Doňa Remedios Trinidad Romualdez Medical Foundation College, Inc.

College of Medicine
Calanipawan Road, Tacloban City

In Partial Fulfillment
of the Requirements
in Research

_________________________________
Comparison of Pediatric Admissions between Remedios Trinidad Romualdez Hospital and Leyte
Provincial Hospital from June, 2017 to May, 2018
_________________________________

by
BACIERRA, Jan Kirk T.
BAJO, Justin Louise R.
BARIKKAD KAKUZHIIYIL, Shabnam Kader
CORDIAL, Michael Dindo U.
ISRAEL, Christine Joy M.
MANI,Kasturi
ORTILLO, Paolo S.
PELICANO, Agah B.
RAGHAVAN, Hrishikesh
TAMAYO, Ma. Chesca R.
TOMENIO, Arvin

Adviser:
Dr. Fe B. Barquin
OCTOBER 2019
 Abstract

The objective of this study is to describe the causes of admission in two local hospitals, RTRH
and LPH for children from zero to ten years of age in the city of Tacloban during June, 2017 to May,
2018. The Study is based on children, ages 0-10 years old only, excluding pediatric patients of NICU. The
researcher collected the data through a communication letter to the administration, the chief of
hospital of the two hospitals: RTRH, and LPH based on hospital records and annual reports and collate
and classify the gathered data according to determine this objectives: To know the magnitude or total
number of pediatric admissions in the two hospitals and the number of admissions per month. To
identify and classify the different causes of admissions as to communicable, noncommunicable and
trauma. To determine the top 10 causes of admissions, and to identify demographical relationship of
age and sex to the number of admissions. then Data is presented using tables. The data was analyzed
and result showed significant findings in the types of diseases being admitted in both hospitals and
there was no significance on the age and sex of the patient in the admissions in both hospitals. The
study also determined which month has peak incidence of children being admitted in each hospital.
Contents
Abstract........................................................................................................................................................ 2
CHAPTER I ................................................................................................................................................ 5
INTRODUCTION....................................................................................................................................... 5
Background/Rationale ............................................................................................................................ 5
Significance of the Study ........................................................................................................................ 6
General Objectives .................................................................................................................................. 7
Specific Objectives .................................................................................................................................. 7
Null Hypothesis ....................................................................................................................................... 7
Alternative Hypothesis ........................................................................................................................... 7
Conceptual Framework .......................................................................................................................... 7
DEFINITION OF TERMS..................................................................................................................... 8
Review of Related Literature and Studies ............................................................................................ 8
Related Literature ............................................................................................................................... 8
Foreign Literature .............................................................................................................................. 9
Related Studies .................................................................................................................................. 12
Synthesis............................................................................................................................................. 16
Chapter II .................................................................................................................................................. 18
Methodology .......................................................................................................................................... 18
Research design ..................................................................................................................................... 18
Scope and Limitation ............................................................................................................................ 18
Population of the Study ........................................................................................................................ 18
Method of Data Collection .................................................................................................................... 18
Chapter III................................................................................................................................................. 19
RESULTS AND DISCUSSIONS ......................................................................................................... 19
CHAPTER IV............................................................................................................................................ 27
CONCLUSION AND RECOMMENDATIONS .................................................................................... 27
Conclusions ............................................................................................................................................ 27
Recommendations ................................................................................................................................. 27
Bibliography .............................................................................................................................................. 29
Appendix A ................................................................................................................................................ 30
Appendix B ................................................................................................................................................ 31
Appendix C ................................................................................................................................................ 34
Appendix D ................................................................................................................................................ 35
Appendix E ................................................................................................................................................ 36
Appendix F ................................................................................................................................................ 37
 CHAPTER I

INTRODUCTION

Background/Rationale

According to the World Health Organization “Hospitals complement and amplify the
effectiveness of many other parts of the health system, providing continuous availability of
services for acute and complex conditions. Hospitals concentrate scarce resources within well-
planned referral networks to respond efficiently to population health needs. They are an essential
element of Universal Health Coverage and will be critical to meeting the Sustainable
Development Goals.”
According to the DOH In the 2008 National Demographic and Health Survey (NDHS),
50 percent of the clients who sought medical advice or treatment consulted public health
facilities, 42 percent went to private health facilities, and almost 7 percent sought alternative or
traditional health care.
They also noted that the country’s health profile depicts a distinct epidemiologic and
demographic transition characterized by double burden of diseases consisting of communicable
and non-communicable diseases. Which puts children at risk.
Current pediatric intensive care unit (PICU) mortality rates approximate 2.5%–5%,
decreased from 8%–18% during the early years of pediatric critical care, and it has been
suggested that a portion of the reduced mortality rates has been an exchange for higher morbidity
rates. (Henegan, 2017)
Despite the low mortality rates and changing primary focus of pediatric critical care to
include morbidity prevention, the primary outcome for many critical care studies and
assessments remains mortality. Studies which formerly could be accomplished with mortality as
a legitimate and meaningful outcome are now difficult or impossible due to sample size
considerations. If mortality is the primary outcome for research, quality or other studies, the
sample size required may be very large, and the time required to obtain these samples may be so
long as to make the results less meaningful when the study is completed.
The prior experience of the researchers in Community and Public Health has driven them
to pursue this study about pediatric admissions in the locality. The objective of this study is to
describe the causes of admission in two local hospitals, RTRH and LPH for children from zero to
ten years of age in the city of Tacloban during May, 2017 to June, 2018 and to determine the
state of the health facilities to cater the needs of treatments to the children. Child Health is
always a global advocacy to promote the prevention of childhood disease. There are studies
show that a child’s health will affect his/her growth and their future health. Children under 5
years has the highest risk in child morbidity and mortality. The recent rise in the number of cases
of dengue, pneumonia, and other infectious diseases has moved the researchers to investigate the
recent trends, and what factors contributed to the rise and/or fall of the cases. Evaluation of the
current trends in the number of cases of infectious diseases among pediatric admission with
emphasis on the effectivity of the management used at the local level could be used as an
indicator in the assessment of the progress attained by the national programs in eradicating the
disease. This study is being conducted to address the number of admissions in two hospitals and
to determine the causes of admissions and the ability of the hospital to cater the needs of the
patient. This will also help in the prevention of infectious spread of disease.

Significance of the Study

Children represent the future, and ensuring their healthy growth and development ought
to be a prime concern of all societies. Children admitted to a hospital often die within 24 hours of
admission and many of these deaths could be prevented if very sick children are identified soon
after their arrival in the health facility and treatment is started immediately.
On a global scale, the vast majority of child deaths are due to neonatal causes,
pneumonia, diarrhea and malnutrition. Recent data showed that 5.6 million children under the
age of 5 died in 2016 despite the significant progress in child survival in the Western Pacific
Region.
One of the sustainable developmental goals targets the average coverage of essential
services based on tracer interventions that include reproductive, maternal, newborn and child
health, infectious diseases, non-communicable diseases and service capacity and access, among
the general and the most disadvantaged population. In many low- and middle-income countries,
deficiencies in the quality of pediatric care at district hospitals also has major role in limiting
reductions in child mortality. A 3-year initiative to improve pediatric quality of care in 40
hospitals was implemented in Angola, Ethiopia, Kyrgyzstan and Tajikistan in 2012. Baseline
assessment showed lack of pediatric emergency care; substandard care in the management of
common childhood conditions such as pneumonia, diarrhea, fever and newborn conditions and
lack of emergency resuscitation equipment.
In the Philippines, where inequity in health status and access to services is the single most
important health problem, 72% of deaths in the under-five are due to neonatal causes, pneumonia
and diarrhea. In region VIII, common causes of pediatric admissions in the ER are not routinely
measured and reported. The researchers of this study determined the common causes of pediatric
admissions between a private hospital, RTRH, and a government hospital, LPH, for the months
of May 2017 thru June 2018. Results have shown that the top causes for admissions were
pneumonia and gastroenteritis and a male predominance among these cases were likewise
observed. The results of this study has a significant implication on the following:
• Government health sectors can prioritize programs and services that needs urgent
implementation and budget allocation in relation to the statistical results of leading
pediatric cases of admissions provided in this study
• Hospitals and healthcare providers can review whether patient care is consistent with
evidence-based practices, and provide feedback to health workers to improve health care
practices. It will also help identify modifiable factors among the leading causes of
pediatric admissions and gear them towards interventions to improve the quality of care
and outcomes in health care facilities.
 • Researchers will have a reference for studies related to the pediatric admissions in the
region, and can provide recommendations regarding health facility measures to facilitate
implementation, track improvement and monitor performance in addressing the most
common conditions that affect children and adolescents in health facilities.
General Objectives

To compare Pediatric Admissions of Remedios Trinidad Romualdez Hospital (RTRH)

and Leyte Provincial Hospital (LPH) from May, 2017 to June, 2018.

