Background: Seasonal fluctuation is an of import public wellness phenomenon. Many common human diseases display predictable seasonal tendencies depending upon direct or indirect factors act uponing patient results. Pakistan lacks clear cut informations about this issue. Seasonal fluctuation assumes critical importance when it comes to paediatric disease in our set up. Our under 5 old ages mortality is one of the highest in WHO-EMRO part.
Aims & A ; Aims: Present survey is aimed at observing and documenting seasonal tendencies in paediatric unwellnesss with highest morbidity and mortality rates in our state, viz. , acute stomach flu, asthma, URTI and LRTI.
Material & A ; Methods: Retrospective reappraisal of Pediatric OPD databases for three ( 2006-2008 ) consecutive old ages in Kuwait Teaching Hospital was carried out by the research workers and instances run intoing inclusion standards were entered in survey database. Data was analyzed for seasonal tendencies utilizing Microsoft Excel 2007.
Consequences: Clear cut seasonal tendencies were seen in Acute Gastroenteritis, URTI, Asthma aggravation and LRTI. Each disease displayed one-year extremums for three back-to-back old ages.
Decision: Major paediatric slayers in our state show predictable seasonal tendencies that can be used for better readiness and improved results in paediatric population
Keywords: Seasonal fluctuation, Acute Gastroenteritis, Upper Respiratory Tract Infection, Lower Respiratory Tract Infection, Asthma, Pediatrics,
List of Abbreviations
AGE Acute Gastroenteritis
EMRO East Mediterranean Regional Office
IMCI Integrated Management of Childhood Illnesss
KTH Kuwait Teaching Hospital
LRTI Lower Respiratory Tract Infection
OPD Out Patient Department
PMC Peshawar Medical College
RSV Respiratory Syncytial Virus
URTI Upper Respiratory Tract Infection
WHO World Health Organization
List of Tables, Graphs and Figures
Table 1: Entire figure of instances of selected diseases for each twelvemonth of survey at Kuwait Teaching Hospital
Figure: Seasonal tendency of Acute Gastroenteritis ( AGE ) instances
Figure: Seasonal tendency of instances with acute aggravation of asthma
Figure: Seasonal tendency of instances with acute aggravation of URTI
Figure: Seasonal tendency of LRTI instances
Seasonal fluctuation is a well-known public wellness property of human unwellness. It is of import from epidemiologic position point and serves as an index of etiologies other than primary causative agent for a disease. Human immune responses, [ 1 ] , bacterial counts, [ 2, 3 ] , allergen denseness, exposure rates, [ 3, 4 ] and opportunity exposure, [ 5 ] are all seasonally determined. Bing able to foretell seasonal fluctuation in any disease is, intelligibly, an assistance in index of intuition, diagnosing and above all aa‚¬A“Emergency Preparednessaa‚¬A? and preventative steps to incorporate disease.
Outside primary attention, seasonal fluctuation has been documented in admittance rates to intensive attention units ( United Kingdom ) , [ 6, 7 ] visits to the exigency section ( United States ) , [ 8 ] and all-cause mortality ( United Kingdom ) , [ 9 ] . Published surveies show seasonal fluctuation in the diagnosing of ischaemic bosom disease in general pattern ( United Kingdom ) , [ 10 ] and in the figure of visits to primary attention doctors ( Sweden ) . The Swedish survey, based on a 14-year observation period from 1969 to 1982, found that visits to primary attention doctors declined during July and August in relation to a diminution in diagnosings related to respiratory tract infections, and that there were no appreciable differences for the remainder of the twelvemonth. Season specific unwellnesss, [ 11, 12, 13 ] and mortality rates, [ 13, 14 ] are now being used to find several wellness parametric quantities and resource allotment in wellness sector. This makes finding of seasonal fluctuation an of import public wellness step particularly in catching diseases.
Although Pakistan is endemic for several catching diseases, yet we do non hold sufficient informations to back up seasonal fluctuation for common primary attention jobs in our population. Bing a state that faces one of the highest under 5 mortality rates in the WHO-EMRO part, we carry the duty of sensing and certification of baseline informations for appropriate intercessions in paediatric unwellness. From a public wellness position, the current survey will assist us place the demand for intercession and formulate schemes on a larger graduated table to cut down under 5 yr. morbidity and mortality rates in our population. Present survey is a Pilot design to look into the seasonal fluctuation of common paediatric wellness jobs showing to a primary attention OPD in a metropolis of Pakistan.
To observe and document seasonal tendencies in paediatric unwellnesss with highest morbidity and mortality rates in our state, viz. , acute stomach flu, asthma, URTI and LRTI in Kuwait Teaching Hospital OPD, from 2006-2008.
Present survey is a retrospective descriptive analysis of an bing database at paediatric OPD at Kuwait Teaching Hospital, KTH, Peshawar. Kuwait Teaching Hospital is an affiliate of Peshawar Medical College, an commissioned establishment of medical instruction.
Pediatric OPD at KTH is of moderate volume with 60-80 OPD visits per twenty-four hours by kids belonging to middle to low socioeconomic category signifier the environing Jamrud Road and Tehkal country. Patients are largely cultural Afghans and Pashtuns. PMC Pediatrics is a well-equipped unit with inpatient bed strength of 35 beds and 5 neonatal isolates. It is staffed by 3 advisers 6 medical officers and 7 paediatric nurses.
Study was approved by PMC Institutional Ethical Committee and informations aggregation was performed on site in KTH. Data was extracted from OPD and ward registries and patient medical records for admitted patients for old ages 2006, 2007 and 2008. Research workers met hebdomadal during informations extraction and informations entry clip and discussed jobs for common declaration.
