Literature DB >> 31143699

Child and adolescent health in northwestern Syria: findings from Healthy-Syria 2017 study.

Abdullah Sulieman Terkawi1,2,3,4, Basil Bakri5, Amena S Alsadek6, Abdulmuhsen H Al-Hasan6, Mohamad S Alrahhal6, Farhan M Alsaleh6, Fadia A Alsatouf6, Musa Ab I Arab6, Hussam Jnaid7,8, Adnan A Hadid7,9, Rayan S Terkawi10, Manal M Zahran6, Nabiha A Alghannam6, Khalid A Altirkawi9.   

Abstract

OBJECTIVES: Since the uprising in 2011, there has been limited health-care data from inside Syria in the academic literature. This study aims to provide an updated account of pediatric health needs in the northwestern part of Syria; this should help inform the management and delivery of health-care services in this population.
METHODS: This is a prospective study, using a data registry, of all pediatric patients seen in a single center in northwestern Syria, between February and December 2017. We used international classification of diseases (ICD-10) codes to define cases, and tested several covariates, including age, sex, season of the year, and conditions of living for possible correlations with major illness categories.
RESULTS: We included 11,819 patients, of whom 5,288 (45%) were male and 6,531 (55%) were female. Collectively, these patients had 23,427 encounters. Respiratory diseases were the most encountered illnesses among all age groups (6320 [27%]), except late teen females, among whom gynecological/obstetric complaints dominated. Infectious diseases caused the greatest disease burden across all age groups, with upper respiratory tract infections (URTIs), infectious diarrhea, and otitis media representing almost half (47%) of all cases in this category. Nutritional deficiencies were diagnosed in 978 patients (8%), mostly in infants and toddlers (92%). We identified 1192 (17%) cases of acute diarrhea among all age groups, making it the second most common condition after URTIs. As compared to town residents, patients living in camps for internally displaced people accounted for more cases of infectious diarrhea (58%), chronic anemia (60%), and malnutrition (66%), especially severe acute malnutrition (76% of malnutrition cases). Vaccine-preventable illnesses represented a sizable category; we reported 69 cases of hepatitis A, 2 of poliomyelitis, 9 of pertussis, 37 of varicella, 11 of mumps, 8 of rubella, and 1 case of measles.
CONCLUSION: We have identified urgent health-care issues in this population, including extreme malnutrition, high rates of infectious diseases, and high rates of teenage pregnancy. Also, we observed a relapse of some vaccine-preventable illnesses, such as mumps and rubella, which are likely associated with the decline in vaccination rates.

Entities:  

Keywords:  Atmeh; Syrian crisis; burden of disease; child and adolescent health; internally displaced people; teenage pregnancy

Year:  2019        PMID： 31143699      PMCID： PMC6530271          DOI： 10.4103/ajm.AJM_184_18

Source DB:  PubMed          Journal:  Avicenna J Med        ISSN： 2231-0770


INTRODUCTION

The eruption of conflict in Syria has brought the country’s health-care system to collapse. The destruction of health-care facilities, critical shortages of supplies and personnel, and mass displacement of people from one part of the country to another have contributed to the failure of health-care delivery that has been described elsewhere extensively.[12345] Recent estimates indicate that more than 5.6 million people have fled Syria as refugees, and 6.5 million people have been internally displaced.[6] Many local, regional, and international organizations have extended their assistance. Their efforts, however, remain limited and often uncoordinated. Among the nongovernmental organizations (NGOs) is the Syrian Expatriate Medical Association (SEMA), formed by a group of health-care professionals who are dedicated to providing the affected population with the much needed health-care services.[7] Efforts to implement and maintain health information systems (HIS) in humanitarian crises or conflict areas, which meet international data protection standards, have been challenging. In Syria, further challenges include the exodus of staff who could carry out this work, the volume of work particularly at the time of attacks, the targeting of health facilities, and the intermittent internet connectivity. To address the gap in HIS, SEMA implemented a data collection and reporting system in SEMA-affiliated health-care facilities called “HealthySyriaTB,” which enables data collection from the field; the main aim is to support reporting and planning for SEMA’s health programs. The Healthy-Syria project is a comprehensive medical project that aims to highlight the health-care challenges in Syria, especially in areas where internally displaced people (IDP) live. The project is inspired by the Global Burden of Disease (GBD) group experience and findings,[8] and envisioned to provide a good start, not only for patient care but for clinical research as well. This study is part of the Healthy-Syria 2017 project. The aim of this study was to review the cohort data obtained prospectively from the routine clinical care of patients using the newly implemented HIS. The focus was on the clinical presentations of children and adolescents with a view to describing their disease burden and understanding their health-care needs.

