Pediatric Outpatient Department Research Articles

Mental Health Disorders among Children and Associated Parental Stress: A Cross-Sectional Study in Pediatric OPD of Burdwan Medical College, West Bengal.

Identification of mental health disorders during childhood is crucial for healthy 'adult roles' in the society, so this study aimed to estimate the magnitude of 'any mental health disorder' and to find out its correlates among children attending the pediatric out-patient department (OPD) of a medical college in West Bengal and to estimate parental stress among their parents. It was a descriptive cross-sectional study done in the pediatric OPD of Burdwan Medical College, West Bengal, during July-December, 2021. The calculated size of 288 children aged between 4 and 12 years and attending with either of their parents was selected through systematic random sampling. One of their parents (preferably mother) was interviewed using a schedule, containing a pre-validated pediatric symptom checklist and parental stress scale. Ethical clearance was obtained from the Institutional Ethics Committee. Data were analyzed using SPSS-v23. The median age of the children was 7 years (5-8 y.). The majority of them were male (57.6%), lived in urban areas (59.0%), and lived in joint families (57.6%). One-fifth (20.5%) of the children were found to have any mental health disorder (AMHD). Living in an urban area (aOR = 2.5, 95% CI: 1.1-5.7), belonging to a nuclear family (aOR = 3.6, 95% CI: 1.7-8.1), and belonging to a family with social problems (aOR = 7.8, 95% CI: 2.3-27.2) were significant correlates of AMHD. Parental stress [median: 60 (55-63)] was found significantly higher (P < 0.001) among parents of children with AMHD as compared to the parents of others. The magnitude of AMHD was high in this study, indicating toward the necessity of implementing opportunistic screening and appropriate public health action.

Determinants of Type 2 Diabetes Mellitus among Children and Adolescents Attending A Tertiary Specialized Hospital in Bangladesh

Background: Type 2 diabetes in children and adolescents has increased in frequency around the world over the past two decades. The worldwide epidemic of childhood obesity has been accompanied by an increase in the incidence of type 2 diabetes in children and adolescents. Objective: To observe the determinants of type 2 diabetes mellitus among children and adolescents attending a tertiary specialized hospital in Bangladesh. Methods: This cross-sectional, descriptive study was done on a total of 151 children and adolescents attending the pediatric diabetic outpatient department (OPD) of Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine, and Metabolic Disorders (BIRDEM) Hospital, Dhaka, Bangladesh. The sampling technique was purposive. All patients who came to the hospital between July to December 2017 were included. Data was collected through a structured questionnaire. Results: Among 151 respondents, 98 were in the age group of 10-14 years (64.9%), female to male ratio of 1.22:1. The majority belonged to a high used to lead socio-economic class. Regarding food habits, 55.6% had a history of eating fast food regularly and used to lead a sedentary lifestyle with a lack of exercise. 43.7% of children and adolescents were obese 76.8% had high cholesterol and 84.1% had high triglyceride levels. Most of the children had a positive family history of type 2 diabetes mellitus (74.8%). Conclusion: Our study reflects that determinants like obesity, physical inactivity, eating habits, and family history are important factors in the development of type 2 diabetes mellitus in children and adolescents. Mugda Med Coll J. 2023; 6(2): 51-56

How well are we prescribing medications to our children?

Introduction: Prescription errors are common and every step in the process of writing a prescription has the potential for error. These errors can be broadly attributed to the lack of knowledge or lack of skill. Poor legibility, inaccuracy in writing, incomplete prescriptions, omissions, and use of abbreviations are the most common type of errors. Objectives: The primary objective of our study was to assess the completeness and legibility of the prescriptions. This is to estimate the rates of skill-based errors. Secondary objective of this study was to assess the appropriateness of the prescriptions using the pediatrics: Omission of Prescriptions and Inappropriate prescriptions (POPI) tool. Methods: This was a cross-sectional study, conducted in the pediatric outpatient department of a tertiary teaching hospital in New Delhi, India. Prescriptions received by outpatients attending both the general and special pediatric clinics were collected and evaluated using the World Health Organization Guide to Good Prescribing and the Medical Council of India guidelines. Results: A total of 343 prescriptions were assessed, in which 753 drugs were prescribed. A total of 1709 errors were uncovered pertaining to the completeness of the prescription. A majority of the prescriptions were written by postgraduates trainees (206), followed by senior residents (61), consultants (42), and junior residents (20). Abbreviations were used while mentioning the drug names in 53.64% prescriptions. The mean legibility score of all prescriptions was 3.35. Forty (11.66%) prescriptions were found inappropriate as per the International POPI tool. Conclusion: The legibility and completeness are largely overlooked yet crucial to the “Art of Prescription Writing.” They deserve as much awareness and education as the appropriateness of the drugs prescribed. The international POPI tool is a promising tool to analyze the appropriateness of pediatric prescriptions.

