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PATTERN OF CHILDHOOD EMERGENCIES (PAEDIATRIC EMERGENCIES) IN FEDERAL TEACHING HOSPITAL

Project Topic: Evaluation of The Pattern of Childhood Emergencies (Paediatric emergencies) in Federal Teaching Hospital


CHAPTER ONE

INTRODUCTION

Information obtained from the epidemiology of diseases is a valuable tool for health care administrations and policy making. It is vital for healthcare planning, resource allocation and patient care as well as a source of information for healthcare decision makers on setting national priorities on health matters.

Most health statistics published in Nigeria are based on information from hospital records and although such statistics may not be true representation of what is obtainable in the entire population, such records may serve as pointers to what exist in the entire country.

Studies from most parts of Africa and other developing countries including Nigeria implicate infections and other communicable diseases such as malaria, acute respiratory infections, diarrhoea and measles as been responsible for most hospital admissions and childhood deaths in the region1-4. In 2008, there was 8.8 million deaths of children under 5years of age; 4.5 million were from Africa especially west and central Africa. This high rate of mortality in the paediatric age group with low life expectancy and increasing food prices make the attainment of the millennium development goals (MDG) related to child survival unlikely for sub-Saharan Africa5. MDG 4 (to reduce child mortality) is directly related to childhood survival. Its target is to reduce by 2/3rds between 1990 and 2015, the under five mortality rate6.

The children emergency unit of federal teaching hospital Abakaliki(FETHA) is the unit that provides care for children who require prompt life saving measures after which they are discharged as soon as possible from the unit preferably within 24 to 48 hours of admission either by transfer to the main paediatric wards or home to continue treatment as out-patients. The attending paediatricians and nursing staffs priorities is to attend to all patients according to severity of their conditions ensuring that the more critically ill child is attended to first7.

MEDICAL EMERGENCY IN CHILDHOOD

A medical emergency is an illness or injury that is acute and poses an immediate risk to a person’s life or long term health……

CLASSIFICATION OF CHILDHOOD EMERGENCIES

Age specific common paediatric emergencies includes:

  1. Neonatal period- Low birth Wight -Jaundice -infections like septicaemia and meningitis.
  2. Infancy– Acute respiratory infections like bronchopneumonia and broncholitis,- diarrheal diseases with associated dehydration and protein energy malnutrition.
  3. 1-5 years of age– Malaria associated with severe anaemia, Heart failure, febrile convulsions, acute respiratory infections, haemoglobinopathies, accidents like burns & poisoning.
  4. >5 years- Malaria, sickle cell disease, bronchial asthma, heart failure, seizure disorders and other endemic diseases.

COMMON PAEDIATRIC EMERGENCIES CLASSIFIED ACCORDING TO SYSTEM

  1. Neurologic emergencies

  –Febrile convulsion, meningitis, status epilepticus, cerebral malaria, encephalitis.

  1.  Haematologic emergencies could be directed into infections and non-infections

– Infections: severe malaria, septicaemia, shock

– Non-infections: Anaemia, sickle cell disease, Haemophilia.

  1.  Cardiovascular emergencies

– Heart failure, shock, severe hypertension, congenital heart disease.

  1.  Respiratory emergencies

– Bronchopneumonia, asthma, Aspiration pneumonitis, broncholitis, lobar pneumonia, pneumothorax

  1.  Skin infections

– Cellulitis, measles, chicken pox, furunculosis

  1. Metabolic emergencies

– Hypoglycaemia, anaphylactic drug reaction

  1. Gastro-intestinal emergencies

-Acute watery diarrhoea, hirchsprung’s disease, intestinal obstruction, acute appendicitis, food poisoning, intussusception, dysentery, under-nutrition, intractable vomiting, peptic ulcer disease, enteric fever, helminthiasis, rectal prolapse, imperforate anus.

  1. Genitourinary emergencies

– Pyelonephritis, haemolytic uremic syndrome, acute renal failure, acute urine retention, dysmenorrhoea

  1. Paediatric accidents

– Road traffic accident, burns, fractures, wounds, poisoning.

  1. Endocrine emergencies

– Diabetic ketoacidosis, thyrotoxicosis, hyperglycaemia

   Study objectives

General:

To ascertain the variations in patterns of childhood emergencies that presented in the children emergency room of Federal teaching hospital Abakaliki(FETHA) and to compare it with pattern noted by previous studies, so that useful deductions can be made to develop the prevention and management of common emergencies.

Specific:

To determine/identify the difference disease that present at the children emergency room (CHER)

– To ascertain the duration of stay

– To find out complications of the different diseases

– To ascertain the management outcome (if any)

– To determine seasonal variation (if any) of the different disease condition

– To use the outcome of the study to inform policy makers on how best to address the problem of childhood emergencies

CHAPTER TWO

LITERATURE REVIEW

   Study of the pattern of childhood emergency of federal teaching hospital Abakaliki (FETHA) 2013 is not the first of its kind. Many studies have been carried out in other centres which are as represented below:

In a study on the Pattern and outcome of admissions into the children emergency room of the university of Nigeria teaching hospital Enugu. The study was carried out over a 5-year period and showed a total of 10,267 admissions with a discharge rate of 50.4% and a transfer-out rate of 44.3% and a mortality of 5.1%. The commonest cause of admission was febrile convulsions (21.5%); severe malaria with anaemic heart failure (18.4%), acute lower respiratory tract infection (16.1%), diarrhoeal diseases (12.3%), complications of sickle cell anaemia (7.6%), acute neurological conditions (7.6%), acute asthma (5.2%) & neonatal conditions (4.8%). surgical emergencies constituted 6.1% of all admissions while chronic medical conditions were only 0.4%8.

In another study, Synopsis of paediatric emergency presentations in Abakaliki 18 months review, there were 1308 admissions within the study period, this consists of 753 males, 549 females and 6 were unclassified. The mean age was 3.15 and 3.67years and children under 5 constituted 81.2% while school age children and adolescents constituted 10.7% and 8.3% respectively. Communicable disease comprised of 1077 (82.3%) while non-communicable disease constituted 230 (17.5%) of the diseases. The top 5 diagnosis were malaria and its complications (33.5%); acute diarrhoeal disease (18.7%); pneumonia (12.6%), sepsis (10%) and sickle cell anaemia (6%) and these were common in children under 5. Haematological system (44.1%), digestive (21.7%); respiratory (17.9%) and central nervous system (7.5%) were the four commonly affected systems. About 19 (1.0%) were discharged against medical advice, 1126 (92.3%) were either discharged home or transferred to the ward for further management while 72 (5.9%) patients died9.

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