METHODS

Overview

The SEMA is an NGO that was established in 2011 to serve the medical needs of people in Syria, especially those living in IDP camps. By 2017, it had registered branches in a number of countries including the United States, Turkey, Italy, and France with 40 affiliated medical facilities in Syria and neighboring countries (http://www.sema-us.org/). The HealthySyriaTB program includes a simplified electronic medical record system developed by the authors (A.S.T. and B.B.). It is designed to describe morbidity and mortality records. The goal is to provide reliable and updated reports to help optimize health-care efforts, through an improved distribution of resources (financial, logistics, and man power), and to guide future structural improvement projects including a telemedicine system. We introduced this program in one of the SEMA-affiliated centers, in February 2017 and are in the process of gradually implementing it in the rest of our facilities. More information about the system is available as a video at https://vimeo.com/240285087 and the online version is available at www.healthysyria.net. The study center is located in the northwest Syrian in a town called Atmeh, which is situated in Idlib governorate; the town is close to several camps that house scores of IDP [Figure 1]. During the study period, the study center served an estimated population of 500,000 people who settled within an area of approximately 65 km2. Approximately, 250,000 people lived in this area before 2011.[9] However, as this area was considered relatively safe, because of its proximity to the Turkish border, the population density in this area continued to increase with each new wave of displacement; the most recent evacuation of civilians from eastern Ghouta in April 2018 resulted in an additional 300,000 to the population in Idlib governorate, some of whom reside in this area.
Figure 1

The study center location represented by the (x) sign in the map

The study center location represented by the (x) sign in the map In the study district, there are a total of five medical centers, one specializing in burns, one in trauma and general surgery, one in trauma and orthopedic surgery, and two in women’s and children’s health. The study center offers free services for women and children health care; it is equipped with a pharmacy and a medical laboratory, which can process all basic laboratory workups. Our center is within 1 km distance from all IDP camps. All services are provided without charge. The children of this area are served by a total of nine physicians (five pediatricians and four pediatric residents). Six of these physicians, including three residents, are based in the study center. One visiting pediatric neurologist contributes to the care of these patients for 8-h shift on a weekly basis.

Data collection

This is a prospective data registry study, conducted under SEMA—institutional review board, approval number (2017-03). Data collection spans from February to December 2017. After the pediatrician makes a diagnosis, data entry is assigned to a dedicated staff member who inputs all the information related to patients’ file using “HealthySyriaTB” program. All diagnoses entered are based on the international classification of diseases (ICD-10) coding system, which has helped to reduce differences in reporting and has decreased the impact of language barriers among providers. Data were entered on daily basis, saved in a local server then synchronized with the mother server. The program designates a unique medical record number (MRN), composed of 12 digital figures and letters for each patient. This unique MRN prevents duplication and maintains anonymity for data analysis and maintains the patients’ records for future use. On each subsequent visit, the program will create a new encounter for each department the patient uses. The minimum required data to create a medical record or register a visit include patient’s name, date of birth, social number, sex, living conditions (IDP vs. resident), visit date, and diagnosis. Other recommended information includes height, weight, blood group, and drug allergies. The pediatric clinic is open from Sunday to Thursday from 8 am to 3 pm, and the hospital provides 24-h emergency services. Once the patient arrives, the nurse performs a triage check including the vital signs and anthropometric measurements, then the patient is medically evaluated. On average, the pediatric clinic serves 50 patients a day. Newborn infants are usually assessed soon after birth by the on-call pediatrician who provides any required resuscitation; after 2h of the customary care and stabilization, the infant is usually discharged home with his or her mother if they are well.

