Introduction: Adolescent morbidity and mortality is a health concern. Objective: To determine morbidity, identify the causes of morbi-mortality and the factors associated with adolescent mortality in Brazzaville . Patients and Methods: A retrospective, descriptive and analytical study was carried out at the Brazzaville Hospital and University Center between January 2015 and December 2016. Adolescents hospitalized in clinical services whose records were workable were included. The Epidemiological, clinical and evolutionary variables were analyzed. The statistical test used was the khi-two, the significance level set at 0.05. Results: In total, Out of 67 , 488 hospitalized patients, 2062 were adolescents: 3% including 891 (43.2%) boys and 1171 (56.8%) girls mean age 14.8 ± 2.92 years, seen in average 9.38 days after the onset of symptoms. Childbirth 415 (20.1%), malaria 309 cases (14.9%), major sickle cell crisis 223 (10.8%) and traumatic injuries 166 cases (8.05%) are the main causes of morbidity. One death was recorded in n = 193 (9.4%), of which n = 104 (5.0%) in the first 48. Tumors, malaria and status epilepticus are the leading causes of death. The female sex, the age between 15 and 19 years, the young age of the father, the higher level of education of the adolescent and the low socio-economic level of the parents are associated with the death. Conclusion: Adolescent morbidity is worrying and mortality is significant. It is important that policies on this issue be developed with an emphasis on the main causes of morbi-mortality, including malaria control and sex education.
Adolescence, the period of life from 10 to 19 years, is a journey from childhood to adulthood [
We reviewed the files of patients hospitalized between January 2015 and December 2016 in the medical and surgical departments of the CHU-B and selected those of adolescents, who constituted the target population of the study. Teenagers whose files were actionable were included. Those whose files were not workable were not included. This was an exhaustive sampling. The study variables were: age, sex, place of residence, provenance, level of education, hospitalization, consultation time, adolescent education level and level of parent education, reason for hospitalization, nutritional status; the cause of hospitalization, length of hospitalization, evolutionary profile and cause of death.
Statistical AnalysisThe data analysis was done using SPSS 20 software. Percentages, averages and standard deviations were calculated. The statistical influence between two variables was assessed by Pearson’s khi-two test with a meaning threshold of less than 0.05.
Confidentiality was respected and a favorable opinion from the ethics committee obtained.
Out of 67488 patients hospitalized during the study period, there were 2062 adolescents: 3% including 891 (43.2%) boys and 1171 (56.8%) girls, i.e. a sex ratio of 0.76. The mean age was 14.82 ± 2.92 extreme years (10 and 19 years): it was 14 years for boys versus 15 years for girls. They were between 10 and 14 years old n = 1162 (56.40%) of which n = 498 (24.2%) boys and n = 0.402 (19.5%) between the age of 15 and 19 (43.60%) of which n = 0.393 (19%) boys and n = 769 (37.3%) girls. They came from home without prior recourse to a health center n = 1854 (89.9%); from a Level II hospital n = 0.120 (5.8%); from a medical practice n = 27 (1.3%); from a clinic n = 16 (0.8%) and another locality in Congo n = 0.45 (2.2%). They were in school n = 1891 (91.7%) Secondary n = 1326 (64.3%), Primary n = 562 (27.2%) and at the university n = 3 (0.2%). One hundred and seventy-one adolescents were out of school n = 171 (8.3%). The reception services were pediatrics n = 885 (42.9%), obstetric gynecology n = 448 (21.7%), surgery n = 430 (14.5%) medicine n = 299 (14.5%).
The average consultation time was 9.38 extreme days (1 and 180 days). This period ranged from one to two days n = 1581 (70%), three and seven days n = 312 (15.10%), seven and 14 days n = 60 (2.9%) and plus 15 days n = 109 (5.3%).
The reason for consultation varied according to the pathology responsible was fever n = 0.489 (23.7%), low-pelvic pain n = 390 (18.9%), functional impotence n = 113 (5.5%), convulsive seizure n = 98 (4.98%), pallor n = 94 (4.6%), cough n = 87 (4.2%), consciousness disorder n = 78 (3.8%), vomiting n = 69 (3.5%), abdominal pain n = 67 (3.3%), asthenia n = 47 (2.3%), headache n = 47 (2.3%), genital bleeding n = 42 (2.0%), otalgia and joint pain n = 40 (1.9%) everyone, abdominal bloating n = 35 (1.7%), ingestion of toxics n = 35 (1.7%), convulsive disease n = 34 (1.7%), diarrhea n = 28 (1.4%), anemia n = 21 (1.6%), Vulvar discharge n = 16 (0.8%), a burn n = 13 (0.6%), psychomotor agitation n = 9 (0.4%), traumatic wound and hemoptysis n = 7 (0.34%) each, hematuria n = 6 (0.29%), hematemesis, jaundice, coca cola urine and neck pain three cases each (0.2%) and a case of epistaxis.
