CLINICAL PROFILE OF ACUTE GASTROENTERITIS IN CHILDREN AT A TERTIARY CENTRE

Introduction: Acute gastroenteritis accounts for millions of deaths each year in young children, mostly in developing communities. diarrhoea, vomiting and fever are the most common presenting symptoms. The aim of the study was to describe the clinical profile of Acute Gastroenteritis in children at National Medical College and Teaching Hospital, Birgunj. Materials and Methods: This descriptive cross-sectional study was carried out in pediatric ward and Intensive Care Unit at National Medical College and Teaching Hospital, Birgunj, Nepal for 6 months (November 2021 to April 2021). Ethical clearance and informed written consent were taken for the study. Results: Among 138 cases enrolled in the study, most common symptoms were diarrhoea, vomiting and fever. Signs of some dehydration was seen in 39.1% of the cases whereas 4.4% cases had signs of severe dehydration. Oral rehydration Solution (ORS) was mainstay of treatment along with zinc and probiotics. Antibiotics was used in 52.2% cases. Among all the cases, 75.4% cases and their caretakers did not routinely wash their hands. Conclusion: Diarrhoea, vomiting and fever are the most common symptoms in acute gastroenteritis. Use of ORS and zinc is recommended for the management in acute gastroenteritis in children. Antibiotic therapy should be used judiciously in the management of acute gastroenteritis. Increase awareness among the public about proper hand washing and hygiene can significantly reduce the incidence of diarrhoea and other infectious diseases in children.


INTRODUCTION
Acute gastroenteritis is defined as an inflammation of the gastrointestinal tract, characterized by the sudden onset of vomiting, diarrhea, and abdominal pain. The condition can be caused by various pathogens, including viruses, bacteria, and parasites, and is usually self-limited. 1 Diarrhea is defined as the passage of three or more loose or liquid stools per day (or more frequently than is normal for the individual), usually accompanied by cramping, abdominal pain, and/or urgency to defecate. The stools may also contain blood, mucus, or pus, depending on the underlying cause of the diarrhea. 2 Acute gastroenteritis accounts for millions of deaths each year in young children, mostly in developing communities. 3 By the age of three years, virtually all children become infected with the most common agents.
Diarrhoea, vomiting and fever are the most common presenting symptoms. Etiology includes a variety of viral, bacterial, and parasitic enteropathogens, improperly prepared food or the reheating of meat dishes, seafood, dairy and bakery products, poisoning with heavy metals. 4 Dehydration, which may be associated with electrolyte imbalance and metabolic acidosis, is the most frequent and dangerous complication. Optimal management with oral or intravenous fluids minimises the risk of dehydration and its adverse outcomes. Routine use of antibiotics, antidiarrhoeal agents, and antiemetics is not recommended and may cause harm. Prevention is the key to controlling gastroenteritis, and highly effective rotavirus vaccine plays a major role in prevention of diarrhoea in children. Prevention includes careful hand washing, nappy disposal, and preparation and storage of food and drinking water, particularly in institutions, including hospitals where nosocomial infection is common. 3,5 Deaths are usually as a result of dehydration, but malnutrition also plays an important role. Furthermore, malnutrition increases the incidence and severity of diarrhoea, as well as other infections. 6 Worldwide, diarrhea related mortality hasdecreased, mainly because of bettertherapeutic interventions along with provisionof safe drinking water, improvement ofsanitation and popularization of primaryhealth care activities. 7 In the present context, the prevalence of acute gastroenteritis is still high among children and AGE complicated with severe dehydration, malnutrition or electrolyte imbalance have relatively poor prognosis. To describe the clinical characteristics (presenting complaints, examination findings and lab findings) of AGE at admission.
To find the association between Hand washing and different clinical pattern in AGE MATERIALS AND METHODS This is a cross-sectional descriptive study carried out in Pediatric ward and Intensive Care Unit at National Medical College and Teaching Hospital, Birgunj, Nepal, The study duration was 6 Months (November 2021 to April 2021) Target Population: All the children age upto 5 years presenting to Pediatrics department with diagnosis fitting to acute gastroenteritis.

Study Variables
Sociodemographic variables-Age, Sex, Weight, Height, MUAC, Socioeconomic status Illness Variables-Type of diarrhoea (watery/ bloody/ mucus/ yellowish/foul smelling), Type of dehydration (No/Some/Severe), use of ORS, Zinc, Antibiotics, Probiotics, Hand Wash The Inclusion Criteria were the subjects with age ≤ 5 years and the clinical diagnosis of Acute Gastroenteritis. The exclusion criteria were preterm neonates, gross congenital abnormalities, chronic illness and consent not given After obtaining Ethical Committee clearance from the institution a proforma was prepared for the study. Proforma included information for patient's details, demographic profile, anthropometric evaluation, and clinical signs. Informed written consent from the caregivers of children was taken. Clinical examinations included a thorough physical examination, including vital signs, hydration status, and assessment of mucous membranes, skin turgor and any sign of infectionA blood sample and stool sample was sent for further laboratory investigations. Laboratory investigations included complete blood count, electrolyte levels, kidney function tests, stool routine microscopic examinations and stool culture.
Statistical Package for Social Sciences (SPSS version 20.0) was used for the statistical analysis.

