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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 6  |  Issue : 9  |  Page : 26-30

Morbidity and mortality pattern among young adolescents at the emergency pediatric unit of a tertiary care facility in Abuja, Nigeria


Department of Paediatrics, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria

Date of Web Publication2-Aug-2017

Correspondence Address:
Uduak M Offiong
Department of Paediatrics, University of Abuja Teaching Hospital, Gwagwalada, Abuja
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/nnjcr.nnjcr_1_16

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  Abstract 


Background/Aims: The period of adolescence can be described as the transition from childhood to adulthood. This transition also comes with changes in the health needs of this group due to their unique biological, psychological, and social characteristics. Defining morbidity and mortality burden in adolescents will help identify their health needs. In developing countries, this information is lacking and hence our study is to describe the emergency room morbidity/mortality pattern among pediatric unit adolescent patients at the emergency of our health institution. Materials and Methods: A retrospective study reviewing case notes and admission records of children aged 10–16 years presenting between January 2008 and December 2012 in the emergency pediatric unit in the University of Abuja Teaching Hospital Gwagwalada was conducted. Both demographic and clinical data on indications for admission were extracted and entered into Microsoft Excel 2007. Data are presented in percentages. Results: Four hundred and eighty-nine adolescents were seen during the study. There were 285 (58.3%) males and 204 (41.7%) females. The major causes of morbidity and mortality were infectious diseases with malaria and septicemia ranking highest. Tetanus was more prevalent in males than females. Sickle cell anemia was the most common noncommunicable disease (NCD) in the study population. Mortality rate was 8.8% with 60.5% occurring in males. Conclusion: Infectious diseases are still a cause of morbidity and mortality in the adolescent population. Tackling infection is necessary while taking steps to control the emergence of NCD among childhood survivors.

Keywords: Adolescent, infections, puberty


How to cite this article:
Offiong UM, Mairiga F. Morbidity and mortality pattern among young adolescents at the emergency pediatric unit of a tertiary care facility in Abuja, Nigeria. N Niger J Clin Res 2017;6:26-30

How to cite this URL:
Offiong UM, Mairiga F. Morbidity and mortality pattern among young adolescents at the emergency pediatric unit of a tertiary care facility in Abuja, Nigeria. N Niger J Clin Res [serial online] 2017 [cited 2022 Aug 16];6:26-30. Available from: https://www.mdcan-uath.org/text.asp?2017/6/9/26/211999




  Introduction Top


An adolescent is defined as any individual between the ages of 10 and 19 years; it is the last stage of childhood as they transition into adulthood.[1],[2] The period of transition is associated with changes in the physical, cognitive, and psychosocial development of the child. it is during this transition that the tendency to engage in risky behaviours is highest.[1],[2],[3],[4]

There is increasing attention being paid to this hitherto neglected population. It is estimated that there are about 1.6 billion adolescents and young adults (10–24 years) in the world, and approximately 90% of these reside in low-income countries.[2],[3],[4] However, there are insufficient data on the health of the adolescent population in middle- and low-income countries to make strategic health preventive planning.[5],[6] the persistence of infectious disease coupled with the emergence of non-communicable diseases (NCD) within the same population of individuals makes them vulnerable to poor health outcomes.[2],[3],[6]

The Nigerian policy for the health and development of adolescents addresses interventions only in the areas of sexual and reproductive health, which have received a lot of attention in published work.[7] With the proposed revision of the policy to include other areas of adolescent health, it is necessary to have sufficient data for program planning.[7] It is thus hoped that this study would contribute to the data pool.

The study would have the objective of determining the emergency room morbidity and mortality pattern in young adolescents and specifically describe the common causes of morbidity and mortality as well as the pattern of disease both by gender and age group of adolescents seen.


