Risk Factors of Persistent Diarrhoea in Children below Five Years of Age

Background Persistent diarrhoea is a commonly observed phenomenon both in Bangladesh and all over the developing countries. It is the single most important cause of diarrhoea related deaths in the community, accounting for over half of them. If associated factors are properly identified & treated, it is possible to prevent most cases of persistent diarrhoea. Objective This study was undertaken to find out the possible risk factors associated with persistent diarrhoea in children below 5 years of age. Methods This was a prospective analytical case control study carried out in a tertiary care hospital, Dhaka. A total of 30 consecutive cases of persistent diarrhoea and 60 consecutive acute diarrhoea controls (matched for age and sex) under 5 comprised the study subjects in this study. Children beyond the age and whose parents didn’t give written consent were excluded from the study. Data were collected using a structured questionnaire and a standered case definition of acute & persistent diarrhoeawere adopted. Data were later processed and analyzed using SPSS (Statistical Package for Social Science version 12) in the year 2012. Results were considered statistically significant when p value was <0.05. Results According to the study, 56.6% of cases and 63.3% of controls were in the ‘6 to 12 months’ age group and about two-third of the participants in both cases 20 (66.7%) and controls 39 (65.0%) were males.Strong association was found with ‘bottle feeding’ RR=2.2556; 95% CI: 1.259, ‘presence of blood/mucus’ RR=2.5038; 95% CI: 1.4129, ‘WAZ≤ 2)’ RR=2.8867; 95% CI: 1.7202 and ‘early complementary feeding [RR=4.67; 95% CI: 2.5017-8.7175 and OR=7.8858; 95% CI: 3.6791-16.9 Conclusion In the present studyfour factors showed some association with persistent diarrhoea, namely: ‘use of animal milk’; ‘antibiotic use during acute diarrhoea’; ‘history of diarrhoea in previous 3 months’ and ‘pre-lacteal feed’. Strong association was found with ‘bottle feeding practices’ ‘presence of blood &/or mucus in stool’, WAZ <-2 and ‘early complementary feeding

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Risk factors, clinico-epidemiological profile of tuberculosis among children attending a tertiary care hospital: a two year study

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20181501 ◽

2018 ◽

Vol 5 (3) ◽

pp. 851

Author(s):

Ravikumar Tenali ◽

Naveen Kumar Badri ◽

Jithendra Kandati ◽

Munilakshmi Ponugoti

Keyword(s):

Risk Factors ◽

Clinical Features ◽

Tertiary Care ◽

Epidemiological Surveillance ◽

P Value ◽

Tuberculous Lymphadenitis ◽

Care Hospital ◽

Female Ratio ◽

Extra Pulmonary ◽

Epidemiological Profile

Background: TB remains as the one among the top 10 causes of death worldwide. In 2016, 10.4 million people fell ill with TB, and 1.7 million died from the disease with 0.4 million with HIV. At least 1 million children become ill with TB each year. Children represent about 10-11% of all TB cases. Having knowledge of the risk factors for tuberculosis infection in children is important to evaluate the level of ongoing transmission of infection and to help adapt activities within national TB control programs. The main objective is to study the risk factors and their association and variable clinical features in cases of pulmonary and extra pulmonary tuberculosis.Methods: The main objective is to study the risk factors and their association and variable clinical features in cases of pulmonary and extra pulmonary tuberculosis.Results: 98 cases of TB were confirmed out of total 628 with a prevalence of 17.07% in the study with 78 PTB cases and 20 EPTB. Females were more with male to female ratio of 0.7:1.5-9 years was the most common age group in the study. Statistically significant association was found between old history of ATT, HIV positivity, contact with an open case of TB and malnutrition (p value<0.05). TB meningitis was the most common EPTB (10/20 cases) followed by tuberculous lymphadenitis (5/20). 69.39% (68/98 cases) were smear positive, radiologically 59.18% of cases were positive and Tuberculin skin test was positive in 46.94%.Conclusions: Childhood tuberculosis is a neglected entity in developing countries due to underreporting and difficulties in diagnosis due to variable clinical picture in children. Hence epidemiological surveillance studies in children are required to determine the actual prevalence of pulmonary and extra pulmonary cases of tuberculosis. Increased efforts are required to isolate TB bacilli from body fluids to identify early the childhood cases and manage them to prevent disease burden in the community.

