Pattern and Outcome of Paediatric Admissions in a Tertiary Hospital in The Niger Delta Region of Nigeria: A Two Year Prospective Study

INTERNATIONAL JOURNAL OF MEDICAL AND APPLIED SCIENCES
ISSN:2320‐3137

Research Paper
PATTERN AND OUTCOME OF PAEDIATRIC ADMISSIONS IN A TERTIARY
HOSPITAL IN THE NIGER DELTA REGION OF NIGERIA: A TWO YEAR
PROSPECTIVE STUDY
G I McGil Ugwu

Department of Paediatrics,
Nigeria

Delta State University, Hospital Oghara Delta State

Abstract
Regular audit of the pattern of admission and diseases is a very good project that should be encouraged as this
will help in planning. To assess the pattern of and outcome of paediatric diseases in a young hospital at Oghara
Delta State of Nigeria
All information about children admitted at the paediatric ward of The Delta State University Teaching Hospital
Oghara were prospective analyzed. The range was from 0-16years. The study period was since its inception in
and for two years. Children admitted at the neonatal intencive care unit, children emergency room and the
paediatric surgical wards were excluded from the study.
A total of seven hundred and seventy children were seen. The male to female ratio was in favour of males.
Respiratory system involvement was highest, with Broncho-pneumonia topping the list. Of the 770 patients
seen, respiratory infections were documented in 163 (21.7%), central nervous system dieases ranked second
with over 153 patients (20.1%). In the central nervous system, febrile convultion topped the list. Oncology case
were the least at 1.7%.The overall mortality was 6.6%. The highest mortality was in the diseases classified as
others while the case fatality ratio showed that it was highest in the oncology group. Upto 2% were discharged
against medical advice. Bronch-peumonia was the commonest presentation with is at variance with documented
in some regions but similar in others. The overall mortality was at 6.6% was much higher than results from
other centres. The discharge against medical was advice was 2%.It is necessary to documents pattern of
illnesses system by system and this will help in effective health planning.
Key words: Paediatric Admissions, Aiary Institution, Nigeria, Oghara Delta State

INTRODUCTION
Disease pattern of admission into the
paediatric ward varies from region to region
and period to period even in the same
locality.1 Many factors other than disease also
influence the admission pattern.2 These
include availability of bed space, physician’s
bias, cost of admission and so on.3 Analyzing

the pattern of admission in the hospital can be
a
valuable
tool
in
assessing
the epidemiology of dieases.4 This will be
helpful to policy makers and planners in
assessing the quality of service and
prioritazation of health care services
especially in resource poor countries like

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ISSN:2320‐3137

Nigeria. It has been found that causes of
admission vary from
region to region in Nigeria. While malaria was
the commonest from a study in a private
hospital in Lagos in the south-west and Enugu
in the south-east, acute respiratory diseases
were commoner in the south-south.5 Also
analysing the diease pattern based on the
system of the body involved will be a guide in
the recruitement of specialized health workers.
We present a two (2) year prospective study of
the pattern and outcome of admissions into the
paediatric
wards
at
Delta
State
UniversityTeaching Hospital Oghara Niger
Delta from its inception in May 2010 to April
2012. The Newborn Special Care Unit , the
Children Emergency Room and the Paediatric
Surgical Ward were excluded from the study.
MATERIALS AND METHOD

paediatric medical ward aged 0-16years were
obtained and analyzed. These include the
biodata of the patients, their addresses,
detailed history and clinical evaluation of the
pateints, the system of the body involved in
the illness, investigations, treatment and
outcome of the various illnesses. The
Newborn Inensive Care Unit, the Children
Emergency Unit and the Paediatric Surgical
ward were excluded fro the study.
RESULTS
A total of seven hundred and seventy (770)
children were seen within the period under
review, of which four hundred and fifty (450)
were males and three hundred and twenty
(320) females, giving a ratio of approximately
1.4:1 in favour of the males. Table 1 shows
the distribution of the patients according to
their ages.

Information on all paients admitted into the

TABLE 1: SHOWING THE DISTRIBUTION OF THE PATIENTS
ACCORDING TO THEIR AGE GROUPS
AGE GROUP

NUMBER OF PATIENTS PERCENT (%)

0 – 1 MONTH (NEONATAL)

8

1%

>1 MONTH – 5 YEARS (PRESCHOOL)

546

71.5%

>5 – 10 YEARS (SCHOOL AGE)

122

16.3%

>10 – 16 YEARS (ADOLESCENCE)

94

11.2%

TOTAL

770

100%

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Over 70% of the admitted children were in the
preschool age group. The least was in the
neonatal period, folloewd by the adolescence
group. The second commonest was in the
school age group which accounted for about
16.3% of the admissions.
Fig 1 is a bar chart showing the diseases
according to the system involved. This ahows
that the most system involved is the respiratory

system with 168 (21.7% of total), followed by
the central nervous system with 153 (20.1%),
then the digestive system with 89 (11.8%),
genito-urinary system with 74 (9.2%),
haematology 52 (6.8%) cardiovascular 40 (5.2),
and oncology being the least with 13 (1.7%). In
this chart however the diseases grouped
together as others have the highest number with
181 (23.5%).

