Pediatric Outpatient Department Research Articles

Growth Status of Bangladeshi Children in Functional Constipation: Experience From A Tertiary Care Hospital

Background: Constipation is one of the common complaints of children with long-term hazardous consequences. It is a frequent cause of hospital visit in both primary and specialized care which needs proper evaluation and management. Recently in few studies, impairment of growth status has been reported as a result of functional constipation. But the relation is not well evaluated, especially in the pediatric population of our country. Aim: To assess the growth status of Bangladeshi children in functional constipation. Methods: This analytical study was conducted at the department of Pediatric Gastroenterology and Nutrition, BSMMU, Dhaka. A total 150 children aged 2-18 years were enrolled in this study. Children were divided into two groups, 75 having functional constipation (FC) and 75 healthy children with no constipation. Samples were collected randomly from pediatric out-patient department of BSMMU with consent of parents and child’s approval. Diagnosis of functional constipation was made by Rome IV criteria. Children with any red flag sign, chronic disease and on treatment of constipation were excluded from the study. Growth status (weight, height & BMI) was evaluated by using growth charts. Data collected in semi-structured questionnaire and analyzed by SPSS 23.0. Results: We evaluated 75 constipated children with the mean age of 7.61±3.50 years and 75 healthy children with the mean age of 7.40±3.88 years. The mean weight of children with functional constipation was 22.8±10.01 kg, mean height 117.7 ±18.4 cm and BMI 15.6±2.3 kg/m2. The mean weight of children with no constipation was 28.6± 13.72 kg, mean height 124.49±23.3 cm and BMI 18.11±2.9 kg/m2,demonstrated significant difference between two sets. In functional constipation group, on weight for age and height for age chart, 28% and 24% children were below the 3rd centile respectively and 18.6% children had BMI below 5th centile. All these parameters (weight, height, BMI) were statistically significant in compare to children without constipation and p value is <.05. Presenting features of functional constipation were anorexia (64%), abdominal pain (73.3%), hard stool (84%), blood mixed hard stool (13.3%) and nausea (34%). Conclusion: Growth impairment occurs in children with functional constipation in comparison to children without constipation. Children aged 2 to 18 years with functional constipation may have decelerated weight, height and BMI growth. And this observation needs further large-scale multicenter study for ensuring optimal growth of children with constipation. J Shaheed Suhrawardy Med Coll 2023; 15(1): 73-77

Clinico-Demographic Profile of Children Attending Pediatric Outpatient Department in Tertiary Care Center in Gandaki Province, Nepal: A Prospective, Descriptive Cross-Sectional Study

Introduction: Pediatric outpatient departments (OPDs) in tertiary care centers provide a vital connection for the early diagnosis and treatment of childhood illnesses. Understanding the clinico-demographic profile of pediatric patients attending these centers provides insight into the healthcare needs and challenges faced by children in specific regions. This study aimed to evaluate the clinico-demographic characteristics of children attending the pediatric OPD.  Methods: A prospective, descriptive cross-sectional study was conducted from April 12 to December 17, 2023 at pediatric OPD at GP Koirala National Centre for Respiratory Diseases and Hospital, Tanahun, Gandaki Province, Nepal. Data were collected from the pediatric OPD during clinical history taking and examination, including 7,020 children aged 0–14 years. Verbal consent was obtained from legal guardians for using clinical history and diagnostic data. Data on age, sex, socioeconomic status, parental education, and disease distribution were analyzed using SPSS version 23.  Results: Out of 7,020 children, 42.89% were aged 1–5 years, and 28.67% were aged 6–10 years. Males (50.7%) slightly outnumbered females (49.3%). Socioeconomic analysis showed that 57.3% of children were from low-income families. Regarding parental(either father or mother or any legal gurdian who brought child at hospital OPD) education, 31.19% had secondary education, and 28.3% had primary education. Respiratory infections (19.97%) were the most common diagnosis, followed by gastroenteritis (11%), pain abdomen (9%), and malnutrition, especially undernutrition (8%). Other notable conditions included enteric fever (7.4%) and acute conjunctivitis (7.3%).  Conclusion: The study highlights a high prevalence of respiratory and gastrointestinal conditions among children, particularly from low-income families. The findings emphasize the need for targeted healthcare interventions and improved parental education to reduce the burden of childhood illnesses in Gandaki Province.

