Morbidity and Mortality in Adolescents at the University Hospital of Brazzaville

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.


Introduction
Adolescence, the period of life from 10 to 19 years, is a journey from childhood to adulthood [1]. It is a period of transition marked by progressive physical, sexual, psychological and social maturation as well as by the acquisition of autonomy. A set of events that make the child an adult [1] [2]. The number of adolescents is estimated at 1.2 billion, or one-fifth of the world's population, four out of five of whom live in developing countries by the World Health Organization (WHO) [1] [3]. About 1.2 million adolescents have died worldwide, two-thirds of them in the regions of Africa and Southeast Asia, making adolescent health a major public health concern [3] [4]. Among the causes of death, road accidents are the first and, the other so-called secondary causes, are attributable to respiratory tract infections, suicide, diarrhoeal diseases and drowning [3]. In developed countries, suicide attempts, traffic accidents, AIDS, and the use of toxics are the main causes of hospitalizations [5]- [11] and road accidents, suicides and cancers are the leading causes of death [12] [13] [14] [15] [16]. In Africa, a continent where adolescent health needs are poorly defined [17], in addition to the causes of the disease, infectious diseases and childbirth are the main causes of morbi-mortality [3] [18] [19] [20] [21]. Also, in order to lay the foundations for a constructive transition to adulthood, various resolutions have been adopted by WHO [22]. And, to guide programmatic actions for adolescent health, the WHO World Assembly has chosen to promote five areas designated "HELPS" [22].
The aim of this study was to contribute to the improvement of adolescent health and to determine the socio-demographic aspects of the adolescent hospitalized at the Brazzaville Hospital and University Centre (CHUB), to identify the causes of morbidity and mortality as well as the factors associated with death.

Patients and Methods
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 Analysis
The 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.  Causes of hospitalization are recorded in Table 1.

Evolution
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 Table 2.

Analytical Study
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. Table 3 shows determinants of adolescent mortality at the CHUB.

Methodology Analysis
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.

Epidemiological Aspects
The hospital morbidity of adolescents is 3.4%, frequency close to that reported by Souour in Tunisia 5% [5]. Higher frequencies are reported by Timité-Konan in Abidjan: 11.3 [21], Djadou: 9.7 [6] and Balaka in Togo [18]: 8.85%. The study framework and population type explain the disparity in these frequencies.  [27]. According to African authors, the high number of early pregnancies explains the female predominance, and in developed countries male predominance is due to road-related injuries [28]. The most sought-after services are paediatrics (42.92%), obstetric gynaecology (21.73%) and paediatric surgery (9.45%) as Nzamé reports in Gabon [21]. In Ivory Coast [20], the services of gynaecology, paediatric surgery and paediatrics are in descending order and, in Tunisia, the services of paediatrics and hematology [5].

Clinical Aspects
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 [20] notes that infectious diseases are the leading cause of hospitalization among adolescents aged 10 to 14 and deliveries and postpartum infections in those aged 15 to 19. This is also the case with the prevalence of infectious diseases and deliveries for Djadou [6]. Gynecological-obstetric and infectious pathologies for Nzame [22] and Balaka [18] and diseases of the genitourinary, endocrine, nutritional and infectious diseases for Souour [5].
In terms of infectious diseases, malaria is the leading cause of adolescent morbidity and mortality in Brazzaville and Abidjan [6] [29] [30] [31]. However, this is not the case in Lomé [18] and Libreville [20] where malaria is the second leading cause of hospitalizations for adolescents, which are the second leading Open Journal of Pediatrics cause of obstetric gynaecology-obstetric pathologies [18] [20].
In terms of gynaecological and obstetrics, our study confirms African data that, childbirth is the leading cause of adolescent hospitalization in obstetric gynecology services [8] [20] [21]. The precocity of sexual intercourse, the lack of sex education and the lack of knowledge of contraceptive methods for some [32] and the low purchasing power of parents, the source of the girl's out-of-school education for others [6] are the source of the precocity of unwanted pregnancies. Beyond the difference in frequency, adolescence, a period characterized by an impulse irruption with an easy passage to action and a tendency to impulsiveness explains why attempts to suicides are more common. But their psychological vulnerability is largely related to environmental attitudes and reactions [25].

Evolution
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 [18] [19] [21] [35] [36]. It was noted a relationship between the female sex, the age group of 10 to 14 years and the secondary education level of the adolescent and morbidity. And between 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 and mortality.

Conclusion
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.