The spectrum of rheumatic in-patient diagnoses at a pediatric hospital in Kenya

Abstract

BackgroundPediatric rheumatic diseases are chronic illnesses that can cause considerable disease burden to children and their families. There is limited epidemiologic data on these diseases in East Africa. The aim of this study was to assess the spectrum of pediatric rheumatic diagnoses in an in-patient setting and determine the accuracy of ICD-10 codes in identifying these conditions.MethodsMedical records from Gertrude’s Children’s Hospital in Kenya were reviewed for patients diagnosed with “diseases of the musculoskeletal system and connective tissue” as per ICD-10 diagnostic codes assigned at discharge between January and December 2011. Cases were classified as “rheumatic” or “non-rheumatic”. Accuracy of the assigned ICD-10 code was ascertained. Death records were reviewed. Longitudinal follow-up of “rheumatic” cases was done by chart review up to March 2014.ResultsTwenty six patients were classified as having a “rheumatic” condition accounting for 0.32% of patients admitted. Of these, 11 (42.3%) had an acute inflammatory arthropathy, 6 (23.1%) had septic arthritis, 4 (15.4%) had Kawasaki disease, 2 (7.7%) had pyomyositis, and there was one case each of septic bursitis, rheumatic fever, and a non-specific soft tissue disorder. No cases of juvenile idiopathic arthritis (JIA) were identified. One case of systemic lupus erythematosus was documented by death records. The agreement between the treating physician’s discharge diagnosis and medical records ICD-10 code assignment was good (Kappa: 0.769). On follow-up, one child had recurrent knee swelling that was suspicious for JIA.ConclusionsPediatric rheumatic conditions represented 0.32% of admissions at a pediatric hospital in Kenya. Acute inflammatory arthropathies, septic arthritis and Kawasaki disease were the most frequent in-patient rheumatic diagnoses. Chronic pediatric rheumatic diseases were rare amongst this in-patient population. Despite limitations associated with the use of administrative diagnostic codes, they can be a first step in evaluating the spectrum of pediatric rheumatic conditions in Kenya and other countries in East Africa.

Spectrum of paediatric rheumatic disorders at a tertiary hospital in Tanzania

“…Kawasaki disease, Takayasu arteritis and IgA vasculitis were observed in this study, our findings which are consistent with reports from India, South Africa and Kenya and demonstrate existence of these rare rheumatic disorder in Tanzania [7,13,16,26]. Kawasaki disease has been previously described from Tanzania in a case report by Noorani et al [11] Interesting Olaosebikan et al did not find any case of vasculitis in a study conducted in Nigeria [8].…”

“…Predominance of female children was observed in our study, this is like report by Olaosebikan et al from Nigeria, this similarity is partly attributed to the predominant rheumatic disorders note in the two reports whereby juvenile idiopathic arthritis was the most frequent condition [8]. Migowa et al and Patra et al reported predominance of male children in their reports, of interest is the fact that Patra et al observed predominance of JIA as was a case for our findings, while Migowa et al did not document JIA [7,13].…”

“…Rheumatic disorders accounted for 0.32% of all paediatric admission in 2011 at Getrude's Children's Hospital in Nairobi, Kenya as reported by Migowa et al [7] The commonest rheumatic condition reported was inflammatory arthropathy which accounted for 42.3%, other conditions documented included septic arthritis, Kawasaki disease and rheumatic fever [7].…”

Challenges in the diagnosis and management of Pediatric Rheumatology in the developing world: Lessons from a newly established clinic in Yemen.

“…Prevalence of PRDs referred to the childhood rheumatology clinic was 57.8% and 2.8% reported in Singapore and Nigeria respectively [3,21]. Migowa A et al, reported PRDs in 0.32% of hospital admitted cases in Kenya in 2011 [10]. In our study, a total of 43 cases with MSK complaint attending the pediatric rheumatology clinic were reviewed, among which 37 cases (86%) were diagnosed as PRDs (Table 2).…”

“…In developing countries, difficult estimation of PRDs prevalence is usually related to decreased awareness of physicians towards rheumatic diseases in children, lack of pediatric rheumatology service and directed attention towards the communicable diseases in comparison to non-communicable rheumatic disorders [6][7][8]. The confusing presentation of musculoskeletal (MSK) symptoms -which are the primary features of rheumatic diseases -in other systemic disorders as metabolic, endocrine, neoplastic and infectious conditions is considered related too [3,[9][10]. Yemen is a developing country; thorough web search did not reveal any published PRDs registry in Yemen.…”