Chin-Chin J. Demayo1, Mark Anthony J. Torres1, Muhmin Michael E. Manting1, Requel Legaspino2 and Cesar G. Demayo1
1Department of Biological Sciences, College of Science and Mathematics, MSU-Iligan Institute of Technology, Iligan City 9200 Philippines
2Adventist Medical Center, Iligan City, Philippines
Received: 25.09.2020, Accepted: 04.10.2020, Published: 10.10.2020
Abstract: Children are the most vulnerable and always at increased risk of some infectious diseases in human society; thus, it is vital to monitor the occurrence of these health concerns to be able to provide appropriate medical attention and management. The Philippines, being an archipelagic country, has shown that for the past several years, based on records of the Department of Health, occurrences of both communicable and non-communicable diseases vary from region to region, and from communities to communities. To be able to have information at the local level, conditions affecting children admitted in hospitals in Iligan City, Philippines, was data-mined to be able to determine the frequencies of communicable and non-communicable diseases affecting the different age groups. Given a list of medical records available from the hospital for a period of nine years (2005 to 2013), patients ranging from 1 to 12 years old were divided into three categories: 1 to 3 years old (toddler), 4 to 5 years old (pre-school), and 6 to 12 years old (grade school). Results of the evaluation of patients’ records show thirty diseases are commonly the cause of hospital admissions. The list based on tabulated data, the number of patients that were diagnosed by these diseases concerning age and gender show the distribution of the diseases for every year shown through stacked bar graphs. Across all the years, it was found out that the most prevalent diseases among children were pneumonia, acute gastroenteritis with dehydration, and urinary tract infection. The number of incidences per year of the mentioned diseases, however, showed some variations in frequencies. Urinary tract infection and acute gastroenteritis were almost similar, while cases of pneumonia varied and were the highest in three years 2008, 2009, and 2012. These findings may be useful in making preventive measures against these diseases from occurring in the succeeding years by the government’s Department of Health and provide appropriate measures to be done by the communities in the city to avoid the incidence of high admissions due to these diseases.
Keywords: Communicable, interventions, toddlers, preschool, archipelagic .
In the Philippines, several diseases that are the leading causes of mortality were attributed to many factors, including poverty, sanitation, poor access, and costly healthcare [1 DOH, 2019]. The distribution of diseases and mortality cases varies among regions due to the archipelagic nature of the country. Issues and concerns regarding the delivery of healthcare services to the people are the primary concerns facing healthcare management, especially at the local level. Children are the most vulnerable and always at increased risk of some infectious diseases in human society [2,3,4,5,6,7 The World Factbook: CIA, 2018, 2019a,b; GBD Compare Data Visualization, 2018, 2019; Population Pyramids of the World from 1950 to 2100]. contagious diseases that can be spread from one child to another. Since children have not yet developed immunity to infections and diseases, the transmission is easy as they tend to gather in groups and may have difficulty with some aspects of hygiene. Young children commonly experience infectious diseases, especially when at work and play together in groups [8 WHO, 2018.]. There is an opportunity for the spread of several common childhood diseases that can be passed on from one child to the next in places like the daycare center, early learning centers, preschool, school, summer camp, and anywhere else that groups of young children spend time together [9 BCCDC, 2019]. Undernutrition and infectious diseases are the major causes of children’s death, especially in Southeast Asia [10 IMF, 2010]. While Iligan City has only 5% of children who were found to be malnourished, recorded data on infant mortality was at 6.2% [11 MINDA, 2011]. It is argued to be due to climate-sensitive, waterborne, foodborne, diarrhoeal, and vector-borne diseases. Included also are due to poor air quality, in particular, indoor smoke and urban air pollution coming from smokes from cooking with solid fuels, industrial growth, rapid urbanization, and motorization. The lack of safe drinking water and sanitation, increasing the volume of various chemicals used in workplaces, and households aggravated the increasing cases of diseases and mortality cases in children [12 WHO, 2019]. Also, adults can develop symptoms and unknowingly spread the disease from one child to another, including the effects of pollution [13-16 CDC, 2018; Communicable Disease Management Protocols, 2020; Infections That Pets Carry - Kids Health, 2020; The Johns Hopkins and the International Federation of Red Cross and Red Crescent Societies: Control of communicable diseases, 2016].