Knowledge, Attitude and Practice of Prevention of Thalassaemia of the Parents of Children with Thalassaemia attending in a Tertiary Care Hospital in Bangladesh

Introduction: Inherited disorder of Hemoglobin is widely distributed throughout the world. Among them, Thalassaemia is a common disorder with widespread geographical distribution. Objectives: The objective of the study was to determine the level of knowledge, attitude and practice of thalassaemia prevention among parents of children with Thalassaemia. Methodology: This was a descriptive cross sectional study. This study was conducted in inpatient and outpatient department of paediatrics, Rajshahi Medical College Hospital over a period of July 2020 to June 2021. 45 parents of children with thalassaemia were purposively selected as study subjects. Informed written consent were obtained from the parents before enrollment in the study. Data were collected on variables of interest. All the findings were recorded and analyzed. Statistical analysis were done using statistical package for social science (SPSS) software version 21. Result: Total 45 parents of children with thalassaemia were enrolled in the study. Among the informants, 73.3% (total 33) were mother and 26.6% (total 12) were father. 77.7% (total 35) children were from rural areas and 22.22% (total 10) were from urban areas. All the study population received knowledge about thalassaemia from the physicians. Knowledge of the parents about the disease, its treatment options and methods of its prevention were assessed by likert scale questionnaire. 22.22% parents had adequate knowledge , 64.44% had average knowledge and 13.33% had inadequate knowledge about the disease. 60% parents had adequate knowledge 31.11% had average knowledge and 8.89% had inadequate knowledge about prevention of thalassaemia. Attitude of all the parents (100%) were positive. Conclusion: Most of the parents have adequate knowledge and positive attitude for thalassaemia prevention and they can serve as resource for spreading awareness about thalassaemia in community. J Bangladesh Coll Phys Surg 2024; 42: 6-11

Outpatient Service Provision In Tertiary Hospital During Covid-19 Pandemic

Background: The COVID-19 pandemic was a challenge for healthcare professionals globally. The outpatient department is an important part of the hospital. Service providers were facing tremendous difficulties and challenges due to sudden thrust of the pandemic. Despite these challenges service providers had to give service during COVID-19 pandemic. The purpose of this study to assess the state of outpatient service in tertiary hospital during COVID-19 pandemic.&#x0D; Methods: This cross-sectional study was conducted among conveniently selected 203 service providers including 156 doctors and 47 nurses. Data were collected through face-to-face interview using semi-structured questionnaire and observation checklist. The study was conducted at medicine, surgery, paediatric and family planning outpatient department of Shaheed Suhrawardy Medical College Hospital, Dhaka Medical College Hospital, and Bangabandhu Sheikh Mujib Medical University during the period from January to December 2021.&#x0D; Results: Among 203 service providers, 76.8% were doctors and 23.2% were nurses. All health services were available during COVID-19 pandemic in outpatient departments (OPDs) of the selected hospitals. At outpatient department there was separate entry-exit door, thermal scan was available at entry point, Patients and visitors are restricted. Number of patients were decrease in outpatient department. Among the three hospitals facility of flu-corner and triage in the OPD of ShSMCH. For the DMCH and BSMMU, flu-corner and triage center were situated at other premises of the hospitals. Outdoor surgery, vaccination service and shishu bikash kendro were open during COVID-19 pandemic. About 80.8% respondents mentioned about availability of adequate amount of personal protective equipment, 42.9% respondents mentioned about proper ventilation, 57.1% respondents said had not. About 32.5% respondent said about availability of N-95 mask and 57.6% said had not. Among the respondents 67.0% said they maintained physical distance during consult with the patients. 57.6% respondents said about lack of manpower. 61.6% respondents said about felt anxiety and high-risk during service.&#x0D; Conclusion: For more improvement of outpatient service during COVID-19 pandemic, the authority should pay special attention, to increase manpower, arrange frequent training for service providers.&#x0D; JOPSOM 2021; 41(2):20-27

Diagnostic Accuracy of Tissue Transglutaminase and Combined Assay of Tissue Transglutaminase and Deamidated Gliadin Peptide in Children with Coeliac Disease: A Cross-sectional Study

