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Ukw Pub H. 2024; 24(10): 1-17. Published Online 2024 October 10
UkwSciID: USPH1
A MULTI-LEVEL STUDY OF A PEDIATRIC POPULATION ATTENDING A TEACHING HOSPITAL IN SOUTH-SOUTH NIGERIA (MuSPePATHS). PART 1: DESCRIPTIVE STATISTICS OF SOCIODEMOGRAPHIC DATA
Edmund Ikpechi Ukwuru, and Onyinye Lydia Okeke
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1, 2
Ukwuru, E.I. and Okeke, L.O. (2024). A Multi-Level Study Of A Pediatric Population Attending A Teaching Hospital In South-South Nigeria Part 1: Descriptive Statistics Of Sociodemographic Data. Ukwuru Public Health, 24(1): 1-15.
Abstract
Background
The health of children is as important as that of adults, and more important because of the level of fragility. In this study, we draw on retrospective data of children who visited a University teaching hospital in south-south Nigeria.
Method
We identified data pertaining to the sociodemographic data of the children and provided descriptive statistics that simply established the prevalence of various sociodemographic features, patient status, health states and antibiotic use. We used SPSS version 29.0 to analyse data obtained from the hospital cards of 1,000 children who visited the University of Benin Teaching Hospital
Findings
Majority of the children 266(26.6%) were less than 1 month old, and this constituted the majority of children 390(39.0%) below 1 years of age. Average age was 12.5 years. Most of the participants were males 547(54.7%). Several of the children were not registered in any school 550(55.0%). Most of the fathers 42.5% had tertiary education compared to mothers (38.1%). Employment status was also higher among fathers (82.9%), than mothers (79.1%). Residential area was mainly urban centers 892(89.2%). Most of the children were outpatients 515(51.5%). Those who were admitted spent a combined total of 1,910 hospital days, and most of the children 214(21.4%) spent 1 week in the hospital. Average number of hospital days was 34.1%. Non-infectious pathogenic diseases were the most dominant causes of ill-health among the children 607(60.7%). Majority of the children presented with at least 1 comorbidity 524(52.4%). Average cases of comorbidities was 208.7 children. A total of 622(62.2%) antibiotics were administered. Majority of the children 245(24.5%) received 2 antibiotics.
Conclusion
What we conclude was that children in Edo state are faced with high exposure to various forms of illnesses, and some of these illnesses started from birth and could go on to cause poor quality of life and disabilities.
Recommendations
Health education and health promotion are required to create change in the health status of children.
Keywords: Children, hospital days, comorbidity, pathogenic, non-pathogenic diseases
Introduction
Typically, individuals across all ages present with various forms of illness or illnesses. Some of such illnesses start in childhood and may last through the lifetime; some other types present temporarily but could result in lifetime disabilities. There are those illnesses that may be terminal, and some illnesses present during gestation. In this multilevel study, we are looking to identify the most frequently occurring diseases among children. We do this from a retrospective standpoint. The basis for this attempt is drawn from findings such as Ajakaye and Ibukunoluwa, (2020) in which 54.0% and 55.2% of children (6 to 10 years of age) presented with anaemia and malaria respectively. These illnesses were accompanied with malnutrition (41.2%). Similar evidence among 6 to 10 year old children is available from Omosigho et al. (2024); however the children presented with 6% prevalence of rotavirus infection; a pathogen responsible for causing gastroenteritis. Both studies Ajakaye and Ibukunoluwa (2020) and Omosigho et al. (2024) were conducted in Edo state Nigeria; albeit in different study locations. Their findings are an indication that children in any part of Edo state are likely to present with haematological and gastroenterological illnesses. A retrospective study conducted by Uangbaoje et al. (2024) revealed that toddlers who presented with malaria; most of them were males (52.9%), the average age was 2.3 years, and the number of hospital days was 3 days. These findings are an indication that children who are less than 6 years of age are not exempt from illnesses such as malaria, and it could result in hospital admissions with cost implications. Similarly, Akhimienho et al. (2022) showed that children below the age of 5 years, presented with diarrhea (38.6%) and dysentery (4.3%). These diagnosis were significantly associated with age, and quality of nutrition, as well as source of water. These findings from Akhimienho et al. (2022) align with the findings from Omosigho et al. (2024); demonstrating that gastroenterological diseases are prevalent among children across all ages. In the findings from Imade and Eghafona, (2015), 42.5% of children presented with 1 case of diarrheagenic virus. Age was significantly associated with infection status.
