Burden and spectrum of paediatric respiratory diseases at a referral hospital in North-Central Nigeria - A five year review.

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.

Burden and spectrum of paediatric respiratory diseases at a referral hospital in North-Central Nigeria - A five year review

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, comorbidities 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

An analysis of national data on care-seeking behaviour by parents of children with suspected pneumonia in Nigeria

Background. Pneumonia is responsible for 940 000 under-5 deaths annually. Most of these deaths result from delays in instituting effective treatment. Objectives. To determine care-seeking behaviour by parents of children with pneumonia and sociodemographic factors that influence decisions to seek appropriate care.Methods. The study was an analysis of the Nigeria Demographic and Health Survey 2013; which was a nationwide cross-sectional survey using a stratified cluster design of 40 680 households. All children under-5 living in the surveyed households with suspected pneumonia in the preceding 2 weeks were recruited along with their mothers. Sociodemographic characteristics of the parents and where they sought care for their child were obtained. Binomial logistic regression analysis was used to determine the contribution of various sociodemographic variables to the decision on seeking appropriate medical care.Results. Of the 28 950 children surveyed; 565 had suspected pneumonia; which equates to an occurrence rate of 19.5 per 1 000 children. About 36% of parents were judged to have sought appropriate care when their children had pneumonia. High paternal education; health decision-making by both husband and wife; and belonging to the higher quintiles on a wealth index were factors that positively influenced care-seeking behaviour. Conclusion. Care-seeking behaviour for pneumonia is poor. Paternal education and joint decision-making are key determinants of parents seeking appropriate care for their children with suspected pneumonia in Nigeria

Validity and accuracy of maternal tactile assessment for fever in under-five children in north central Nigeria: a cross-sectional study.

OBJECTIVES: This study seeks to determine not only the reliability of parental touch in detecting fever as compared to rectal thermometry in under-five children, but also the sociodemographic factors that may predict its reliability. SETTING: The study was carried out in the Emergency Paediatric Unit of a tertiary hospital in North Central Nigeria. PARTICIPANTS: 409 children aged less than 5 years with a history of fever in the 48 h prior to presentation and their mothers were recruited consecutively. All the children recruited completed the study. Children with clinical parameters suggestive of shock, and those who were too ill, were excluded from the study. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the proportion of mothers who could accurately predict if their child was febrile or not (defined by rectal temperature) using tactile assessment only. Secondary outcomes were the validity and accuracy of touch in detecting fever and factors related to its accuracy. RESULTS: About 85% of the children were febrile using rectal thermometry. The sensitivity, specificity, positive predictive and negative predictive values for touch as a screening tool were 63%, 54%, 88.3% and 21%, respectively. High maternal socioeconomic status and low maternal age influenced positively the accuracy of touch in correctly determining the presence or absence of fever. CONCLUSIONS: This study has shown that tactile assessment of temperature is not reliable and that absence of fever in a previously febrile child should be confirmed by objective methods of temperature measurement.

A comparative study of rectal tympanic and axillary thermometry in febrile children under 5 years of age in Nigeria.

BACKGROUND: Fever alone accounts for over 25% of paediatric emergency room consultations. Accurate determination of temperature is critical for the management of sick children by both parents and health care-providers. AIMS AND OBJECTIVES: To compare simultaneous measurements of temperature measured by the rectal, axillary, and tympanic routes in children under 5 admitted to the University of Ilorin Teaching Hospital. METHODS: 400 children under 5 years of age with a rectal temperature of ≥ 38·0°C were recruited consecutively into the study. Rectal and axillary temperatures were measured using digital thermometers. Tympanic measurements were undertaken with an infrared tympanic thermometer. All measurements were made simultaneously and compared. RESULTS: Mean (SD) rectal temperature was 38.8 (0.7)°C, and mean (SD) tympanic and axillary temperatures were 38.7 (0.7)°C and 38.1 (0.7)°C, respectively. There was no significant difference between rectal and tympanic temperatures (P = 0.14), and a strong correlation was identified between values from these two sites (r = 0.91). At 91.5%, the sensitivity of tympanic thermometry in determining fever was higher than that of axillary measurements (54.0%). A mathematical relationship was demonstrated between rectal/tympanic temperatures and between rectal/axillary temperatures as follows: Rectal temperature (°C) = 6.03+0.85 * Mean tympanic temperature (°C) Rectal temperature (°C) = 11.7+0.71 * Axillary temperature (°C) Conclusion: In febrile children, tympanic temperature better reflects rectal temperature than does axillary temperature; tympanic temperature should therefore be measured when there are no contra-indications for its use.