The First 18 Months of a Pediatric Rheumatology Service at a Tertiary Referral Hospital in Kenya
Paediatrics and Child Health (East Africa); Population Health (East Africa)
Background/Purpose: Pediatric rheumatic diseases impart a significant disease burden upon children and their families with the potential to cause diminished quality of life and significant direct and indirect costs. Determination of the burden of disease is a prerequisite to improving access to care and optimizing use of the healthcare ecosystem for the well-being of these patients.We thus set out to describe what clinical cases were referred to the Pediatric Rheumatology Service at Aga Khan University Hospital, Nairobi Kenya (AKUHN) since its establishment.
Methods: A prospective chart review of all patients referred to the pediatric rheumatology service at AKUHN was undertaken from October 2016 to March 2018. Patients were followed up for at least 3 months to determine the course of their disease. Data on bio-demographics was extracted from medical records of these patients and documented in a standard study tool. Frequencies were calculated for each disease category and sub-category.
Results: A total of 113 patients attended the pediatric rheumatology service of which 61.06% (69 of 113) were female and 53.15% (59 of 113) were aged above 10 years. Most patients attending the service were
Kenyan accounting for 95.58% (108 of 113). Two patients from Tanzania and one from Somalia, France and Uganda were reviewed in this clinic. Among the Kenyan patients seen, 77.88% (88 of 113) were from the capital, Nairobi. Out-patients accounted for 84.96% (96 of 113) of the patients compared to 15.04% (17 of 113) who were seen as in-patients. Inflammatory musculoskeletal conditions accounted for 36.3% of all cases (41 of 113) compared to 52.2% (59 of 113) of non-inflammatory musculoskeletal conditions as shown in graph 1.
Among the inflammatory conditions diagnosed, reactive arthritis accounted for 29.3% (12 of 41), juvenile idiopathic arthritis (JIA) accounted for 14.6% (6 of 41) and vasculitides accounted for 12.2% (5 of 41) of the cases as demonstrated in graph 2. The non-inflammatory musculoskeletal conditions included mechanical joint pain 42.4% (25 of 59), conversion disorder 13.6% (8of 59), benign joint hypermobility 8.5% (5 of 59) among others as illustrated in graph 3. The other medical conditions diagnosed at the pediatric rheumatology service were two cases of acute lymphoblastic leukaemia and one case of neurofibromatosis, serum sickness, sturge weber syndrome, diabetes, eczema, epidermolysis bullosa and a case of suspected griscelli syndrome. There were four patients lost to follow up; two children with prolonged fever of more than three weeks and two others with unexplained painless unilateral limb swelling. There were three mortalities; two lupus patients and the systemic scleroderma patient, all of whom succumbed to sepsis.
Conclusion: Non inflammatory mechanical musculoskeletal complaints are the commonest complaints noted at the pediatric rheumatology service at a tertiary referral hospital in Kenya. The three commonest inflammatory musculoskeletal conditions are reactive arthritis, JIA and vasculitides. Sepsis was the main cause of mortality among the pediatric rheumatology patients. Further studies are required to better describe the burden and natural history of these diseases in Kenya and Sub-Sahara Africa at large.
(2020). The First 18 Months of a Pediatric Rheumatology Service at a Tertiary Referral Hospital in Kenya. Arthritis Rheumatolology, 72(4).
Available at: https://ecommons.aku.edu/eastafrica_fhs_mc_paediatr_child_health/170