Introduction: Coeliac Disease (CD) is a systemic immune disorder caused by gluten in genetically susceptible individuals. A serological screening assay for CD has been designed to detect Immunoglobulin A (IgA) and IgG anti-tissue Transglutaminase (a-tTG) and IgA and IgG Deamidated Gliadin Peptide antibodies (a-DGP) simultaneously. The seronegative gap can be closed when these two antigens are combined on a single solid phase. This is primarily because untreated CD children who are negative for antibodies of one of the antigens may exhibit a positive result for the other. Aim: To determine the diagnostic parameters {sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV)} of tTG-IgA and htTG-DGP (Coeliac fusion- a combination of IgA and IgG to human tTG and synthetic DGP) for the diagnosis of CD in clinically symptomatic children. Materials and Methods: This cross-sectional study was conducted at the Paediatric Outpatient Department (OPD) of Santokhba Durlabhji Memorial Hospital, Jaipur, Rajasthan, India from April 2023 to November 2023. The study population comprised 45 children (age &gt;6 months and &lt;18 years) showing clinical features of CD. Considering biopsy as the gold standard, the diagnostic parameters (sensitivity, specificity, PPV, NPV) of tTG-IgA and htTG-DGP were calculated with a 95% confidence interval for both tests. To determine the agreement between the two tests, Cohen’s kappa was calculated. A p-value less than 0.05 was considered statistically significant. Results: Out of the study population, 23 (46%) CD patients were in the age group of 3-6 years, while 13 (26%) patients were in the age group of 6-9 years. A total of 24 (53.3%) CD patients were males, and 21 (46.7%) were females. Chronic diarrhoea was the most common clinical feature in 31 (62%) patients. Considering duodenal biopsy as the gold standard, the study results showed that the anti tTG-IgA antibody test had a sensitivity of 91.1%, specificity of 80%, PPV of 97.6, and NPV of 50%. In comparison, the htTG-DGP antibody test had a sensitivity of 95.6%, specificity of 100%, PPV of 100%, and NPV of 71.43%. Conclusion: Currently, tTG-IgA is considered the best CD screening test. However, the inclusion of DGP IgG could increase diagnostic sensitivity, and a Combined IgA/G-DGP/ tTG assay could be even better than tTG-IgA for the diagnosis of childhood CD.

Effect of Quality Improvement Interventional Tool on Emotional, Behavioural and Self-perception Profile of Children with Type 1 Diabetes Mellitus: A Pretest, Post-test Quasi-experimental Study

Introduction: Psychological stress associated with Type 1 Diabetes Mellitus (T1DM) in children is relatively higher in developing countries due to limited health resources. However, no data are available regarding the impact of a Quality Improvement (QI) intervention on emotional, behavioural, and self-perception in paediatric patients with T1DM. Aim: To study the impact of a QI interventional tool on the emotional, behavioural, and self-perception profile in children with T1DM. Materials and Methods: This pretest, post-test quasiexperimental study was conducted at PGIMS, Rohtak, Haryana, India from August 2021 to July 2022. A total of 50 children, aged between 6-14 years with T1DM, were enrolled from the paediatric outpatient department and paediatric ward for the study. Initially, baseline data were collected, and patients were followed-up for six months during which required interventions were given, including one-on-one counseling with mother and child, demonstration of insulin injection, providing them with a booklet for recording blood glucose at home, etc. After six months, data were collected again for comparison. The Strengths and Difficulties Questionnaire (SDQ) and Self-perception Profile for Children (SPPC) questionnaires were used for the study. Data were statistically analysed using a paired t-test. Results: In the present study, there were 27 (54%) males and 23 (46%) females with an average age of 9.64±2.3 years. Positive outcomes were noted in the emotional, behavioural, and selfperception profiles of children following the intervention. HbA1C values (pre: 13.12±1.02%, post: 10.63±1.07%), hypoglycaemic episodes (pre: 2.54±0.88, post: 1.24±0.43), and Diabetic Ketoacidosis (DKA) episodes (pre: 2.76±0.52, post: 1.08±0.27) significantly reduced following the intervention. The SDQ score was significantly lower (pre: 16.97±1.48, post: 7.76±2.14), and the SPPC score was significantly higher (pre: 76.52±0.61, post: 94.34±1.06) after the intervention. Conclusion: In the present study, it was found that psychological and behavioural interventions have a beneficial effect on children with diabetes in terms of better compliance with therapy, glycaemic control, as well as better relationships with family and peers, and improved coping capability.