Misuse of Antibiotics in Pediatric Patients – A Comprehensive Review .

To identify and assess the likely causes of antibiotic overuse in the Pediatric outpatient department (OPD) of a busy teaching hospital. Overuse of antibiotics has emerged as a significant global pediatric concern. Specifically, the sale of drugs without a prescription from a doctor and other circumstances may have an impact on the abuse of antibiotics. Antibiotic resistance is encouraged by the misuse of antibiotics, particularly when antibiotics are used, even when they are not the recommended course of therapy. The Centers for Disease Control and Prevention estimate that between one-third and half of all antibiotic usage in humans is unwarranted or improper. Viral pathogens are the primary cause of respiratory tract infections (RTI) in children compared to adults. Interestingly, compared to adults with RTI, very little is known regarding the usage of antibiotics in children.

Contributing Risk Factors to Pneumonia in Children Under Five Years in Madhesh Province of Nepal

Introduction: Pneumonia is the significant cause of morbidity and mortality in under five year children worldwide. In Nepal, pneumonia is the second most common cause of childhood mortality. Exclusive breastfeeding and basic immunization in preventing pneumonia cannot be underestimated. This study aims to assess the contributing risk factors associated with childhood pneumonia among children aged 16 months to under-5 year.  Methods: A case-control study was conducted from January to July 2022 including children under 5 years visiting the pediatric out-patient department of JMCTH. A total of 200 subjects aged 16–59 months were enrolled, in which ‘cases’ included 100 patients diagnosed with pneumonia and ‘controls’ included 100 patients with non-pneumonia illnesses, matched by age and setting. The WHO guideline was followed for the diagnosis of pneumonia. The data on contributing risk factors were collected from both cases and controls via interview method from their parents.  Results: The study showed non-exclusive breastfeeding [odds ratio (OR) =7.82 in 95% confidence interval (CI)], indoor air pollution [OR=7.47 in 95% CI], incomplete basic immunization [OR= 4.44 in 95% CI], low birth weight [OR=3.11 in 95% CI] and severe acute malnutrition i.e. high degree of wasting [OR=2.70 in 95% CI] were the major contributing factors of pneumonia in children under age five in the Madhesh Province of Nepal. However, nutritional status (height-for-age z score), age, sex, and educational status of mother did not appear to be contributing risk factors for pneumonia.  Conclusion: This study highlights non-exclusive breastfeeding, indoor air pollution, incomplete basic immunizations, low birth weight, and severe acute malnutrition significantly increase the risk of childhood pneumonia. Exclusive breastfeeding plays a vital role, while gender seems to influence the relationship between exclusive breastfeeding and pneumonia incidence.

Knowledge, Attitude and Practice of Parents of Children with Childhood Asthma in a Tertiary Care Hospital