FIG 1: A BAR CHART SHOWING THE DISEASES ACCORDING TO THE SYSTEM
INVOLVED

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ISSN:2320‐3137

For the respiratory diseases, bronchpneumonia was the highest with 69, followed
by bronchiolitis 33, aspiration pneumonitis 14,

the least was Ludwig Angina seen in two
patients. Asthma and pulmonary tuberculosis
had same number of patients. These are all
shown in table2. The specific disease pattern
in the various systems are shown in tables 3-9.

TABLE 2: SHOWING THE RESPIRATORY DIEASES
DISEASE

NUMBER

Broncho-pneuminia

69

41.3

Broncholitis

33

19.7

Aspiration pneumonitis

14

8.3

Lobar pneumonia

6

3.8

Pertusis

6

3.8

Pulmonary TB

8

4.9

Tonsilitis

7

4.3

Puemocystic Jereventi Pneumonia

3

1.9

Ludwig Angina

2

1.4

Adenoiditis

6

3.8

Bronchiectasis

3

1.9

Asthma

8

4.9

168

100

Total

PERCENTAGE (%)

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TABLE 3: SHOWING THE TYPE OF DISEASE IN THE CENTRAL NERVOUS SYSTEM

DISEASE TYPE

NUMBER

PERCENTAGE (%)

Meningitis/encephalitis

24

15.4

Febrile convusions

28

18.0

Tetanus

19

12.1

Tuberculosis of the spine

4

2.4

Tuberculous meningitis

4

2.4

Cerebral malaria

16

10.2

Mental retardation

4

2.4

Cerebral palsy

8

5.0

Status epilepticus

5.0

Space occupying lesions

4

2.4

Craniosynostosis

2

1.2

Deafness

2

1.2

Seizure disorders

12

7.6

Cerebellar ataxia

2

1.2

Hydranencephaly

1

0.6

Spinal bifida

5

3.1

Hypertensive encephalopathy

4

2.4

Cerebrovascular accident

2

1.2

Microcephaly

3

1.9

Hydrocephaly

5

3.1

Ascending myelitis

2

1.2

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Total

153

100.0

TABLE 4: SHOWING THE DISEASE PATTERN IN THE

DISEASE TYPE

NUMBER

PERCENTAGE (%)

Dysentry

7

4.5

Actute watery diarrhoea

38

42.7

Hirschprung disease

2

2.2

Cleft lip

3

3.4

Gastrointestinal obstruction

10

11.2

Peptic ulcer disease

7

7.9

Inguinal hernia

8

9

Rectal prolapse

7

7.9

Trache-oecephageal fistula

2

2.2

Duodenal atresia

1

1.1

89

100

Total

20

DIGESTIVE SYSTEM


ISSN:2320‐3137

TABLE 5: SHOWING THE DISEASE PATTERN IN THE
GENITO-URINARY SYSTEM

DISEASE TYPE

NUMBER

PERCENTAGE (%)

Stage renal disease

8

9.4

Nephrotic syndrome

12

16.2

Renal calculi

2

2.7

Hydrocoele

4

4.1

Hypospadia

2

2.7

Urethrocutaneous fistula

2

2.7

Acute glomerulonephritis

9

12.1

Urethral stricture

3

4.1

Chronic renal failure/End

Cryptorchidism

5

5.4

Acute renal injury (failure)

8

9.3

Posterior urethral valve

4

5.4

Pelvi-ureteric obstruction

3

4.1

Ectopic kidney

1

1.4

Unilateral renal agenesis

1

1.4

Polycystic kidney disease

3

4.1

Haemolytic-uraemic syndrome

4

5.4

Schistosomiasis

2

2.7

74

100

Total

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TABLE 6: SHOWING THE DISEASE PATTERN IN THE CARDIOVASULAR SYSTEM

DISEASE TYPE

NUMBER

PERCENTAGE (%)