Effectiveness of the Buzzy Bee device on pain perception during invasive pricks among school age children: An interventional study.

Children often develop phobia toward needle pricks and invasive procedures. It is difficult for medical personnel to manage children's pain when they are in the hospital. When it comes to assessing and treating children's discomfort, nurses interact with them the most. The main objective of the study was to evaluate the effectiveness of the Buzzy Bee device on pain perception among children undergoing invasive needle pricks as part of their treatment. The study used a quantitative approach with a quasi-experimental design employing simple random sampling. A post-test-only design was used. After obtaining ethical clearance, data collection was done in the pediatric outpatient department and pediatric wards of Sultan Qaboos University Hospital, Muscat, Oman, between February 2020 and August 2021. Faces Pain Rating Scale for children was used to rate the pain during the procedure, which is a standardized tool. Data were analyzed using SPSS version 23. Descriptive and inferential statistical tests were done to analyze the data. Totally, 120 children along with their parents were interested in the study. After taking appropriate parental consent and children's assent, the participants were recruited by simple random sampling. They were equally divided into 60 in the experimental group and 60 in the control group. The mean age was 8.14 (+/-2.3) in both groups. Among the 120 samples, 63 (52.5%) of them were males and 57 (47.5%) were females. The majority of them had diagnoses like thalassemia, leukemia, and sickle cell and were getting cannulated for blood transfusion therapy. t-test shows that 51.7% (31 samples) reported no pain in the experimental group and 33.3% (20 samples) reported only mild pain, whereas in the control group, only 5.0% (3 samples) reported no pain and 21.7% (13 samples) reported mild pain. About 26.7% of the samples reported very much pain as against the 7% who reported very much pain in the interventional group. There was a statistically significant difference in the pain scores between the control group and the experimental group (likelihood ratio test, P = 0.0001). The Buzzy Bee method significantly reduced the pain. The introduction of a toy-like, child-friendly device, which works on the mechanism of vibrations and cold application, lessened the pain intensity during the procedure and acted as a good distractive therapy for children.

A Cross-sectional Study of Cutaneous Manifestations in Overweight and Obese Children

Abstract Background: Overweight and obesity are a major public health problem and are now considered to be a global epidemic. The skin is one of the main organs to be affected due to metabolic abnormalities in obesity. The various cutaneous manifestations of obesity are directly related to the age of onset, duration, and severity of the underlying disease. Aims: The aim of this study is to determine the frequency and pattern of cutaneous manifestations in overweight and obese children. Materials and Methods: The present study was a cross-sectional study conducted among 150 overweight and obese children (according to the World Health Organization definition), of age group 5–19 years (school-going children) attending the dermatology and pediatrics outpatient department. The study utilized a prestructured pro forma to record demographic profile, weight, height, and body mass index; the different cutaneous manifestations were noted in overweight and obese children. Relevant investigations such as pus culture, potassium hydroxide (KOH) preparation, and skin biopsy were done wherever indicated. Results: Most of the patients were overweight (82%). Males (61.33%) outnumbered females (38.67%) in our study. Majority of the patients had acanthosis nigricans (74.67%), followed by striae distensae (32.67%), acne vulgaris (20%), and dermatophytosis (17.33%). Hidradenitis suppurativa was found in two children, and cellulite in one child. Conclusion: As obesity and its effects on the skin in school-going children are understudied by dermatologists and pediatricians, a proper examination and diagnosis of different cutaneous manifestations of obesity in children will further help in preventing multiple comorbidities in future.

Clinical profile and growth pattern of children with congenital adrenal hyperplasia attending endocrine clinic, in a tertiary care center, South India

Background: Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders that result from the deficiency of one of several enzymes involved in the steroidogenic pathway for cortisol or aldosterone biosynthesis. Glucocorticoid replacement therapy, though largely effective in managing crises and limiting virilization, is far from perfect. Aims and Objectives: The aims and objectives of the study are to study the clinical profile and association between type of disease and glucocorticoid dosage with the growth of children with CAH attending pediatric and endocrinology outpatient department in a tertiary care hospital. Materials and Methods: This is a prospective observational study. All children who were newly diagnosed and old cases of CAH were consecutively recruited. Background details of the patient including sociodemographic data were obtained by a structured pro forma. Medical history and details of treatment were obtained from previous records. Patients were then followed up 6 monthly for 1 year and height and height velocity were obtained. Results: This study included 33 children (23 salt wasting [SW] and 10 simple virilizing [SV] CAH). Mean age was 6.3 ± 4.3 years. Among SW CAH, while 83.3% of male babies presented with adrenal crises while only 20% of the female babies went for a crisis, because most of them were diagnosed by the presence of ambiguous genitalia. Among SV patients, all females presented with ambiguous genitalia and males presented with precocious puberty. The overall height standard deviation was 0.8 ± 1.2 with a greater growth faltering in those taking higher doses of hydrocortisone. Growth was compromised more in SW CAH than in SV CAH. Conclusion: Growth in CAH is less compared to normal population and many factors including glucocorticoid dose and type of disease determine the growth and final height.

