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[Diabetic ketoacidosis in children: epidemiological and prognostic aspects]
Aymar Pierre Gildas Oko1,2, Fayçal Khalil Zaharo Ali2, Steve Vassili Missambou Mandilou3
1Faculté des Sciences de la Santé, Université Marien Ngouabi, Brazzaville, République du Congo.
Insights
Diabetic ketoacidosis (DKA) in children is a serious condition in Congo, often presenting as the first sign of diabetes. Key mortality risk factors include young age, delayed diagnosis, and severe symptoms, highlighting the need for public awareness and better management.
Area of Science:
- Pediatrics
- Endocrinology
- Public Health
Background:
- Diabetic ketoacidosis (DKA) data in children from Congo are scarce and outdated.
- DKA represents a significant proportion of childhood diabetes hospitalizations.
Purpose of the Study:
- To describe the sociodemographic characteristics of pediatric DKA cases in Brazzaville.
- To identify risk factors associated with mortality in children with DKA.
Main Methods:
- An analytical study was conducted from January 2013 to June 2016 at the University Hospital in Brazzaville.
- Data included socio-demographic, clinical, paraclinical, and outcome variables.
- Statistical analyses involved univariate (Chi-Square, Fisher's exact, odds ratio) and multivariate (logistic regression) methods.
Main Results:
- Of 172 diabetic children, 55 (31%) presented with DKA, predominantly girls (60%) with a mean age of 11.1 years.
- Low parental socioeconomic status (61.8%) and infection (52.7%) were common. DKA was the initial presentation in 67.2%, with 50% misdiagnosed before hospitalization.
- The mortality rate was 12.7%. Significant risk factors for mortality included age < 5 years, delayed consultation (>7 days), severe dehydration, hemodynamic instability, severe malnutrition, low Glasgow Coma Scale score (<9), and diarrhea.
Conclusions:
- DKA is a severe pediatric complication in the study region, necessitating urgent preventive strategies.
- Public awareness, information, and education campaigns are crucial.
- Effective management of identified mortality risk factors is essential for improving outcomes.
Introduction:
In Congo, data on diabetic ketoacidosis (DKA) in children are old and rare. This study aims to describe the sociodemographic features of DKA and to identify risk factors for mortality.
Patients And Methods:
We conducted an analytical study on DKA in childred at the University Hospital in Brazzaville over the period from January 2013 to June 2016. We examined the socio-demographic, clinical, paraclinical and evolutionary variables. Chi-Square Test, Fisher's exact test and odds ratio were used in the univariate analysis process and logistic regression model in the multivariate analysis.
Results:
Out of 172 children hospitalized with diabetes 55 (31%) were hospitalized with ketoacidosis. They were girls (33; 60%) with an average age of 11.1± 4.9 years (ranging from 1 months to 17 years), 61.8% of parents came from low socioeconomic status. Ketoacidosis was the revealing symptom in 67.2 % of cases. The diagnosis made before hospitalization was wrong (50%). The triggering factor was often an infection (52.7%). Mortality rate was 12.7%. The risk factors for mortality in the univariate analysis were: age < 5 years (p=0,000006), average consultation time higher than 7 days (p= 0.001), severe dehydration (p = 0.0006), hemodynamic disorders (p= 0.0006), severe undernutrition (p= 0.02), Glasgow Coma Scale < 9 (p= 0.007) and diarrhea (p= 0.001).
Conclusion:
The importance and the seriousness of ketoacidosis impose preventive measures based on awareness, information and education campaigns as well as on the management of risk factors for mortality.
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