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      Influencia de la consulta previa con empíricos sobre la morbilidad y mortalidad de niños internados Translated title: Influence of previous consultation with non-medical personnel on morbidity and mortality in hospitalised children


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          Objetivos: Primario: Determinar si la consulta previa (CP) con el curandero influye sobre la morbilidad (días de estadía hospitalaria y complicaciones), y mortalidad de los niños internados por infección respiratoria baja (IRB) o diarrea aguda. Secundario: Comparar la influencia de la CP a la internación, con el pediatra, médico general, enfermera y farmacéutico. Material y Método: Diseño de cohorte prospectivo y analítico. Se incluyó a 135 niños de 1 mes a 5 años, internados por diarrea aguda o IRB entre agosto del 2003 y marzo del 2004, en el Hospital Nacional de Itauguá. Se realizó cálculos de frecuencia en el análisis univariado, tablas de contingencia en el bivariado y regresión logistica para variables independientes en el multivariado. Para la diferencia entre variables nominales se utilizaron, X2 y el test exacto de Fisher; en continuas u ordinales el test de Mann-Whitney o Wilcoxon. Resultados: 117 pacientes realizaron 176 consultas previas: Pediatra: 63 (35,7%), Curandero: 44 (25%), Médico Gral.: 44 (25%), Enfermera 16 (9%) y farmacéutico 9 (5,1)%. El 39,2% de las CP no fueron al médico. La gravedad al ingreso fue mayor en pacientes, que consultaron con el curandero (p=0,004), y con el farmacéutico (p= 0,001) Las complicaciones aumentaron cuando el niño había consultado más de 2 veces con el curandero OR: 2,6; RR: 1,6. - 68 pacientes utilizaron 49 tipos de hierbas en forma aislada o combinada, sin aumento de complicaciones (p= 0,2), con 3,8 días más de estadía. La media de días de internación fue: Sin CP: 5,3 días (DS3, 2), curandero: 17,2 días (DS 16), médico general 13,5 (DS 15,5) pediatra: 11,6 días (DS14). Los días de internación aumentaron cuando el inicio de los síntomas fue ≥ a 3 días previos. Existieron más complicaciones en los niños que realizaron consultas previas, (p=0,003). Fallecieron 6 pacientes, habían realizado 26 consultas de las cuales 16 fueron con empírico. El análisis multivariado mantuvo la independencia de curandero en relación con: complicaciones (p=0,006) y días de internación (p=0,02). Conclusión: La consulta previa con el curandero aumentó la morbilidad en pacientes internados con relación a retraso en la consulta y mayor gravedad al ingreso. Los pacientes con menor morbilidad fueron los que consultaron directamente en el hospital previo a la hospitalización.

          Translated abstract

          Objetivos: Primary Objective: To determine whether a previous consultation (PC) with a curandero(***) has an effect on morbidity (days of hospital stay and complications) and mortality in children admitted to hospital for lower respiratory tract infection (LRI) or acute diarrhea. Secondary objective: to compare the influence of the PC with those of the pediatrician, the general practitioners, nurses and pharmacists. Material and methods: Analytical, prospective cohort design. One hundred thirty children were included, with age range from 1 month to 5 years, admitted for acute diarrhea or LRI between August 2003 and March 2004 at the National Hospital of Itauguá. Frequency calculations were done as univariate analysis, contingency tables as bivariate and logistic regression for independent variables as multivariate. The X² and Fisher’s exact test were used for the difference between nominal variables, the Mann-Whitney or Wilcoxon test for continuous or ordinals. Results: One hundred seventeen patients went to 176 previous consultations: Pediatrician: 63 (35.7%), curandero: 44 (25%), General Practitioner: 44 (25%), Nurse 16 (9%) and pharmacist 9 (5.1%). Many (39.2%) of PC were not with a physician. Severity on admission was greater in patients who had consulted with the curandero (p=0.004) and with the pharmacist (p=0.001). Complications increased when the child had consulted more than twice with the curandero (OR 2.6; RR 1.6). Sixty eight patients used 49 types of herbs alone or in combination, with no increase in complications (p=0.2) with 3.8 more days in hospital. The average hospital stay in days was: With no PC: 5.3 days (SD 3.2), curandero 17.2 days (SD 16), general practitioner 13.5 (SD 15.5), pediatrician 11.6 days (SD 14). The number of days in hospital increased when symptoms began 3 or more days before admission. There were more complications in children who had had PC (p=0.003). Six patients died; these had had 26 consultations, 16 of which with an empiricist. Multivariate analysis showed that consultation with the curandero was an independent risk factor for complications (p=0.006) and length of hospitalisation (p=0.02). Conclusion: A previous consultation with the curandero increased morbidity in hospitalised patients due to a delay in consultation and worse conditions on admission. Patients with the lowest morbidity were those who consulted directly in the hospital before admission.