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Clinical and Epidemiological Profile of Paediatric Encephalitis Patients in a Tertiary Care Hospital

Bangladesh Journal of Child Health ◽

10.3329/bjch.v38i1.20020 ◽

2014 ◽

Vol 38 (1) ◽

pp. 5-10

Author(s):

Nasir Uddin Mahamud ◽

Sanat Kumar Barua ◽

Pranab Kumar Chowdhury ◽

Md Rezaul Karim ◽

Prabad Chandra Barua ◽

...

Keyword(s):

Tertiary Care ◽

Altered Mental Status ◽

Case Definition ◽

Neurological Dysfunction ◽

P Value ◽

Care Hospital ◽

Age Group ◽

Cns Inflammation ◽

College Hospital ◽

New Onset

Introduction: Acute encephalitis is potentially harmful central nervous system (CNS) inflammation usually caused by infections. The diagnosis is difficult to establish and the etiology often remain unclear. It is endemic throughout the year with occasional epidemics in various localities in our country. So this study was carried out to see the clinical and epidemiological background of hospitalized children with encephalitis. Methodology: A retrospective, observational study, conducted in the department of Paediatrics, Chittagong Medical College Hospital (CMCH). The study period was from January 2009 to December 2010. Children with all ages and sex with clinical case definition of encephalitis characterized by new onset of fever (tempareturee380C) or history of fever during present illness along with altered mental status (confusion, disorientation, coma) and/or neurological deficit (focal or diffuse neurological dysfunction or new onset of seizure) were included. Results: A total of 666 cases were analyzed during the study period. The mean age of the children was 3.77 years (SD± 2.9 years), most of the cases (48.5%) were between 12 months to 60 months age group. Urban cases were 144 (25%) & rural cases were 421 (75%).Year wise admissions in 2009 & 2010 were 312 & 354; deaths were 46% & 56%. Prominent clinical features of admitted encephalitis patients were fever (89%), convulsion (84%) and altered consciousness (75%). The trend of admission was high in the months of January, April and October. Significant number of death were observed under 5 years age group (P value <0.02%). Conclusion: It was observed from this study that clinical profiles among children with encephalitis can help to understand the course and epidemiological pattern of the disease. The spectrum of encephalitis can differ from rural to urban area and the months of January, April and October were the peak seasons for encephalitis in south-east region of Bangladesh; probably due to viral surge. DOI: http://dx.doi.org/10.3329/bjch.v38i1.20020 Bangladesh J Child Health 2014; VOL 38 (1) : 5-10

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Prognostic factors and outcome of Post-Neonatal Tetanus in an intensive care unit of a Tertiary Care Hospital

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.5.656 ◽

2019 ◽

Vol 35 (5) ◽

Author(s):

Nighat Sultana ◽

Attia Bari ◽

Mehwish Faizan ◽

Muhammad Sarwar

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Prognostic Factors ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Neonatal Tetanus ◽