Effect of Routine Vitamin D Supplementation on the Physical Growth of Exclusively Breastfed Infants at Six Months of Age: An Observational Study

Introduction: Vitamin D is essential for bone mineral metabolism and for the growth and development of the skeleton. The American Academy of Paediatrics and the Indian Academy of Paediatrics recommend the administration of 400 IU per day of oral Vitamin D to all infants in the first year of life. The authors hypothesised that routine supplementation of 400 IU of Vitamin D to exclusively breastfed infants would result in better physical growth. Aim: To examine the effect of routine vitamin D supplementation (400 IU/day) on the weight, length, and head circumference of term, exclusively breastfed infants at six months of age. Materials and Methods: An observational study was conducted at Department of Paediatrics, Smt. Kashibai Navale Medical College, Pune, Maharashtra, India, from November 2018 to March 2020, comparing the weight, length, and head circumference at birth and at six months of age for 111 exclusively breastfed term, appropriate for gestational age, healthy infants who were not supplemented with oral Vitamin D (Group-I) with 111 infants who were supplemented with 400 IU of oral Vitamin D daily (Group-II). Infants who presented at the Paediatric Out-Patient Department of SKNMC, Pune at around six months of age were enrolled in the study. Birth data and anthropometry at birth were recorded from available medical records. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 23.0. Quantitative data were presented with the mean and standard deviation. Comparison among the study groups was done using an unpaired t-test as per the results of the normality test. Association among the study groups was assessed with the help of a Student's t-test. A p-value of &lt;0.001 was considered statistically significant. Results: The mean birth weight, length, and head circumference of infants who were not supplemented with vitamin D (Group-I) were 2907.57±250.18 gm, 53.34±1.47 cm, 35.99±1.067 cm, respectively, and those who were supplemented (Group-II) were 2901.08±231.63 gm, 53.75±1.51 cm, and 35.85±1.09 cm, which were comparable in both groups. At six months, the mean weight, length, and head circumference in Group-I and Group-II were 7211.08±626.39 gm, 70.25±1.58 cm, 43.82±1.19 cm, and 7973.87±532.31 gm, 70.90±1.75 cm, and 45.01±1.34 cm, respectively. There was an increase in anthropometric parameters in both groups. The increase was greater in GroupII than in Group-I and was statistically significant (p&lt;0.001). Conclusion: Infants supplemented with vitamin D (400 IU/ day) demonstrated better physical growth in terms of higher anthropometric values.

Knowledge, Attitude, and Practice among Parents toward Early Childhood Development in Belagavi City: A Cross-sectional Study

Context: As the educational levels and socioeconomic status of parents are low in developing countries, providing knowledge about early childhood development (ECD), the importance of early stimulation, proper caregiving practices, and ensuring the quality of the home environment through an integrated intervention is critical. In this situation, it is also critical to consider and assess the parental facts, attitudes, and practices before devising any intervention strategy. Hence, the current study intended to assess the knowledge, attitude, and practice of parents in ECD. Materials and Methods: An observational study was conducted in Belagavi City on 200 parents of children between the age group of 0 and 5 years. A structured questionnaire was used to assess the knowledge, attitude, and practice of the parents about ECD visiting the well-baby clinic and pediatric outpatient department of a tertiary care hospital. Statistical Analysis: For the test of significance, Chi-square and multiple liner regression analysis were used to find out the relationship between factors and to find the dependency status between dependent and independent variables. Results: In knowledge, P = 0.001 indicated significant knowledge of parents about the ECD, providing a strong understanding of their child’s development. The parents frequently paid attention to their children’s behavior, indicating that they had a positive attitude toward their children’s growth with a significant P = 0.001, and in the practice part, P = 0.001 indicated good significant practice of parents by frequently performing home learning techniques. Conclusion: The present study concluded that parents exhibit significant knowledge, positive attitudes, and effective practices regarding child development for children aged 0 to 5 years.