Specific Objectives

1. To know the magnitude or total number of pediatric admissions in the two hospitals and the
number of admissions per month.
2. To identify and classify the different causes of admissions as to communicable,
noncommunicable and trauma.
3. To determine the top 10 causes of admissions, and
4. To identify demographical relationship of age and sex to the number of admissions.

Null Hypothesis
There is no relationship between the age and sex of the patient to the amount of
admissions.

Alternative Hypothesis
There is a significant relationship between the age and sex of the patient to the number of
admissions.

Conceptual Framework
INDEPENDENT VARIABLE DEPENDENT VARIABLE

Pediatric CAUSES OF
admissions ADMISSIONS

CONFOUNDING VARIABLE

AGE
SEX
DEFINITION OF TERMS
The following terms were used operationally in the study:

 Pediatric patients- refers to children aged 0-10 years old in RTRH and LPH for the
months of May 2017 to June 2019 only, excluding pediatric patients of Neonatal
Intensive Care Unit (NICU).
 Pediatric admissions – refers to the admitting diagnosis made by the physician upon
arrival of the patient at the health care facility.
 Nature of the disease – refers to diagnosed diseases categorized as communicable, non-
communicable and traumatic injuries.
 Communicable diseases – Communicable, or infectious diseases, are caused by
microorganisms such as bacteria, viruses, parasites and fungi that can be spread, directly
or indirectly, from one person to another. Some are transmitted through bites from insects
while others are caused by ingesting contaminated food or water.
 Non-communicable diseases – also known as chronic diseases, tend to be of long
duration, noninfectious and are the result of a combination of genetic, physiological,
environmental and behaviors factors.
 Traumatic injuries – refers to physical injuries of sudden onset and severity which
require immediate medical attention.
 Chi-square - a statistical method assessing the goodness of fit between a set of observed
values and those expected theoretically.

Review of Related Literature and Studies

This chapter includes the ideas, finished thesis, generalization or conclusions,

methodologies and others. Those that were included in this chapter helps in familiarizing
information that are relevant and similar to the present study.

Related Literature
Local Literature

Philippine health status indicators show that the country lags behind most of South-East
and North Asia in terms of health outcomes. While rapid improvements were seen during the last
three decades, these have slowed in recent years. Communicable diseases continue to be major
causes of morbidity and mortality in the Philippines. As shown in Table 1-4 and 1-5, infectious
diseases such as tuberculosis and pneumonia are leading causes of death. Malaria and leprosy
remain a problem in a number of regions of the country. Also shown in the tables is the
prevalence of non-communicable diseases, such as diseases of the heart, diabetes mellitus and
cancers. Inequity in health status and access to services is the single most important health
problem in the Philippines. As the succeeding sections will show, this inequity arises from
structural defects in the basic building blocks of the Philippine health system, including the low
level of financial protection offered – problems which until recently have been inadequately
addressed by reform efforts. (Source: Philippine Health Systems Review, Asia Pacific
Observatory on Health Systems and Policies 2011)

In a policy framework by the Philippine Government, it stated that the right to health is
protected under the Philippine Constitution in Article II, Section 15 which states that “The State
shall protect and promote the right to health of the people and instill health consciousness among
them.” Article XIII, Sections 11-13 of the Constitution sets out further provisions related to
health. In the Philippines there is a government mandate to ensure Universal Health Care, also
referred to as Kalusugan Pangkalahatan (KP). KP mandates the “provision to every Filipino of
the highest possible quality of health care that is accessible, efficient, equitably distributed,
adequately funded, fairly financed and appropriately used by an informed and empowered
public.

Foreign Literature
A two-year retrospective record analysis of pediatric ward admission and
discharge of Chiro hospital during September 2000 - August 2002 was conducted A record book
of pediatric ward of the Hospital was reviewed using pre-tested format. The main diagnosis,
cause of admission and death, personal characteristics and length of stay was included in the
analysis. Data were analyzed by SPSS version 11. computer statistical software.
In our current study, this is conducted to address the number of admissions in two
hospitals and to determine the causes of admissions and the ability of the hospital to cater the
needs of the patient. This involves a one-year retrospective analysis of pediatric admissions of
Remedios Trinidad Romualdez Hospital (RTRH) and Leyte Provincial Hospital (LPH) from
May, 2017 to June, 2018. Like the aforementioned study, the main diagnosis, cause of admission
and death, personal characteristics was included in the analysis, however the length of stay was
not included. The entirety of the data involved in the study was sourced from hospital records
and annual reports of both hospitals. Data were analyzed by Chi-square.
According to G/Mariam A. (2005), a study on “A two year retrospective review of
reasons for pediatric admission to Chiro Hospital, Eastern Ethiopia.” The objective of this study
was to review pediatric admission and discharge records of Chiro Hospital, East Ethiopia. It was
done through A two-year retrospective record analysis of pediatric ward admission and discharge
of Chiro hospital during September 2000 - August 2002 was conducted A record book of
pediatric ward of the Hospital was reviewed using pre-tested format.
Nine hundred and sixty three pediatric patients were admitted to the hospital within the
two years Period. Most common diagnosis leading to pediatric admission were diseases of
respiratory system 215 (22.9%) and infective and parasitic diseases (22.9%). The three most
common infections: pneumonia 368 (39.2%), malaria 140 (14.9%) and tuberculosis 103 (10.9)
were more common among male than female children, but no statistical difference was observed
between the ten common infectious diseases and sex of the children (P>0.5). More death was
observed in males 50 (5.3%) than females 32 (3.4%). Twenty-eight (34.2%) of the deaths
occurred within 48 hours and (39.0%) died after 72 hours of admission.
 The review showed that communicable diseases were the most common causes of
admissions (61.3%) and the patterns of morbidity and mortality reflects those of developing
countries that call for extensive preventive measures.
In a similar study by Heneghan (2010) et al entitled, “Morbidity: Changing the Outcome
Paradigm for Pediatric Critical Care”, focused mainly on morbidity assessment. The objectives
of the study were, o review the conceptual framework of morbidity most relevant to pediatric
critical care; to describe the uses of morbidity in research, quality, and other types of studies, to
describe measures of morbidity, especially those that measure functional status; to review the
foundational evidence that strongly supports the use of functional status morbidity as an
equivalent or separate outcome to mortality; and to summarize the current pediatric critical care
morbidity literature and the methods used to assess morbidity.
The study recommended that morbidity assessments should be available from the medical
record to ensure they are available for routine studies of quality and available for other large-
scale studies. Similarly, databases must incorporate appropriate morbidity measures in their
quality and research studies. Currently, large databases such as those of the Society of Thoracic
Surgery (STS), American College of Surgeons (ACS) Trauma Registry, and the Pediatric Health
Information System (PHIS) do not include a patient-level functional status morbidity assessment.
In our current study, morbidity was not assessed however the data gathering techniques
of both studies involved a retrospective analysis concerning pediatric admissions. However, the
studies differ in terms of scope, our study mainly focused on a limited age-group unlike the
aforementioned which included a wider age group thus a better representation of the current
status for the pediatric patients as a whole.
Cumbria Intelligence Observatory (2010) states that the health and wellbeing status of
children is of high importance with problems in childhood often having an effect on their health
as adults. It is therefore imperative that prevention efforts and services meet the needs of this
age group. In England, younger children (under 5) have higher admission rates than older
children with emergency hospital admissions being more common than planned admissions.
This is reflected in the types of diagnoses for childhood admissions with respiratory diseases
being one of the most common causes.
The data is extracted from the admitted patient care database for patients aged between 0
and 18 years who had been admitted to hospital (finished consultant episodes) between 1st April
2008 and 31st March 2009.
There were a total of 14,908 hospital admissions for children aged 0-18 in 2008-09 in
Cumbria. Of these admissions, the top five diagnoses were for respiratory diseases (16.17%),
symptoms and signs not elsewhere classified (12.7%), injury and poisoning (11.5%), digestive
diseases(9.8%) and infectious and parasitic diseases(7.4%).
Nhung T T Nguyen, Tran Minh Dien, Christian Schindler, et al (2014), “Childhood
hospitalization and related deaths in Hanoi, Vietnam: a tertiary hospital database analysis from
2007 to 2014”, a study aimed to describe hospital admission and emergency visit rates and
potential risk factors of prolonged hospitalization and death among children in Hanoi. It followed
a retrospective study design, where they reviewed 212216 hospitalization records of children
aged 0-17. They used four indicators for reporting; (1) rate of emergency hospital visits, (2) rate
of hospitalization, (3) length of hospital stay and (4) number of deaths. Their results show a
significant increase in annual rates of emergency visits for infants during 2012-2014 and an
increase in hospital admissions in children during the years 2009-2014. It was also found out that
Digestive diseases (32.0%) and injuries (30.2%) were common causes of emergency visits,
whereas respiratory diseases (37.7%) and bacterial and parasitic infections (19.8%) accounted
for most hospital admissions. They went on to conclude that preventable health problems, such
as common bacterial infections and respiratory diseases, were the primary causes of hospital
admissions in Vietnam.
A paper by Margolis, Rachel(2010) examines whether morbidity in early and later
childhood is associated with health later in life. I investigate the relationship between five types
of childhood morbidity and risk factors for cardiovascular disease among Guatemalan adults who
experienced high levels of morbidity in childhood. The analysis is based on the Human Capital
Study (2002–2004), a recent follow-up of the INCAP Longitudinal Study conducted between
1969 and 1977. I find that most types of childhood morbidity are associated with poorer adult
health, independent of family background, adult socioeconomic status, and health behaviors.
Higher levels of infections in childhood were associated with a low level of high-density
lipoprotein (HDL), and higher level of triglycerides, plasma glucose, waist circumference, and
obesity (but not hypertension). These results are consistent with the literature that finds that
childhood morbidity is associated with increased morbidity and mortality at older ages.
However, diarrheal disease in later childhood was associated with lower levels of some risk
factors, as measured by triglycerides and plasma glucose, suggesting that exposure to bacteria
after infancy may be beneficial for some measures of adult health.
In 2012, a cross-sectional study on “Epidemiology of pediatric hospitalizations at general
hospitals and freestanding children’s hospitals in the United States” was conducted by Leyenaar
et al. The objective of the study was to describe the volume and characteristics of pediatric
hospitalizations at acute care general hospitals and freestanding children’s hospitals in the United
States in children and adolescents less than 18 years of age, excluding in-hospital births and
hospitalizations for pregnancy and delivery (identified using All Patient Refined-Diagnostic
Related Groups (APR-DRGs)) but retaining neonatal hospitalizations from transfers or new
admissions. Researchers examined differences between hospitalizations at general and
freestanding children’s hospitals, using the Healthcare Cost and Utilization Project’s 2012 Kids’
Inpatient Database (KID) from 44 participating states. Reasons for hospitalization were
categorized using a pediatric grouper, and differences in hospital volumes were assessed for
common diagnoses. Results showed that a total of 1,407,822 (SD 50,456) hospitalizations
occurred at general hospitals, representing 71.7% of pediatric hospitalizations. Hospitalizations
at general hospitals accounted for 63.6% of hospital days and 50.0% of pediatric inpatient
healthcare costs. Median volumes of pediatric hospitalizations, per hospital, were
significantly lower at general hospitals than freestanding children’s hospitals for common
medical and surgical diagnoses. The leading causes for both GH and FSC pediatric medical cases
were pneumonia, asthma, bronchiolitis, cellulitis, dehydration, UTI, chemotherapy & neonatal
hyperbilirubinemia. For surgical cases, the leading causes were appendicitis with and without
peritonitis, acute appendicitis with abscess, supracondylar fracture of the humerus, and pyloric
stenosis. For mental health cases, major depression, episodic mood disorders, and bipolar
disorder were the leading causes. While the most common reasons for hospitalization were
similar for both GH and FSC hospitalizations, the most costly conditions differed substantially.
These findings have important implications for pediatric clinical care programs, research, and
quality improvement efforts.
According to the CRC and ICESCR, every child has the right to ‘the highest attainable
standard of physical and mental health’ (CRC, article 24, ICESCR, article 12). The right to
health is an inclusive right, encompassing not only the right to appropriate and timely health
care, but also to the ‘underlying determinants’ of health, including access to safe and potable
water and adequate sanitation, an adequate supply of safe food, nutrition and housing, healthy
occupational and environmental conditions, and access to health related education and
information, including on sexual and reproductive health.465 The right to health encompasses a
number of components, and the analysis accordingly covers the following broad areas: child
mortality, communicable disease and immunization, maternal health, sexual and reproductive
health, HIV/AIDS, substance abuse and mental health.