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          Most cited references26

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            In rural Malawi, 703 newborns were visited monthly for 1 year to describe the epidemiology and health-seeking behaviour during acute episodes of diarrhoea, respiratory infections (ARI) and malaria. On average, the infants suffered from 1.3 annual episodes (11.0 illness days) of diarrhoea, 1.1 episodes (9.4 days) of ARI and 0.7 episodes (4.8 days) of malaria. Multivariate analysis with polychotomous logistic regression indicated that the amount of morbidity was associated with the child's area of residence, weight in early life, number of siblings, father's marital status and the source of drinking water. Diarrhoea and malaria were most common at 6-12 months of age and during the rainy months whereas respiratory infections peaked at 1-3 months of age and in the cold season. Ten per cent of diarrhoea, 9% of ARI and 7% of malaria episodes lasted for more than 14 days. Fifty-eight infants died, giving case fatality rates of 1% for diarrhoea, 2% for ARI and 4% for malaria. One-third (37%) of the illness episodes were managed at home without external advice. A traditional healer was consulted in 16% of episodes and a medical professional in 55% of episodes. If consulted, traditional healers were seen earlier than medical professionals (median duration after the onset of symptoms 0.7 vs. 1.8 days, P < 0.001). Traditional healers were significantly more commonly used by those families whose infants died than by those whose infants did not die (odds ratio 1.8, 95% CI 1.1, 3.0). Our results emphasise the influence of seasonality, care and living conditions on the morbidity of infants in rural Malawi. Case fatality for diarrhoea, ARI and malaria was high and associated with health-seeking behaviour among the guardians. Future interventions must aim at early and appropriate management of common childhood illnesses during infancy.
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              Traditional methods in management of diarrhoeal diseases in Uganda.

              A total of 292 traditional healers were interviewed in five districts of Uganda to discover how diarrhoeal diseases were treated by them. At least two healers were present in every village visited, and over 42% of their case-load was concerned with diarrhoeal treatment. The investigation showed that a great variety of herbs/plants are used by traditional healers in the treatment of diarrhoeal diseases. All those interviewed used water as the main vehicle for their herbal preparations, the amount prescribed daily ranging from 20 ml to over 100 ml for children (in the case of 54.5% of healers) and 100 ml to over 500 ml for adults (56.6%); 26.4% of healers considered fluid supplements as mandatory and 70.5% advised patients to take as much fluid as possible. Only 3.1% of healers either limited or did not advise fluid intake. These findings indicate that traditional healers could play an important role in interventions to control diarrhoeal diseases using modern oral rehydration therapy if they are assisted to improve their techniques.

                Author and article information

                Role: ND
                Role: ND
                Revista de la Sociedad Boliviana de Pediatría
                Rev. bol. ped.
                Sociedad Boliviana de Pediatría (La Paz, , Bolivia )
                August 2006
                : 45
                : 3
                : 191-200
                [01] San Lorenzo orgnameHospital General Pediátrico Niños de Acosta Ñú orgdiv1Servicio de Medicina Interna Paraguay
                [02] orgnameHospital Nacional de Itauguá orgdiv1Servicio de Pediatría Paraguay

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 19, Pages: 10

                SciELO Bolivia

                empíricos,consulta,diarrea aguda,neumonía,empiricists,consultations,acute diarrhea,pneumonia


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