Back ground: Asthma is one of the most common reasons that children visit doctors, miss days at school or are admitted to hospital. If asthma is well managed, child should be able to lead a healthy and active life. Methods: The study aims to investigate parental knowledge, attitudes about childhood asthma, and practices regarding the management of their children’s asthma. An observational cross-sectional study was conducted among parents of children aged between 2 and 12 years with asthma who had visited the outpatient or inpatient department of Pediatrics at Dhaka Medical College Hospital over a period of approximately 6 months. Data were collected using a preformed Knowledge, Attitude, and Practice (KAP) questionnaire. Results: Total 110 parents of children with childhood asthma were interviewed in this study. There were 63 (57.3%) male and 47 (42.7%) female with M:F ratio 1.34:1 (Slightly male predominance). Most of the patients 57(87.6%) visited in out-patient department (OPD). Almost half of the parents (52.7%) knew their children had asthma. Most of the parents (80.9%) thought oral form of drug (syrup/ tablet) is better than inhaler. Almost two-third parents believed asthma can be cured and they did not know the importance of adherence with asthma medications. The overall parental knowledge was poor (49.09%). Nearly half of them (49.09%) had negative attitude about childhood asthma & 50.9% parents had poor practice about avoidance of allergens, use of asthma medications and regular follow up of their children. Knowledge, attitude and practice are significantly associated with education, socioeconomic condition and living area. Statistically significant positive correlation has been found between knowledge and practice, but knowledge and attitude has not showed significant positive correlation. J Dhaka Med Coll. 2022; 31(2) : 194-200

Clinical, Genetic, Biochemical, Hormonal, and Radiological Profile in Patients with Disorders of Sex Development Presenting at a Tertiary Care Center in Central India

Abstract Introduction: Disorders of sexual differentiation or differences in sex development (DSD) is a congenital anomaly with abnormal differentiation between internal gonads and external genitalia. We present the clinical, genetic, biochemical, hormonal, and radiological profile of DSD patients who presented at a tertiary care institute in Chhattisgarh during 2 years. Methodology: All patients with DSD and age <18 years who presented in the Outpatient Department of Pediatrics and Pediatric Surgery between January 2022 and December 2023 (2 years) in All India Institute of Medical Sciences, Raipur, Chhattisgarh, were included in this study. Our aim was to study the clinical, genetic, biochemical, hormonal, and radiological profile of patients with DSD presenting at our institute to outline the management plan in these patients. Results: During the study period, there were seven patients with DSD; with age ranging from 1 year to 15 years. Four patients presented in adolescent age. There were two patients with XXDSD – diagnosed to have classic congenital adrenal hyperplasia (21-hydroxylase deficiency). There was one patient with XYDSD – androgen insensitivity. Four patients had ovotesticular DSD – two had pure gonadal dysgenesis and two had mixed gonadal dysgenesis. Four patients needed gender reassignment. Conclusion: Patients with DSD require a systematic management at a tertiary care center. Assigning the sex of rearing should be done only after proper workup of patients and arriving at a diagnosis. Proper counseling of parents and individualized management as per the Indian Association of Pediatric Surgeons guidelines is mandatory.

Perception and Practice of Sub-Himalayan Region Mothers for Breastfeeding: A Cross-Sectional Survey

Abstract Background: Breast milk is an ideal food for neonates, which is also beneficial for mothers. Nowadays, modern mothers choose not to breastfeed their babies. The World Health Organization also recommends continuous breastfeeding of babies for up to 2 years. The present study focuses on assessing the perception and practice of mothers for exclusive breastfeeding in the sub-Himalayan region of India. Materials and Methods: A cross-sectional study was conducted among postnatal mothers who were attending pediatric outpatient departments (OPDs) and immunization clinics at All India Institute of Medical Sciences, Rishikesh, India. Interview schedules were conducted to assess knowledge and skills, and data related to breastfeeding were collected from 210 mothers. Purposive sampling techniques were used to select each participant. Results: The mean age of mothers was 26.8 years, 56% had previous experience of breastfeeding, 76% had a cesarean delivery, and 70% had started breastfeeding within 1 h. More than half (53%) of the mothers had inadequate knowledge of breastfeeding. On the Iowa Scale, only 8% of mothers reported a very positive attitude toward breastfeeding. On the Bristol scale, 81% of mothers reported that they were following good breastfeeding practices. Conclusions: The study concludes that sub-Himalayan mothers have inadequate knowledge of breastfeeding, but their practices are still suboptimal. We recommend more public health awareness programs to promote breastfeeding in this region.

Impact of Covid-19 on Psychosocial Well-Being of School-Going Children: A Cross-Sectional Study.