  Materials and Methods Top


This was a 5-year retrospective descriptive study. Admission records of children aged 10–16 years admitted to the emergency pediatric unit (EPU) between January 2008 and December 2012 of the University of Abuja Teaching Hospital (UATH) were reviewed. The EPU caters for medical and surgical emergencies (excluding burns, factures, and road traffic accident victims) of children between the ages of 29 days to 16 years (children above 16 years are seen in the casualty unit of the hospital). It serves the federal capital territory and the neighboring states of Niger, Nasarawa, Kogi, and Kaduna. Patients were divided into two age groups: representing the developmental periods of adolescents, early (10–13) and middle (14–16).[5] Demographic and clinical data were extracted which included age, gender, principal diagnosis, and emergency room outcome. The principal diagnosis was based on the assessment by the managing unit at admission using the presenting clinical features, with or without the results of laboratory tests. Emergency room mortality was the only outcome extracted. Collected data were entered into spreadsheet using Microsoft Excel 2007. Analysis was mainly descriptive. Percentages, mean, ratio, and mortality/case fatality rates calculations were done. Frequency tables and prose were used to present results.

Ethical approval was obtained from the Research and Ethics Committee of the UATH.


  Results Top


A total of 4591 children were admitted during the 5 years under review. Four hundred and eighty-nine (10.6%) were aged between 10 and 16 years. There were 285 (58.3%) males and 204 (41.7%) females. There were 364 children aged 10–13 years and 125 aged between 14- and 16-year-. The mean age was 12.1 years. [Table 1] shows ten major causes of morbidity seen in the study population.
Table 1: Pattern of diseases in the study population

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Of the 72 (14.7%) children with malaria, 49 (68%) were severe forms of malaria, of which 12 (24.5%) had cerebral malaria. Typhoid septicemia was diagnosed in 41 (74.5%) of the 55 patients with septicemia. Acute abdomen was used to define nonsurgical conditions presenting with acute abdominal pains. Acute intestinal obstruction was the most common surgical condition (56.5%) with the second most common being acute appendicitis (34.8%). Other surgical diseases were testicular torsion, blunt abdominal trauma, and anal laceration.

There were seven types of NCDs observed in the study population [Table 2]. Sickle cell anemia (SCA) ranked highest. Asthma and epileptics disorders were second and third, respectively, with more cases seen among the early adolescent. More cases of diabetes mellitus were observed in the age group of 14–16 years and were all type 1 diabetes mellitus, of which 5 presented with diabetic ketoacidosis. The types of malignancies observed in the study were brain tumor, lymphomas, and acute leukemia.
Table 2: Noncommunicable/chronic diseases in the study

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[Table 3]a and [Table 3]b show the top diseases/disorder by sex and age.
Table 3:

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Malaria was the most commonly occurring disease among females while this came second among males. While tetanus was fourth in males, it ranked eight among females.

The disease distribution for both sexes was similar; however, urinary tract infection and meningitis were not observed in females while diarrheal disease and pyelonephritis were not observed in males.

Other disease conditions which are not shown in the tables but was observed in five or more patients included food poisoning, alcohol and drug intoxication, acute glomerulonephritis, lower gastrointestinal bleeding, and viral hepatitis.

The mortality pattern in the study population is shown in [Table 4]. Forty-three patients died giving a mortality rate of 8.8%. Twenty-six (60.5%) were male and 17 (39.5%) were female. The highest number of deaths was seen among children aged 10–13 years (76.7%). Four diseases with the highest mortality were severe malaria, SCA, septicemia, and tetanus. This was seen in both male and female patients. Other causes of mortality were acute hepatitis, chronic liver disease, food poisoning, lower gastrointestinal bleeding, severe anemia, diabetic ketoacidosis, and chronic kidney disease.
Table 4: Mortality by age group

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  Discussion Top


The adolescents in this study were in the developmental levels of early and middle. The late adolescent age group of 17–19 years was not included as this age group is not seen by the pediatric unit in the UATH. This absence of the late adolescent age group was seen also in studies done in other centers.[8],[9],[10],[11],[12],[13] These studies also showed variations in the cutoff age for pediatric admission. The study by Ojukwu and Ogbu.[14] however captured the late adolescent age group though taken from individuals in nonpediatric care sections of their center.

