Reasons for hospitalization in children under five

Mrs. Diaz, Mrs. Vongphachanh and Mr. Norkhankham during sample pre-processing.

Collaboration

• Children’s Hospital, Vientiane Capital.

Funding

• Luxembourg Ministry of Foreign and European Affairs, Defence, Development Cooperation and Foreign Trade.
• Luxembourg Institute of Health.

Objectives

The main objective of the project is to determine the frequent reasons of hospitalizations in children under five years of age (CUF). In addition, the following secondary objectives were defined:

• Determine the proportion of hospitalized CUF with a suspected infectious disease etiology in relation to all other causes.
• Assess disease severity, using length of hospital stay as a proxy, based on clinical diagnoses.
• Identify frequent hospitalization reasons other than respiratory and gastrointestinal syndromes.
• Identify microorganisms associated with respiratory and gastrointestinal syndromes in hospitalized CUF.

Background

Hospital-based active surveillance is an effective method for monitoring severe diseases within a population. In Laos, there is a lack of comprehensive data on the causes of hospitalization among children under five years of age. While research has been conducted with a focus on gastrointestinal or respiratory diseases, it has not provided a broad understanding of the overall burden of illness. The aim of this study is to identify and describe the most common causes of hospitalization in this age group. The study is being undertaken in collaboration with the Children’s Hospital, a leading paediatric institution in Vientiane Capital.

Methodology

In collaboration with the Children’s Hospital, we plan to include 3000 patients under the age of 5 years who are admitted to the hospital. The sample size calculations were based on an expected 58% infectious disease prevalence from data provided by the Children’s Hospital, and accounting for a 20% dropout rate.

In addition, power analyses were performed for the comparison of clinical outcomes with the estimated sample size. The study will run over the course of two years. A pooled nasal and throat swab and a rectal swab or stool sample are collected from the participants. The data is collected through questionnaires at the moment of admission and discharge. A study team member calls the legal guardian of the patient 30 days after discharge to capture adherence to treatment, and clinical outcomes such as mortality or re-admission into the hospital. The questionnaires were translated into Lao and were administered to the legal guardians by the nurses in the hospital. All replies are collected digitally using tablets provided by the laboratory. The questionnaires include demographic information, clinical data (such as symptoms and antibiotic usage), anthropometric measurements (such as weight and height/length), and relevant exposure history. The digital data collection enabled real-time monitoring of the process and was the basis for the early identification and resolution of encountered challenges. Prompt feedback to hospital staff, refining of the questionnaire and multiple discussion rounds with all study team members significantly reduced instances of missing data and errors during data entry.

Results

Data and sample collection is ongoing. As of November 2024, more than 1100 participants have been enrolled since January 2024 (Figure 2), about 60% of them are male. The median age of the participants was 13 months, ranging from 0 to 59 months. Most of the participant are residents of Vientiane Capital (73%) and are Tai-Kadai/ Lao Loum (76%). The healthcare workers reported gastrointestinal diseases (38%) and respiratory diseases (39%) as the most frequent reason for hospitalization.

Figure 2. Numbers of enrolled participants from January to November 21st 2024.

Conclusion & perspectives

This project aims to elucidate the primary reasons for hospitalizations among children under five years of age, with a specific emphasis on infectious diseases. By determining the proportion of hospitalizations due to suspected infectious diseases compared to other causes, and assessing disease severity through length of hospital stay, the study will provide crucial insights into the burden and nature of childhood illnesses in Laos.

Additionally, the results may also inform healthcare policy and paediatric care strategies, aiming to improve health outcomes for Lao children.