The mandated closure of schools due to Covid-19 is likely to have a negative impact on school-going children. This study aimed to assess the psychosocial well-being of school children during the pandemic in eastern India. This cross-sectional study was conducted in the outpatient pediatric department of tertiary care teaching hospitals. Children between the ages of 4 and 14 were enrolled. The main outcome measures included the Emotional Symptoms Scale, Conduct Problem Scale, Hyperactivity Scale, Peer Problem Scale, and Prosocial Scale from the Strength and Difficulties Questionnaire (SDQ), as well as the Children's Hope Scale. Out of 169 children aged 4-14, 104 (61.5%) were male, 140 (82.8%) were from urban areas, 66 (39.1%) had a family member who was a healthcare worker or frontline worker, and 12 (7.1%) had experienced the death of a family member due to Covid-19. Anxiety-related and depressive symptoms were observed in 81 (47.9%) and 70 (41.4%) children, respectively. Psychosocial difficulties with a 'clinically significant problem likely' were observed in 26 (15.4%) children, more common in males (16.35%, P=0.035) and older children (12-14 years). Children from families with healthcare/frontline workers, Covid-affected families, loss of job in the earning member, and uninvolved parenting style were associated with more psychosocial difficulties. The mean (SD) hope score was 22.46 ± 6.42 in children above eight years. The psychosocial well-being of school-going children is adversely affected during Covid-19, particularly in families with frontline workers, loss of job, and death of family members due to Covid-19. The poor hope score in children aged 8 years and above indicates an adverse impact on their ability to achieve future goals.

Melatonin as an add-on anti-seizure medication in children with epilepsy: An open-label randomized controlled trial

Objectives: The primary objective of this study is to measure the effect of melatonin in decreasing seizure frequency in intervention group as compared to controls in children with drug-resistant epilepsy. Materials and Methods: An open-label randomized controlled trial was conducted from July 2020 to June 2022 in children between 2 and 14 years with drug-resistant epilepsy attending Pediatric and Neurology outpatient department and inpatient department. After noting down baseline seizure frequency, children were randomized into the melatonin group and control group. In the melatonin group, add-on melatonin was added to the existing ASM, and in the control group, ASMs were continued. The primary and secondary outcomes were measured after 3 months of follow-up. Results: The percentage change in the seizure frequency between both groups at the end of 3 months of follow-up was not statistically significant, but the percentage reduction of seizure frequency was more than 50% in the melatonin group. Melatonin was well tolerated in our children except for 4 (22%) who developed minor adverse effects. Conclusion: Add-on melatonin decreases seizure frequency to some extent which was not statistically significant with no major side effects. Further studies are needed to assess add-on melatonin’s long-term effectiveness and safety in children with drug-resistant epilepsy.

Transitional Urology in Korea: Initial Insights Through a Cross-Sectional Study.

In Korea, the field of transitional urology (TU) is in its nascent stages, with its introduction only beginning. This study aims to evaluate the existing state of TU prior to implementing a transition protocol, and to identify key areas of focus for the development of an effective transition protocol. From June 1, 2021 to May 31, 2023, clinical data were retrospectively collected for patients who visited the adult urology or pediatric urology outpatient departments of this hospital and were aged 10 or older, with medical conditions falling under the category of TU. We analyzed the patient distribution across different disease groups. The transitional stages were categorized from T1, indicating initial care by pediatric urologists, to T4, denoting complete transition to adult care. 'T4x' was used for patients with unknown medical histories, and 'T4only' for those who had never been under pediatric urology care. During a 2-year period, a total of 1,484 patients received outpatient care for diseases in TU field. The most prevalent diseases were hypospadias (40.4%), spinal bifida (37.3%), and congenital ureteral anomalies (17.7%), with other conditions accounting for 4.6%. Among 553 spinal bifida patients, only 5.3% completed transitional care (T4), while 80.1% were in the initial phase (T1). For patients introduced to adult urology (T2-T4), 37.7% reached T4, highlighting a marked increase in transition completion within this subset (P<0.001). TU in Korea is in its nascent stage, with a significant gap in the initiation and completion of transitional care for patients with congenital urologic conditions. Early initiation and active engagement in transitional care are crucial for successful transition. This study highlights the need for structured transition protocols to address the complex needs of this patient population.