Factors associated with biliary atresia in children with cholestasis in Surabaya

Introduction. Biliary atresia (BA) represents a progressive and obstructive fibrotic cholangiopathy, serving as a leading cause of liver failure and pediatric liver transplantation worldwide. Identifying risk factors associated with BA incidence is crucial for expediting diagnosis; however, limited research has been conducted in Indonesia. This study aims to investigate the characteristics and analyze the factors associated with the occurrence of BA. Methods. A retrospective observational analysis of medical records encompassing 523 cholestatic patients at the Pediatric Hepatology Outpatient Department and Pediatric Ward of Dr. Soetomo General Academic Hospital, Surabaya, from 2011 to 2022 was conducted. The data was segregated into BA and non-BA groups, and diagnostic chi-square tests were employed to determine interrelationships among variables. Subsequently, logistic regression analysis was performed to identify the most impactful variable. Results. Notably, age at first time visiting specialist (p = 0.003), gestational age (p &lt;0.001), birth weight (p = 0.039), and domicile (p = 0.028) exhibited substantial associations with BA. Moreover, gestational age emerged as the most influential factor (p = 0.004). Infants with normal birth weight (≥2,500 grams) exhibited strongest factor associated factor of BA cholestasis. Conclusion. Initial specialist consultations were predominantly observed within the 0-6 months age range, while term infant and normal birth weight were linked to a higher likelihood of BA cholestasis. Residence in rural areas exhibited a significant correlation with BA incidence.

Magnitude of Pneumonia and Bronchiolitis and Their Treatment Modalities Practiced in Under Five Children Attending a Tertiary Care Hospital

Background: Pneumonia is the leading cause of death globally among children younger than five years of age. Acute bronchiolitis is also a major public health problem throughout the world. Many children with pneumonia and bronchiolitis are not properly diagnosed, and overuse of antibiotics has led to increasing drug resistance. Objectives: To determine the magnitude of pneumonia and bronchiolitis and to study their treatment modalities practiced in under five children. Methods: This cross-sectional observational study was carried out in the Pediatric inpatient department and outpatient department of Rajshahi Medical college Hospital from October 2015 to March 2016. Total 373 cases between 1 month to 59 months of age with acute respiratory infection who fulfilled the inclusion criteria were enrolled in the study. The inclusion criteria were any child between 1 month to 59 months of age presented with respiratory symptoms including cough/runny nose or breathing difficulty as complained by the caregivers or having chest in-drawing. Detailed information was obtained through structured questionnaire and then analyzed. Results: In this study majority of the children 223 (59.78%) were under 12 months of age. There were 234 (62.73%) male and 139 (37.27%) female cases, male to female ratio being 1.68:1. Among studied children 217 (58.18%) were urban dwellers and 156 (41.82%) were from rural areas and majority of the children 268 (71.85%) came from lower socioeconomic strata. Out of 373 cases, pneumonia was diagnosed in 131(35.12%) cases, bronchiolitis in 88 (23.60%) cases and other acute respiratory tract infections in 154 (41.28%) cases. Most common antibiotic used for the treatment of both pneumonia and bronchiolitis was ceftriaxone in 34.35% and 25% cases respectively followed by other antibiotics and medications. Conclusion: It is concluded that pneumonia was found in 35.12% cases and bronchiolitis in 23.60% cases among the under five children attending a tertiary care hospital with acute respiratory infection. Majority were under 12 months of age, male children, residing in urban areas and coming from lower socioeconomic status. Ceftriaxone was the commonest antibiotic used in the treatment of both pneumonia and bronchiolitis. TAJ 2023; 36: No-2: 163-170

A cross sectional observational study to evaluate utilization of antimicrobials in paediatric department of a tertiary care teaching hospital

Background: Antimicrobials play cardinal role in management of infectious disease. Paediatric age group forms significant part of developing countries and have high chances of acquiring infectious. Misuse and overuse of these antimicrobials are leading culprits in causing antimicrobials resistance. The purpose of this study was to analyse utilization of antimicrobials among paediatric department of a tertiary care teaching hospital. Methods: A cross sectional observation study was conducted for three months in paediatric department of a tertiary care teaching hospital. The demographics and antimicrobials use details were observed daily from patients admitted to paediatric outpatient department, wards and intensive care unit to assess according to The World Health Organization-International Network of Rational Use of Drugs drug prescribing indicators and WHO antibiotics AWaRe (Access, Watch, Reserve) classification. Results: In our study we found that mean antimicrobial use in OPD, wards and ICU was1.15±0.35, 1.12±0.33 and 2.25±1.01 respectively. Cephalosporins were most commonly prescribed in OPD (34.62%) and wards (65.26%) while piperacillin-tazobactam (29.93%) in ICU. Percent encounter with an antibiotic in OPD, Wards and ICU was 8.41%, 30.71% and 33.58% respectively. 56.69%, 81.35% and 55.80% antibiotics prescribed in OPD, Wards and ICU respectively were of Watch group. 5.66% Reserve group antibiotics were prescribed in the ICU. Conclusions: Prescribing trends of antimicrobials is near to WHO standard but according to AWaRe classification, watch group antibiotics were prescribed more than Access group.