Data management

We divided patients into six distinct age groups: neonates (1–27 days), infants (28–364 days), toddlers (1–4 years), childhood (5–9 years), early teenage (10–14 years), and late teenage (15–19 years) groups. This classification has been used consistently in large epidemiological studies, such as the GBD 2016 study.[10] Prevalence is presented as frequency and percentage for each disease entity. The denominator used for percentages is the total number of patients seen at the center. Thus, patients who visited the center but did not receive a diagnosis (e.g., normal examination) were included in the denominator for calculating the percentage/prevalence rates. The patient’s condition of living is based on the location of residence; those who reside in any one of the IDP camps were designated as IDP, whereas those who lived outside the camp, whether renting or owning homes, were classified as town residents; some of this latter group could also be IDP from other areas. In any given patient, when a diagnosis of an infectious disease was made within 2 weeks of a similar diagnosis, we considered both as a continuum of one disease entity that have not abated yet. Online Supplementary Table 1 enlists the ICD-10 codes used in grouping diseases/conditions reported in this study, based on definitions used in previous GBD study.[10]
Supplementary Table 1
Diagnosis categoryICD-10 codes used
Upper Respiratory Tract Infections (URTI)J01 - Acute sinusitis, J02 - Acute pharyngitis, J020 - Streptococcal pharyngitis, J03 - Acute tonsillitis, J030 - Streptococcal tonsillitis, J04 - Acute laryngitis and tracheitis, J040 - Acute laryngitis, J05 - Acute obstructive laryngitis [croup] and epiglottitis, J06 - Acute upper respiratory infections of multiple and unspecified sites, J09 - Influenza due to certain identified influenza viruses, J10 - Influenza due to other identified influenza virus, J11 – Influenza, J31 - Chronic rhinitis, nasopharyngitis and pharyngitis, J32 - Chronic sinusitis, J340 - Abscess, furuncle and carbuncle of nose, J36 - Peritonsillar abscess, J37 - Chronic laryngitis and laryngo-tracheitis, A36 – Diphtheria, and A37 - Whooping cough.
Lower Respiratory Tract Infections (LRTI)J041 - Acute tracheitis, J12 - Viral pneumonia, not elsewhere classified, J13 - Pneumonia due to Streptococcus pneumoniae, J14 - Pneumonia due to Hemophilus influenzae, J15 - Bacterial pneumonia, not elsewhere classified, J16 - Pneumonia due to other infectious organisms, not elsewhere classified, J17 - Pneumonia in diseases classified elsewhere, J18 – Pneumonia, J20 - Acute bronchitis, J21 - Acute bronchiolitis, J22 - Unspecified acute lower respiratory infection, J40 - Bronchitis, not specified as acute or chronic, and J41 - Simple and mucopurulent chronic bronchitis
Infectious Diarrheal diseasesA06 – Amebiasis, A084 - Viral Gastroenteritis, A09 - Bacterial Gastroenteritis, A090 - Acute Bloody Diarrhea (suspected Shigella), A099 - Gastroenteritis of unspecified infectious origin, A03 – Shigellosis, A04 - Other bacterial intestinal infections, and A00 - Cholera / acute watery diarrhea.
Chronic anemiaD50 - Iron deficiency anemia, D51 - Vitamin B12 deficiency anemia, D52 - Folate deficiency anemia, D53 - Other nutritional anemias, D55.0 - Favism - G6PD Deficiency, D55 - Anemia due to enzyme disorders, D56 – Thalassemia, D57 - Sickle-cell disorders, D58 - Other hereditary hemolytic anemias, D59 - Acquired hemolytic anemia, D60 - Acquired pure red cell aplasia [erythroblastopenia], D61 - Other aplastic anemias and other bone marrow failure syndromes, D62 - Acute posthemorrhagic anemia, D63 - Anemia in chronic diseases classified elsewhere, D64 - Other anemias, and D649 – Anemia.
Malnutrition disordersE45 - Retarded development following protein-energy malnutrition, E64 - Sequelae of malnutrition and other nutritional deficiencies, E63 - Other nutritional deficiencies, E55 - Vitamin D deficiency, E61 - Deficiency of other nutrient elements, E46 - Unspecified protein-calorie malnutrition, E58 - Dietary calcium deficiency, E56 - Other vitamin deficiencies, R62.51 - Failure to thrive, E43 - Unspecified severe protein-calorie malnutrition, Rickets, E44 - Protein- calorie malnutrition of moderate and mild degree, E60 - Dietary zinc deficiency.
