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Ukw Pub H. 2024; 24(10): 1-12. Published Online 2024 October 10 DOI
UkwSciID: USPH4
A MULTI-LEVEL STUDY OF A PEDIATRIC POPULATION ATTENDING A TEACHING HOSPITAL IN SOUTH-SOUTH NIGERIA (MuSPePATHS). PART 4: NUMBER OF HOSPITAL DAYS
Edmund Ikpechi Ukwuru, and Onyinye Lydia Okeke
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Ukwuru, E.I. and Okeke, L.O. (2024). A Multi-Level Study Of A Pediatric Population Attending A Teaching Hospital In South-South Nigeria (Muspepaths). Part 4: Number Of Hospital Days. Ukwuru Public Health, 24(1): 1-12.
Abstract
Background
The number of hospital days is an important theme when discussing healthcare for all populations. Children for instance are likely to spend much time in the hospital because they are a vulnerable population; characterized by poorly formed immune systems. Neonates with congenital birth defects are highly likely to spend a lot of time in hospital admissions. We investigated the number of hospital days among the 1,000 children attending the University of Benin Teaching Hospital.
Method
Data was obtained from 1,000 patient record. The population of in-patients was determine, and the difference between date of admission and date of discharge was the number of hospital days. Chi Square and correlation was used to determine the association between the number of hospital days and various variables.
Findings
A total of 1,910 days were recorded. On average, children spend 34 days in the hospital. Majority of children (214) spent between 1 and 7 days in the hospital. There was a statistically significant association between the number of hospital days and the number of antibiotics received (p<.001).
Conclusion
The number of hospital days is linked to the number of antibiotics administered because children who receive more than one antibiotic may require monitoring, especially if they are less than five years of age.
Recommendations
Children visiting hospital, who also have been administered antibiotics should be admitted for better observation.
Keywords: Number of hospital days, discharge, antibiotics, monitoring, neonates
Introduction
In every society, individuals across all ages go to seek healthcare services. Access to healthcare is very important, and it also a social determinant of health. Individuals who visit hospitals may be admitted or allowed to go home depending on the severity of their illnesses. Thus, even for illnesses such as fever, the decision to become an inpatient or an outpatient varies depending on the severity of the illness, the financial capability to afford in-hospital care with or without insurance, and a host of other variables. Children who visit hospitals may get admitted depending on the severity of the illness, and if the healthcare provider deems it necessary to keep the child under supervision. Children below the age of five years do not usually have an option to go home if the healthcare provider considers admission as a key necessity. On the other hand, older children such as those from 6 years and above may be allowed to go home. In all cases, keeping the child for a minimum of one day to determine if there is a need for further admission is always a useful option.
Baniasadi et al. (2019) revealed that in an Iranian hospital, children spent a media of 3 days in the hospital. The number of hospital days was determined by several factors such as the place of residence, the time of admission, the type of admission, and the degree of the attending physician. This is an indication that there are several factors that affect the number of hospital days. A 2017 study by Aurthi and Rahaman, (2017) revealed that the number of hospital days varied depending on whether the hospital was a government hospital (4.62 days), or a private hospital (4.53 days), or an autonomous hospital (2.7 days). This differs from the evidence provided by Baniasadi et al. (2019). The core difference is that the findings by Baniasadi et al. (2019) are internal factors that are associated with he hospital; therefore, they can be found within government, private, or autonomous hospitals. Mokogwu, (2022) described experiences of quarantine during the pandemic, as an exceptional instance of number of hospital days. Although, the study was not focused on children, it gives insight into how, the severity of a suspected health condition can lead to admitting patients and holding them for a supervision period that is more than one overnight stay. Findings from Urhoj et al. (2022) studied the number of hospital days among children in Europe, considering those who had been born with congenital anomalies. What they found was that the number of hospital days was determined by the severity of the health condition; such as, the subgroup of congenital anomalies like congenital heart defects, and gastrointestinal anomalies. It is also possible to posit that the number of hospital days is longer among neonates and toddlers, than among older children.
In this fourth and last part of our study, we intend to identify the number of hospital days among children who were inpatients. We attempted to establish the presence of statistically significant associations that confirmed that a variety of factors affected the number of hospital days. We believe that knowledge of some of these factors would assist healthcare providers with better decision making.
Method
We refer to the method described in Ukwuru and Okeke, (2024). Primarily, data in this study relied on the difference between date of admission and date of discharge in order to identify the number of days spent in the hospital. The data was then analysed using Chi-Square and Correlation statistics. Significant difference was determined at p<.001.