P Value ◽

Care Hospital

Objective: To determine the prognostic factors and outcome of tetanus in children of post-neonatal age admitted in the intensive care unit (ICU) of a tertiary care hospital. Methods: This prospective cross sectional study, carried out in the Pediatric ICU of The Children’s Hospital Lahore from Jan 2013 to March 2017. Children of both genders with age range of two months to 16 years diagnosed clinically as tetanus were included. All 132 patients were scrutinized for all possible risk factors, need for mechanical ventilation and outcome. Data was analyzed by SPSS version 20. Results: Mean age of children was 7.5±3.4 years with male predominance (70.5%). Only (38.6%) received three doses of vaccination but none had booster dose. Trauma (43.2%) encompassed maximum predisposing factor followed by ear or nose prick and ear discharge. Mean duration of ICU stay was 20±13.3 days. Mortality rate was (17.4%). Ventilator support was given to (78.8%). Neurological outcome was normal in (82.6%). Trauma, ear or nose prick in girls and ear discharge were significantly associated with poor outcome and death with p-value of <0.001, 0.011 and <0.001 respectively. Other factors associated with poor outcome were need for mechanical ventilation and neurological impairment with p-value of 0.001 and <0.001 respectively. Conclusion: Tetanus is causing our children to suffer from devastating disease. Vaccination status is not satisfactory and along with trauma, ear discharge and ear or nose prick are identifiable risk factors. To combat these issues large scale vaccination and booster doses remains promising option. doi: https://doi.org/10.12669/pjms.35.5.656 How to cite this:Sultana N, Bari A, Faizan M, Sarwar M. Prognostic factors and outcome of Post-Neonatal Tetanus in an intensive care unit of a Tertiary Care Hospital. Pak J Med Sci. 2019;35(5):---------. doi: https://doi.org/10.12669/pjms.35.5.656 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Aetiology and outcome of acute diarrhoea in children with severe acute malnutrition: a comparative study

Public Health Nutrition ◽

10.1017/s1368980019003069 ◽

2019 ◽

Vol 23 (9) ◽

pp. 1563-1568

Author(s):

Abhishek Jain ◽

Dheeraj Shah ◽

Shukla Das ◽

Rumpa Saha ◽

Piyush Gupta

Keyword(s):

Comparative Study ◽

Urban Poor ◽

Severe Acute Malnutrition ◽

Tertiary Care ◽

Total Duration ◽

Acute Diarrhoea ◽

Therapeutic Interventions ◽

Acute Malnutrition ◽

Care Hospital ◽

Persistent Diarrhoea

AbstractObjective:To compare the microbiological profile, clinical course and outcome of acute diarrhoea in children aged <5 years having severe acute malnutrition (SAM) with those of children having normal nutritional status.Design:Cross-sectional comparative study.Setting:Tertiary-care hospital catering mainly to the urban poor of East Delhi, India.Participants:Children aged <5 years (n 140; seventy with SAM (cases) and seventy with normal anthropometry (controls)) with acute diarrhoea (duration < 14 d). Stool samples were collected for conventional culture, microscopy, acid-fast staining, rotavirus and Cryptosporidium antigen detection, and subtyping of diarrhoeagenic Escherichia coli (DEC). We followed-up these children for persistent diarrhoea and subsequent diarrhoeal episode in the next 3 months.Results:Rotavirus was detected in six (9 %) cases and in fifteen (21 %) controls (P = 0·03; OR = 0·34; 95 % CI 0·12, 0·94). DEC was isolated significantly more in cases compared with controls (93 v. 64 %; P < 0·001; OR = 7·25; 95 % CI 2·57, 20·4). Cryptosporidium was detected in seven (10 %) cases and five (7 %) controls. Total duration of diarrhoea and percentage change in weight after resolution of diarrhoea were comparable between cases and controls. At 3-month follow-up, number of subsequent episodes of diarrhoea and persistent diarrhoea were comparable between the two groups.Conclusions:Rotavirus was found significantly less frequently, whereas DEC was detected more frequently in children with SAM in comparison to non-malnourished children. To further reduce diarrhoea-related mortality, preventive and therapeutic interventions need to be designed against organisms causing diarrhoea in children with SAM.

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A study of the risk factors of various arrhythmias in patients with coronary heart disease

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20174285 ◽

2017 ◽

Vol 4 (5) ◽

pp. 1369

Author(s):