Exploring Mother’s Perspectives about Routine Immunization in District Peshawar: A Cross Sectional Survey.

Objective: of this study was to investigate mothers' opinions and knowledge regarding regular immunization of their chil-dren.Methodology: Between July 2019 to January 2020, this descriptive cross-sectional study was conducted at pediatrics outpatient department, Khyber teaching Hospital Peshawar. Women aged between 19-44 years, having at least one child less than 5 years of age were asked to complete standardized questionnaire. After stratification of the collected data, regression analysis performed.Results: Mean age of participants was 27.72 ±4.07 years, 41.98% received elementary education, while 61.32% were housewives. We observed enough knowledge in 162(88.04%) patients aged 19-29 years as compared to 55 (93.22%) aged 30-44 years (p=0.002). Additionally, knowledge was noticeably greater in situations involving several children.Conclusion: Women having secondary school or higher education and several children has sufficient knowledge of im-munization.&#x0D; Key words: KAP, Immunization, Mothers, Infectious Diseases, Vaccination

Knowledge, attitude, and practices among caregivers of children with Cystic Fibrosis.

Caregivers have crucial role in the care of the children with Cystic Fibrosis (CF), but there is limited knowledge about their knowledge, attitude, and practices (KAP) regarding chronic disease. This pilot study aimed to validate a self-developed KAP questionnaire for caregivers of young children with CF in India and determine factors associated with KAP. A cross-sectional study was conducted among 95 caregivers of children with CF attending the specialty clinic of the pediatric outpatient department (OPD) in Northern India. Participants possessing certain characteristics such as willingness to participate and ability to understand Hindi or English language were enrolled in the study. Caregivers of children reported to the OPD with acute exacerbation requiring immediate hospitalization were excluded from the study. The self-developed KAP questionnaire had good content validity (CVI- 0.87-1.0) and internal consistency (Cronbach's α coefficient = 0.70, 0.71, 0.75 respectively). The majority of participants belonged to the Good KAP group (85.3%), while the remaining were in the Poor KAP group (14.7%). A χ2 test showed that KAP clusters vary significantly with sociodemographic variables like gender, marital status, educational status and monthly family income (p < .05). A weak negative correlation was found between knowledge and attitude scores in the Good KAP group (p < .001). Multiple linear regression analysis showed that the KAP of the caregivers was significantly influenced by knowledge related to clinical manifestation and complications, and attitude. All three sections of the KAP tool demonstrated good content validity and internal consistency. Caregivers had good knowledge, a positive attitude, and appropriate practices related to CF. However, targeted interventions are necessary to address specific areas for improvement, particularly for male caregivers with lower educational levels belonging to poor socioeconomic strata.

Guiding Mothers About Early Detection and Addressing Speech Delay and Disorders Among Children in a Rural Setup.