RESULTS
A total 138 patients of acute gastroenteritis aged below 5 years attending Department of Pediatrics were include in this study. There were a total of 26(18.8%) patients in the 0-6 months age group out of which 12 female and 14 male, 36 (26.1%) patients in the 6-12 months age group out of which 14 female and 22 male, 52 (37.7%) patients in the 1-2 years age group out of which 8 female and 44 male. Similarly, total of 24 (17.4%) patients in the 2-5 years age group out of which 14 were female and 24 were male. Most of the children included in the study were 6-9 kg-82 (59.5%), followed by 46 (33.3%) children between 10-12 kg, 8 (5.8%) children between 13-15 kg and remaining 2 (1.4%) children between 3-5 kg.

Figure 3: Duration of Diarrhoea
Abdominal pain and vomiting with abdominal pain was only seen in 2-5 years age group with 4 and 2 cases respectively. There were 2 cases in each age group (i.e. 0-6 months, 6 months-1 year, 1-2 years, and 2-5 years) with all three symptoms-fever, vomiting and abdominal pain. Among all the 138 cases included in the study, 78 (56.5%) cases had no signs of dehydration, 54 (39.1%) of the cases had some dehydration and 6 (4.4%) cases had signs of severe dehydration.
Among 78 cases with no dehydration, 24 cases was in age group 1-2 years, 20 in 0-6 months age group, 18 in 2-5 years age group and 16 in 6 months to 12 months age group. Similarly, among 54 cases with some dehydration, 24 cases were in age group 1-2 years, 18 cases in 6-12 months age group, and 6 cases in age groups 0-6 months and 2-5 years each. Age goup 1-2 years had 4 cases of severe dehydration and age group 6-12 months had 2 cases of severe dehydration.

Figure 4: Hand Washing
Among all the cases, 104 (75.4%) cases and their caretakers did not routinely wash their hands.
Among all the admitted cases, 56 (40.6%) cases had improved symptoms on day 3 rd day, 48 (34.8%) improved on 2 nd day, 18 (13.0%) improved on 1 st day and 8 cases each improved on 4 th and 5 th day.

DISCUSSION
Acute gastroenteritis is a common illness in children worldwide, particularly in developing countries, and it is a leading cause of morbidity and mortality in children under five years old. 8 The results of this study provide valuable insights into the clinical profile of acute gastroenteritis in children in Nepal. Male predominance was seen in cases acute gastroenteritis in children which is consistent with the findings in the study done by Huilan et al 9 .The study found that diarrhea and vomiting were the most common presenting symptoms, consistent with previous studies. 10,11 The high incidence of fever is also notable, as it can indicate a more severe illness and may require more aggressive treatment.
Dehydration is a significant complication of acute gastroenteritis and is associated with an increased risk of morbidity and mortality. 11 In our study, 43.5% of the children with acute gastroenteritis had dehydration, and 4.4% had severe dehydration. The severity of dehydration was significantly associated with younger age. These findings are consistent with previous studies which highlight the importance of early recognition and management of dehydration in children with acute gastroenteritis. 12,13 Oral rehydration therapy (ORT) is the mainstay of management for children with acute gastroenteritis and has been shown to significantly reduce morbidity and mortality. 2 In our study, ORT was used to manage the majority of children with acute gastroenteritis. Antibiotic therapy was prescribed to a large proportion of children (52.2%) with acute gastroenteritis, without positive bacterial cultures. This is concerning, as overuse of antibiotics can contribute to the development of antibiotic resistance and can also increase the risk of adverse effects. According to the guidelines for the management of AGE, antibiotic therapy should not be given to the vast majority of children with AGE, unless specific conditions are present. Even in cases of proven bacterial gastroenteritis, antibiotic therapy is not routinely needed but should be considered only for specific pathogens or in defined clinical settings.The routine use of antimicrobials for diarrhea in children is not recommended by the World Health Organization (WHO) except for clinically recognizable severe cases. 14 Therefore, there is a need for increased awareness among healthcare professionals and the public about the appropriate use of antibiotics in the management of acute gastroenteritis. The inappropriate use of antibiotics can lead to the emergence of antibiotic-resistant bacteria, which is a global public health threat. 15 In addition to medical management, preventive measures such as hand washing can also reduce the burden of acute gastroenteritis. Hand washing is a simple, lowcost intervention that can significantly reduce the incidence of diarrhea and other infectious diseases. 13,14,16,17 However, hand washing practices are suboptimal in many developing countries, including Nepal, due to lack of access to clean water and soap and lack of awareness about the importance of hand washing. 18 Therefore, targeted interventions aimed at promoting hand washing practices in these settings can significantly reduce the burden of acute gastroenteritis and other infectious diseases in children.
Limitations of the study include study of pathogens associated with acute gastroenteritis. In addition, the study was conducted in a single center, which may limit the generalizability of the results.

CONCLUSION
This study provides valuable insights into the clinical profile of acute gastroenteritis in children in Nepal. The results suggest that diarrhoea, vomiting and fever are the most common symptoms in acute gastroenteritis. Early recognition and prompt management of dehydration is required for better prognosis of AGE in children. Use of ORS and zinc is recommended for the management in acute gastroenteritis in children. Antibiotic therapy should be used judiciously in the management of acute gastroenteritis. In addition, efforts should be made to increase awareness among the public about proper hand washing and hygiene which can significantly reduce the incidence of diarrhea and other infectious diseases in children, particularly in resource-limited settings.