Pediatric Outpatient Department Research Articles

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.

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

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

Abstract Introduction: 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. Methods: 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. Results: 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 &lt;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 &lt;0.05). The sensitivity and negative predictive value for all anthropometric parameters were higher for synthetic charts. Conclusion: Indian charts were more sensitive for diagnosing growth-related disorders from birth to 60 months of age when compared to WHO growth standards.

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

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.

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.

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