Introduction Speech is one of the most important milestones to be achieved by a growing child. The significance of being informed about different pediatric speech abnormalities, especially to mothers, allows them to help their children in cases of irregularities in the maturation in this domain. Aim and objectives The study aimed to assess and educate mothers on the important milestones of speech delay in children and make them address the issue and be aware of various corrective measures to treat the underlying conditions of speech disorders in children.The objectives of the study includeunderstanding the pre-acquired knowledge of the mothers regarding the delay in speech in children, imparting knowledge regarding different speech disorders and their management, spreading awareness on how to seek help for various underlying causes of speech irregularities or delay, and to train the mothers into approaching the challenges in an orderly manner. Methods A study was conducted to guide rural mothers visiting the Obstetrics and Gynecology and Pediatric out-patient departments and Neonatal wards in a rural tertiary care hospital situated in the Sawangi Meghe village of Wardha City, Maharashtra, India, about the detection and treatment of children with disabilities of speech as early as possible. The mothers' knowledge was assessed before and after the study with the help of questionnaires, and basic understandable information on different types, causes, symptomatology, and management of speech delay and disorders among children was explained with the help of group discussions and posters. Results The motive behind this study was to be aware of facts known by the rural mothers, their actions on coming across such presentations by their children, cues that they would pick up, and the need to ask for help at the appropriate time were assessed and elaborated if not known by them. The Relative Learning Gain and Normalized Gain were calculated to be 76.43% and 0.74 (high gain), respectively, and out of the total subjects, 97.16% of mothers voted that this study proved helpful, and six mothers (4.23%) benefited with the intervention and were referred to experts for evaluation of their children. Conclusion Awareness in this field is necessary to manage children's development, especially by their mothers. Knowing the prevalence of knowledge in mothers may build an association with the prevalence of the recognized cases of speech disorders in children. Evaluation at different community levels may be conducted to gauge the need to impart required knowledge about speech disabilities in children to the maternal population. Future research and the impartation of knowledge to caregivers are vital to promote vigilant and systematic action to be taken regarding the proper growth of their children.

Assessment of Knowledge, Attitudes, and Practices of Parents/Caregivers Towards Migraine in Children: A Cross-Sectional Observational Study

Purpose: This study aimed to evaluate the knowledge, attitudes, and practices (KAP) of parents or caregivers of children suffering from migraines at a tertiary care center in North India.Methods: We conducted a cross-sectional study involving 100 parents or caregivers, using convenience sampling. A 20-item questionnaire was administered in English and also translated into the local language (Hindi). The study included children with migraines who visited the pediatric outpatient department within a 6-month period (December 2022 to May 2023).Results: Over 60% of caregivers were aware of the chronic nature of the illness, its triggering factors, the role of family history, and the importance of lifestyle modifications. However, only 46% understood the pathophysiology of the illness, and 53% were aware of the medication used for childhood migraines. More than 85% of caregivers believed that recurrent headaches necessitate a doctor’s consultation, may require regular visits for optimal treatment, and were willing to alter their child’s lifestyle to prevent headaches. However, a significant percentage of caregivers (47%) practised self-medication for their children’s headaches. Most caregivers believed that lifestyle modifications and avoiding triggers were the best treatments for migraines. There were significant associations (&lt;i&gt;P&lt;/i&gt;&lt;0.05) between the level of education and responses to questions related to migraine definition, prophylaxis, treatment, investigations, lifestyle modifications, and screen time.Conclusion: Most participants were well-educated on migraine, and their KAP regarding migraine prevention and treatment were generally adequate. However, the practice of self-medication without professional guidance is a significant concern.

Parental Knowledge of Appendicitis and Its Management Options Among Children of Makkah Region, Saudi Arabia.

Despite decades of studies, appendicitis in children still presents several uncertainties regarding optimal treatment. To assess parental understanding of appendicitis, along with its risks and treatment, and to determine attitudes to operative and non-operative treatment of uncomplicated appendicitis. This is a cross-sectional study. The current study has targeted all parents who visited the pediatric outpatient departments or clinics at three different hospitals in Makkah and Jeddah City, including Maternity and Children Hospital (MCH) in Makkah, King Fahad Armed Force Hospital (KFAFH), and Saudi German Private Hospital (SGH) in Jeddah. Data was collected via an online Google form and was analyzed by using SPSS. A total of 408 subjects were involved in this study. The majority of them were females (74.5%); 25.5% weremales. Most of the study participants aged between 25 and 34 years. Our results found that the average knowledge score of the study population was 4.1±1.81 out of 11. Only 23.5%of them had good knowledge about appendicitis. More than half of the respondents identified the appendix as a part of the digestive system and most of the study population were aware of the currenttreatment for appendicitis, which is surgery (80.9%). Female participants and respondents who knew someone that has been treated for appendicitis were significantly associated with a better level of knowledge about appendicitis (P-values: 0.011 and 0.033, respectively). Moreover, we found that educational level significantly influenced preference for treatment with antibiotics and surgeryif appendicitis happened again (P-value: 0.049). The study population had poor knowledge of appendicitis and its management options. The highlighted criteria of self-reported relevance to parents should be addressed in all appendicitis counseling and consent. We advocate for the establishment of national public awareness campaigns, as well as increased research and clinical trials. Understanding lay views of treatment alternatives and efficacy will influence future approaches to appendicitis therapy by analyzing the community's preference for emerging treatment modalities and identifying future directions for patient-centered clinical trials.