Umbilical hernia in pediatric patients attending outpatient department in tertiary care centre

Background: Umbilical hernias are estimated to affect 15% of children. Age, race, gestational age, and coexisting disorders are some of the variables that affect it. In comparison to the general population, there are greater incidences of connective tissue illnesses in children, premature delivery, low birth weight, syndromic newborns, black children, and children with pathologies that raise intraabdominal pressure. To determine the prevalence and to assess the risk factors of umbilical hernia in pediatric patients attending outpatient department (OPD) in tertiary care centre. Methods: The present observational study was conducted in paediatric OPD, of a tertiary care centre over a period of one year. A total of 100 study subjects were enrolled with suspected umbilical hernia. The data was collected with the help of a structured clinical proforma and analysed with SPSS version 20.0. Results: In our study the most prevalent age group involved being 0-1 years (6%) followed by 8-10 years (3%) and 2-4 years (2%). Umbilical hernia was seen more in males (64%) than females. Low birth weight (81%), premature delivery (54.54%), and undernutrition (90.9%) were the risk factors that were observed to be associated with the development of umbilical hernia. Conclusions: The study concluded that the overall prevalence of umbilical hernia was 11% and the associated risk factors were premature delivery, low birth weight and poor nutrition.

Children's Ages, Reasons, and Experiences for First Dental Visit and Barriers of a Late Visit: A Cross-Sectional Community-Based Study in Saudi Arabia.

This study aimed to determine the age and reason of pediatric patients at the first visit and the barriers to a late visit. A study was conducted among guardians of children attending the Outpatient Pediatric Dentistry Department. Children who visit the dentist for the first time were included in the study. A self-administered questionnaire was used and the behavior of children was evaluated by using Frankl's scale. Descriptive statistics was used to explore the general data. A total of 211 children had their first dental visit. The majority (n = 112, 53.1%) visited the dentist for the first time at the age of three to six years. Reasons for the first dental visit for most children were dental caries (n = 118, 32.8%) followed by dental pain (n = 114, 31.7%). More than half of the parents (n = 160, 75.8%) reported that the overall experience of the first visit was very good. The highest reported barriers to a late dental visit were that the child's not complaining of dental problems (n = 60, 20.5%) and dental fear and anxiety (n = 58, 19.8%). Most of the children in this study visited the dentist for the first time beyond the internationally recommended age and the reason behind this visit is to relieve a specific chief complaint. Moreover, the barriers contributing to the postponement of a child's first dental visit vary in this study. The childnot complaining of any dental problems and dental fear and anxiety were the highest reportedbarriers.

Risk Factors, Clinical Profile and Association of Clinical Grading With Radiological Grading of Adenoid Hypertrophy in Children