In this study, an assessment as to the kind and nature of diseases plaguing children in an urbanized and the multiethnic city of Iligan in the Philippines was done to be able to determine the prevalence of both communicable and noncommunicable diseases affecting children and provide possible interventions the government will make to address the issues and concerns affecting children.
MATERIALS AND METHODS
From a long list of the medical record of hospital-admitted children with random ages and diseases, sampling was used for respondents ranging from 1 to 12 years old. The ages were divided into three groups: 1 to 3 y/o (toddler), 4 to 5 y/o (pre-school), and 6 to 12 y/o (grade school). A tabulated form was made to sort all the significant variables available in the data. The gender was grouped into female and male to compare, which has a higher frequency for a particular disease. There are 30 types of diseases found in the list; these are Acute Gastroenteritis with dehydration, Acute Respiratory Tract Infection, Urinary Tract Infection, Benign Febrile Convulsion, Acute Lymphocytic Leukemia, Systemic Viral Infection, Acute Bronchitis, Pneumonia, Upper Respiratory Tract Infection, Intestinal Amoebiasis, Dengue Fever Type 2, Acute Gastritis Hydrated, Bronchial Asthma, Dengue Hemorrhagic Fever Type 3, Acute Gastritis, Acute Gastroenteritis, Acute Tonsilitis, Bronchopneumonia, Typhoid Fever, Dengue Fever, Dengue Hemorrhagic Fever Type 1, Acute Tonsillopharingitis, Viral Exanthematous Disease, Acute Exudative Tonsillitis, Intestinal Parasitism, Acute Febrile Illness, Oral Thrush, Asthma In Exacerbation, Systemic Bacterial Infection and Dengue Shock Syndrome. The number of patients that were diagnosed by these diseases had been tallied in the table manually related to their ages and gender. Below is the tabulated form of the significant variables that were sorted from the original data. The table is consists of the total sum of both males and females, ages 1-12 of every diagnosed disease each year. The distribution of the diseases every year were then shown through stacked bar graphs.
Figures 1 to 4 are stacked bar graphs showing the distribution of the diseases from 2005 to 2013. Of these figures, the first stacked bar graphs which reflect pooled data show that pneumonia, acute gastroenteritis with dehydration, and urinary tract infection top the diseases among children. Of these diseases, the incidence of pneumonia was highest in the years 2008, 2009, and 2012. The recorded number of cases dropped by 2013. For Acute gastroenteritis (AGE) with dehydration and urinary tract infection, the number of incidents per year was almost similar from 2005 to 2013. Acute bronchitis, which appeared fourth in rank, had its highest incidence in 2013. A notable observation from this graph is the increased incidence of URTI, intestinal amoebiasis, dengue fever 2, and AGE in 2012.
Figure 1. Line graphs showing the distribution of diseases from 2005-2013 among all children.
One must take note that the pattern above is for the sex-disaggregated data. When data were segregated by sex and by year, the trends change across age groups and sometimes between males and females. For example, for children aged 1 to 3, Acute gastroenteritis with dehydration outnumbered pneumonia in terms of several documented cases. From 2008, the number of cases of Acute gastroenteritis with dehydration was higher compared to those reported from 2005 to 2007. For this age group, acute bronchitis was also seen highest in 2013.
Figure 2. Stacked bar graphs showing the distribution of diseases from 2005-2013 in (a) males and (b) females aged 1-3 from Iligan City.
A shift towards having more cases of pneumonia were observed among those aged 4 to 5 with more documented cases among females. An interesting find is that pneumonia is seemingly absent in 2013 but peaked in incidence in 2008 and 2012. Acute gastroenteritis, on the other hand, was lesser in frequency among females. While the pattern may have changed, one can observe that based on data on the number of incidence, pneumonia, acute gastroenteritis with diarrhea, and UTI still topped the other diseases.
Figure 3. Stacked bar graphs showing the distribution of diseases from 2005-2013 in (a) males and (b) females aged 4-5.