Congestive cardiac failure

10

25

Congenital heart disease

12

30

Rheumatic heart disease

6

15

Atrial myxoma

1

2.5

Cleft of the mitral valve

1

2.5

Infective endocarditis

2

5

Cardiomyopathy

1

2.5

Angina Pectroris

4

10

Viral Myocarditis

2

5

Supraventricular Tachycardia

1

2.5

40

100

Total

TABLE 7: SHOWING THE DISEASE PATTERN IN THE HAEMATOLOGICAL SYSTEM

DISEASE TYPE

NUMBER

PERCENTAGE (%)

Anaemia

18

34.7

Sickle cell disease

26

50

Haemophilia

2

3.8

Hyper immune malaria spleen (TSS)

2

3.8

Septicaemia

3

5.8

Polycythaemia

1

1.9

Total

52

100

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TABLE 8: SHOWING THE ONCOLOGY DISEASE PATTERN
DISEASE TYPE

NUMBER

PERCENTAGE (%)

Nephroblastoma

2

15.4

Leukaemia

2

15.4

Neuroblastoma

1

7.7

Burkittes lymphoma

2

15.4

Hodgkin’s disease

1

7.7

Rhabdomyosarcoma

1

7.7

Non-Hodgkin’s lymphoma

2

15.4

Retinoblastoma

1

7.7

13

100

Total

FIG 2: A PIE CHART SHOWING THE IMMEDIATE OUTCOME OF THE ADMISSIONS

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TABLE 9: SHOWING OTHER DISEASES
DISEASE TYPE

NUMBER

Hepatitis

10

Malaria

56

Diabetes mellitus

PERCENTAGE (%)

10

6.1
30.9
6.1

Avascular necrosis of the
Head of the fermur

2

Burns

8

Chronic osteomyelitis

4

Alcohol intoxication

6

Other poisons

10

6.1

Trauma

10

6.1

Cellulitis

6

Duchene Muscular dystrophy

1

HIV Infections
Erb’s Duchene Palsy

10

6.1

2

Sexual abuse

2

Hysteria

3

Rheumatoid arthritis

4

Septic arthritis

3

Pyomyoscitis

4

Acute osteomyelitis

4

Tuberculous adenitis

4

Congenithal hypothyroidism

2

Biliary atresia /Cirrhosis

3

Protein-Energy malnutrition

7

Rikettes

4

Acute suppurative otitis media

3

Total

181

From all the data above Acute Lower
Respiratory Diseases combined make up the
commonest cause of admission (Bronchopneumonia,
Bronchiolitis,
Aspiration
pneumonitis and lobar pneumonia combined )

All combined accounted for 16.2% of the total
admission (Table 2). This is followed with
malaria related ill health at 9.4% (7.1% for noncerebral malaria and 2.3% for cerebral malaria
Tables 3 and 9 respectively). The top ten

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ISSN:2320‐3137

diseases are as follows: bronch-pneumonia
8.9%, non-cerebral malaria at 7.1%, acute
watery diarrhoea 5%, bronchiolitis 4.8%, febrile
convulsons 3.4%, sickle cell disorders at 3.3%,
meningitis/encephalitis 3.1%, tetanus 2.5%
anaemia and cerebral malaria at approximately
2.3% for each of them. Together these ten
diseaes make up 42.7% of all admissions during
the period under review.

Fig 3 is a histogram showing the mortality
pattern according to the system involved. This
shows that the diseases classified as others
acounted for 21.8% of the overall mortality,
followed by central nervous system with 17.2%,
genitourinary system 15.3%. Respiratory and
haematological diseases each accounted for
13%, cardiovascular 8.7%, digestive system
6.6%, with oncology as the least with 4.4%.

The general immediate outcome of these
admissions are shown in fig 2, which is a pie
chart

However, case fatality rate shows that the
highest was from oncology with 15.4%,
haematology11.5%,
cardiovascular
10%,
genitourinary 9.5%. For the dieases classified as
others, its 5.5%, central nervous system 5.3%
with the least from the respiratory at 3.5%.
These are shown in fig4.

This shows that about 89% of the patients were
discharged while mortality was 6% or forty six
(46). 21 or 3% were reffered out for many
reasons not included in the sturdy review, while
2% or 16 pateints were discharged against
medical advice.
Of the forty six that died, thirty (30) of them
were males and sixteen (16), giving a male to
female mortality raio of approximately 2:1.