Results
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 (figure I).
Figure I: Antibiotic Use status among children
Age
Our findings revealed that there were 484 children who were in-patients. As shown on table 1, 384(79.3%) of them were below the age of five years. Among those below the age of five years 167(43.5%) spent up to 7 days in the hospital, while 113(29.4%) spent up to 14 days in the hospital. These majority make up the total number of children across all ages who spent less than 7 days 213(55.5%) and up to 14 days 148(30.6%) in the hospital. The Chi-square analysis did not yield a statistically significant relationship between age and the number of days spent in the hospital (p=1.000). Pearson’s R was very weak negative (-0.093), and it was statistically insignificant (p=0.040). Spearman correlation was weak negative (-0.223) but it was statistically significant (p<.001). What the correlation indicates is a weak likelihood for age to decrease as the number of hospital days increases.
Table I: No statistically significant relationship was found between age and number of hospital days
Chi-square p = 1.000; Pearson’s R (-0.093; p=0.040) Spearman Correlation (-0.223; p <0.001)
Number of Hospital Days and Sex
More males 248(51.2%) were admitted into hospitals than females 236(48.8%). A total of 214(44.2%) of those children who were admitted spent up to 7 days in the hospital; 115(53.7%) of them were males, the remaining 98(45.8%) were females. Among the 148(30.6%) children who spent up to 14 days in the hospital, there was a parity between males and female 74(50%). The rest of the children spent more than 15 days in the hospital. One male child spent 192 days in the hospital. The relationship was not statistically significant (p=0.999). An indication that sex was not a predictor of the number of hospital days (tanble II).
Table II: Number of Hospital days is not associated with sex of the child
Chi Square p value = 0.999
Educational Status
Children who were not schooling accounted for the largest number of admitted children 352(72.7%). This group of children also accounted for the largest population of children who spent up to 7 days 141(65.9%), and 14 days 109(73.6%) in the hospital. The relationship was not statistically significant (p=0.962); implying that the number of hospital days was not influences by the educational status of the child (table III).
Table III: Number of hospital days is not associated with educational status
Chi Square p value = 0.962
Paternal Employment Status
Majority of children who were admitted in hospital, their parents were employed 389(80.2%). Among them, 178(45.8%) spent up to 7 days in the hospital while 114(29.3%) spent up to 14 days in the hospital. The difference was not statistically significant (p=0.991) (table IV).
Table IV: Number of hospital days is not associated with paternal employment status
Chi-Square p value = 0.991
Maternal Employment Status
Maternal employment status was not associated with the number of hospital days. No statistically significant difference was obtained (p=0.959). majority of the children who were admitted; their mothers were employed (table V).
Table V: Number of hospital days is not associated with maternal employment status
Chi Square p value = 0.959
Residential area
No statistically significant association was found between number of hospital days and residential area (p=0.999). Majority of the children were living in an urban area 437(90.1%). Among this group, 194(44.4%) were admitted for up to 7 days, while 131(30%) were admitted for up to 14 days (table VI).
Table VI: Number of hospital days is not affected by residential area
Chi Square p = 0.999
Disease Type
The number of hospital days is not statistically associated with disease type (p=0.97). Most of the children who were admitted were experiencing illnesses of pathogenic causes 261(53.8%) (table VII).
Table VII: Number of hospital days is not associated with diseases type
Chi Square p value = 0.97
Number of Comorbidities
The number of comorbidities is not statistically associated with the number of hospital days (p=0.995). Very weak Pearson’s R (0.105) was obtained and it was not significant (p=0.21). However, Spearman correlation was a very weak negative (-.0163) and it was significant (p<.001). Most of the children had 1 comorbidity 276(57%) (table VII).
Table VIII: Number of hospital days is not associated with the number of comorbidities
Chi Square p = 0.995; Pearson’s R = 0.105 p = 0.21: Spearman Correlation = -.0163 p <0.001
Number of Hospital Days versus Number of Antibiotics
A statistically significant association was obtained between number of antibiotics and the number of hospital days (p<.001) (table IX).
Table IX: Number of hospital days is statistically associated with the number of antibiotics
Chi-Square asymptotic significance (p<0.001) Linear-by-Linear association (p<0.001): Pearson R is significant at p<0.001. Spearman correlation p<0.001
Discussion
The average number of hospital days was 34 days. Most of the children spent fewer than 34 days in the hospital. Our findings differ from those of Heys et al. (2017) in which the children spent an average of 1 hospital day. The differences in the number of hospital days have been suggested by Baniasadi et al. (2019) and Aurthi and Rahaman, (2017) in which the former indicated internal factors within the hospital, while the latter indicated the type of ownership of the hospital (government, private, or autonomous) as the determinants of the number of hospital days. Our analysis did not reveal statistically significant association between any of the variables and the number of hospital days; except for the number of antibiotics used.