We used the World Health Organization (WHO) criteria for diagnosing acute malnutrition based on three criteria; mid-upper arm circumference (MUAC), weight-for-height/length (z score), and clinical (i.e., presence of edema). Although severe acute malnutrition (SAM) is defined by a very low weight-for-height (below – 3 z scores of the median WHO growth standards), by visible severe wasting (based on MUAC), or by the presence of nutritional edema.[11] The MUAC was mainly used for patients aged between 6 and 59 months, plus their z score. Although for patients under 6 months old, we mainly used the z score. For acute diarrheal diseases, we used the WHO classification,[12] which classifies acute diarrhea into three categories: Acute watery diarrhea: lasts several hours or days, and includes cholera Acute bloody diarrhea: also called dysentery Other acute diarrhea: not included in the above two categories Finally, correlation between the prevalence of encountered diseases/conditions and potentially related variables was explored. We evaluated the effect of age, sex, season of the year, and condition of living (IPD vs. town resident) on the incidence of the most common communicable diseases and nutritional deficiencies.

Statistical analysis

We present descriptive results, using frequency, percentage, mean, standard deviation (SD), median, and minimum and maximum numbers (min – max), as appropriate. We used the chi-square test to calculate P values when comparing categorical and frequency results. We used McNemar’s test to compare odd ratios (OR). We considered a P value of 0.05 or less as statistically significant. Analyses were carried out and graphs were prepared using Excel 2017 (Microsoft) and R version 3.3.2.

RESULTS

We included 11,819 patients in this study, of them 5,288 (45%) were males and 6,531 (55%) were females. Among these patients, 6300 (53%) lived in an IDP camp and 5,520 (47%) were residents in town. Their age distribution is as follows: Neonates: 862 (7%) patients, 467 (9%) males and 395 (6%) females, from all cases Infants: 3662 (31%) patients, 1921 (36%) males and 1741 (27%) females, from all cases Toddlers: 2383 (20%) patients, 1267 (24%) males and 1116 (17%) females, from all cases Childhood: 2103 (18%) patients, 1142 (22%) males and 961 (15%) females, from all cases Early teenage: 988 (8%) patients, 455 (9%) males and 533 (8%) females, from all cases Late teenage: 1821 (15%) patients, 36 (1%) males and 1785 (27%) females, from all cases A total of 23,427 patient encounters were observed during the study period; 19,740 resulted in a recorded diagnosis. Encounters because of respiratory diseases topped the list of the most common illness categories for all age groups, 6320 (27%), except in the late teenage, when gynecological/obstetric complaints dominated, pregnancy-related issues represented the most common cause for consultation. Etiologically, infectious diseases caused most of the burden across all age groups; with upper respiratory tract infections (URTIs), infectious diarrhea, and otitis media representing almost half (47%) of all cases. Nutritional deficiencies were diagnosed in 978 patients (8%), mostly in infants and toddlers (92%). Patients in the IDP camps represented a greater proportion of those with nutritional deficiencies (66% of all cases) compared to town residents (P ≤ 0.001). SAM cases were also more common among IDP (77% of all cases) (p ≤ 0.001). Of interest, a similar distribution for dermatological conditions was observed. As for endocrine disorders, children and early teens were more affected (78%) than other age groups. The same pattern was found for the musculoskeletal illnesses with 64% of cases among IDP. Cardiac presentations were encountered only in 44 (0.003%) patients. A total of 59% were diagnosed in patients who were less than 1 year old. Poisoning was encountered in 100 patients with clear predilection in males and young age; 60% of them occurred in children aged 4 years or younger. No difference was found related to the condition of living (camps vs. town). No cases were reported in newborn infants or late teenage groups. Thirty-two percent (n = 32) of cases labeled as “poisoning” were secondary to insect and arthropod envenomation, 41% (n = 41) secondary to food poisoning, and the remainder 27% (n = 27) were due to the ingestion of household chemicals and medications. Figure 2 summarizes the top 20 most common diseases encountered by patients.
Figure 2