Teenagers were eutrophic n = 1904 (92.33%), emaciated n = 106 (5.14%), severely emaciated n = 44 (2.15%) and overweight n = 8 (0.38%).
Causes of hospitalization are recorded in
The Infectious Causes n= 452 (21.9%) were malaria 309 (68.4%) of which 152 (49.19%) simple form and 157 (50.81%) severe form, tuberculosis n = 38 (8.4%), sepsis n = 29 (6.4%), encephalitis n = 12 (2.7%), tetanus, gastroenteritis and meningitis n = 11 (2.4%) each HIV infection n = 9 (1.9%), erysipelas n = 7 (1.6%), meningoencephalitis n = 6 (1.3%). The Other pathologies were measles, hepatitis and chickenpox n = 8 (1.8%) and a case of trypanosomiasis.
| Causes | Cases | |
|---|---|---|
| N | % | |
| Infectious | 452 | 21.9 |
| Gyneco-obstetrics | 448 | 21.7 |
| Diseases of the blood and blood-forming organs | 228 | 11.1 |
| Traumatic | 166 | 8.1 |
| Respiratory | 138 | 6.7 |
| Digestive | 118 | 5.7 |
| Uro-nephrologic | 105 | 5.1 |
| Neurologic | 75 | 3.6 |
| Psychiatric | 75 | 3.6 |
| Tumor | 63 | 3.1 |
| ENT | 53 | 2.6 |
| Endocrine, nutritional and metabolic | 51 | 2.5 |
| Osteoarticular | 51 | 2.5 |
| Dermatological | 20 | 1.0 |
| Cardiovascular | 19 | 0.9 |
| Total | 2062 | 100 |
Gyneco-obstetric causes were: n = 415 (92.63%), vaginal delivery n = 303 (73%) and n = 114 (27%) high-births; hematological causes n = 228 (11.1%) major sickle cell disease n = 223 (97.8%) and medullary aplasia n = 5 (2.19%); accidental causes n = 166, were noted in 112 boys (67.46%) and 54l girls (32.53 per cent), they were the result of a road accident n = 136 (81.92 per cent) and sports n = 30 (18.07%) inducing a fracture n = 109 (65.66%), a head injury n = 27 (16.27%), a burn n = 13 (7.83%) and a wound n = 7 (4.22%); osteoarticular causes n = 51 (2.5%): arthritis n = 29 (56.86%) and acute osteomyelitis n = 22 (43.13%); respiratory causes n = 138 (6.7%): acute respiratory infection n = 124 (89.9%), asthma exacerbation n = 13 (9.4%) and a case of respiratory failure; digestive causes n= 118 (5.7%): surgical n = 107 (90.7%) n = 11 (9.3%); uro-nephrological causes n = 105 (5.1%): urinary tract infection n = 53 (50.5%), nephrotic syndrome n = 15 (14.3%), inguino-scrotal hernia n = 14 (13.3%), kidney failure n = 12 (11.4%), hydrocele n = 7 (6.8%) and acute glomerutolephritis n = 4 (3.8%); neurological causes n = 75 (3.6%): epilepsy n = 66 (88.0%), cerebral abscess n = 5 (6.7%) stroke n = 0.4 (5.3%); psychiatric causes n = 75 (3.6%); tumor causes n = 63 (3.1%): nephroblastoma n = 18 (28.6%), leukemia n = 10 (15.9%), brain tumors n = 10 (15.9%), Hodgkin lymphoma n = 9 (14.3%), retinoblastoma n = 8 (12.7%), primary liver cancer n = 4 (6.3%), osteosarcoma n = 3 (4.7%) and a case of neuroblastoma; otolaryngological causes n = 53 (2.6%): acute otitis of otitis n = −40 (75.47%), mastoiditis n = 10 (18.86%) and a tympanic perforation n = 3 (5.66%); endocrine, nutritional and metabolic causes n= 51 (2.5%); dermatological causes n = 20 (1.0%): cellulite n = 14 (70%), phlegmon n = 5 (25%) and a case of Lyell syndrome; cardiovascular causes n = 19 (0.9%): heart failure n = 9 (47.4%), pericarditis n = 4 (21.1%), arterial thrombosis n = 3 (15.8%), high blood pressure n = 2 (10.5%) and a case of valvulopathy.