The results showed that age such as being less than 5 years old could have influenced the number of hospital days. Evidently, this is because of children who were born with congenital defects as confirmed by Urhoj et al. (2022). Also, the severity of the birth defect affects the number of hospital days. Our findings from Ukwuru and Okeke, (2024b) showed that majority of children were diagnosed with a non-pathogenic health condition. It is understandable that non-pathogenic health conditions such as cardiological and neurological conditions are likely to have emanated congenitally. On the other hand, majority of the children were below the age of five years (698(68.9%)), whole 266(26.6%) of the children were below 1 month old. Taken together, it implies that most children below the age of five years must have been born with a congenital defect that led to increase in the number of hospital days. This may be the reason for a statistically insignificant association based on Chi-square analysis. However, the correlation analysis was significant in favour of a weak negative correlation that confirmed that as age increased, the number of hospital days decreased.
Other sociodemographic features such as sex and educational status of the child did not show a statistically significant association with the number of hospital days. Similar observations were observed for residential area, and the parents employment status. The implications of the findings based on the distribution of the data is, children are likely to spend at most, 14 days in the hospital. The type of illness and the number of comorbidities were not capable of influencing these outcomes. Findings from Abiodun and Sadoh, (2021) showed that low socioeconomic status affected the severity of presentation among children experiencing circulatory failures in southern Nigeria. This is consistent with the findings from Baniasadi et al. (2019) in which the severity of health condition influenced the number of hospital days among the children. Findings from Osazuwa and Hailey, (2021) are an indication that children could present with illnesses that are capable of increasing the number of hospital days. An apparent reason for the lack of a statistically significant difference between the variables and the number of hospital days may be explained in line with the breadth of the variable. For example, it was imperative to categorise our age data, otherwise segregating the age data to allow for an even distribution of the dataset rather than overloading the population below the age of five years could have resulted in a statistically significant association. However, this would be inconsistent with our earlier analysis in which attention was not given to any specific age group. Also, it conflicts with the analysis for sex and educational status which did not result in a statistically significant association. Our argument is that, despite the lack of a statistically significant association, it is important to recognise that the large number of study participants below the age of five years is indicative of the possibility that infants and toddlers born with birth defects are likely to spend more time in the hospital. Similarly, male children are more likely than females to spend more time in the hospital, and infants generally are more likely to present with illnesses due to a weak immune system. Our findings are confirmed by analysis carried out by Baniasadi et al. (2019).
We identified a statistically significant relationship between the number of antibiotics and the number of hospital days. Our evidence allows us make a number of assumptions that are linked to our findings in part 3, in which Ukwuru and Okeke, (2024c) demonstrated that the number of antibiotics was statistically associated (p<.001) with being an in-patient, and educational status, and the number of hospital days. What the findings suggested is, generally, children who have been admitted into a hospital and are administered more than one antibiotic are likely to be kept for monitoring. This is expected to help with providing better health outcomes for the child regardless of their sociodemographic features. Findings from Medeiros et al. (2021) suggested that the number of hospital days can be used for better resource planning and allocation. Thus, as stated above, a child receiving more than one antibiotic is an indication of the severity of the illness, and the need to keep the child for more than one day. It is also a reflection of the number of comorbidities and the need to keep the child in hospital, especially if the child is below five years.
Conclusion
Our finding is ultimately linked to the fact that the number of hospital days is influenced by the number of antibiotics administered. This is based on drawing assumptions that the number of antibiotics is tied to the number of diseases that a child might have been diagnosed with. Not to mention that if a child is below five years, it is imperative to keep the child for at least one day and monitor their performance.
Limitation
The study is limited by being a retrospective study, it made it difficult to obtain certain data that would have demonstrated additional evidence pertaining to the number of hospital days. For example, the type of parental employment and income status would have shed more light on the number of hospital days.
References
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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 (MuSPePATHS). Part 4: Number Of Hospital Days. Ukwuru Public Health, 24(1): 1-12
Received: 1 August 2024
Accepted: 1 October 2024
Published: 10 October, 2024
Keywords: Number of hospital days, discharge, antibiotics, monitoring, neonates