Puneet Patil ◽

Aamera Sait ◽

Dilip Ratan Patil

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Statistical Significance ◽

Tertiary Care ◽

P Value ◽

Care Hospital ◽

Av Block ◽

Cross Sectional ◽

Multiple Risk Factors ◽

Multiple Risk

Background: Complications like arrhythmias, cardiac failure, cerebrovascular and mechanical complications. Among these complications, arrhythmias are the most common complication of acute myocardial infarction. The objective of this study was to study the risk factors of various arrhythmias in patients with coronary heart disease.Methods: Present study was a hospital based cross sectional study conducted at department of General Medicine of a tertiary care hospital for a period of two years among 102 patients. Detailed history, clinical examination, investigation was done. All patients were followed for one year to assess the outcome among them. All data was entered in the Microsoft Excel worksheet and analyzed using proportions.Results: Arrhythmias were more common with low ejection fraction (72.73%). The overall mortality was 7.84%. Ventricular fibrillation was seen in 50% of the patients who did not receive thrombolytic therapy. First-degree AV block and second-degree AV block were present in 6.25% and 7.50% respectively and did not affect the mortality while complete heart block was present in 8.75% and mortality rate of 28.57% with right ventricular involvement. Risk factors like smoking, alcohol, hypertension, diabetes mellitus and obesity had higher incidence of arrhythmias but was not found to have any statistical significance (p >0.05). However, patients having multiple risk factors strongly associated with the high mortality in statistically significant manner (p value 0.0006).Conclusions: Patients with risk factors like smoking, alcohol, hypertension, diabetes mellitus and obesity had higher incidence of arrhythmias. Multiple risk factors increase the incidence of both arrhythmias and mortality (67% mortality with 4 risk factors and 75% mortality with 5 risk factors).

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A 4 year ERCP Profile of Tertiary Care Hospital: Indications and Diagnosis

10.53350/pjmhs211561419 ◽

2021 ◽

Vol 15 (6) ◽

pp. 1419-1422

Author(s):

A. H. Alvi ◽

A. Z. K. Chachar ◽

R. Parvaiz

Keyword(s):

Obstructive Jaundice ◽

Response Rate ◽

Tertiary Care Hospital ◽

Strong Association ◽

Tertiary Care ◽

Final Diagnosis ◽

P Value ◽

Care Hospital ◽

Statistical Association ◽

Chi Square

Aims: To find the indications and diagnosed conditions in the cases reported in Fatima Memorial Hospital Lahore. Also, the prevalence of this procedure amongst the genders in our setting. To establish statistical association between indications and diagnosis. Methodology: All the ERCP procedures done in 4 years from January, 2011 to January 2014 were compiled. The data was gathered using a simple form after the intervention. A total of 554 patients’ data was available, all participants were above the age of 18 years. A response rate 93% was recorded for who consented and allowed to share their information anonymously in the study. Chi square was used to find statistical association, with p-value <0.005 was taken as significant. IBM SPSS 22 was used for data input and evaluation. Results: In our study 35% of the participants were males and 65% were females. 58.33% of the patients underwent sphincterotomy. The highest number of patient’s indicated of undergoing ERCP was 58.33% because of obstructive jaundice without any cause on further investigations. Choledocholithiasis was the commonest diagnosis with 36.6%. A strong association between the indications and the final diagnosis was also found with p-value of 0.000. The success rate of the intervention was 79% making it a safer procedure to be applied. Conclusion: More females have undergone this procedure. Obstructive jaundice was declared as major indication with choledocholithiasis as the commonest condition diagnosed. It was a successful procedure in our setting. Keywords: ERCP, Gastroenterology, Intervention

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Association of Diabetes and Hypertension as risk factors with Ischemic Heart Disease among patients visiting a Public Sector Tertiary Care Hospital of Karachi, Pakistan

Pakistan Journal of Public Health ◽

10.32413/pjph.v10i4.509 ◽

2021 ◽

Vol 10 (4) ◽

pp. 215-219

Author(s):

Zulfiqar Ali Shaikh ◽

Javeria Shamim ◽

Akmal Khurshid Bhatti ◽

Sahar Soomro ◽

Zareen Kiran ◽

...