BACKGROUND: Adenoid hypertrophy producing obstructive airway symptoms is the most commonly encountered pediatric ENT problem. Clinical symptoms in combination with lateral nasopharyngeal x ray is a reliable technique for selection of children requiring surgical intervention. METHODOLOGY: The current cross sectional prospective study was conducted among 250 children aged 3-12 years with clinical symptoms and radiological evidence suggestive of enlarged adenoids, at Pediatric outpatient department of a tertiary care center, Dhaka, during 1-year period. RESULT: In our current study, majority children (74%) with adenoid hypertrophy were 3-6 years old followed by 26% between 7-12 years. 66% children were male and 34% were female with a male to female ratio of 1.9:1. 44% children were from lower class family and history of atopy was present among 54% children. Clinical grading of adenoid hypertrophy was done on the basis of presenting symptoms (mouth breathing, snoring, sleep disturbances and adenoid facies) and radiological grading was done from calculating adenoid nasopharyngeal ratio. Correlation between clinical scoring and radiological grading of adenoid hypertrophy among study population was observed. Clinical score of 0-4, 5-8, 9-12 and 13-16 was graded clinically into Grade I, II, III and IV respectively. Highly significant p value (.000) was observed in Grade II clinical and radiological grade of enlarged adenoid. The remaining clinical and radiological grade of enlarged adenoids showed significant p value .031, .024 and .019 among grade I, III and IV respectively. CONCLUSION: Though various diagnostic modalities for detection of degree of obstruction caused by enlarged adenoids are available, clinical scoring in combination with radiological grading can be effectively used to select patients requiring surgical intervention for pediatric adenoid hypertrophy. J Shaheed Suhrawardy Med Coll 2022; 14(2): 11-17

Assessment of weaning practices among mothers for their infants attending the Pediatric Outpatient Department of Sindh Government Hospital Paretabad Hyderabad.

General Objective: To assess the weaning practices among mothers for their infants those attending the pediatric outpatient department of Sind Government Hospital, Paretabad, Hyderabad.Specific objectives:1. To determine the age of onset of weaning2. To determine the type of weaning food3. To determine the level of education and its relation to weaningMethods: It was a cross-sectional study conducted at Sind Government Hospital, Paretabad, Hyderabad, duringthe period of 15th May 2008 to 15th June 2008. We had included all the patients according to the inclusion criteriaand did not do sampling. Data was collected by principal investigator herself on a pre-formed, pre – tested questionnaire about weaning practices among mothers for their infants. Respondents were mothers/care givers accompanying their infants who were interviewed in their own language to avoid inconvenience. The operationaldefinitions of variables were already set before the starting of data collection process. The study population included all new patients visiting in out patient department of Sindh Government Hospital Paretabad, Hyderabadduring the study period. The variables included the basic demographic variables i.e. age, residence, occupation,education and socio-economic status of mothers, age of onset of weaning, type of first food given as weaning,hygienic practices of mothers etc.The exclusion criteria included prematurely borne infants, those revisiting OPD, and those who visited the facilityfor acute medical problems that required hospitalization.Result: Among 307 infants aged 3-12 months registered, males were 54.1% in comparison to females (45.9%).The majority of the mothers visiting the facility belonged to slum areas (79.2%). Regarding maternal attitudesand practices of weaning, 67 (21.8%) mothers considered cow’s milk as a weaning diet while majority of them i.e.240 (78.2%) were of the opinion that semisolids were the weaning foods. About 24.8% mothers started weaningearlier and only 47.6% of them started to give weaning food to their infants between ages 3 – 6 months. A strongassociation is evident between socio- economic status of mothers and the use of commercial weaning foods(p=0.01). The study concludes that there is a dire need of promoting among mothers the norms of giving properweaning foods to their infants.

Clinical profile of children with metabolic liver diseases presenting in a tertiary care hospital of Eastern India

Clinical profile of children with metabolic liver diseases presenting in a tertiary care hospital of Eastern India

Effect of Dhupana (medicated fumigation) on the microbial concentration in the indoor air in Kumaragara (pediatric OPD and IPD): an experimental study