The average length of hospitalization was 6.96 days, extreme (1 and 365 days). The trend was favorable n = 1881 (91.2%), an exit against medical advice n = 30 (1.5%) and two health transfers. One death was recorded n = 193 (9.4%), of which n = 104 (5.0%) in the first 48 hours. The main causes of death are recorded in
| Causes | Death | Survival | Lethality (%) |
|---|---|---|---|
| N (%) | N (%) | ||
| Tumor | 27 (13.98) | 63 | 42.86 |
| Severe malaria | 24 (12.43) | 157 | 15.28 |
| Epilepsy | 18 (9.32) | 66 | 27.27 |
| Bacterial lung disease | 11 (5.69) | 81 | 13.58 |
| Anemia | 6 (3.10) | 64 | 9.37 |
| Medullary aplasia | 5 (2.07) | 5 | 100 |
| Encephalitis | 4 (2.07) | 12 | 33.33 |
| Cerebral abscess | 4 (2.07) | 5 | 80.00 |
| Nephrotic syndrome | 4 (2.07) | 15 | 26.66 |
| Tuberculosis | 4 (2.07) | 38 | 10.52 |
| Sepsis | 3 (1.55) | 29 | 10.34 |
| Tetanus | 3 (1.55) | 11 | 27.27 |
| HIV | 3 (1.55) | 9 | 33.33 |
| Renal faillure | 3 (1.55) | 12 | 25.00 |
| Lower limb fracture | 2 (1.03) | 84 | 2.38 |
| Deep vein thrombosis | 2 (1.03) | 3 | 66.66 |
| Burns | 2 (1.03) | 13 | 15.38 |
| Heart faillure | 2 (1.03) | 9 | 22.22 |
| gastrointestinal hemorrhage | 2 (1.03) | 5 | 40.00 |
| Cholecystitis | 2 (1.03) | 15 | 13.33 |
| Vaso-occlusive crisis | 2 (1.03) | 121 | 1.65 |
| Stroke | 2 (1.03) | 3 | 66.66 |
| Meningitis | 2 (1.03) | 11 | 18.18 |
| Others* | 56 (29.01) | 1038 | 5.39 |
| Total | 193 | 1869 | 10.32 |
*n = 1. Lyell syndrome, cellulitis, hypertension, appendicitis, peritonitis, intoxication, undernutrition, diabetes, respiratory failure, head trauma, digestive hemorrhage, upper limb fracture.
Factors associated with morbidity were the female sex, the 10 - 14 age groups, and the adolescent’s secondary education level. Those associated with the risk of death were the female sex, the age between 15 and 19 years, the young age of the father (<30 years), the higher level of education of the adolescent and the low socio-economic level of the parents.
| Determinants | Clinical evolution | ||||||
|---|---|---|---|---|---|---|---|
| Total | healed | Death | OR (IC à 95%) | p-value | |||
| N = 2062 | N = 1869 | N = 193 | |||||
| n | % | n | % | ||||
| Sex (of the adolescent) | |||||||
| male | 891 | 821 | 92.14 | 70 | 7.86 | 1.37 [1.01 - 1.87] | 0.04 |
| female | 1171 | 1048 | 89.50 | 123 | 10.50 | 1 | |
| Age (year-old) of the adolescent | |||||||
| 10 - 14 | 1162 | 1097 | 94.41 | 65 | 5.59 | 1 | 0.000 |
| 15 - 19 | 900 | 772 | 85.78 | 128 | 14.22 | 2.79 [2.04 - 3.82] | |
| Education | |||||||
| Elementary school | 224 | 217 | 96.87 | 7 | 3.13 | 3.49 [1.6 - 7.5] | 0.0006 |
| Secondary | 898 | 886 | 98.66 | 12 | 1.34 | 13.50 [7.5 - 24.5] | 0.0000 |
| High education | 315 | 245 | 77.77 | 70 | 22.22 | 0.26 [0.19 - 0.36] | 0.0000 |
| Unschooled | 625 | 521 | 83.36 | 104 | 16.64 | 0.33 [0.24 - 0.44] | 0.0000 |
| Age (year-old) of mothers | |||||||
| 11 - 20 | 224 | 42 | 18.75 | 182 | 81.25 | 0.001 [0.0007 - 0.002] | 0.00000 |
| 21 - 30 | 896 | 895 | 99.88 | 1 | 0.12 | 17.4 [24.6 - 26.1] | 0.000 |
| 31 - 40 | 936 | 930 | 99.36 | 6 | 0.64 | 30.8 [13.6 - 69.9] | 0.0000 |
| 41 - 50 | 4 | 1 | 25 | 3 | 75 | 0.03 [0.003 - 0.32] | 0.0000 |
| 51 and higher | 2 | 1 | 50 | 1 | 50 | 0.10 [0.06 - 1.6] | 0.04 |
| Education of mothers | |||||||
| Elementary school | 219 | 217 | 99.09 | 2 | 0.91 | 12.5 [3.0 - 50.8] | 0.0006 |