Related Studies
Local
A study by Abello (2016) et al entitled, “Factors Associated with the Time of Admission
among Notified Dengue Fever Cases in Region VIII Philippines from 2008 to 2014”, determined
the factors associated with the time of admission among notified Dengue cases. The study
covered the period between 2008 and 2014 in Region VIII, Philippines. The factors assessed
were age, sex, hospital sector, hospital level, disease severity based on the 1997 WHO Dengue
classification, and period of admission (distinguishing between the 2010 Dengue epidemic and
non-epidemic time).
The analyzed secondary data from the surveillance of notified Dengue cases. We
calculated the association through chi-square test, ordinal logistic regression and linear
regression at p value < 0.05. The study included 16,357 admitted Dengue cases. The reported
cases included a majority of children (70.09%), mild cases of the disease (64.00%), patients from
the public sector (69.82%), and non-tertiary hospitals (62.76%). Only 1.40% of cases had a
laboratory confirmation. The epidemic period in 2010 comprised 48.68% of all the admitted
cases during this period. Late admission was more likely among adults than children (p<0.05).
The severe type of the disease was more likely to be admitted late than the mild type (p<0.05).
Late admission was also more likely in public hospitals than in private hospitals (p<0.05); and
within tertiary level hospitals than non-tertiary hospitals (p<0.05). Late admission was more
likely during the non-epidemic period than the 2010 epidemic period (p<0.05). A case fatality
rate of 1 or greater was significantly associated with children, severe diseases, tertiary hospitals
and public hospitals when admitted late (p<0.05). Data suggests that early admission among
child cases was common in Region VIII.
This behavior is encouraging, and should be continued. However, further study is needed
on the late admission among tertiary, public hospitals and non-epidemic period with reference to
the quality of care, patient volume, out of pocket expense, and accessibility We recommend the
consistent use of the 2009 WHO Dengue guidelines in order to standardize the admission criteria
and time across hospitals.
 The study concluded that in Region VIII, in the Philippines, late admission of Dengue
cases was more likely among adults, public hospitals, tertiary hospitals and during non-epidemic
period. Among the factors, the highest likelihood of late admission was in public hospitals than
in private hospitals. Late admission was associated with hospital sector and level. These may be
influenced by patients’ financial capacity, a high patient load and lack of resources in healthcare
facilities, the geographic location of hospitals, and noncompliance with Dengue guidelines.
The study also suggested a higher likelihood of early admission among children in
comparison to adults. This behavior should be encouraged, as severe cases are more common
among children than adults. The severe cases of Dengue were more likely to be admitted late
than mild cases. However, severe diseases have late presentation which may have favored their
late admission.