The bars shifted in sizes again for children aged 6 to 12. This time, there was a number of UTI reported, followed by pneumonia. There seem to be fluctuations in the number of UTI cases in both sexes, but one can observe that more of this was recorded from 2007 to 2008. While pneumonia ranked second in terms of frequency, there was a record drop in the number of cases in 2013. Although Acute gastroenteritis with diarrhea ranked third among males, this was outnumbered by the number of reported cases of intestinal amoebiasis, dengue fever 2, and acute bronchitis in females. Still, a notable observation is an increase in the number of acute bronchitis in 2013 for this particular age group.
Figure 4. Stacked bar graphs showing the distribution of diseases from 2005-2013 in (a) males and (b) females aged 6-12.
It can be seen from the results that while the distribution of both communicable and noncommunicable diseases between sexes across all the years of monitoring varies. It can be argued, however, that the major causes of the rise and fall in numbers of communicable diseases among children can be attributed to their varying degrees of exposures to sources of contaminants and pollution. The sanitation problem, including pollution from solid wastes, dust, and motor vehicles in many villages in the city, may explain these variations in the rise and fall in numbers of communicable diseases, especially those related to respiratory and gastrointestinal diseases. The city government programs for reducing the disease burden to the communities is through preventive strategies. The goal of prevention is to preserve the health of children—predicting and lessening the impact of any possible outbreak of those communicable diseases. While community leaders, volunteers, and health workers play a critical role in planning and carrying out preventive strategies such as health education and sanitation, positive behavior change in the communities should be made. The city, however, lacks the recruitment of health workers and community workers due to low compensation and availability. To be able to improve the delivery of healthcare services to children and the community, active and well-respected members of the affected community should be recruited and trained as volunteers in health education since they share the same language and culture as the target population. They can also provide valuable insight into the community perspectives about specific diseases, including the local terms for the cause, symptoms, and treatment, and thereby make health education messages more effective. Since the city has multiethnic populations, it is crucial to ensure that all sub-groups are represented, including women and minority ethnic groups [16 JHIFRCRCS, 2016]. It can also be deduced from the results that while the information generated show low numbers of noncommunicable diseases (NCDs), resulting from noninfectious and nontransmissible factors, these are often argued to be caused by modifiable factors[17 Proimos and Klein, 2012]. The worldwide burden of NCDs is enormous [18, 19 Bloom et al., 2012 Alwan and MacLean 2009], actually accounting for the majority of all deaths, but these are not the major concerns of children in the city of Iligan. Asthma, otitis, and respiratory infections in children were recorded to be admitted to hospitals in the city. Records show from the Department of Health in the country show a rise in the prevalence and significance of NCDs, and these diseases have been argued to be causing diminished resources within families, especially the poor and the middle class [20 MINDA, 2011.]. People are therefore encouraged to make and maintain healthy living choices, health literacy to improve their health, and local government provides health services focused on early detection and cost-effective management of noncommunicable diseases and their risk factors. At present, population-based interventions made by the current government to reduce NCDs which are on the rise is by the signing into law The Tax Reform for Acceleration and Inclusion (TRAIN) Act, officially cited as Republic Act No. 10963 which includes increasing excise tax on tobacco and alcohol argued to be the major contributor of NCD in the country [21 TRAIN-BIR 2019]. Aside from dietary risk factors and physical inactivity, preventive interventions are also suggested such as risk-factor assessment and treatment with behavioral interventions and medication for persons at high risks [22, 23, 24 Hunter and Reddy, 2013; Shulman 2004; Ahmad and Gaash, 2013] including the mothers and pregnant women.
It was shown in this study that across all the years, the most prevalent diseases among children were communicable pneumonia and non-communicable acute gastroenteritis with dehydration and urinary tract infection, although the number of incidences per year varies in frequencies. These conditions are argued to may cause diminished resources, especially with needy families. Population-based interventions, such as risk-factor assessment and treatment with behavioral interventions and medication for persons at high risks, especially at the community level, is needed to avoid the incidence of top admissions due to these diseases.