We recognise that children anywhere in Edo state are likely to present with pathogenic illnesses, and possibly non-pathogenic illnesses; this is evident in the background. The sample sizes used in these studies, the largest of them was 223 (Imade and Eghafona, 2015). Also, these studies were conducted in various parts of Edo state. What we did differently was that we increased the sample size of our study, and we collected our data retrospectively from the University of Benin Teaching Hospital. We believes that as a teaching hospital, various residents of Edo state would present there for treatment; and this would give us a more holistic study population. Lastly, by carrying out a retrospective study, we have an advantage of making predictions that are beneficial for health promotion and health education purposes.
This study is a multi-level study divided into four parts. We did not focus on any specific disease prevalence, our interest was in the sociodemographic features (part 1), the disease diagnoses (part 2), the number of antibiotics used (part 3), and the number of days spent in the hospital (part 4). In this first part, we begin by highlighting the sociodemographic findings of the study. The Methodology described here will be referred to across the rest of the parts.
Method
Ethical Approval
Approval to conduct this study was obtained from the Health Research Ethics Committee (HREC) of the University of Benin Teaching Hospital; Approval number: NHREC-UBTH-HREC/24/12/2022B. Since the study was conducted retrospectively, no additional ethical requirements had to be met.
Study Population and Data Source
The study population (table I) was pediatrics attending University of Benin teaching hospital. Our data was drawn from 2022 and 2023. Across both years, there was a total of 97,277 patient visits, and there were apparently more males who visited the hospital, than females.
We selected a sample of 1,000 because we were interested in stabilizing the sample size at a round value of three zero digits (000). Evidently, our sample size is considerably small when compared to the total population of children who visited the hospital. Nonetheless, the sample size is considerably large for a quantitative study in line with the philosophy of positivism. It facilitated carrying out critical analysis.
Data Collection
A data collection tool was custom-made; focusing on sociodemographic data (age, sex, educational status, parental educational status, parental employment status, and place of residence); patient status (date of admission, date of discharge, and outpatient); health state (diagnosis and comorbidities); medicines (particularly antibiotics). The data was collected over a period of 30 days. Ten members of the Ukwuru Science Study Group participated in the collection of data over the 30-day period. The process was achieved by retrieving patient cards and entering the required data into the data collection tool. L.O. Okeke (M.D.) was in charge of the data collection process and ensured that the data was well documented. E.I. Ukwuru was in charge of data entry into Microsoft excel sheet, and reviewing for any irregularities.
Data Analysis
Statistical Package for Social Sciences (SPSS) version 29.0 was used for the analysis of the data. In this first part of the study, descriptive statistics were presented for the sociodemographic data. There was no inferential or crosstab analysis to indicate associations across ages. This was because the intent was to show the social characteristics of the children and that of their parents.
Table I: Pediatric Population who visited the University of Benin Teaching Hospital
Results
The sociodemographic characteristics are presented and described below.
Age Distribution of Participants
Age of Participants is shown in figure Ia. Out of the 1000 children whose datasets were selected, 266 (26.6%) of the children were less than 1 month old. This accounted for the largest age range for any of the selected populations. Most of the children were less than 1 year of age; accounting for 390(39.0%) of the population (figure Ib). Similarly, there were more children who were either 5 years old or less; accounting for 698(68.9%) of the population as seen in figure Ic. the rest of the children were between ages 6 and 19 years of age; accounting for 299(29.9%) of the number participants (figure Id). The average age was 12.5 years. What the findings imply is that there were several neonates and infants who were present in the hospital for some for of health condition.
Figure I: Age distribution of participants shows that most of the children were below 1 month of age, followed by a wider population below 5 years of age.
Sex of Participants
There were more males 547(54.7%) than females 450(45.0%) (figure II). This is an indication that there were more males who had presented with some type of illness, compared to the female children.
Figure II: Most of the participants were males
Children's Educational status
In figure III; Majority of the children were not schooling 550(55.0%), 164(16.4%) of the children were in Nursery, 140(14.0%) of them were in primary school, while 136(13.6%) of them in secondary school. This aligns with the distribution based on age, most of the children were less than 5 years of age; therefore, it was unlikely that they would have started schooling. In contrast, the lower majority who were above the age of years were likely to have begun schooling, which explains the split between children in primary and secondary school.