Adolescents made up less than a fourth of the total admissions during the study and there were more boys than girls. The authors found no local studies which examined the adolescent population morbidity and mortality independent of young children (<10 years) or young adult (>19 years). However, one study of the pediatric population that grouped adolescents independently showed a low number of adolescents recorded.[9] Other studies which captured adolescents in the age group of >5 years also recorded lower patients than other age groups.[8],[10],[11],[12],[13] It may be suggested that there was a low adolescent number in these studies.

The stages of adolescence, early (10–13), middle (14–16), and late (17–19), are individually significant in that they are varied in their biological and social transition which have implications on their health.[4] Adolescents have peculiar characteristic making their health needs/challenges different from those of childhood and the adult period, thus should be studied as a unique group. This has contributed to a dearth in health-related research in this transitional population, particularly in developing countries, which in turn has limited the development of adolescent-specific health services.[15] In the current study, 60% of the causes of mortality were from infections. Malaria, tetanus, and septicemia had high prevalence in both males and females and across age groups. Infection as a cause of mortality in children who have survived the under 5 period is still a major issue in Sub-Saharan Africa.[2],[3],[6] This may not be unrelated to the persistence of an environment of poverty, poor health services, malnutrition, and high illiteracy rates, in which these children continue to grow exposing them to a continuing barrage of infections. while infectious diseases prevail as a cause of morbidity and mortality in low- and middle-income countries, global reviews show that noncommunicable diseases such as accidental and intentional injuries, sexually related issues are more prevalent among adolescents having a higher.[16],[17],[18],[19]

The morbidity and mortality of adolescents vary with age, gender, and region.[3],[6] The morbidity and mortality patterns in this study for both genders were similar though tetanus was more prevalent among males than females leading to a much higher mortality rate among males. The preponderance of tetanus in males was found in other studies in Nigeria and was attributed to the exploratory nature of males, while females are more domestic making them less likely to sustain penetrating injuries and infection by Clostridium tetani.[20],[21],[22]

Only human immunodeficiency virus (HIV) as a globally recognized cause of morbidity and mortality was identified in this study occurring in both male and female patients. The prevalence of HIV in this study could be considered to be low considering the rising trend of HIV among adolescents in developing countries.[1] HIV infection is among the leading infectious cause of death worldwide, and it is estimated that Nigeria has the highest number of new HIV infections in children.[1],[16],[19],[23]

NCDs are also on the increase worldwide.[24] Risk-taking behaviors of the adolescent period have shown to contribute significantly to the development of NCDs.[17] None of the NCDs seen in this study were diseases that have been shown to develop from risky behaviors, with more than half of them being those of genetic or familial origins.

Apart from the risky behaviors that are common in adolescent period, studies have further shown the association of infectious agents and malnutrition (both maternal and childhood) with the development of NCDs.[24] These further place adolescents in developing countries at greater risk of NCDs. Although this study did not examine this relationship, it shows that there are various types of NCDs that occurred in the adolescent population studied, even those that are of public health importance.

With regard to reproductive health issues, particularly unplanned pregnancies and sexually transmitted diseases, as a common problem in adolescents, this study did not record such cases. Initiation of sexual intercourse is lowest in the studied age groups of adolescents; thus, reproductive issues are negligible.[25],[26] Furthermore, reproductive issues are not attended in the EPU. These could be the reason why it was not seen in this study.

The adolescent population in Sub-Saharan Africa is steadily rising with a projected 436 million by 2025 and a further increase to 605 million by 2050.[15] Still the adolescents are an underserved population befitting much less than other age groups, especially younger children, from services targeted at a reduction in mortality.[11] Adolescents health status affects their adult health status and directly the economic viability of a community. Therefore, more data on the morbidity/mortality among adolescents in a developing country like Nigeria are pertinent to aid in the formulation of policies and effective interventions.


