Clinical characteristics associated with increased resource utilization of hospitalized children under 5 years with acute gastroenteritis at a tertiary hospital in the northern region of Ghana: a retrospective study

• Published in: The Pan African medical journal 2019, Vol.33 (186), p.186-186
• Main Authors: Abdul-Mumin, Alhassan, Ervin, Sean, Halvorson, Elizabeth Eby
• Format: Article
• Language: English
• Subjects: Acute Disease; acute gastroenteritis; Anti-Bacterial Agents - administration & dosage; Antimalarials - administration & dosage; Child, Preschool; Dehydration - epidemiology; Dehydration - therapy; Female; Fever - epidemiology; Fluid Therapy - statistics & numerical data; Gastroenteritis - therapy; Ghana; Health Resources - statistics & numerical data; Hospitalization - statistics & numerical data; Humans; Infant; length of stay; Length of Stay - statistics & numerical data; Logistic Models; low resource setting; Male; resource utilization; Retrospective Studies; Tertiary Care Centers
• ISSN: 1937-8688; 1937-8688
• DOI: 10.11604/pamj.2019.33.186.13133

Acute gastroenteritis (AGE) is a leading cause of mortality in children in developing countries. Management of AGE consumes medical resources, including antibiotics and intra-venous fluids, but factors affecting resource utilization in the management of AGE are under-studied. We hope to identify clinical predictors of resource utilization in AGE. We performed a retrospective chart review of patients 1-60 months of age admitted to a tertiary hospital in Northern Ghana between January 2013 and December 2014 with an admitting diagnosis of AGE. We collected data on patient demographics, presenting symptoms, and subsequent management. Our primary outcome was prolonged hospital length of stay, defined as >4 days. Secondary outcomes included other measures of resource utilization, such as use of antibiotics, antimalarials and intravenous fluids. Demographic and clinical characteristics were compared between groups with Pearson chi square test for categorical variables and ANOVA for continuous variables. Multivariable logistic regression modeling for each outcome included all variables found to be significant in the bivariate analysis. We reviewed charts for 473 patients admitted for AGE during this timeframe. 264 (56%) were male, median age was 12 months. 448 (95%) received antibiotics, 396 (84%) received antimalarials and 365 (77.2%) received intravenous fluids. 167 (35.3%) had prolonged LOS >4 days. Following multiple logistic regression analysis, clinical features associated with prolonged LOS included fever duration (OR 2.87, 95% CI 2.28-3.61 per 1-day increase), mild (OR 2.39, 95% CI 1.12-5.08) or moderate (OR 3.13, 95% CI 1.57-6.21) dehydration (compared to none) and symptom duration (OR 1.13, 95% CI 1.01-1.27 per 1-day increase). Dehydration and duration of symptoms prior to presentation predict prolonged hospital LOS in young children with AGE in Northern Ghana.