Operational definitions used were standard WHO/IMCI definitions. Acute Gastroenteritis was a kid less than 5 old ages age showing with history of increased frequence and reduced consistence of stool over past 24 hours with or without febrility and emesis. Upper Respiratory Tract Infection was child less than 5 old ages age showing with acute ear aching, sore pharynx, tonsillitis, spasmodic laryngitis or epiglottitis with moderate to severe respiratory hurt category harmonizing to IMCI categorization, Lower Respiratory Tract Infection was a kid less than 5 old ages showing with respiratory hurt harmonizing to IMCI categorization and chest X-ray findings consistent with lobar or bronchial pneumonia. Acute Exacerbation of Asthma was presence of respiratory hurt and wheezing in a kid less than 5 old ages age who was known to hold reactive air passages disease.
Data was entered in Microsoft Excel 2007 and later analyzed for seasonal fluctuation. Graphs were constructed for each paediatric status under consideration and compared for consistence.
A sum of 7209 patients were included in the survey reported in Kuwait Teaching Hospital OPD from January 2006 to December 2008. Entire figure of instances reported for Acute Gastroenteritis, Upper Respiratory Tract Infections, Asthma and Lower Respiratory Tract Infections were 3129, 1527, 1599, and 954 severally. 72.80 % of instances of AGE were reported in the months of April, May, June, July, August and September ( summer ) as shown in Figure 1. Patients with acute aggravation asthma reported most in the month of April ( spring ) ( 13.01 % ) and winter season. The Numberss of instances show a gradual addition from September to December ( winter ) ( 51.16 % ) as shown in figure 2. 61.36 % of instances of URTI were in the months of February, April, October, November and December. An addition in patient count was observed from the month of October to December ( 36.87 % of entire instances ) as shown in Figure 3. Extremums in the figure of patients reported for LRTI was observed in the months of April and July ( 15.93 % of entire ) and there was a gradual addition in patient count in winter months i.e. September, October, November, December and January ( 55.87 % of entire instances ) as shown in Figure 4.
Year of Study
Upper Respiratory Infection
Lower Respiratory Infection
Acute Exacerbation of Asthma
Table: Entire figure of instances of selected diseases for each twelvemonth of survey at Kuwait Teaching Hospital
Figure 1: Seasonal tendency of Acute Gastroenteritis ( AGE ) instances
Figure2: Seasonal tendency of instances with acute aggravation of asthma
Figure 3: Seasonal tendency of instances with acute aggravation of URTI
Figure 4: Seasonal tendency of LRTI instances
Our chief aim was to observe and document seasonal tendencies in paediatric unwellnesss with high morbidity and mortality rates in our state, viz. , acute stomach flu, Asthma, URTI and LRTI. Although seasonal tendencies of assorted wellness jobs have been studied by assorted research workers in Pakistan and other SAARC states. Areas of probe include childhood poisoning [ 15 ] and shot, [ 16 ] . Probe of seasonal tendencies of childhood unwellnesss in Pakistan has non been carried out to the authoraa‚¬a„?s cognition.
AGE exhibited a reasonably unvarying distribution form over the assorted old ages with regard to its seasonality. Higher sensing rate of AGE during the summer season may be explained due to assorted factors. First of all high temperature during this clip of the twelvemonth is thought to advance growing of morbific beings in the environment. [ 17 ] Furthermore, monsoon season causes a batch of strain on already unequal sewerage disposal system hence ensuing in a greater figure of incident instances. Particularly in the summers, the frequence of AGE towers above other paediatric diseases. The greater load of this disease exists in kids because of their under developed immune system.
Asthma showed a bimodal distribution with its first extremum in spring and 2nd extremum in winters. The consequences clearly show that most people seek medical attention for Asthma in spring and winter. The rise in admittance for Asthma in spring may hold been related to increasing tree and grass pollen counts. The oncoming of cold conditions has been shown to be related to symptoms of asthma [ 18, 19, 20 ] . The acquisition of viral infections, [ 21 ] the seasonal prevalence of fungous spores, [ 22, 23 ] and the fluctuation in the house dust mite population [ 24, 25 ] may lend. The clear seasonal fluctuation is consistent throughout our state, proposing that similar environmental trigger factors are responsible for arousing onslaughts.
Our consequences showed an addition in patient count with LRTI and URTI during the months of February, April, and July and in winter season in all the three old ages under survey. This may be due to the fact that people remain indoors during cold conditions. Due to shut contact in indoor environment, people, particularly kids, are more prone to acquire disease. The agents that cause LRTI are most frequently transmitted by droplet spread ensuing from close contact with a beginning instance. Contact with contaminated vehicles besides may be of import in the acquisition of viral agents, particularly RSV. Probably the somewhat fewer studies in summer were a manifestation of epidemic instead than seasonal fluctuation. For grounds that are unknown, different viruses cause extremums of infection at different times during the respiratory virus season ; these extremums rarely occur at the same time [ 26 ] . Seasonal tendencies are complex phenomena that require elaborate surveies with multiple samples from diverse population beginnings over long periods of clip to be able to foretell seasonality of disease. Therefore, farther surveies with bigger samples and over longer continuance of clip are required to foreground the phenomena better in our set up.
A important seasonal fluctuation was observed in AGE, URTI, LRTI and Asthma. Summer received most instances of AGE. Most of the patients with Asthma were reported in spring and winter. A important addition in patient count with URTI was observed in winter and spring in all the three old ages. Most of the patients with LRTI were observed in winter and in the months of April and July. Further surveies with bigger samples and over longer continuance of clip are required to foreground this phenomena better.