Abstract Introduction: Bioaerosols causing infectious diseases are a major concern for the environmental safety in hospital indoors. Chemical fumigation used for controlling infectious bioaerosols leads to several health hazards such as allergic reactions, hyperbilirubinemia, carcinogenicity, and toxicity. Corrosion of metal surfaces, bleaching of fabrics, risk of accidental consumption, high cost, unpleasant odor, flammability, and formation of toxic gases are other concerns. In Ayurveda, Dhupana (medicated fumigation) is advocated for controlling invisible agents capable of disease transmission. It can be a safer alternative to chemical fumigation. However, many ingredients of classical Dhupana preparations are rare or impractical to use; hence, a novel “Shodashanga Dhupa” (16-ingredient fumigation preparation) was formulated using easily accessible ingredients of classical Dhupana formulations. Materials and Methods: The antimicrobial and antifungal activities of Shodashanga Dhupa were ascertained by enumerating colony-forming units (CFUs) in the passive air samples obtained from hospital rooms before and after 1 h of Dhupana. These samples were collected on suitable agar media, and the settle plate method was carried out. Results: There was improvement in the Index of Microbial Air Contamination and a statistically significant reduction in bacterial CFUs in the pediatric outpatient department (P = 0.000218) and in the Panchakarma therapy room (P = 0.000218). There was a statistically significant reduction in fungal CFUs (P = 0.0137) in the pediatric outpatient department and in the Panchakarma therapy room (P = 0.00109) after 1 h of Dhupana. Conclusion: The study suggests that fumigation with common herbs and spices is effective in decreasing bacterial and fungal bioaerosol concentration in the indoor air of hospital rooms, and it can be used as an economical, hassle-free, and safe method of disinfection.

Resistance pattern observed in community-acquired urinary tract infection in children from a tertiary care hospital situated in a tribal district of eastern India

ABSTRACT Background: Community-acquired urinary tract infection (CA-UTI) is mostly treated empirically. There are limited studies on pediatric UTIs, their microbiological profile, and resistance patterns. Antimicrobial resistance and even multidrug resistance are on the rise among uropathogens in the pediatric population and may lead to complications in the long run. This study was done to know the microbiological profile and the resistance pattern of CA-UTI in the pediatric population of a tertiary care hospital in a tribal district of northern Odisha among children aged 5–14 years. Methods: A hospital-based cross-sectional study was done from January 2021 to June 2021. All cases aged between 5 and 14 years attending the pediatrics outpatient department suspected of UTI were included. Descriptive statistical analysis and regression analysis were done using the statistical software Stata SE 13. Results: Out of the total 311 cases, vomiting and pain in the abdomen were the most common clinical presentations. Significant bacterial growth was isolated in 74 samples. Escherichia coli (39.2%) was the predominant isolate. Resistance to cefotaxime (38.2%) and ciprofloxacin (36.4%) is highest and seen in both gram-positive and negative bacteria. Multidrug resistance was detected in 33.7% of the bacterial isolates. Conclusion: The present study highlights the problem of the rising resistance pattern of common bacterial pathogens causing CA-UTI in children. Further studies on genotypic resistance and appropriate measures are required to prevent the rapidly spreading resistance among these common uropathogens.

Factors associated with hospitalization in a pediatric population of rural Tanzania: findings from a retrospective cohort study

BackgroundDespite pediatric acute illnesses being leading causes of death and disability among children, acute and critical care services are not universally available in low-middle income countries, such as Tanzania, even if in this country significant progress has been made in child survival, over the last 20 years. In these countries, the hospital emergency departments may represent the only or the main point of access to health-care services. Thus, the hospitalization rates may reflect both the health system organization and the patients’ health status. The purpose of the study is to describe the characteristics of clinical presentations to a pediatric Outpatient Department (OPD) in Tanzania and to identify the predictive factors for hospitalization.MethodsRetrospective cohort study based on 4,324 accesses in the OPD at Tosamaganga Voluntary Agency Hospital (Tanzania). Data were collected for all 2,810 children (aged 0–13) who accessed the OPD services, within the period 1 January − 30 September 2022. The association between the hospitalization (main outcome) and potential confounding covariates (demographic, socio-contextual and clinical factors) was evaluated using univariate and multivariate logistic regression models.ResultsFive hundred three (11.6%) of OPD accesses were hospitalized and 17 (0.4%) died during hospitalization. A higher (p < 0.001) risk of hospitalization was observed for children without health insurance (OR = 3.26), coming from more distant districts (OR = 2.83), not visited by a pediatric trained staff (OR = 3.58), and who accessed for the following conditions: burn/wound (OR = 70.63), cardiovascular (OR = 27.36), constitutional/malnutrition (OR = 62.71), fever (OR = 9.79), gastrointestinal (OR = 8.01), respiratory (OR = 12.86), ingestion/inhalation (OR = 17.00), injury (OR = 6.84).ConclusionsThe higher risk of hospitalization for children without health insurance, and living far from the district capital underline the necessity to promote the implementation of primary care, particularly in small villages, and the establishment of an efficient emergency call and transport system. The observation of lower hospitalization risk for children attended by a pediatric trained staff confirm the necessity of preventing admissions for conditions that could be managed in other health settings, if timely evaluated.