Top 20 causes of diseases in all studied population. Note: Percentages of this figure are of the total numbers of patients with these top 20 illnesses not the total of all cohorts. Values represent percentage among all patients

Top 20 causes of diseases in all studied population. Note: Percentages of this figure are of the total numbers of patients with these top 20 illnesses not the total of all cohorts. Values represent percentage among all patients Table 1 summarizes the top 15 most common diagnoses encountered among different age groups.
Table 1

Top 15 most common diagnosis among different age groups

DiagnosisTotal
Male
Female
FrequencyPercentage among age groupFrequencyPercentage among age groupFrequencyPercentage among age group
Neonates (1–27 days)Total (862 patients)Male (467 patients)Female (395 patients)
 Neonatal jaundice; due to all reasons25629.715232.5410426.32
 Abdominal colic/other and unspecified abdominal pain9210.67439.214912.41
 Influenza due to other identified influenza virus729.36388.14348.61
 Omphalitis of newborn677.77316.64369.11
 Recurrent oral aphthae576.61275.78307.59
 Acute bronchiolitis414.76214.50205.06
 Conjunctivitis394.52255.35143.54
 Nonsuppurative otitis media252.90132.78123.04
 Nasopharyngitis, common cold252.90132.78123.04
 Infantile colic242.78183.8561.52
 Viral and other specified intestinal infections242.78102.14143.54
 Dehydration fever232.67122.57123.04
 Nausea and vomiting212.44102.14112.78
 Diaper (napkin) dermatitis202.32102.14102.53
 Fever of other and unknown origin192.20132.7861.52
Infants (28–365 days)Total (3662 patients)Male (1921 patients)Female (1741 patients)
 Nonsuppurative otitis media90124.6050226.1339922.92
 Influenza due to other identified influenza virus85523.3543822.8041723.95
 Acute bronchiolitis66818.2438920.2527916.03
 Viral and other specified intestinal infections60516.5234417.9125514.65
 Asthma43611.9130916.091277.29
 Other nutritional deficiencies41911.4422911.9219010.91
 Viral intestinal infection, unspecified2667.261407.291237.06
 Urinary tract infection1915.22663.441257.18
 Acute watery diarrhea/suspected cholera1885.13844.37985.63
 Abdominal colic/other and unspecified abdominal pain1564.26884.58683.91
 Fever of unknown origin1353.69643.33693.96
 Nasopharyngitis, common cold1293.52703.64593.39
 Acute bronchitis1253.41623.23633.62
 Diarrhea and gastroenteritis of presumed infectious origin1213.30763.96432.47
 Recurrent oral aphthae1153.14572.97583.33
Toddlers (above 1–4 years)Total (2383 patients)Male (1267 patients)Female (1116 patients)
 Nonsuppurative otitis media64326.9837029.2027324.46
 Influenza due to certain identified influenza viruses51421.5725420.0526023.30
 Viral intestinal infection, unspecified45919.2627321.5518616.67
 Asthma38015.9523818.7814212.72
 Acute bronchiolitis31113.0519815.6311310.13
 Acute tonsillitis1777.431078.45706.27
 Urinary tract infection1586.63393.0811910.66
 Streptococcal, tonsillitis1134.74574.50565.02
 Fever of unknown origin1074.49473.71605.38
 Acute pharyngitis1024.28524.10504.48
 Acute watery diarrhea/suspected cholera893.73473.71423.76
 Streptococcal pharyngitis883.69413.24474.21
 Gastroenteritis and colitis of unspecified origin632.64272.13363.23
 Diarrhea and gastroenteritis of presumed infectious origin622.60403.16221.97
 Nasopharyngitis, common cold572.39302.37272.42
Childhood (5–9 years)Total (2103 patients)Male (1142 patients)Female (961 patients)
 Influenza due to other identified influenza virus25612.1718015.7617618.31
 Asthma1778.421079.37707.28
 Acute tonsillitis1738.23998.67747.70
 Nonsuppurative otitis media1627.70867.53767.91
 Streptococcal, tonsillitis1627.70877.62757.80
 Urinary tract infection1265.99262.2810010.41
 Acute bronchiolitis1135.37595.17545.62
 Viral and other specified intestinal infections1024.85564.90464.79
 Streptococcal pharyngitis793.76403.50394.06
 Fever of unknown origin703.33272.36434.47
 Acute pharyngitis653.09373.24282.91
 Cystitis602.85121.05484.99
 Anorexia592.81282.45313.23
Childhood (5–9 years)Total (2103 patients)Male (1142 patients)Female (961 patients)
 Unspecified urinary incontinence572.71191.66383.95
 Chronic sinusitis532.52252.19282.91
Early teenage (10–14 years)Total (988 patients)Male (455 patients)Female (533 patients)
 Influenza due to other identified influenza virus14214.377015.387213.51
 Urinary tract infection878.81112.427614.26
 Short stature747.49316.81438.07
 Asthma696.984910.77203.75
 Acute tonsillitis686.88296.37397.32
 Streptococcal, tonsillitis626.28275.93356.57
 Viral and other specified intestinal infections525.26286.15244.50
 Nonsuppurative otitis media444.45224.84224.13
 Acute pharyngitis363.64153.30213.94
 Acute bronchiolitis353.54214.62142.63
 Abdominal and pelvic pain343.4461.32285.25
 Acute sinusitis303.04163.52142.63
 Chronic sinusitis292.9491.98203.75
 Unspecified urinary incontinence272.73102.20173.19
 Fever of unknown origin252.53143.08112.06
Late teenage (15–19 years)Total (1822 patients)Male (36 patients)Female (1785 patients)
 Pregnancy118364.93NANA118366.27
 Excessive, frequent, and irregular menstruation1085.93NANA1086.05
 Urinary tract infection1035.6500.001035.77
 Infection of vagina and vulva814.45NANA814.54
 Absent, scanty, and rare menstruation804.39NANA804.48
 Malaise and fatigue291.5900.00291.62
 Abdominal and pelvic pain261.4300.00261.46
 Female infertility, unspecified231.26NANA231.29
 Urethritis and urethral syndrome221.2100.00221.23
 Abortion: spontaneous160.88NANA160.90
 Other abnormal uterine and vaginal bleeding140.77NANA140.78
 Dorsalgia140.7700.00140.78
 Delayed menses130.71NANA130.73
 Dysmenorrhea, unspecified110.60NANA110.62
 Unspecified ovarian cysts110.60NANA110.62

