PATTERN OF MORBIDITY AMONG CHILDREN UNDER FIVE YEARS OF AGE SEEN AT RURAL HEALTHCARE FACILITY IN SOUTH-SOUTH NIGERIA

admission rate of 14.17%. Complicated malaria was the commonest cause of admission while 89.19% of those admitted were successfully treated and discharged. Most of the morbidities that presented in the facility during the period of the study were preventable through improved socioeconomic condition, health education and immunization. The need therefore to improve the socioeconomic conditions of the populace especially those aspects that affect the wellbeing of under five children and strict adherence to immunization programme as a panacea for reduction of morbidity among the under five children in rural areas is recommended. Pattern, morbidity, under five, children. Conclusion:


INTRODUCTION
Under five morbidity still remains a serious health challenge globally with far-reaching implications for effectiveness or otherwise of the healthcare system of nations.Although much effort had been made through the erstwhile Millennium Development Goal four (MDG4) to reduce under five mordidity and mortality globally from 91 deaths per 1000 live births in 1990 to 43 deaths per 1000 live births in 2015, it has been documented that about 5.9 million children under five years of age died with about 16,000 deaths daily as at 2015.While under five mortality rate is generally high in the least developing countries, the rate appears to be even much more higher in sub-Saharan Africa.Also, according to UNICEF recent survey, everyday, Nigeria loses 2,300 under five year old children thereby making the country the second largest contributor to under five mortality globally.Of profound concern is the fact that most of these deaths are caused  This was a retrospective study where data was retrieved from the case notes of all children, under five years of age, who presented at the facility between June 2014 and June 2017 for treatment of one illness or the other at the out patient clinic and the children ward.The data obtained include age, sex, definitive diagnosis, causes and outcome of admission.These were entered into a spread sheet for analysis.The diagnoses of the various illnesses were made by the medical personel in the facility, based on medical history obtained from the parents, clinical examination of the children, and confirmed with laboratory investigations.

Area of Study
The data obtained were analysed using Statistical Package for Social Sciences (SPSS) version 20.0.The frequency and percentages of age, gender distribution and pattern of morbidity among the children were determined.Tables were used to show various data distributions as appropriate.
Approval for the study was obtained from the management of QICLH, Ekpene Obom and Akwa Ibom State Health Research Committee before the commencement of the study.
A total of four hundred and ninety-four (494) under five years old children presented in the hospital during the period of the study.

RESULTS TABLE 1: GENDER AND AGE DISTRIBUTION OF ALL THE CHILDREN UNDER FIVE YEARS OF AGE SEEN AT THE FACILITY. TABLE 2: MORBIDITIES AMONG THE UNDER FIVE CHILDREN SEEN AT THE FACILITY.
NB: Some children presented with more than one morbidity.

Pattern of Morbidity among Children Under Five Years of Age
Seen   Table 4 shows causes of admission among the under five children in the study.Again complicated malaria, 31(41.89%),constituted the commonest cause of admission, followed by acute respiratory infections, 9(12.16%) and diarrheal disease 7(9.46%) while neonatal sepsis, inguinal hernia, pulmonary tuberculosis, protein energy malnutrition, road traffic accident, paediatric HIV and burns constituted 6.76%, 6.76%, 5.41%, 5.41%, 4.05%, 2.70%, 2.70%, and 2.70% respectively.PEM, RTA, Paediatric HIV and burns respectively were the causes of admission among the children.This pattern of admission among the under five children are similar to findings by Duru, etal in Nigeria and Munthali, etal in Zambia .Furthermore, the study has shown that among the admitted cases, a greater percentage were successfully treated and discharged, a smaller percentage of the admitted cases were referred to the University of Uyo Teaching Hospital (UUTH) while the least percentage of the admitted cases left the facility against medical advice (LAMA).Again this finding among admitted cases is similar to findings in other studies .However among the cases seen in the centre during the period of the study no mortality was recorded.This is in disagreement with findings from other studies which documented mortality among under five children in other centres .This zero mortality among the under five children in the facility, a rare finding in morbidity study among children under five years of age, could be due to a deliberate policy of prompt referral of severely ill patients seen in the facility to higher levels of care, with readily available ambulance.Moreover there is a well organized emergency service in the facility such that the staff on duty respond swiftly to emergency cases presented there at anytime.Finally it is interesting to note that most of the morbidities presented at the centre are largely preventable through simple measures such as personal and environmental hygiene, provision of safe drinking water, improved nutrition based on locally available diet, premarital/prenatal counseling and screening, antenatal booking and supervised delivery, use of insecticide treated nets, close monitoring of children, childhood immunization, maternal education and other child survival strategies.The WHO and UNICEF have consistently recommended these measures as means of preventing under five morbidity and mortality globally.The need therefore to put these measures into practical implementation to reduce morbidity immediate environment and beyond.The facility operates a 24 hour emergency service and out patient clinics from 8am to 4pm daily from Monday to Friday and attends to health needs of children and adults.It also has children and adult wards for admission.Patients in the facility are seen by medical officers and consultants employed by the state hospital management board and the medical mission of Qua Iboe Church.The facility has a general laboratory manned by qualified medical laboratory scientists.

at Rural Healthcare Facility in South-south Nigeria As
shown in table 1, of the 494 under five children who presented at the facility, majority 259(52.43%)were male while 235 (47.57%) were female, giving male to female ratio of 1.1:1.The age of the children ranged from 0-59 months with a mean of 21.63 ± 15.34 months.Greater percentage of the children, 171(34.61%)were infants ( 12 months), while the least 42(8.5%)belonged to 49-59months age group.≤

TABLE 4 : CAUSES OF ADMISSION AMONG THE UNDER FIVE CHILDREN IN THE STUDY.
Table3shows age distribution of the admitted cases among the children.Most of those admitted, 27(36.49%)were 13-24 months of age, followed by infants with 23(31.08%)cases.The least admitted group, 5(6.76) were those in 49-59 months.

Table 2
shows morbidity pattern among the under five children in the study.Out of 526 morbidities that presented during the period of the study, malaria had the highest percentage of occurrence 262 (49.81%),

TABLE 5 : OUTCOME OF ADMISSION CASES AMONG THE UNDER FIVE CHILDREN IN THE STUDY.
*LAMA Left Against Medical Advice.
Table5shows the outcome of admission cases among the under five children in the study.Most of the admitted cases (89.19%) were successfully treated and discharged, a lesser percentage (8.11%)were referred to a tertiary health facility while 2.70% of the cases left the facility against medical advice.However, from the records available, no mortality was recorded during the period of the study among under-five children in the facility.