| Secondary | 890 | 886 | 99.55 | 4 | 0.45 | 42.5 [15.7 - 115.1] | 0.0000 |
| Higher education | 247 | 245 | 99.19 | 2 | 0.81 | 14.4 [3.5 - 58.40] | 0.0000 |
| Unschooled | 706 | 521 | 73.80 | 185 | 26.20 | 0.01 [0.008 - 0.03] | 0.0000 |
| Socio-economic level | |||||||
| Low | 1940 | 1755 | 90.46 | 185 | 9.53 | 1 | 0.000 |
| Medium | 118 | 111 | 94.07 | 7 | 5.93 | 135.1 [64.9 - 281.2] | |
| High | 4 | 3 | 75 | 1 | 25 | ||
| Time to admission (days) | |||||||
| 1 - 7 | 1893 | 1718 | 90.76 | 15 | 9.24 | 1 | |
| 8 to ≥14 | 169 | 151 | 89.35 | 18 | 10.65 | 1.17 [0.7 - 1.9] | 0.54 |
In order to determine the adolescent’s hospital morbidity, identify the causes of hospitalization and deaths, and identify factors associated with adolescent mortality in Brazzaville, we reviewed the hospital records of the CHUB between January 2015 and December 2016. The benefits of this study are the completion of this study in Congo’s largest hospital, the sample size and duration. But its retrospective nature is undoubtedly a source of bias.
The hospital morbidity of adolescents is 3.4%, frequency close to that reported by Souour in Tunisia 5% [
A female predominance is reported by some as in our study [
The most sought-after services are paediatrics (42.92%), obstetric gynaecology (21.73%) and paediatric surgery (9.45%) as Nzamé reports in Gabon [
The main morbid entities at University Hospital of Brazzaville are infectious diseases, obstetrical pathologies and childbirth, blood diseases and traumatic injuries. The causes of morbidity vary from one study to another. Timité-Konan [
In terms of infectious diseases, malaria is the leading cause of adolescent morbidity and mortality in Brazzaville and Abidjan [
In terms of gynaecological and obstetrics, our study confirms African data that, childbirth is the leading cause of adolescent hospitalization in obstetric gynecology services [
Traumatic pathology is dominated by fractures, contusions, bruises and wounds, the main causes of hospitalizations of adolescents in surgical services [
The frequency of voluntary poisoning, mental disorders and behaviour is higher in this study compared to the studies of the authors consulted [
A death was recorded in 9.4% of cases, of which 5.0% were reported in the first 48 hours in Brazzaville. In developing countries, as reported in Ghana and Togo, adolescents pay heavy prices for the disease, although at varying rates [
The adolescent hospitalized at the Brazzaville Hospital and University Center has high morbidity and mortality. The main morbid entities are infectious and parasitic diseases, pregnancies, sickle cell disease and traumatic injuries. And, tumors and infectious diseases including severe malaria, the main causes of death. The female sex, the high age of adolescents, the young age of the father, the adolescent’s higher level of education and the low socio-economic level of the parents are associated with death.
The authors declare no conflicts of interest regarding the publication of this paper.
Moyen, E., Ouemeyi-Enani, V., Okoko, A.R., Nianga, B.B., Bomelefa-Bomel, V. and Moyen, G.M. (2021) Morbidity and Mortality in Adolescents at the University Hospital of Brazzaville. Open Journal of Pediatrics, 11, 243-253. https://doi.org/10.4236/ojped.2021.112024