Foreign
A study by Ferrer (2010) entitled, “Causes of Hospitalization among Children Ages Zero
to Nine Years Old in the City of São Paulo, Brazil” showed a paradoxical increase in the number
of hospitalization among 0-9 year old in the City of Sao Paulo, Brazil during the expansion if
primary intention indicated the rise was not associated with a significant improvement in the
quality of service. The study utilized Hospital Information System as the source of data.
Respiratory diseases are the leading cause and perinatal diseases in Sao Paulo and infectious-
parasitic diseases in Brazil.
The profile of child morbidity is an important parameter for defining and altering health
policies. Studies about infant mortality are more numerous than those on morbidity, especially
related to hospital admissions. The objective of this study is to describe the causes of admission
in the public health system for children from zero to nine years of age in the city of São Paulo
during the years 2002 to 2006 and compare these results to those from the national data. Through
a cross-sectional study, data were obtained from the Hospital Information System, which is
available in the Information System of the Unified Health System - DATASUS.
This study is a descriptive and analytic cross-sectional study about hospitalization of
children from zero to nine years of age in the São Paulo public health system, during a five-year
period. The admissions that occurred from January 2002 to December 2006 were appraised. The
study began in 2002 because the city of São Paulo joined the Unified Health System, Sistema
Único de Saúde (SUS), in 2001. The study concluded in 2006 because it appeared as though all
necessary information was contained in the updated and complete database, considering a
latency between the occurrence of the hospitalization and its inclusion in the information system.
The results of the study showed that within the period, 16% of the total admissions
corresponded to children from zero to nine years of age, with most of the children being younger
than one year of age. In the city of São Paulo, the admission coefficient increased 11%, and in
Brazil, it decreased 14%. Respiratory diseases were the main causes of hospitalization. In São
Paulo, the second most frequent causes of admission were diseases that originated during the
perinatal period (15.9%), and in Brazil, the second most frequent cause of admission was
infectious-parasitic diseases (21.7%). Admissions for perinatal diseases increased 32% in São
Paulo and 6% in Brazil. While hospitalizations for diarrhea decreased in Brazil, an increase was
recorded in the city of São Paulo for children under five years old.
In another similar study by Ezeonwu et al(2014), determined the pattern of morbidity and
mortality of children seen at the emergency room of a tertiary hospital, Federal Medical Center
in Asaba, Nigeria through a descriptive study of post-neonatal childhood admissions over a 5
year period. Inclusive to research’s data are age, gender, diagnosis, month of admission and
outcome which was analyzed through descriptive and inferential statistics. The research showed
malaria as the common indication for admission and mortality.
Morbidity and mortality from childhood illnesses has remained a major point of interest
globally. Malaria, respiratory tract infection and diarrheal diseases are the leading causes of
childhood morbidity and mortality. The aim of the study is to determine the pattern of morbidity
and mortality of children seen at the children emergency room of a tertiary hospital, Federal
Medical Center in Asaba, Nigeria.
A descriptive study of post-neonatal childhood admissions over a 5 year period (January
2007-December 2011) was undertaken. Information obtained included age, gender, diagnosis,
month of admission and outcome. Descriptive and inferential statistics were used to analyze the
demographic characteristics of the patients and associations with outcome variables.
The results of the study showed that a total of 3,830 children with aged ranges between 1
month and 180 months were admitted within this period of study from January 2007 to
December 2011: 2,189 males (57.2%, 2189/3830) and 1,641 (42.8%, 1641/3830) females. More
than 70% (2912/3830) were under 5 years of age. The common indications for admission were
malaria (30.3%, 1159/3830), diarrheal diseases (20.4%, 780/3830), respiratory tract infections
(RTIs) (19.0%, 728/3830) and sepsis (4.4%, 168/3830). There were 221 (5.8%, 221/3830) deaths
and more deaths were recorded in children <12 months of age, P < 0.01. Major causes of death
were complicated malaria (24.4%, 54/221), sepsis (19.9%, 44/221), diarrheal diseases (18.1%,
40/221) and RTIs (7.7%, 17/221).
The study concluded that preventable infections are the major causes of morbidity and
mortality in CHER and children <5 years of age are commonly affected.
In a study by Dossetor et al (2017) entitled, “PEDIATRIC HOSPITAL ADMISSIONS
IN INDIGENOUS CHILDREN: A POPULATION-BASED STUDY IN REMOTE
AUSTRALIA (Nov. 2017)”, analyzed hospital admissions of a predominantly Aboriginal cohort
of children in the remote Fitzroy Valley in Western Australia during the first 7 years of life.
Wherein all children born between January 1, 2002 and December 31, 2003 and living in the
Fitzroy Valley in 2009-2010 were eligible to participate in the Lililwan Project. Of 134 eligible
children, 127 (95%) completed Stage 1 (interviews of caregivers and medical record review) in
2011 and comprised our cohort. Lifetime (0-7 years) hospital admission data were available and
included the dates, and reasons for admission, and comorbidities. Conditions were coded using
ICD-10-AM discharge codes.
The results showed that the primary reasons for admission (0-7 years) were infections of
the lower respiratory tract (27.4%), gastrointestinal system (22.7%), and upper respiratory tract
(11.4%), injury (7.0%), and failure to thrive (5.4%). Comorbidities, particularly upper respiratory
tract infections (18.1%), failure to thrive (13.6%), and anemia (12.7%), were common. In
infancy, primary cause for admission were infections of the lower respiratory tract (40.8%),
gastrointestinal (25.9%) and upper respiratory tract (9.3%). Comorbidities included upper
respiratory tract infections (33.3%), failure to thrive (18.5%) and anemia (18.5%).
In a similar study by Leyenaar et al (2015) entitled, “DIRECT ADMISSION TO
HOSPITALS AMONG CHILDREN IN THE UNITED STATES (MAY 2015)”, analyzed the
Agency for Healthcare Research and Quality’s 2009 Kids’ Inpatient Database, including non-
neonatal, nonmaternal, and nonelective pediatric hospitalizations in children younger than 18
years. Direct admission, defined as admission to a hospital without receiving care in the
hospital’s ED, is 1 alternative.
The reasons for hospitalization were categorized using All Patient Refined
Diagnostic Related Groups. Weighted direct admission frequencies, proportions, and hospital-
level variation in direct admission rates were calculated for each All Patient Refined Diagnostic
Related Group. For the 10 most common All Patient Refined Diagnostic Related Groups, they
assessed differences between children admitted directly and those admitted through EDs using
Rao-Scott χ2 tests for categorical variables and weighted t tests for continuous variables.
The results of the study showed that of 1.47 million nonelective pediatric
hospitalizations, 24.6% occurred via direct admission. The 10 most common diagnoses
accounted for 49.2% of these hospitalizations. Among children with these diagnoses, children
admitted directly were more likely to be white, privately insured, and had lower disease severity
compared with children admitted through EDs. There was substantial variation in direct
admission rates across conditions, ranging from 8.9% for appendectomy to 38.0% for bipolar
disorder. Similarly, they observed considerable hospital-level variation, with appendectomy
showing the least variation and bipolar disorder showing the greatest variation in direct
admission rates. In models adjusting for patient and hospital characteristics and disease severity,
direct admissions were associated with 5% to 31% lower costs than ED admissions.
In a similar study by Anyanwu et al (2014) entitled, “PATTERN AND OUTCOME OF
ADMISSIONS AT THE CHILDREN EMERGENCY ROOM AT THE FEDERAL TEACHING
HOSPITAL ABAKALIKI (2014)”, determined the pattern and outcome of CHER admissions at
Federal Teaching Hospital Abakaliki (FETHA). The children emergency room (CHER) in
Federal Teaching Hospital Abakaliki (FETHA) is one of the units of pediatrics department
specialized in meeting the unique needs of children during medical emergencies. The study used
descriptive analysis using SPSS version 20 (IBM statistics).
Over the period, 1022 patients were seen with a mean age of 1.9 + 2.6 years. Males were
58.8%, 41.2% were females. The most common diagnosis was diarrheal disease (36.1%)
followed by malaria (16.2%) and pneumonias (11.7%). A mortality of 10% was recorded while
66.6% were discharged home, 3.8% discharged against medical advice while 19.6% were
transferred to other units in the ward. Majority of deaths were in infancy (57.8%), more in males
(69.6%), and from diarrheal disease (43.1%)
Synthesis
The aforementioned studies commonly employed descriptive, retrospective,
cross-sectional formats. The study by G/Miriam A. on the reasons for pediatric admission to
Chiro Hospital, Eastern Ethiopia, employed a two-year retrospective format focusing on the
review of admissions and discharges during September 2000-2002. Hence, including length of
stay of pediatric patient as part of the study’s collective data, a factor of which our study did not
lean into. Similarly, the study of Heneghan (2010) et al which focused on morbidity assessment
on pediatric critical care had a wider coverage in terms of age group compared to our study’s
limited scope, including only 0-10 years old, providing a better representation of pediatric status.
A paper by Leyenaar, et al on “Epidemiology of pediatric hospitalizations at general hospitals
and freestanding children’s hospitals in the United States” employed a cross-sectional format
comparing the differences in number of hospitalizations from the 2 hospitals using pediatric
group as the basis and assessing hospital volumes through common diagnoses. Our study had a
similar concept of comparison however certain limitations of the mentioned study were different,
such as age group limitations and the exclusion of in-hospital births, and hospitalizations for
pregnancy and delivery.
As compared to the related literatures, this study limited its coverage, including
only the 0-10 age group and a time span of only a year, however other demographic data was
included such as gender and geographic distribution. The source of data was gathered from
previous hospital records and annual reports, and was analyzed through the use of the Chi square
method.
A related study of G/ Miriam A. used SPSS version 11. Computer clinical software to
analyze the data collected. A paper of Abello et al entitled, “Factors associated with the time of
admission among dengue cases in Region VIII Philippines from 20018 to 2014” used chi square,
ordinal logistic regression and linear regression at p value < 0.05 to calculate the association
between the factors and time of admission among notified Dengue cases. The study by Ferrer
(2010) entitled, “Causes of hospitalization among children ages zero to nine years old in the city
of Sao Paulo, Brazil” utilized a more effective and convenient source of data, gathering through
the Hospital Information System, which is available in the information System of the United
Health System – DATASUS.
After careful data gathering, collection and analysis this study yielded results presenting
Communicable diseases, particularly Pneumonia, as the predominant cause of pediatric
admission in both RTRH and LPH (from May, 2017 to June, 2018). The study of G/Miriam had
a similar result showing communicable diseases as the leading cause of admission in Chiro
Hospital, Eastern Ethiopia reflecting those of developing countries that call for extensive
preventive measures. To include, the study of Nguyen et entitled “Childhood hospitalization and
related deaths in Hanoi, Vietnam: a tertiary hospital database analysis from 2007 – 2014” also
had respiratory diseases and bacterial and parasitic infections as their primary cause of
admissions. In contrast, a study of Ezeonwu et al regarding the morbidity and mortality of
children seen at the emergency room of a tertiary hospital, Federal Medical Center in Asabia,
Nigeria through a descriptive study of post-neonatal childhood admissions over a 5 year period,
showed malaria as the common indication for admission and mortality.
 Chapter II
Methodology

Research design

The researchers chose a descriptive type of research design. This study involves
gathering information by examining records and documents among the pediatric wards of the
two hospitals: RTRH and LPH.