Figure III: Most of the children were not attending school
Parental Educational Status
Figure IV shows the parental educational status; most of the parents have tertiary education; accounting for 42.5% for fathers, and 38.1% for mothers. More fathers have tertiary education compared to mothers. The gap between secondary and tertiary education shows that more mothers have better progression from secondary to tertiary education (difference of 5%) than the fathers (12.5%). This implies that mothers were more likely to attain a tertiary education if they had gained a secondary education. In contrast, the fathers were less likely to gain tertiary education after secondary education. This observation is same for the difference between primary and secondary education. Nonetheless, within households, more fathers had acquired education than mothers.
Figure IV: Paternal Educational Status was higher than maternal educational status
Parental Employment Status
The data on employment status (figure V) shows that paternal employment is up 82.9%, followed by maternal employment 79.1%. The evidence implies that within the independent population of fathers and mothers, more mothers were unemployed compared to fathers in their population group. Implying that there is low employment status for mothers.
Figure V: Paternal employment status was higher than maternal employment status
Residential Area
Most of the children live in an urban area 892(89.2%). An indication that most of the children had good access to healthcare (Figure VI).
Figure VI: Majority of children lived in urban areas
Patient Status
Majority of the patients were outpatients 515(51.5%). This is an indication that most of the children were likely to be experiencing health conditions that were less debilitating and warranting of hospitalization (figure VII).
Figure VII: There were more outpatients than inpatients
Number of Hospital Days
Most of the patients 214(21.4%) spent less than 7 hospital days, followed by 148(14.8%) who spent up to 2 weeks in the hospital. In total, children spent 1,910 days in the hospital. The average number of hospital days was 34.1 days (figures VIII and IX).
Figure VIII: Most of the Children were hospitalized for one week or less
Figure IX: Distribution of Hospital days by weeks.
Disease Type
Most of the children visited the hospital for illness of non-pathogenic origin; accounting for 607(60.7%) of the total population of children. The rest of the children 389, visited the hospital due to illnesses of pathogenic etiology 389(38.9%) (figure X).
Figure X: Most of the children visited the hospital due to illnesses of non-pathogenic etiology
Number of Comorbidities
Majority of the children presented with at least 1 comorbidity 524(52.4%). More than one-third of the children 371(37.1%) did not present with any comorbidity. Average cases of comorbidities was 208.7 children (figure XI).
Figure XI: Most of the children presented with 1 comorbidity
Number of Antibiotics
A total of 622(62.2%) antibiotics were administered. Majority of the children 245(24.5%) received 2 antibiotics. One child received up to 7 antibiotics. Some of the antibiotics were administered as combination therapies (figure XII).
Figure XII: Most of the children received 2 antibiotics
Discussion
Our findings show that children less than 1 year of age are highly likely to make hospital visits. This is consistent with findings from Imade and Eghafona, (2015) in which 42.6% of children below the age of 3 years, presented with gastroenterological viral infection in Edo state. This is an indication that children within Edo state are exposed to illnesses; therefore, preventive practices must be initiated through health education and health promotion. Studies such as Edosomwan et al. (2020) also revealed that children between the ages of 6 to 15 years presented at hospitals with illnesses; most of them were internally displaced persons. It is imperative that preventive practices should be initiated to curb the prevalence of illnesses among pediatric population in Edo state.
Unlike this study in which most of the participants were males, Edosomwan et al. (2020) revealed that females presented with more cases of ill-health; although there were more males than females in the study. In this study, there were more male patient visits among children, and it reflected as higher cases of ill-health among males than females because all the participants visited the hospital for one or more health cases. Cases of non-infectious diseases were also identified among children in Edo state. Enato et al. (2021) revealed that higher levels of triglycerides were found among male children who were less than 3 years of age. This indicated that the children were experiencing dyslipidemia. The implication is that more males are likely to present with poor health conditions than females.
Our findings revealed high prevalence of out of school children (55.0%) compared to those who were in school. We assumed that an upper majority of this population was accounted for by children who were below the age of 5 years. Contrasting evidence from Osiruemu, (2007) showed that children aged from 5 years and above were involved in child labour to enable them contribute to the overall family income. This implies that some of our participants who were not attending school, and are above the age of 5 years, may have been involved in child labour prior to taking ill. Also, it implies that family poverty kept the children out of school. It is possible to assume that lack of education which is capable of leading to unemployment, can result in family poverty that forces children out of school and into child labour. However, majority of the parents in our study had received tertiary education (42.5% for fathers, and 38.1% for mothers), and majority of parents were employed (paternal employment 82.9%; maternal employment 79.1%). Although Osiruemu, (2007) argued that children living in urban areas were the most likely to be involved in child labour; apparently due to high cost of living in urban areas. In our study, 89.2% of the children were living in an urban area. In the study by Olabiyi, (2021), the nature of job or parental employment was a facilitator of poor health outcomes, while the well-being of the child was driven by the parental income level. Although, the study was not focused on Edo state, it emphasized the association between the well-being of the child and the employment status of the parents. Contrasting findings are also available from Omorogiuwa and Igun, (2023), indicating that religion was a determinant of whether children attended school or not; although it was focused on female children. It shows that beyond employment and income levels, religion was capable of preventing children from being placed in school, and sent to work to contribute to the family income.