The first author would like to acknowledge the DOST-ASTHRDP (Department of Science and Technology - Accelerated Science and Technology Human Resource Development Program) for funding this research. Special acknowledgment is due to the Climate Change Program of the Premier Institute of Science and Mathematics (PRISM) of MSU-Iligan Institute of Technology for the support provided for this study.
The Leading Causes of Child Mortality. (2019). https://www.doh.gov.ph/Statistics/Leading-Causes-of-Child-Mortality. Accessed May 13, 2019.
The World Factbook: CIA. (2019).
GBD Compare (2019). Data Visualization. Seattle, WA: IHME, University of Washington, 2018.
Population Pyramids of the World from (1950 to 2100).
The World Factbook. (2019). Washington, D.C.: Central Intelligence Agency. . Accessed July 12, 2019.
GBD Compare Data Visualization. (2019). Seattle, WA: Institute for Health Metrics and Evaluation, University of Washington; 2017. . Accessed July 12, 2019.
Population Pyramids of the World from (1950 to 2100). . Accessed July 12, 2019.
WHO. (2018). The burden of the Disease. http://www.wpro.who.int/health_research/documents/dhs_hr_health_in_asia_and_the_pacific_11_chapter_6_burden_of_disease.pdf.
BCCDC. (2019). BC Centre for Disease Control: A Quick Guide to Common Childhood Diseases. 2009. http://www.bccdc.ca/resource-gallery/Documents/Guidelines%20and%20Forms/Guidelines %20and%20Manuals/Epid/Other/Epid_GF_childhood_quickguide_may_09.pdf. Retrieved July 12, 2019.
IMF. (2010). Picture This: Reducing Child Mortality. Despite progress, under-5 mortality rates remain unacceptably high. Finance and Development, 47(3), 20-21.
MINDA. (2011).Vital and Health Statistics. http://minda.gov.ph/products-and-services/statistical-reference/vital-and-health-statistics.
WHO. (2019).Health Research in the Western Pacific. https://www.who.int/westernpacific/health-topics/health-research.
CDC. (2018). Center for Disease Control and Prevention. Hepatitis A Information | Division of Viral Hepatitis | CDC. https://www.cdc.gov/hepatitis/ hav/index.html.
Communicable Disease Management Protocols. (2020). Children with Sexually Transmitted Diseases (STDs). https://www.gov.mb.ca/health/publichealth/ cdc/protocol/children.pdf. Accessed January 2020.
Infections That Pets Carry - Kids Health. (2020). https://kidshealth.org/en/parents/pet-infections.html. (Accessed January, 2020).
The Johns Hopkins and the International Federation of Red Cross and Red Crescent Societies. (2016). Control of communicable diseases. Retrieved August 12, 2016, from http://www.jhsph.edu/research/centers-and-institutes/center-for-refugee-and-disaster-response/publications_tools/publications/_CRDR_ICRC_Public_Health_Guide_Book/Pages_from_Chapter_7_.pdf.
Bloom, D.E., Cafiero, E.T., Jané-Llopis, E., Abrahams-Gessel, S., Bloom, L.R., Fathima, S., Feigl, A.B., Gaziano, T., Mowafi, M., Pandya, A., Prettner, K., Rosenberg, L., Seligman, B., Stein, A.Z., & Weinstein, C. (2011).The Global Economic Burden of Noncommunicable Diseases. Geneva: World Economic Forum. Retrieved from http://www3.weforum.org/docs/WEF_Harvard_HE_GlobalEconomicBurdenNonCommunicableDiseases_2011.pdf
Alwan, A., & MacLean, D.R. (2009). A review of non-communicable disease in low- and middle-income countries. International Health, 1(1): 3–9. Retrieved from http://inthealth.oxfordjournals.org/content/1/1/3.abstract
MINDA. (2011). Vital and Health Statistics (2011). http://minda.gov.ph/products-and-services/statistical-reference/vital-and-health-statistics. (Accessed December 2019).
TRAIN. (2019). Bureau of Internal Revenue. 2019. https://www.bir.gov.ph/index.php/train.html
Ahmad, M. G. (2013). Challenges of communicable diseases during disasters. The Journal of Communicable Diseases, 45: 77-89. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25141558