Scope and Limitation

The study limits its coverage on the pediatric patients of Leyte Provincial hospital (LPH)
a level 2 public hospital and Remedios Trinidad Romualdez Hospital(RTRH) a level 2 private
hospital. Furthermore, it is intended to compare the top 10 leading causes of admissions between
the aforementioned hospitals only from June, 2017 to May, 2018. The Study would include
children aged 0-10 years old only, excluding pediatric patients of Neonatal Intensive Care Unit
(NICU).
Population of the Study

The target population for this research includes all pediatric admissions in RTRH and
LPH aged 0-10 years old during the months of June , 2017 to May, 2018.

Method of Data Collection

The method of collection used was sending letters to the respective heads of each hospital
and using tables to collect relevant information from the different hospitals.

The following procedures were done:

1. Formulated a communication letter to the administration, the chief of hospital of the two
hospitals: RTRH and LPH;
2. Collected the data based on hospital records and annual reports;
3. We determined the number of pediatric patients in the two hospitals.
4. We divided the patients into communicable, non-communicable and trauma cases.
5. We arranged the cases from the greatest number of admissions to the least admitted.
6. Took the top 10 cases from each hospital and divided them into their particular age and
gender.
7. Used frequency counts, means, and percentages as statistical tools in determining the
pediatric admissions based on the data gathered; and,

8. Observed the facilities and interviewed the health workers of the ward and the head of
department.
 Chapter III
RESULTS AND DISCUSSIONS

RTRH summary of Pediatric Admissions (0-

10 years old)
LPH Summary of Pediatric Admissions (0-10
JUNE 2017 71 years old)
JULY 2017 149
JUNE 2017 170
AUGUST 2017 121
JULY 2017 61
SEPTEMBER 2017 81
AUGUST 2017 62
OCTOBER 2017 106
SEPTEMBER 2017 105
NOVEMBER 2017 84
OCTOBER 2017 129
DECEMBER 2017 101
NOVEMBER 2017 131
JANUARY 2018 140
DECEMBER 2017 119
FEBRUARY 2018 63
JANUARY 2018 137
MARCH 2018 68
FEBRUARY 2018 124
APRIL 2018 60 MARCH 2018 134
MAY 2018 65 APRIL 2018 150
Total 1109 MAY 2018 135
total 1457

These tables represents the total number of pediatric admissions of RTRH and LPH in the year
june 2017 to may 2018. The total number of admissions of the two hospitals is 2,566 with LPH
having the majority of admissions of the two hospitals. The peak number of admissions was on
the month of July 2017 in RTRH and the least number of admissions was on the month of May
2018 while the peak number of admissions was on the month of June 2017 in LPH and the least
number of admissions was on the month of July 2017.
 1600

1400 7.62%
1200
13.18%
4.06%
1000 11.63%

800

600 79.20%
84.31%
400

200

0
LPH RTR

COMMUNICABLE NON- COMMUNICABLE TRAUMA & OTHERS

The majority of pediatric admissions of both hospitals are

Communicable Diseases (CD) which consist 79.2% of the total pediatric admission for LPH and
84.31% of the total pediatric admissions for RTRH, followed by Non Communicable Diseases
(NCD) and with the least cause are trauma cases.

REMEDIOS TRINIDAD ROMUALDEZ HOSPITAL

CASE AGE M F TOTAL
0-2 110 65 175
3-4 38 31 69
5-6 25 22 47
Pneumonia
7-8 12 10 22
9-10 9 8 17
TOTAL 194 136 330

0-2 66 53 119
3-4 31 12 43
5-6 12 8 20
Acute Gastroenteritis
7-8 14 5 19
9-10 4 5 9
TOTAL 127 83 210

Upper Respiratory Tract Infections 0-2 29 23 52

 3-4 18 14 32
5-6 15 8 23
7-8 6 3 9
9-10 7 6 13
TOTAL 75 54 129

0-2 8 19 27
3-4 6 10 16
5-6 5 11 16
Urinary Tract Infections
7-8 2 5 7
9-10 3 3 6
TOTAL 24 48 72

0-2 19 22 41
3-4 0 2 2
5-6 1 1 2
Sepsis
7-8 0 0 0
9-10 0 1 1
TOTAL 20 26 46

0-2 14 7 21
3-4 4 1 5
5-6 2 6 8
Viral Infection without complication
7-8 1 2 3
9-10 3 2 5
TOTAL 24 18 42

0-2 1 3 4
3-4 5 4 9
5-6 4 4 8
Dengue
7-8 6 7 13
9-10 2 2 4
TOTAL 18 20 38

0-2 8 4 12
Asthma 3-4 4 0 4
5-6 1 2 3
 7-8 5 1 6
9-10 1 0 1
TOTAL 19 7 26

0-2 8 5 13
3-4 3 0 3
5-6 2 1 3
Febrile Seizure
7-8 0 0 0
9-10 0 0 0
TOTAL 13 6 19

0-2 0 0 0
3-4 1 0 1
5-6 15 0 15
Malignant Neoplasms
7-8 0 0 0
9-10 0 1 1
TOTAL 16 1 17

The most number of Pneumonia cases in RTRH are from ages 0-2,
consisting of 175 out of 330 cases. For AGE, the majority of cases come from ages 0-2,
consisting of 119 out of 210 cases. For URTI majority of cases are from ages 0-2, consisting of
52 out of 129 cases. For UTI majority of cases come from ages 0-2, consisting of 27 out of 72
cases. For Sepsis, majority of cases come from ages 0-2, consisting of 41 out of 46 cases. For
viral infections without complications, majority of cases come from ages 0-2, consisting of 21
out of 42 cases. For Dengue, majority of cases come from ages 7-8, consisting of 13 out of 38
cases. For Asthma, majority of cases come from ages 0-2, consisting of 12 out of 26 cases. For
Febrile seizure, majority of cases come from ages 0-2, consisting of 13 out of 19 cases. For
Malignant neoplasm, majority of cases come from ages 5-6, consisting of 15 out of 17 cases.

LEYTE PROVINCIAL HOSPITAL

CASE AGE M F TOTAL
0-2 215 151 366
3-4 55 41 96
5-6 35 13 48
Pneumonia
7-8 16 17 33
9-10 7 8 15
TOTAL 328 230 558
 0-2 76 58 134
3-4 29 14 43
5-6 9 4 13
Acute Gastroenteritis
7-8 5 8 13
9-10 1 4 5
TOTAL 120 88 208

0-2 41 36 77
3-4 22 10 32
5-6 18 9 27
Urinary Tract Infections
7-8 12 10 22
9-10 8 7 15
TOTAL 101 72 173

0-2 14 8 22
3-4 5 5 10
5-6 4 2 6
Peptic ulcer
7-8 5 1 6
9-10 4 2 6
TOTAL 32 18 50

0-2 5 2 7
3-4 7 4 11
5-6 13 4 17
Dengue
7-8 5 2 7
9-10 2 3 5
TOTAL 32 15 47

0-2 20 3 23
3-4 3 3 6
5-6 5 0 5
Intestinal disorders
7-8 7 3 10
9-10 0 1 1
TOTAL 35 10 45

0-2 4 10 14
Pyelonephritis 3-4 2 3 5
5-6 5 3 8
 7-8 5 2 7
9-10 3 4 7
TOTAL 19 22 41

0-2 5 5 10
3-4 2 0 2
5-6 6 3 9
Sequelae of trauma
7-8 5 1 6
9-10 9 2 11
TOTAL 27 11 38

0-2 7 0 7
3-4 2 5 7
5-6 1 1 2
Upper Respiratory Tract Infection
7-8 1 2 3
9-10 2 1 3
TOTAL 13 9 22

0-2 6 0 6
3-4 1 3 4
5-6 3 2 5
Intracranial injuries
7-8 4 1 5
9-10 2 0 2
TOTAL 16 6 22

The most number of Pneumonia cases in LPH are from ages 0-2,
consisting of 366 out of 558 cases. For AGE, the majority of cases come from ages 0-2,
consisting of 134 out of 208 cases. For UTI majority of cases are from ages 0-2, consisting of 77
out of 173 cases. For Peptic Ulcer majority of cases come from ages 0-2, consisting of 22 out of
50 cases. For Dengue, majority of cases come from ages 5-6, consisting of 17 out of 47 cases.
For Intestinal disorders, majority of cases come from ages 0-2, consisting of 23 out of 45 cases.
For Pyelonephritis, majority of cases come from ages 0-2, consisting of 14 out of 41 cases. For
Sequela of trauma, majority of cases come from ages 9-10, consisting of 11 out of 38 cases. For
URTI, majority of cases come from ages, 0-2 and 3-4 both consisting of 7 out of 22 cases. For
Intracranial Injuries, majority of cases come from ages 0-2, consisting of 6 out of 22 cases.
 RTRH TOP 10 CASES AND GENDER DISTRIBUTION