NA = Not applicable

Top 15 most common diagnosis among different age groups NA = Not applicable Figure 3 summarizes the frequency and distribution of diagnoses classified by category.
Figure 3

Frequency and distribution of diagnoses classified by category among different age groups. Values represent percentage among each age category

Frequency and distribution of diagnoses classified by category among different age groups. Values represent percentage among each age category A more comprehensive report about the incidence of all diseases is available in the online Supplementary Table 2.
Supplementary Table 2
Neonates (1 to 27 days)Total number of patients862Total number of diagnoses1244
TotalMale (467 patients)Female (395 patients)
DiagnosisICD-10 codeFrequencyPercentage among age groupFrequencyPercentage among age groupFrequencyPercentage among age group
Cardiology91.0440.8651.27
Cardiac murmurs and other cardiac soundsR0191.0440.8651.27
Dermatology424.87224.71205.06
Rash and other nonspecific skin eruptionR2160.7040.8620.51
Other erythematous conditionsL5350.5820.4330.76
Diaper [napkin] dermatitisL22202.32102.14102.53
Allergic contact dermatitisL2320.2310.2110.25
Exfoliatn due to erythemat cond accord extent body involvNA10.1200.0010.25
ImpetigoL0110.1210.2100.00
Infective dermatitis/Eczematoid dermatitisL30330.3520.4310.25
Erythema multiformeL5110.1200.0010.25
Erythema in diseases classified elsewhereL5410.1200.0010.25
Unspecified contact dermatitisL2510.1210.2100.00
PemphigusL1010.1210.2100.00
Endocrinology10.1200.0010.25
HypoglycemiaNA10.1200.0010.25
Gastroenterology20023.209620.5610426.33
Abdominal Colic/Other and unspecified abdominal painR1049210.67439.214912.41
Anal fissure, unspecifiedK60210.1210.2100.00
Cellulitis and abscess of mouthK12220.2300.0020.51
ConstipationK59030.3500.0030.76
Flatulence and related conditionsR1410.1200.0010.25
Gastro oesophageal reflux diseaseK21920.2310.2110.25
Gastroentestinal bleedingNA10.1210.2100.00
Inguinal herniaK4030.3530.6400.00
Intestinal malabsorptionK9010.1200.0010.25
Nausea and vomitingR11212.44102.14112.78
Other and unsp noninfective gastroenteritis and colitisK5240.4630.6410.25
Other diseases of anus and rectumK6220.2320.4300.00
Other diseases of lip and oral mucosaK1330.3520.4310.25
Recurrent oral aphthaeK120576.61275.78307.59
Stomatitis and related lesionsK1260.7020.4341.01
Ventral herniaK4310.1210.2100.00
Hematology & Immunology10.1210.2100.00
Other and unsp diseases of blood and blood-forming organsD7510.1210.2100.00
Infectious disease10011.605110.924912.41
Viral and other specified intestinal infectionsA08242.78102.14143.54
Other bacterial intestinal infectionsA0410.1200.0010.25
Fever of other and unknown originR50192.20132.7861.52
Dehydration feverNA9232.67122.57123.04
Cholera/ AWD/ Suspected CholeraA00121.3951.0771.77
Viral intestinal infection, unspecifiedA08450.5830.6420.51
Gastroenteritis and colitis of unspecified originA09950.5820.4330.76
Circumcision infectionNA1010.1210.2100.00
Diarrhea and gastroenteritis of presumed infectious originA0960.7030.6430.76
septicaemia/SepsisA4120.2310.2110.25
Acute hepatitis AB1510.1210.2100.00
Musculoskeletal disorders10.1210.2100.00
Other disorders of boneM8910.1210.2100.00
Neonatology / congenital anomalies38945.1321946.9017043.04
Birth injury to skeletonP1320.2310.2110.25
Chronic respiratory disease origin in the perinatal periodP2760.7040.8620.50
Cleft lipQ3620.2300.0020.51
clitoreomegalyNA10.1200.0010.25
Congenital deformities of feetQ6610.1200.0010.25
Congenital deformities of hipQ6510.1200.0010.25
Cri de chat syndromeQ93.410.1200.0010.25
Disord of NB related to slow fetal growth and fetal malnutP0520.2300.0020.51
Down syndromeQ9010.1210.2100.00
Erb Duchenn palsyP14.050.5830.6420.51
infantile colicNA242.78183.8561.52
Inflammatory disorders of breastN6110.1200.0010.25
Intracranial laceration and hemorrhage due to birth injuryP1010.1210.2100.00
Labia migora megalyNA20.2300.0020.51
Neoborn vaginal hemorrhageNA10.1200.0010.25
Neonatal Breast EnlargementNA10.1210.2100.00
Neonatal jaundice due to other excessive haemolysisNA16719.3710322.066416.20
Neonatal jaundice from other and unspecified causesP59809.28459.64358.86
Newborn affected by maternal complications of pregnancyNA10.1200.0010.25
Omphalitis of newbornP38677.77316.64369.11
open posterior fontanelleNA20.2300.0020.51
Other congenital malformations of digestive systemQ4510.1210.2100.00
Other disorders of breastO9210.1200.0010.25
Other infections specific to the perinatal periodP3910.1200.0010.25
Respiratory distress of newbornP2250.5830.6420.51
Swallowed blood syndromeP78.220.2310.2110.25
Umbilical hemorrhage of newbornP5150.5840.8610.25
Unspecified jaundiceR1750.5820.4330.76
Nephrology and urology293.36163.43133.29
CystitisN3030.3530.6400.00
Urinary tract infectionN390111.2840.8671.77
PyelonephritisN1220.2320.4300.00
HematuriaR3150.5830.6420.51
Oth and unsp symptoms and signs involving the GU sysR3920.2310.2110.25