  Conclusion Top


With the projected increase of adolescents in Nigeria to 73 million by 2025 and 116 million in 2050, the time to act is now.[1] Adolescent should be seen as a distinct developmental stage of life, and research should capture this developmental distinction separate from others. Furthermore, sub-specialization of adolescent health in pediatric practice should be seen as a necessity. With more research in the health of the Nigerian adolescent, other than reproductive and sexuality, data will emerge which will help government plan for this future generation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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2.
Patton GC, Coffey C, Cappa C, Currie D, Riley L, Gore F, et al. Health of the world's adolescents: A synthesis of internationally comparable data. Lancet 2012;379:1665-75.  Back to cited text no. 2
    
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WHO. Health for the World Adolescent. A Second Chance in a Second Decade. Available from: http://www.who.int/maternal_child_adolescence/document/second-decade/en. [Last accessed on 2016 Feb 22].  Back to cited text no. 3
    
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Marcell AV. Adolescence. In: Nelson Textbook of Pediatrics. 18th ed. Philadelphia: W.B. Saunders Company; 2007. p. 60-5.  Back to cited text no. 5
    
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Gore FM, Bloem PJN, Patton GC, Ferguson J, Joseph V, et al. Global burden of disease in young people aged 10-24 years: A systemic analysis. Lancet 2011;377:2093-102.  Back to cited text no. 6
    
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Federal Ministry of Health. National Strategic Frame Work on the Health and Development of Adolescents and Young Adults in Nigeria; 2007-2011. Available from: http://www.health.gov.ng/doc/strategicframework. [Last accessed on 2014 Oct 15].  Back to cited text no. 7
    
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Sa'ad YM, Hayatu A, Al-Mustapha II, Orahachi YM, Hawwa MU. Morbidity and mortality childhood illnesses at the emergency paediatric unit of a tertiary hospital, North Eastern Nigeria. Sahel Med J 2015;18:1-2.  Back to cited text no. 8
    
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Okechukwu AA. Morbidity pattern in paedaitric outpatient unit of the University of Abuja Teaching Hospital Gwagwalada Nigeria. N Niger J Clin Res 2010;13:1-6.  Back to cited text no. 9
    
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Abhulimhem-Iyoha BI, Okolo AA. Morbidity and mortality of childhood illness at the emergency paediatric unit of University of Benin Teaching Hospital Benin City. Niger J Paediatr 2012;39:71-4.  Back to cited text no. 10
    
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Onyiriuka AN. Morbidity and mortality of post neonatal paediatric medical conditions in a large mission hospital in Benin City. JMBR 2005;1:49-58.  Back to cited text no. 11
    
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Ibeziako SN, Ibekwe RC. Pattern and outcome of admissions in the emergency room of the University of Enugu Teaching Hospital Enugu. Niger J Paediatr 2002;29:103-7.  Back to cited text no. 12
    
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Ojukwu JU, Ogbu CN. Mortality pattern among adolescents attending the ambulatory care unit in Abakiliki. Niger J Paediatr 2005;32:33-9.  Back to cited text no. 14
    
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Fatusi AO, Hindin MJ. Adolescents and youth in developing countries: Health and development issues in context. J Adolesc 2010;33:499-508.  Back to cited text no. 16
    
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Cappa C, Wardlaw T, Langevin-Falcon C, Diers J. Progress for children: A report card on adolescents. Lancet. 2012;379:2323-5.  Back to cited text no. 18
    
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Alhaji MA, Akuhwa MT, Mustapha MG, Ashir GM, Mava Y, Elechi HA, et al. Post-neonatal tetanus in University Of Maiduguri Teaching Hospital North Eastern Nigeria. Niger J Paediatr 2013;40:154-7.  Back to cited text no. 21
    
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Alhaji MA, Mustapha MG, Ashir GM, Akuhwa RT, Bello MA, Farouk AG. Recurrent generalized tetanus: A case report. Trop Doct 2011;41:127-8.  Back to cited text no. 22
    
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UNAIDS. 2013 Progress Report on the Global Plan: Towards the Elimination of HIV Infection Among Children by 2015 and Keeping Their Mothers Alive. Available from: http://www.unaids.org. [Last accessed on 2015 Sep 25].  Back to cited text no. 23
    
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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