A Quality Improvement Initiative to Reduce Prescription Error in a Pediatrics Outpatient Department at a Secondary-Level Community Hospital.

Background Medication errors are common, especially by new trainees in primary care settings. Our study aimed at reducing the rate of prescription error in the pediatric outpatient department (OPD) of a secondary healthcare center in suburban north India using a quality improvement methodology. Methods Based on a survey and focused group discussion (FGD) involving all stakeholders, the identified problems and difficulties faced during outpatient prescriptions, interventions, and outcome parameters were drafted. The primary outcome measure was the prescription error rate evaluated by a senior resident (SR) of pediatrics, and the secondary outcome measures included the frequency of antibiotic prescriptions and investigations. Intervention Two cycles of Plan-Do-Study-Act (PDSA) were conducted on accessible drug formularies and standard treatment protocols for common pediatric conditions. Results The mean baseline prescription error was 72.2% (95% confidence interval (CI): 63.2-81.1). After the implementation of the first PDSA cycle, the mean error rate was 46.5% (95% CI: 36.6-56.5). There were eight consecutive points of prescription error below the control limit (63.2% and 81.1%) of the baseline. The PDSA-2 cycle showed the same shift to below the control limit (36.6% and 56.5%). The mean error rate found at the end of the PDSA-2 cycle was 22.5% (95% CI 15.7-29.5). There was no clinically significant difference in the number of investigations or antibiotics prescribed. Conclusion The application of standardized drug formularies and standard treatment protocols (STPs) can help reduce prescription errors, especially in a primary care setting. Expansion of such techniques to other centers could be particularly useful.

Comparison of WHO 2006 Growth Standards and Synthetic Indian References in Assessing Growth in Normal Children and Children with Growth-Related Disorders.

A good screening tool, such as a growth chart, should distinguish between children with normal growth and those with perturbed growth. Suitability of synthetic Indian growth references for diagnosing growth-related disorders for under-five children has not been evaluated. To assess the validity of World Health Organization (WHO) 2006 standards vs synthetic Indian references (2019) (by comparing weight, height, body mass index (BMI), standard deviation scores (SDS) and the composite index of anthropometric failure (CIAF)) in differentiating normal children and children with growth-related disorders. Records of 2188 children (0-60 months) attending a tertiary centre paediatric outpatient department (OPD) were retrospectively studied; 1854 children were healthy and 334 were diagnosed with growth-related disorders as per the European Society for Paediatric Endocrinology (ESPE) classification. The anthropometric parameters converted to Z-scores for weight-for-age (WAZ), height-for-age (HAZ), BMI-for-age (BAZ) and a CIAF were computed using WHO and synthetic charts; Student's t-test was used for assessing differences and Youden's index for validity. Disease status of children and anthropometric failure on WAZ, HAZ, BAZ and CIAF on both WHO and synthetic charts had a significant association (P-value <0.05). WAZ, HAZ on both charts and CIAF on synthetic chart had a fair to moderate agreement (Kappa statistics) with disease status as per diagnosis (P-value <0.05). The sensitivity and negative predictive value for all anthropometric parameters were higher for synthetic charts. Indian charts were more sensitive for diagnosing growth-related disorders from birth to 60 months of age when compared to WHO growth standards.