Urethritis and urethral syndromeN3420.2320.4300.00
Anuria and oliguriaR3420.2310.2110.25
Pain associated with micturitionR3010.1200.0010.25
Retention of urineR3310.1200.0010.25
Neurology20.2300.0020.51
Other paralytic syndromesG8310.1200.0010.25
Febrile ConvulsionR56010.1200.0010.25
Nutrition and metabolisim disorders343.94204.28143.54
Other nutritional deficienciesE63182.09132.7800.00
suboptimal breastfeedingNA30.3530.6400.00
Failure to thriveR62.5120.2310.2110.25
Deficiency of other nutrient elementsE6130.3500.0030.76
Sequelae of malnutrition and other nutritional deficienciesE6430.3500.0030.76
Other nutritional deficienciesE63182.0900.0051.27
Vitamin D deficiencyE5520.2300.0020.51
Retarded development following protein-energy malnutritionE4520.2320.4300.00
AnorexiaR63010.1210.2100.00
Oncology20.2300.0020.51
HemangiomaNA10.1200.0010.25
Neoplasm of uncertain behavior of brain and cnslNA10.1200.0010.25
Ophthalmology526.03347.28184.56
ConjunctivitisH10394.52255.35143.54
Stenosis and insufficiency of lacrimal passagesH04591.0461.2830.76
DacryoadenitisH04010.1210.2100.00
Disorders of lacrimal systemH0410.1210.2100.00
Other disorders of conjunctivaH1120.2310.2110.25
Otolaryngology293.36173.64123.04
Nonsuppurative otitis mediaH65252.90132.78123.04
coanal atresiaNA10.1210.2100.00
Acute tonsillitisJ0320.2320.4300.00
Acute suppurative otitis mediaH66010.1210.2100.00
Poisoning10.1210.2100.00
Venom of other arthropods/ Insect biteT63410.1210.2100.00
Respiratory diseases17920.779319.918621.77
Acute bronchiolitisJ21354.06163.43194.81
Acute bronchitisJ2091.0461.2830.76
Acute laryngitisJ04010.1200.0010.25
Acute pharyngitisJ0230.3510.2120.51
Acute respiratory distress syndromeJ8010.1210.2100.00
Acute upper resp infections of multiple and unsp sitesJ06111.2851.0761.52
AsthmaJ4560.7051.0710.25
Bacterial pneumonia, not elsewhere classifiedJ1510.1210.2100.00
CoughR0530.3510.2120.51
Diseases of vocal cords and larynx, not elsewhere classifiedJ3820.2310.2110.25
Influenza due to other identified influenza virusJ10729.36388.14348.61
Laryngeal spasmJ38520.2300.0020.51
LaryngomalaciaNA30.3500.0030.76
Meconium aspirationNA10.1210.2100.00
NASOPHARYNGITIS, Common cold129252.90132.78123.04
Edema of larynxJ38410.1210.2100.00
Other interstitial pulmonary diseasesJ8410.1210.2100.00
PneumoniaJ1810.1210.2100.00
Streptococcal pharyngitisJ02010.1210.2100.00
Infants (28 to 365 days)Total number of patients3662Total number of diagnoses8303
TotalMale (1921 patients)Female (1741 patients)
DiagnosisICD-10 codeFrequancyPercentage among age groupFrequancyPercentage among age groupFrequancyPercentage among age group
Cardiology170.46120.6250.29
Cardiac murmurs and other cardiac soundsR01110.3070.3640.23
Nonrheumatic pulmonary valve disordersI3720.0520.1000.00
Obstructive hypertrophic cardiomyopathyI42110.0310.0500.00
Other and unspecified disorders of circulatory systemI9910.0310.0500.00
Rheumatic chorea with heart involvementI02020.0510.0510.06
Dermatology2246.121166.041086.20
Abscess furuncle and carbuncle of noseNA20.0500.0020.11
Allergic contact dermatitisL23130.3570.3660.34
CellulitisL0320.0510.0510.06
Cicatricial alopecia [scarring hair loss]L6610.0310.0500.00
Cutaneous abscess, furuncle and carbuncle, unspecifiedL029100.2720.1080.44
Diaper [napkin] dermatitisL221092.98502.60593.39
EczemaL30390.2580.4210.06
ImpetigoL0170.1940.2130.17
Infective dermatitis/Eczematoid dermatitisL303210.5770.36140.80
Mongolian spotNA10.0300.0010.06
Nail disordersL6020.0520.1000.00
oral thrush (candidiasis)B37.010.0310.0500.00
Other and unspecified dermatitisL3050.1450.2600.00
Other local infections of skin and subcutaneous tissueL0810.0310.0500.00
Pityriasis roseaL4220.0520.1000.00
PsoriasisL4010.0300.0010.06
Rash and other nonspecific skin eruptionR21300.82190.99110.63
Scalp infectionNA10.0310.0500.00
Skin wortNA10.0310.0500.00
Unspecified contact dermatitisL2510.0310.0500.00
UrticariaL5040.1130.1610.06
Endocrinology60.1620.1040.23
Disorders of glycoprotein metabolismE7710.0300.0010.06
PorphyriaE80.2010.0300.0010.06
Short statureR62.5210.0310.0500.00
Subclinical iodine-deficiency hypothyroidismE0230.0810.0520.11
Gastroenterology65117.7835818.6429316.83
Abdominal and pelvic painR1030.0820.1010.06
Abdominal Colic/Other and unspecified abdominal painR1041564.26884.58683.91
Anal fissure, unspecifiedK60250.1440.2110.06
Cellulitis and abscess of mouthK122280.76170.88110.63
Coeliac diseaseK90070.1930.1640.23
ConstipationK590330.90150.78181.03
Diseases of salivary glandsK1110.0310.0500.00
Disorders of esophagus in diseases classified elsewhereK2310.0300.0010.06
DyspepsiaR101180.4960.31120.69
Fecal incontinenceR1510.0300.0010.06
Femoral herniaK4110.0310.0500.00
Fissure and fistula of anal and rectal regionsK6060.1610.0550.29
Flatulence and related conditionsR1420.0510.0510.06
Food allergyNA10.0300.0010.06
Foregin body injestionNA20.0510.0510.06
Functional dyspepsiaK3020.0520.1000.00