Pneumonia

AGE

UPRTI

UTI

SEPSIS

VIRAL INFECTION

DENGUE

ASTHMA

FEBRILE SEIZURE

MALIGNANT NEOPLASM

-50.00% -40.00% -30.00% -20.00% -10.00% 0.00% 10.00% 20.00% 30.00% 40.00%

M% F%

The Top Ten Pediatric Admissions of RTRH are: Pneumonia, AGE, URTI, UTI, Sepsis,
Viral Infection, Dengue, Asthma, Febrile Seizure and Malignant Neoplasm
Pneumonia cases represent 29.75% of the 1,109 pediatric admissions of RTRH from June
2017 to May 2018. Females represent 41.21% and males representing the larger half being
58.78%. Acute Gastroenteritis cases represent 18.94% of the pediatric admissions, with females
representing 39.52% and males representing the majority, being 60.48% of these cases. Upper
Respiratory Tract Infections represent 11.63% of the pediatric admissions with females
representing 41.86% and males representing the majority, being 58.12%. Urinary tract Infections
represent 6.49% of the pediatric admissions, with females representing the larger half being
66.67% and males on the other hand represent 33.33%. Sepsis cases represent 4.14% of the
pediatric admissions, with females representing 56.52% and Males on the other hand represent
43.48% of these cases. Viral infections without complications represent 3.78% of the pediatric
admissions with females representing 42.86% and males representing 57.14% of these cases.
Dengue represent 3.43% of the pediatric admissions with females representing 52.63% and
males on the other hand represent 47.37% of these cases. Asthma represent 2.34% of the
pediatric admissions with females representing 26.92% and males on the other hand represent
73.08% of these cases. Cases of Febrile Seizure represent 1.71% of the pediatric admissions with
Females representing 31.58% and males on the other hand represent 68.42% of these cases.
Malignancies of lymphoid, hematopoietic and related tissues represent 1.53% of the pediatric
admissions with female case representing 5.88% and males on the other hand represent the
remaining 94.12% of these cases.
 LPH TOP 10 CASE AND GENDER DISTRIBUTION
-60.00% -40.00% -20.00% 0.00% 20.00% 40.00% 60.00%

Pneumonia
Acute Gastroenteritis
Urinary Tract Infections
Peptic ulcer
Dengue
Intestinal disorders
Pyelonephritis
Sequelae of trauma
Upper Respiratory Tract Infection
Intracranial injuries

M% F%

Pneumonia cases represent 38.27% of the 1,458 pediatric admissions of LPH from June
2017 to May 2018 with females representing 41.14% and representing the majority being
58.78% of these cases. Acute Gastroenteritis cases represent 14.27% of the pediatric admissions,
females represent 42.31% of these cases and Males on the other hand represent the majority,
being 57.69% of these cases. Urinary Tract Infections represent 11.86% of the pediatric
admissions with females representing 41.62% and Males representing the majority, being
58.38% of these cases. Peptic ulcer cases represent 3.43% of the pediatric admissions. Females
represent 36% of these cases and. Males on the other hand represent 64% of these cases. Dengue
cases represent 3.22% of the pediatric admissions. Females represent 32% and Males represent
68.1% of these cases. Intestinal disorders represent 3.09% of the pediatric admissions. Females
represent 22.22% and Males on the other hand represent 77.8% of these cases. Pyelonephritis
cases represent 2.81% of the pediatric admissions. Females represent 53.7% and Males on the
other hand represent 46.34% of these cases. Sequelae of trauma represent 2.61% of the pediatric
admissions. Females represent 28.94% and Males representing the majority, being 71 % of these
cases. Upper Respiratory Tract Infection represent 1.51% of the pediatric admissions of LPH.
Females represent 40.91% and Males represent the majority, being 59.09% of these cases.
Intracranial injuries represent 1.51% of the pediatric admissions. Females represent 27.27% and
Males on the other hand represent the majority, being 72.72% of these cases.
 CHAPTER IV

CONCLUSION AND RECOMMENDATIONS

Conclusions
The researchers derived the following conclusions:

1. There is no significant relationship between the age and sex on being admitted in the
hospital but there is a significant relationship on the category of disease in being admitted to
the hospital.
2. In the last June 2017- May 2018, RTRH had a total of 1109 admissions while LPH had
1458, and upon classification both hospitals presented a similar stratification wherein
communicable diseases caused the highest number of admissions followed by Non-
communicable diseases and lastly by Trauma cases.
3. Enumerating the top 10 causes of pediatric admissions of RTRH in descending order the
data showed Pneumonia as the leading cause, followed by AGE, URTI, UTI, Sepsis, Viral
infections, Dengue, Asthma, Seizures, and lastly, malignant neoplasms with the lowest
number of cases. LPH had the same top 2 respectively, which is then followed by UTI,
Peptic ulcer, Dengue, Intestinal disorders, Pyelonephritis, Sequela of trauma, URTI and
lastly Intracranial injuries.
4. Both RTRH and LPH had their highest admission rate in the 0-2 age group with
Pneumonia being the leading cause of pediatric admission, with a male gender
preponderance. There are also significant cases of acute gastroenteritis in both hospitals.
There is a high incidence of infectious case admissions compared to non – infectious cases
in both hospitals. Comparing both hospitals there is a greater amount of admissions in LPH
compared to RTRH.
5. RTRH had a peak admission on the month of May 2018 and showed the least during the
month of July 2017. Whereas LPH presented a peak admission during the month of June
2017 and the least on May 2018.

Recommendations
The future researchers:
1. Trend analysis for each of the top causes of pediatric admissions to see the monthly rise
and falls of each case
2. A choropleth map should be employed to look for geographical patterns for the top
causes of pediatric admissions.
3. Government health sectors should reduce inequity and invest more in programs and
services, such as wide coverage pneumococcal vaccinations for children less than 2 years
old, and give better healthcare access to the people.
4. Local hospitals and healthcare providers must be at par with globally set standards in
pediatric healthcare provision through establishment of quality improvement teams, data
systems and feasible interventions that require minimal resources. Proper triaging for
children aged 0-2 who are susceptible to CAP, and infrastructural developments when
 necessary to improve the hospital physical environment and allow for reorganization of
service delivery.
5. Researchers who have related studies regarding the common pediatric admission in the
region, can look further into the other possible variables contributing to the emergence of
communicable diseases in the region such as socio-economic status, exposure, compliance,
and delivery of healthcare services.
 Bibliography
Journals
Campbell, James D. et al. The Causes of Hospital Admission and Death among Children in
Bamako, Mali. University of Maryland School of Medicine,Center for Vaccine
Development, Baltimore, Maryland, USA Centre pour les Vaccins en Développement,
Mali (CVD-Mali), Centre National d’Appui la lutte contre la Maladie (CNAM),
Ministière de la Santé,Bamako, Mali
Cumbria Intelligence Observatory (2010) The Top Five Cases of Hospital Admissions in
Children
Dien TM, Nguyen NTT, Schindler C, et al. (2017). Childhood hospitalisation and related
deaths in Hanoi, Vietnam: a tertiary hospital database analysis from 2007 to 2014
G/mariam A (2005). A two year retrospective review of reasons for pediatric admission to
Chiro Hospital, Eastern Ethiopia. Department of Population and FH,PO. # 480,
Jimma University, Jimma, Ethiopia.
Leyenaar et al (2012), “Epidemiology of pediatric hospitalizations at general hospitals and
freestanding children’s hospitals in the United States”
Dossetor PJ, Martiniuk ALC, Fitzpatrick JP, Oscar J, Carter M, Watkins R, Elliott EJ,
Jeffery HE, Harley D(nov. 2017) “Pediatric Hospital Admissions In Indigenous Children: A
Population-Based Study In Remote Australia”
JoAnna K. Leyenaar, MD, MPH, MSc; Meng-Shiou Shieh, PhD; Tara Lagu, MD,
MPH(MAY 2015) “Direct Admission To Hospitals Among Children In The United States”
Onyinye U Anyanwu, Obumneme B Ezeanosike, Chinonyelu T Ezeonu(2014) “Pattern
And Outcome Of Admissions At The Children Emergency Room At The Federal Teaching
Hospital Abakaliki”
Ferrer, Sucupira, Grisi, (2010) “Causes of Hospitalization among Children Ages Zero to
Nine Years Old in the City of São Paulo, Brazil”
Ezeonwu et al(2014) “Morbidity and Mortality Pattern of Childhood Illnesses Seen at the
Children Emergency Unit of Federal Medical Center, Asaba, Nigeria”
Heneghan; Pollack (2018) “Morbidity: Changing the Outcome Paradigm for Pediatric
Critical Care”
Abello et al (2016) “Factors Associated with the Time of Admission among Notified Dengue
Fever Cases in Region VIII Philippines from 2008 to 2014”
 Appendix A
Tool used Dummy tables

Causes of Admissions in Pediatric Ward of RTRH (June, 2017-May,2018)

Hospital: Date:
Date of Initials of patient age sex diagnosis Address
admission

Causes of Admissions in Pediatric Ward of LPH (June, 2017 - May, 2018)

Hospital: Date:
Date of Initials of patient age sex diagnosis Address
admission
 Appendix B
Letter and Consent form
Communication Letter
May 27, 2019

_______________
_______________
_______________

Dear Ma’am/ Sir:

Greetings!
The undersigned are second year students of the Doña Remedios Trinidad Romualdez
Medical Foundation College of Medicine. We will be conducting a research study on the
“Comparison of Hospital Admissions in the Pediatric Wards of Remedios Trinidad
Romualdez Hospital and Leyte Provincial Hospital from May, 2017 to June, 2018”
Remedios Trinidad Romualdez Hospital is one of the locales for sample collection.
1. To know the magnitude or total number of pediatric admissions in the two hospitals and
the number of admissions per month.
2. To identify and classify the different causes of admissions as to communicable,
noncommunicable and trauma.
3. To determine the top 10 causes of admissions, and
4. To identify demographical relationship of age and sex to the number of admissions.