FIG. 3: A HISTOGRAM SHOWING THE MORTALITY PATTERN

A – OTHER DISEASES
B – CENTRAL NERVOUS SYSTEM
C – GENITOURINARY SYSTEM
D – RESPIRATORY SYSTEM
E – HAEMATOLOGICAL
F – CARDIOVASCULAR

=
=

=

=
10 (21.8%)
8 (17.2%)
7 (15.3%)
=
6 (13.0%)
=
6 (13.0%)
4 (8.7%)

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ISSN:2320‐3137
G – DIGESTIVE
H – ONCOLOGY

=

3 (6.6%)
=
2 (4.4%)

FIG 4: BAR CHART SHOWING CASE FATALITY

DISCUSSION
The pattern showed that respiratory dieases
were the commonest cause of admission into
the wards. This is at variance with the finding in
a study in Lagos6 and Benin7 where malaria
accounts for the commonest. Also, a study on
the pattern of presentation at the children
emergency unit of this hospital and about the
same period showed that malaria was the
commonest presentation.8 The reasons for the
difference in presentation may be becuase most
cases seen as acute cases were discharged from
the children emergency unit without being
admitted into the wards. Morever, some of the
severe cases of malaria especially cerebral
malaria were grouped into central nervous
system and also some the haematological
dieases actaully coexisted with malaria. For

instance malaria presipitating sickle cell crises
were not grouped under malaria. Respiratory
dieases were the commonest in this study and
this is similar to the study in Nepal9. Infact the
study showed respiratory diseases to account
for 43.7%
Broncho-pneumonia is the
commonest in this study, accounting for 42.9%
of all respiratory ilnesses. This is the experience
elsewhere.8,9. It is not suprising as bronchpneumonia occurs mainly in the under-5 group
which also topped the list of presentation
according to age.The study also showed that
more males were seen than females and this is
similar with other studies.10. The highest
number of patients seen were in the under-5 age
group
which
is
similar
to
studies
9,11,12
elsewhere.
. In the study in Nepal, underfives excluding neonates accounted for 39.7%
but but 71% in this study. Lower respiratory

26


ISSN:2320‐3137

tract infections especially broncho-pneumonia
were the commonest respiratory dieases. This is
similar to studies in other places. 9, 12,13. Febrile
convulsion was the commonest central nervous
system
presentation
followed
by
meningitis/encephalitis and this is the
experience elsewhere.9, 14 The most common
digestve system disease is acute watery
diarrhoea. This has been documented in other
places and remains a major cause of morbidity
in developing countries especially in the Under5 or preschool age group.15This is because
rotavirus and other gastrointestinal infections
and infestations have remained high in
developing countries despite the UNICEF and
WHO campaigns. Nephrotic syndome was the
most common renal disease. Thisis at variance
with some studies elsewhere.16 but similar in
some centers.17,. In Calabar also in the Niger
Delta region, Acute glomerulonephritis was the
commonest renal presentation16. In some
studies in the same Niger delta, urinary tract
infection was the commonest with however
presenting as a significant complication of
nephrotic syndrome There is also a high
percentage of chronic renal failure/end-stage
renal diseases. This may be because of the fact
that it is the only facility in the state that offers
paediatric nephrology services. The most
common haematological presentation is Sickle
cell anaemia. This accounted for 50% of the
cases. This is similar to studies elsewhere18
Burkittes lymphoma remains one of the most
common childhood malignancy in Nigeria as
shown by the study19.
The overall motality was 6.6% which higher
than the experience in Ife 20and much higher
than the experience in Port Hacourt at 2%21and
Benin7
The mortality pattern is highest in the diseases
grouped as others and malaria is the disease
most implicated, even when there is evidence of
declining malaria presentations22. However, the

case fatality ratio shows that cancers remain
avery strong cause of mortality. It accounted for
more than 15% of the cases of malignancy.
Haematological diseases rank second in the list
of case fatality This was largely due to deaths
from septicaemis and sickle cell disease. The
outcome of the diseases showed that over 80%
were discharged and only 2% were discharged
against medical advice which was significanly
lower that a study in Abuja23.The reason for this
low incidence may be due to the fact thet the
institution is young and has not yet been
overused by patients and also immediate
attension to patients. Infact the sudy in Abuja
Nigeria showed that discharge against medical
advice came mainly from the Emergency unit
where work load is always too much in
developing countries.
CONCLUSION
The disease patten has shown tht respiratory trct
infectios are the commonest presentation. This
is the picture worldwide. Pneumonia has been
ageorgded the most common cause of morbidity
and mortality in children worldwide. This is
why the world set aside every November 12th
as the world pneumonia day, with heavy
sponsorship from many organizations.24
AKNOWLEDGEMENT
We wish to aknowledge the immense services
of Dr U Chinemelu, Miss T K Ugwu, Ik Ugwu,
and Drs Okwesa and Aso.
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Pattern and Outcome of Paediatric Admissions in a Tertiary Hospital in The Niger Delta Region of Nigeria: A Two Year Prospective Study

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Pattern and Outcome of Paediatric Admissions in a Tertiary Hospital in The Niger Delta Region of Nigeria: A Two Year Prospective Study