0.001).

Factors influencing the mortality of children with gastroenteritis at the Pediatric Ward of Dr. Pirngadi Hospital, Medan

A retrospective study was done on infants and children hospitalized from January 1, 1988 to December 31, 1988 at the Pediatric Ward of Dr. Pirngadi Hospital, Medan. In this period a total of 3370 patients had been hospitalized and 1356 (40.24%) had gastroenteritis of whom 96 patients (7.08%) died. The causes of death as the complications were encephalopathy in 27 patients (28.12%), bronchopneumonia in 32 (33.33%), shock in 27 (28.12%), sepsis in 6 (6.25%) and acidosis in 4 (4.17%). Fifty one (53.12%) of those 96 patients who died were in the age group of under one year. The age specific mortality rate was highest in the age group of 1 month (14.28%). Of those 1356 patients with gastroenteritis 566 (41.74%) were well nourished of whom 8 patients died (1.42%); mildly malnourished in 532 patients of whom 36 (6.77%) died; and severely malnourished in 258 patients of whom 52 (20.16%) died. As far as the duration of illness was concerned 43 patients (12.73%) who died had a history of illness at home of 1 day. Beside the complications of the disease it seemed that the nutritional factors might have interfered with the mortality of patients with gastroenteritis.

Infantile diarrhea in the Pediatric Ward of Dr. Pirngadi Hospital Medan

A retrospective study was done on infants with diarrhea who were hospitalized at the Pediatric ward of Dr. Pirngadi Hospital, Medan in a period of one year (January 1 to December 31, 1986). There were 3317 hospitalized patients and 1506 (45.40%) of them had diarrhea. Of these, 773 (51.32%) were in the age group of under 2 years. Thirty eight patients (4.91%) with infantile diarrhea died and prolonged diarrhea was found in 54 (6.98%) cases.

Spectrum of digestive tract diseases 1985-1987 at the Pediatric Gastroenterology Outpatient Clinic of Dr. Pirngadi General Hospital, Medan

A retrospective study has been done on infants and children attending to the Pediatric Gastroenterology Outpatient Clinic of Dr. Pirngadi General Hospital in Medan, from 1985 through 1987. During the study there were 874 patients, 477 (54.58%) suffered from diarrhea, 209 (23.91%) had bloody stool, 20 (2.99%) jaundice, 57 (6.52%) abdominal pain, 48 (5.49%) abdominal distention, 30 (3.43%) vomiting, 13 (1.49%) constipation, and 20 (2.29%) others. Of all cases with diarrhoea, watery diarrhoea were found in only 319 (66.88%), diarrhoea with vomiting 84 (17.61%), and bloody diarrhoea 74 (15.51%). Stool examination in patients with diarrhoea revealed 144 (30.19%) cases with Candida albicans, while 16 (3.35%) of them with steatorrhoea. Of 63 patients with diarrhoea on which the clinitest had been performed, sugar intolerance were found in 30 (47.62%) cases.

Intussusception at the pediatric ward of Dr. Pirngadi Hospital, Medan

A retrospective study had been conducted on hospitalized infants and children in the Pediatric ward of Dr. Pirngadi Hospital, Medan from January 1, 1987 through December 31, 1988. The purpose is to assess the incidence and clinical manifestations of intussusception. During the same period, there were 6484 infants and children hospitalized, 39 (0.6%) with intussusception, consisting of 23 (58.9%) males and (41.1%) females. Most of the cases (53.85%) were in age group of 4-6 months. Thirty four patients (87.12%) were wellnourished, and 5 patients (12.82%) undernourished. The major symptoms of intussusception were bloody diarrhoea (87.17%), vomiting (82.05%) and abdominal distention (66.41%). Successful reposition with barium enema occurred in 1 (20%) out of 5 patients. The major symptoms of intussusception were bloody diarrhoea (87.17%), vomiting. Surgical intervention was performed in 22 patients (56.41%). The result was as follows: discharged in good condition in 15 (68.18%) and deaths occurred in the remaining cases (7 cases = 31.82%). Of those 7 cases who died after operation, 2 cases were hospitalized in less than 2 days, 3 cases in less than 3 days and the remaining 2 cases in more than 3 days, after the symptoms developed.