Our findings showed a 34.1 average hospital days; those children who were admitted, achieved a combined 1,910 hospital days. The number of participants in our study is much larger than that of Fasipe et al. (2019), which explains why they obtained a 12.9 hospital days for females, and 10.9 hospital days for males. According to Fasipe and colleagues, the number of hospital days was driven by adverse drug reaction. In our study, several reasons could have led to the high number of hospital days, starting with debilitating health conditions in which 1 patient spent nearly 7 months in the hospital, and most children spent 1 week in the hospital. Eki-Udoko et al. (2024) revealed that extended number of hospital days had significant implications such as child death; depending on the type of illness and comorbidities. Only 1 death was reported out our 1,000 participants, and it was a 17-year-old child. The observations with respect to the number of hospital days and patient status imply good quality of healthcare and access to healthcare in Edo state. Similarly, Tesfay et al. (2020) reported an association between number of hospital days and severe acute malnutrition among children below the age of 5 years. Our study showed high cases of non-pathogenic illnesses, but these were not comprised majorly by malnutrition related illnesses. What we do know at this point is that various illnesses of pathogenic and non-pathogenic etiologies were responsible for high number of hospital days. Lastly, large number of antibiotics were administered, 622 antibiotics were administered to our participants, and most children received up to 2 antibiotics (24.5%) but some of these were mainly combination therapies. The quality of antibiotics and drug interaction could have contributed to the number of hospital days. However, none of these can be ascertained at this point.
Conclusion
In this study, what we identified was that most of our participants were below five years of age compared to children above the age of 5 years. More concerning is that children below 1 year of age accounted for the highest number of cases of children who visited the hospital. This calls for more attention to be given to health education and health promotion that can curb cases of illness among neonates. Preventing practices must begin during antenatal visits so that complications that could result in illness upon birth would be prevented. Our study also found that male children were at higher risk of illness than females; equal efforts must be committed to ensuring that children are free of illness. So that their growth is not affected, and they can live normal health lives starting in childhood. Children must be provided with education, and the onus rests on the government to provide the necessary resources that can aid with childhood education. Parental income status must receive significant attention so that children can get good quality education, and health and well-being that frees them from illness. Majority of parents had good level of education and were employed; this should be reflected in practices that ensure the children are healthy. Meaning that parents should receive health education as well, so that preventive measures can be implemented. Various factors could have contributed to children spending extended amounts of time in the hospital; starting with the presence of comorbidities, and the type of illness. Nonetheless, high quality care must be provided to ensure that children can go home as soon as possible.
Limitation
Sample size limitations affected the possibility of making projections across years.
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Acknowledgements
We acknowledge the efforts of Ukwuru Science Management team and Ukwuru Science Study Group in bringing this study to reality.
Funding
Funding was provided by Ukwuru Science.
Author Information
Edmund Ikpechi, Ukwuru is the research director at Ukwuru Science Lagos. He works with a number of private organisations and individuals, consulting on public health and biomedical science research. He is also a Management Consultant and holds a Honorary Doctor of Business Administration (DBA) for his expertise in business practices.
Onyinye Lydia, Okeke (Medical Doctor) is the Medical Director at Ukwuru Science. She works with several healthcare institutions and private professionals as a consultant. She also works as a Medical Doctor at Rhowil Total Care Hospital Lagos.
Corresponding Author
Edmund Ikpechi, Ukwuru
Competing Interests
There are no competing interests for this study.
Rights
The publication is open for public use; credits must be provided by acknowledging the authors of the study.
Cite as
Ukwuru, E.I. and Okeke, L.O. (2024). A Multi-Level Study Of A Pediatric Population Attending A Teaching Hospital In South-South Nigeria Part 1: Descriptive Statistics Of Sociodemographic Data. Ukwuru Public Health, 24(1): 1-15.
Received: 1 August 2024
Accepted: 1 October 2024
Published: 10 October, 2024