Keyword(s):

Risk Factors ◽

Heart Disease ◽

Family History ◽

Public Sector ◽

Ischemic Heart Disease ◽

Sedentary Lifestyle ◽

Tertiary Care ◽

Ischemic Heart ◽

P Value ◽

Care Hospital

Background: Ischemic Heart Disease (IHD) is a leading cause of morbidity and mortality worldwide. IHD results from myocardial ischemia, and occurs whenever perfusion outgrows the demand. Though lethal, but can be prevented by modification of predisposing conditions, most important are diabetes and hypertension. Almost fifty percent of IHD patients are found hypertensive with or without being diabetic. The objective of the study was to determine association of diabetes and hypertension as risk factors for IHD patients Methods: This was a hospital-based cross-sectional study that included 199 IHD patients of 35-70 years age, visiting Civil Hospital Karachi, a tertiary care public sector hospital, from September 2017 to January 2018 by using non-probability convenient sampling technique. The patients were approached in the hospital and briefed about the purpose of the study. A pre-tested, structured close ended questionnaire was used to collect the data. Data entry and analysis were done by using SPSS version 20.0. A p-value of <0.05 was considered as statistically significant. Results: Out of 199 participants, 156 (78%) were males while 43 (22%) were females; 119 60%) were 56-65 years of age. Family history of ischemic heart diseases was unremarkable in 126 (63%) patients. In total, 122 (61%) were diabetic; among them, 24 were of less than 40years and 98 of more than 40years of age. The older age of the diabetics had a direct association with the risk of IHD (p-value <0.05). About 83% had a non-significant family history for diabetes; and 83% of the total study participants were having a sedentary lifestyle. Out of 199, 166 (83%) had never checked their blood pressures earlier. The lifestyle, diet, addiction, and duration of hypertension had a strong association with IHD (p-value <0.05). Conclusion: IHD occurs more frequently in males of 56-65 years age, with insignificant family history for IHD and diabetes. The IHD is associated with hypertension and diabetes along with sedentary lifestyle, unhealthy diet and smoking/tobacco addiction.

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Complementary feeding practices among mothers of children aged six months to two years admitted in a tertiary care hospital

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20175566 ◽

2017 ◽

Vol 5 (1) ◽

pp. 97 ◽

Cited By ~ 1

Author(s):

Madhu G. N. ◽

Harish S.

Keyword(s):

Child Nutrition ◽

Complementary Feeding ◽

Tertiary Care ◽

Child Survival ◽

Feeding Practices ◽

Bottle Feeding ◽

Care Hospital ◽

Cross Sectional Survey ◽

Child Feeding ◽

Cross Sectional

Background: Optimal infant and young child feeding (IYCF) is an evidence-based measure for improving child nutrition and child survival. After 6 months of exclusive breast feeding, introduction of appropriate complementary feeds is essential. To ensure desirable growth and development of children, complementary feeding should be timely, culturally acceptable, nutritionally adequate, safe and responsive. Objective of this study was to assess the complementary feeding practices among the mothers of children between 6 months and 1 year of age with respect to the time of introduction, quantity and quality.Methods: This is a hospital based cross sectional survey among the mothers of children aged 6 months to 2 years admitted in pediatric wards at KIMS Bangalore during a study period of 6 months. A predesigned questionnaire was used for the collection of data. Details including socio demographic profile of the family and feeding practices of the infant were collected in detail.Results: Out of the 200 participants, 59% were males. 74.5% of the respondent mothers were housewives. Complementary feeds were started at appropriate time in 64.5% of the cases. The feeds were adequate in amount and frequency in 34.5% of the children. Bottle feeding was noted in 33.5% of the cases. Conclusions: Apart from the timely introduction of complementary feeds to infants, emphasis also should be given to the adequacy and quality of the feeds with respect to nutrients. Health professionals should focus on counseling the mothers on appropriate complementary feeding during antenatal, delivery, postnatal, and immunization services.

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EPIDEMIOLOGICAL INVESTIGATIONS OF ACUTE WATERY DIARRHEA OUTBREAK DURING JULY-AUGUST 2017 IN AMARPURA, RAWALPINDI - PAKISTAN

Pakistan Journal of Public Health ◽

10.32413/pjph.v9i2.204 ◽

2019 ◽

Vol 9 (2) ◽

pp. 74-77

Author(s):

Khurram Shahzad Akram ◽

Muhammad Wasif Malik ◽

Mumtaz Ali Khan ◽

Majid Ali Tahir ◽

Syeda Shazia Adeel ◽

...