We recognize that our plans concerning our research study will only come to fruition
with the full support of your good office.

Informed consent form

Comparison of Pediatric Admissions between Remedios Trinidad Romualdez Hospital and
Leyte Provincial Hospital from June, 2017 to May, 2018
You are being asked to take part in a research study. Before you decide to participate in
this study, it is important that you understand why the research is being done and what it will
involve. Please read the following information carefully. Please ask the researcher if there is
anything that is not clear or if you need more information.
 The purpose of this study is to compare the causes of Hospital Admissions in the
Pediatric Wards of Remedios Trinidad Romualdez Hospital (RTRH) and Leyte Provincial
Hospital (LPH) from June, 2017 to May, 2018 and to determine the condition of the facility.
Specifically, the objectives are the following:
1. To know the magnitude or total number of pediatric admissions in the two hospitals and
the number of admissions per month.
2. To identify and classify the different causes of admissions as to communicable,
noncommunicable and trauma.
3. To determine the top 10 causes of admissions, and
4. To identify demographical relationship of age and sex to the number of admissions.

Comparison of Pediatric Admissions between Remedios Trinidad

Title of the study Romualdez Hospital and Leyte Provincial Hospital from June,
2017 to May, 2018

BACIERRA, Jan Kirk T.

BAJO, Justin Louise R.
Study team BARIKKAD KAKUZHIIYIL, Shabnam Kader
CORDIAL, Michael Dindo U.
ISRAEL, Christine Joy M.
MANI,Kasturi
ORTILLO, Paolo S.
PELICANO, Agah B.
RAGHAVAN, Hrishikesh
TAMAYO, Ma. Chesca R.
TOMENIO, Arvin

The study limits its coverage on the pediatric patients of RTRH and LPH. Furthermore,
it is intended to compare the top 10 leading causes of admissions between the aforementioned
hospitals only from June, 2017 to May, 2018. The Study would include children aged 0-10 years
old only, excluding pediatric patients of Neonatal Intensive Care Unit (NICU).
The collection of data will utilize the following methods:

1. Formulate a communication letter to the administration, the chief of hospital of the two
hospitals: RTRH and LPH;
2. Collect the data based on hospital records and annual reports;
3. Collate and classify the gathered data according to:
3.1 Age and Gender
3.2 Nature of the disease (communicable, noncommunicable and trauma)

4. Using frequency counts, means, and percentages as statistical tools in determining the
pediatric admissions based on the data gathered; and,
 You are free to ask questions about any concerns within the whole duration of the study
and you have the right not to respond or to decide to leave study. Your participation is purely
voluntary. We will keep your identity confidential in our reports. If you decide to take part in this
study, you will be asked to sign a consent form. After you sign the consent form, you are still
free to withdraw at any time and without giving a reason. Withdrawing from this study will not
affect the relationship you have, if any, with the researcher. If you withdraw from the study
before data collection is completed, your data will be returned to you or destroyed.

If you have any questions regarding the study you may contact:
Jan Kirk Bacierra: 0917829932

CONSENT

I have read and I understand the provided information in the informed consent document which
was administered by ____________________________________. I understand my role and
responsibility as a participant in this study. I am confirming that I have made careful
consideration of all this information and I am joining voluntary.

I understand that:

o The researcher will protect the privacy and confidentiality of information collected by the
study especially personal information
o I am free to retract or remove from the study
o My participation is voluntary

Participant's signature over printed name: ________________________

Investigator's signature over printed name: _________________________

Witness: _________________________

Date: _________________________
 Appendix C
Statistical analysis on the age and gender predilection on Leyte Provincial Hospital
pediatric admissions
(𝑂−𝐸)2
Formula: x2=∑ d.f. = (r-1) x (c-1)
𝐸

OBSERVED VALUES IN LPH

AGE M F TOTAL
0-2 457 325 782
3-4 159 108 267
5-6 124 52 176
7-8 82 60 142
9-10 52 38 90
TOTAL 874 583 1457

EXPECTED VALUES
AGE M F TOTAL
0-2 469.09 312.91 782
3-4 160.16 106.84 267
5-6 105.58 70.42 176
7-8 85.18 56.82 142
9-10 53.99 36.01 90
TOTAL 874 583 1457

x2= 9.38 d.f. =4

the corresponding P value on Table A5 of x2 = 9.38 lies greater than the p value of 0.05
level of significance (p > 0.05), we fail to reject the null hypothesis.
 Appendix D
Statistical analysis on the age and gender predilection on Remedios Trinidad Romualdez
Hospital pediatric admissions
(𝑂−𝐸)2
Formula: x2=∑ d.f. = (r-1) x (c-1)
𝐸

OBSERVED VALUES IN RTRH

AGE M F TOTAL
0-2 303 230 533
3-4 125 89 214
5-6 94 79 173
7-8 58 49 107
9-10 44 38 82
TOTAL 624 485 1109

EXPECTED VALUES
AGE M F TOTAL
0-2 299.90 233.10 533
3-4 120.41 93.59 214
5-6 97.34 75.66 173
7-8 60.21 46.79 107
9-10 46.14 35.86 82
TOTAL 624 485 1109

x2= 1.14 d.f. =4

the corresponding P value on Table A5 of x2 = 1.14 lies greater than the p value of 0.5
level of significance (p > 0.5), we fail to reject the null hypothesis.
 Appendix E
Statistical analysis on the Categories of disease between Leyte Provincial Hospital and
Remedios Trinidad Romualdez Hospital pediatric admissions
(𝑂−𝐸)2
Formula: x2=∑ d.f. = (r-1) x (c-1)
𝐸

OBSERVED VALUES
LPH RTR TOTAL
COMMUNICABLE 1154 935 2089
NON-
COMMUNICABLE 192 129 321
TRAUMA & OTHERS 111 45 156
TOTAL 1457 1109 2566

EXPECTED VALUES
LPH RTR TOTAL
COMMUNICABLE 1186.154716 902.8452845 2089
NON-
COMMUNICABLE 182.2669525 138.7330475 321
TRAUMA & OTHERS 88.57833203 67.42166797 156
TOTAL 1457 1109 2566

X2= 16.34 d.f. = 2

the corresponding P value on Table A5 of x2 = 16.34 lies less than the p value of 0.001
level of significance (p < 0.001), we reject the null hypothesis.
 Appendix F
Data collected

Table 1. Categories of Diseases

Category LPH RTR
COMMUNICABLE 1154 935
NON- 192 129
COMMUNICABLE
TRAUMA & OTHERS 111 45

Table 2. Monthly Admission in Count

LPH
JUNE 2017 170
JULY 2017 61
AUGUST 2017 62
SEPTEMBER 2017 105
OCTOBER 2017 129
NOVEMBER 2017 131
DECEMBER 2017 119
JANUARY 2018 137
FEBRUARY 2018 124
MARCH 2018 134
APRIL 2018 150
MAY 2018 135
TOTAL 1457

Table 3. MONTHLY Count

ADMISSIONS IN RTRH
JUNE 2017 71
JULY 2017 149
AUGUST 2017 121
SEPTEMBER 2017 81
OCTOBER 2017 106
NOVEMBER 2017 84
DECEMBER 2017 101
JANUARY 2018 140
FEBRUARY 2018 63
MARCH 2018 68
APRIL 2018 60
MAY 2018 65
TOTAL 1109
Table 4. REMEDIOS TRINIDAD ROMUALDEZ HOSPITAL
CASE AGE M F TOTAL
0-2 110 65 175
3-4 38 31 69
5-6 25 22 47
Pneumonia
7-8 12 10 22
9-10 9 8 17
TOTAL 194 136 330

