Typology of morbidity diagnosed in a pediatric department of a secondary care center (Msaken, Sousse, Tunisia)
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Abstract
Introduction: Pediatric services are tracer services for the assessment of the integration and performance of the national health system.
Objectives: Describe the typology of morbidity notified to the Pediatrics department of the Msaken regional hospital (Sousse, Tunisia) and the flow of its patients.
Methods: This is a descriptive and exhaustive study, covering all the patients hospitalized in the pediatric ward of Msaken, during the year 2015. The data were collected through medical files and medical registers. admission, based on the Minimum Clinical Summary (RCM) form. The notified diagnoses were coded according to the WHO ICD-10 classification. The main diagnosis was defined by the major pathology that led to the hospitalization. Early readmission was retained before 28 days.
Results: A total of 521 children were hospitalized, with a sex ratio of 1.04 and a mean age of 2 ± 3 years; 70% of the patients came from the administrative center of the governorate and 62% were infants (age <two years). Entry was provided via the emergency room in 58% of cases. The main diagnoses reported were diseases of the respiratory system (37%) including acute bronchiolitis, and diseases of the genitourinary system (28%) including urinary tract infections. About one in four patients (23%) were former patients of the department. The readmission rate was 18.7%. The average length of stay for hospitalized children was 4.5 ± 4 days. The transfer rate to university hospitals was 1.9%.
Conclusion: The morbidity profile of the regional pediatric ward of Msaken illustrates the new health needs of infants, dominated by infections of the respiratory and urinary tracts. Hence the importance of strengthening primary health care and referral / referral system between the pediatric services of district, regional and university hospitals, for an integrated and efficient national health system.
Keywords:
Secondary Care Centers - Hospitals, Pediatric - Urinary tract infections - Respiratory tract infection - Bronchiolitis - Infant - Child - Tunisia##plugins.themes.academic_pro.article.details##
References
- Références 1. El-Saharty S. Etude du secteur de la santé en Tunisie. Washington: La Banque mondiale, Département du Développement Humain, Région Moyen-Orient et Afrique du Nord; 2006. 2. Breen C, Altman L, Ging J, Deverell M, Woolfenden S, Zurynski Y. Significant reductions in tertiary hospital encounters and less travel for families after implementation of Paediatric Care Coordination in Australia. BMC Health Serv Res 2018; 18(1): 751. 3. Desai AD, Starmer AJ. Process Metrics and Outcomes to Inform Quality Improvement in Pediatric Hospital Medicine. Pediatr Clin North Am 2019; 66(4): 725-737. 4. Potentier C, Martin E, Brousse P, Mosnier E, Henaff F, Guarmit B et al. Morbidité pédiatrique d'un village amérindien en Guyane française (2009-2016). Bull Soc Pathol Exot 2018; 111(3): 167-175. 5. Bucens IK, Reid A, Barreto AC, Dwivedi V, Counahan M. Three years of paediatric morbidity and mortality at the National Hospital in Dili, East Timor. J Paediatr Child Health 2013; 49(12): 1004-9. 6. Singh M, Qureshi MA, Aram GN, Hadi F, Atif SY, Adel SS et al. Morbidity and mortality in childhood in Afghanistan: a study of 40 492, consecutive admissions to the Institute of Child Health, Kabul. Ann Trop Paediatr 1983; 3(1): 25-30. 7. Tsolia MN, Kafetzis D, Danelatou K, Astral H, Kallergi K, Spyridis P et al. Epidemiology of respiratory syncytial virus bronchiolitis in hospitalized infants in Greece. Eur J Epidemiol 2003; 18(1): 55-61. 8. Thélot B, Bénichou JJ, Chéron G, Chevallier B, Bégué P, Bourrillon A. Surveillance épidémiologique hospitalière de la bronchiolite du nourrisson par le réseau ERBUS. Rev Epidemiol Sante Publique 1998; 46(4): 277-88. 9. Foo AL, Chay OM, Hiew J, Tan CK, Lim KW, Cheng HK. Severe bronchiolitis in children. J Singapore Paediatr Soc 1991; 33(3-4): 165-8. 10. Nakamura MM, Zaslavsky AM, Toomey SL, Petty CR, Bryant MC, Geanacopoulos AT et al. Pediatric Readmissions After Hospitalizations for Lower Respiratory Infections. Pediatrics 2017; 140(2): e20160938. 11. Brini I, Guerrero A, Hannachi N, Bouguila J, Orth-Höller D, Bouhlel A et al. Epidemiology and clinical profile of pathogens responsible for the hospitalization of children in Sousse area, Tunisia. PLoS One 2017; 12(11): e0188325. 12. Janahi I, Abdulkayoum A, Almeshwesh F, Alkuwari M, Al Hammadi A, Alameri M. Viral aetiology of bronchiolitis in hospitalised children in Qatar. BMC Infect Dis 2017; 17(1): 139. 13. Brini I, Bhiri S, Ijaz M, Bouguila J, Nouri-Merchaoui S, Boughammoura L et al. Temporal and climate characteristics of respiratory syncytial virus bronchiolitis in neonates and children in Sousse, Tunisia, during a 13-year surveillance. Environ Sci Pollut Res Int 2020; 27(19): 23379-23389. 14. Vincent JO, Lo HY, Wu S. Bronchiolitis Care in the Hospital. Rev Recent Clin Trials 2017; 12(4): 246-252. 15. Menif K, Kechaou W, Bouziri A, Khaldi A, Belhaj S, Hamdi A et al. Prise en charge de la bronchiolite aiguë en Tunisie. Tunis Med 2007; 85(8): 665-8. 16. Bryan MA, Desai AD, Wilson L, Wright DR, Mangione-Smith R. Association of Bronchiolitis Clinical Pathway Adherence With Length of Stay and Costs. Pediatrics 2017; 139(3): e20163432. 17. Ralston SL, Garber MD, Rice-Conboy E, Mussman GM, Shadman KA, Walley SC et al. Value in Inpatient Pediatrics Network Quality Collaborative for Improving Hospital Compliance with AAP Bronchiolitis Guideline (BQIP). A Multicenter Collaborative to Reduce Unnecessary Care in Inpatient Bronchiolitis. Pediatrics 2016; 137(1). 18. Ralston S, Garber M, Narang S, Shen M, Pate B, Pope J et al. Decreasing unnecessary utilization in acute bronchiolitis care: results from the value in inpatient pediatrics network. J Hosp Med. 2013; 8(1): 25-30. 19. Sandweiss DR, Mundorff MB, Hill T, Wolfe D, Greene T, Andrews S et al. Decreasing hospital length of stay for bronchiolitis by using an observation unit and home oxygen therapy. JAMA Pediatr 2013; 167(5): 422-8.