Keyword(s):

Risk Factors ◽

Water Samples ◽

Tertiary Care ◽

Control Measures ◽

Protective Measure ◽

Watery Diarrhea ◽

P Value ◽

Care Hospital ◽

District Health ◽

Acute Watery Diarrhea

Background: On July 24, 2017, two cases suspected of acute watery diarrhea (AWD) were reported from tertiary care hospital, Rawalpindi. District health authorities directed to conduct outbreak investigation, identified risk factors and recommend control measures. Methods: A descriptive followed by age-sex matched case control study (1:3) was done from Jul 27 to Aug 02, 2017. Case definition was "sudden onset of loose watery stools (? 3 in past 24hrs) with any of symptoms i.e. vomiting, nausea, abdominal cramps or fever in residents of Amar Pura from July 19 to August 02, 2017". Active and passive case finding technique were done in addtion to hosptial record review. Total 02 stool and 03 water samples were collected for microbiological testing. Odd ratios computed on 95% confidence interval and P value <0.05. Results: Total 18 cases were identified (mean age: 16 year; range: 02 m-55yrs), predominate were male 2.6:1. Overall attack rate (AR) was 7.2/1000 and preponderate affected age group was 15-24 years (AR: 10/1000). Significantly associated risk factors were; use of untreated municipal water (OR:15, CI: 4.00-73.96) and use of untreated well water (OR:14.52, CI: 3.98-59.99). Use of water from filtration plant was found protective association (OR: 0.12, CI: 0.005-0.750). Laboratory found Vibrio Cholera Serotype Inaba in stool samples and coliforms in water samples. Conclusion: Consumption of contaminated water was most probable cause of outbreak. Use of filtered water was found to be a protective measure. Chlorination of water sources and health awareness sessions on water sanitation and hygiene were done in community.

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Study of pregnancy outcome of threatened abortion and its correlation with risk factors in a tertiary care hospital of Mumbai, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20184514 ◽

2018 ◽

Vol 7 (11) ◽

pp. 4598

Author(s):

Dipali S. Sivasane ◽

Rekha G. Daver

Keyword(s):

Risk Factors ◽

Maternal Age ◽

Pregnancy Loss ◽

Demographic Data ◽

Tertiary Care ◽

P Value ◽

Care Hospital ◽

Number Of Patients ◽

Significant Difference ◽

Threatened Abortion

Background: Early pregnancy loss is very common and, in most cases, it can be considered as nature’s method to select for a genetically normal offspring. Threatened abortion is a relatively common complication during pregnancy, occurring in approximately 20% of all pregnancies. Maternal age, Outcome of previous pregnancies, health of mother, any infection etc can be decisive factors in the risk of pregnancy loss.Methods: The present study was a cross sectional study where patients admitted with threatened abortion were interviewed using pretested semi-structured questionnaire after the treatment. Outcome of pregnancy was recorded. Their basic socio-demographic data along with possible risk factors were recorded. TORCH Ig M and Ig G were done in all patients.Results: Out of 95 patients admitted with threatened abortion, 42 (44%) patients undergone abortion whereas in 53 (56%) patients, pregnancy was continued. Out of total 60 patients admitted with the complain of only vaginal spotting, in 39 pregnancy continued and in 21 patients pregnancy was aborted. (p-value<0.05). 50.52% were from age group of 21 to 25 years of age. It was also seen that after 35 years of age, significant number of patients aborted. Out of these 11 patients with high BMI, pregnancy was continued only one patient. Out of total 20 patients positive for IgM of toxoplasma infection, pregnancy was aborted in 13 (65%) patients. Out of total 15 patients positive for IgM of cytomegalo virus infection, pregnancy was continued in 11 (73.3%) patients.Conclusions: Patients of threatened abortion with only symptom of spotting per vagina have good chances of continuation of the pregnancy. Increased maternal age above 35, Overweight and bad obstetric history are also associated with pregnancy loss. Though there was no statistically significant difference it was evident that among all TORCH infections, IgM toxoplasma and Rubella are associated more with pregnancy loss.

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