0-2 66 53 119
3-4 31 12 43
5-6 12 8 20
Acute Gastroenteritis
7-8 14 5 19
9-10 4 5 9
TOTAL 127 83 210

0-2 29 23 52
3-4 18 14 32
5-6 15 8 23
Upper Respiratory Tract Infections
7-8 6 3 9
9-10 7 6 13
TOTAL 75 54 129

0-2 8 19 27
3-4 6 10 16
5-6 5 11 16
Urinary Tract Infections
7-8 2 5 7
9-10 3 3 6
TOTAL 24 48 72

0-2 19 22 41
3-4 0 2 2
5-6 1 1 2
Sepsis
7-8 0 0 0
9-10 0 1 1
TOTAL 20 26 46

0-2 14 7 21
3-4 4 1 5
5-6 2 6 8
Viral Infection without complication
7-8 1 2 3
9-10 3 2 5
TOTAL 24 18 42
 0-2 1 3 4
3-4 5 4 9
5-6 4 4 8
Dengue
7-8 6 7 13
9-10 2 2 4
TOTAL 18 20 38

0-2 8 4 12
3-4 4 0 4
5-6 1 2 3
Asthma
7-8 5 1 6
9-10 1 0 1
TOTAL 19 7 26

0-2 8 5 13
3-4 3 0 3
5-6 2 1 3
Febrile Seizure
7-8 0 0 0
9-10 0 0 0
TOTAL 13 6 19

0-2 0 0 0
3-4 1 0 1
5-6 15 0 15
Malignant Neoplasms
7-8 0 0 0
9-10 0 1 1
TOTAL 16 1 17

Table 5. LEYTE PROVINCIAL HOSPITAL

CASE AGE M F TOTAL
0-2 215 151 366
3-4 55 41 96
5-6 35 13 48
Pneumonia
7-8 16 17 33
9-10 7 8 15
TOTAL 328 230 558

0-2 76 58 134
3-4 29 14 43
Acute Gastroenteritis 5-6 9 4 13
7-8 5 8 13
9-10 1 4 5
 TOTAL 120 88 208

0-2 41 36 77
3-4 22 10 32
5-6 18 9 27
Urinary Tract Infections
7-8 12 10 22
9-10 8 7 15
TOTAL 101 72 173

0-2 14 8 22
3-4 5 5 10
5-6 4 2 6
Peptic ulcer
7-8 5 1 6
9-10 4 2 6
TOTAL 32 18 50

0-2 5 2 7
3-4 7 4 11
5-6 13 4 17
Dengue
7-8 5 2 7
9-10 2 3 5
TOTAL 32 15 47

0-2 20 3 23
3-4 3 3 6
5-6 5 0 5
Intestinal disorders
7-8 7 3 10
9-10 0 1 1
TOTAL 35 10 45

0-2 4 10 14
3-4 2 3 5
5-6 5 3 8
Pyelonephritis
7-8 5 2 7
9-10 3 4 7
TOTAL 19 22 41

0-2 5 5 10
3-4 2 0 2
5-6 6 3 9
Sequelae of trauma
7-8 5 1 6
9-10 9 2 11
TOTAL 27 11 38
 0-2 7 0 7
3-4 2 5 7
5-6 1 1 2
Upper Respiratory Tract Infection
7-8 1 2 3
9-10 2 1 3
TOTAL 13 9 22

0-2 6 0 6
3-4 1 3 4
5-6 3 2 5
Intracranial injuries
7-8 4 1 5
9-10 2 0 2
TOTAL 16 6 22

Table 6. Cases in RTRH Count

PNUEMONIA 330
ACUTE GASTROENTERITIS 210
UPPER RESPIRATORY TRACT INFECTION 129
URINARY TRACT INFECTION 72
SEPSIS 46
VIRAL INFECTION WITHOUT COMPLICATION 42
DENGUE FEVER 38
ASTHMA IN ACUTE EXACERBATION 26
UNKNOWN 21
FEBRILE SEIZURE 19
INTESTINAL DISORDER 17
MALIGNANT NEOPLASMS OF LYMPHOID, HEMATOPOIETIC AND RELATED 17
TISSUE
SEQUELAE OF TRAUMA INJURIES 17
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 14
PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 13
CELLULITIS 8
SKIN INFECTIONS 8
LIVER DISEASE 7
ANAPHYLACTIC SHOCK 6
MUSCLE, TENDON, SOFT TISSUE DISORDERS 6
CUTANEOUS CYSTS 5
PERITONITIS 5
ANEMIA 4
BURN 4
INTRACRANIAL INJURIES 3
MENINGITIS 3
POISONING CAUSED BY ORGANIC SUBSTANCES AND HEAVY METALS 3
POSTPROCEDURAL DISORDERS 3
SUPERFICIAL INJURIES 3
ACUTE RENAL FAILURE 2
AMOEBIASIS NONHEPATIC 2
CARDIAC ARRHYTHMIA 2
CONNECTIVE TISSUE DISEASES 2
DISEASES OF THE PANCREAS 2
FLUID AND ELECTROLYTE DISTURBANCES 2
ISCHEMIC HEART DISEASE WITH MYOCARDIAL INFARCTION 2
LYMPHADENITIS 2
ABSCESS OF RESPIRATORY TRACT 1
ALLERGIC REACTIONS 1
DISEASES OF BLOOD AND BLOOD FORMING ORGANS 1
HEART VALVE DISORDERS 1
HEMORRHAGIC CONDITIONS 1
INFLUENZA 1
JAUNDICE IN THE NEWBORN 1
OTHER SPIROCHAETAL DISEASES 1
OTITIS MEDIA 1
PARASITIC INFECTION WITHOUT COMPLICATION 1
PARASITIC INFECTION WITHOUT COMPLICATIONS 1
POISONING CAUSED BY ANTIBIOTICS 1
POISONING FROM ANIMALS, INSECTS, PLANTS 1
TYPHOID FEVER 1
TOTAL 1109

Table 7. Cases in LPH Count

PNEUMONIA 558
ACUTE GASTROENTERITIS 208
URINARY TRACT INFECTION 173
PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE 50
DENGUE FEVER 47
INTESTINAL DISORDER 45
PYELONEPHRITIS 41
SEQUELAE OF TRAUMA INJURIES 38
INTRACRANIAL INJURIES 22
UPPER RESPIRATORY TRACT INFECTION 22
CLEFT LIP AND PALATE (MEDICAL MISSION) 20
UNKNOWN 19
INTESTINAL DISORDERS 18
DISEASES OF STOMACH AND DUODENUM 18
SEPSIS 17
PARASITIC INFECTION WITHOUT COMPLICATIONS 17
VIRAL INFECTION WITHOUT COMPLICATION 17
AMEOBIASIS NONHEPATIC 17
FEBRILE SEIZURES 17
AMOEBIASIS, NONHEPATIC 10
TYPHOID FEVER 9
ASTHMA IN ACUTE EXACERBATION 8
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES 5
EPILEPSY 4
HEART FAILURE 4
SHOCK 4
PERITONITIS 3
ANAPHYLACTIC SHOCK 3
POISONING CAUSED BY ORGANIC SUBSTANCES AND HEAVY METALS 3
CELLULITIS 2
HEMORRHAGIC CONDITIONS 2
COMPLICATIONS OF BENIGN NEOPLASMS OF THE URINARY SYSTEM 2
PNEUMONIA MODERATE RISK 2
BURNS 2
TUBERCULOSIS, EXTRAPULMONARY 2
MALNUTRITION 2
SKIN INFECTIONS 2
ABSCESS 2
MUSCLE, TENDON, SOFT TISSUE DISORDERS 2
SUPERFICIAL INJURIES 2
CHOLECYSTITIS 1
LEPROSY 1
POISONING FROM ANIMALS, INSECTS, PLANTS 1
CHRONIC KIDNEY DISEASE 1
UKNOWN 1
CONNECTIVE TISSUE DISEASE 1
ARTHRITIS INFECTIOUS 1
SCHISTOSOMIASIS 1
OTHER DISORDERS OF THE NERVOUS SYSTEM 1
ANEMIA 1
CEREBRAL PALSY 1
HEART VALVE DISORDERS 1
CONGENITAL HEART DISEASES 1
DISORDERS OF CARBOHYDRATE METABOLISM 1
FLUID AND ELECTROLYTE DISTURBANCES 1
PERINATAL INFECTIONS 1
HEADACHE SYNDROMES 1
PULMONARY COMPLICATIONS IN THE NEWBORN 1
TOTAL 1457
Table 8. LPH POPULATION
AGE M F Total
0-2 457 325 782
3-4 159 108 267
5-6 124 52 176
7-8 82 60 142
9-10 52 38 90
TOTAL 874 584 1457

Table 9. RTRH POPULATION

AGE M F TOTAL
0-2 303 230 533
3-4 125 89 214
5-6 94 79 173
7-8 58 49 107
9-10 44 38 82
TOTAL 624 485 1109