Gastro-esophageal reflux diseaseK21960.1650.2610.06
Hemorrhoids and perianal venous thrombosisK6410.0310.0500.00
Inguinal herniaK40140.38120.6220.11
Intestinal malabsorptionK9020.0500.0020.11
Lactose intoleranceE7320.0500.0020.11
Nausea and vomitingR11912.48462.39452.58
Oth symptoms and signs involving the dgstv sys and abdomenR1980.2270.3610.06
Other and unsp noninfective gastroenteritis and colitisK52882.40502.60382.18
Other diseases of anus and rectumK6210.0310.0500.00
Other diseases of biliary tractK8310.0300.0010.06
Other diseases of lip and oral mucosaK1340.1130.1610.06
Recurrent oral aphthaeK1201153.14572.97583.33
SialoadenitisK11210.0310.0500.00
Stomatitis and related lesionK12431.17281.46150.86
Umbilical herniaK4250.1420.1030.17
Unspecified jaundiceR1730.0820.1010.06
Vascular disorders of intestineK5510.0310.0500.00
Hematology & Immunology912.48502.60412.35
Anaemia, unspecifiedD649210.57120.6290.51
Favism - G6PD DeficiencyD55.010.0310.0500.00
Folate deficiency anemiaD52210.57130.6880.46
Other and unsp diseases of blood and blood-forming organsD7510.0310.0500.00
Other hereditary hemolytic anemiasD5810.0310.0500.00
Other nutritional anemiasD53401.09170.88231.32
ThalassemiaD5650.1450.2600.00
Iron deficiency anemiaD5010.0300.0010.06
Infectious disease150140.9981042.1767138.54
Acute bloody DiarrheaA09050.1410.0540.23
Acute hepatitis AB1540.1120.1020.11
Acute hepatitis BB1610.0310.0500.00
Acute poliomyelitisA8010.0300.0010.06
BacteremiaNA30.0800.0030.17
Cholera/ AWD/ Suspected CholeraA001885.13844.37985.63
Circumcision infectionNA1040.1140.2100.00
Dehydration feverNA9290.79180.94110.63
Diarrhea and gastroenteritis of presumed infectious originA091213.30763.96432.47
Fever of other and unknown originR501353.69643.33693.96
Gastroenteritis and colitis of unspecified originA099952.59542.81412.35
Hand, foot and mouth diseaseB08.460.1630.1630.17
Helminthiasis/Other helminthiasesB8320.0510.0510.06
Influenza due to certain identified influenza virusesJ0920.0520.1000.00
MumpsB2620.0510.0510.06
OsteomyelitisM8610.0310.0500.00
Other bacterial intestinal infectionsA0450.1420.1030.17
Other intestinal helminthiases, not elsewhere classifiedB8110.0310.0500.00
Other protozoal intestinal diseasesA0720.0520.1000.00
Rat-bite feversA2510.0310.0500.00
Salivary gland abscessK11310.0300.0010.06
septicaemia/SepsisA4120.0520.1000.00
Stomatitis and related lesionNA10.0310.0500.00
Streptococcal sepsisA4040.1110.0530.17
Typhoid and paratyphoid feversA0110.0300.0010.06
Unspecified viral hepatitisB1910.0310.0500.00
Varicella chickenpoxB0140.1110.0520.11
Viral and other specified intestinal infectionsA0860516.5234417.9125514.65
Viral intestinal infection, unspecifiedA0842667.261407.291237.06
Viral meningitisA8720.0510.0510.06
Whooping coughA3760.1610.0550.29
Musculoskeletal disorders80.2230.1650.29
Muscle fibrosis after injectionsNA10.0300.0010.06
Osteoarthritis of hipM1630.0800.0030.17
Other disorders of cartilageM9410.0310.0500.00
Other joint disorder, not elsewhere classifiedM2510.0310.0500.00
Shoulder lesionsM7520.0510.0510.06
Neonatology / congenital anomalies1494.07904.69593.39
Birth injury to scalpP1210.0310.0500.00
Cardiovascular disorders originating in the perinatal periodP2930.0810.0520.11
Cleft lipQ3610.0310.0500.00
Cleft palate with cleft lipQ3710.0310.0500.00
Congenital malformation of heart, unspecified/Other congenital malformations of heartQ24980.2240.2140.23
Congenital torticolisNA30.0830.1600.00
Disord of NB related to slow fetal growth and fetal malnutP0540.1110.0530.17
excessive crying (isolated)NA30.0820.1010.06
excessive crying and hypotoniaNA60.1600.0060.34
infantile colicNA611.67432.24181.03
MicrocephalyQ0230.0830.1600.00
Neonatal jaundice due to other excessive haemolysisP58190.52110.5780.46
Neonatal jaundice from other and unspecified causesP59130.3570.3660.34
Newborn affected by oth complications of labor and deliveryP0310.0300.0010.06
Omphalitis of newbornP3890.2550.2640.23
Oth respiratory conditions origin in the perinatal periodP2810.0310.0500.00
Other disturbances of cerebral status of newbornP9140.1120.1020.11
Other infections specific to the perinatal periodP3910.0300.0010.06
Other problems with newbornP8410.0310.0500.00
Respiratory distress of newbornP2230.0820.1010.06
Umbilical hemorrhage of newbornP5120.0510.0510.06
Nephrology and urology3118.491186.1419511.20
Calculus of ureterN20110.0310.0500.00
Calculus of urinary tract in diseases classified elsewhereN2210.0310.0500.00
CystitisN30340.93170.88170.98
HematuriaR3120.0510.0510.06
HydroceleNA50.1450.2600.00
HypospadiasNA10.0310.0500.00
Kidney calculusN20010.0310.0500.00
Noninflammatory disorders of testisN4430.0830.1600.00
Orchitis and epididymitisN4510.0300.0010.06
Oth and unsp symptoms and signs involving the GU sysR39461.2640.21422.41
Other disorders of bladderN3220.0520.1000.00
Other disorders of penisN4820.0520.1000.00
Pain associated with micturitionR3040.1120.1020.11
PyelonephritisN12120.3390.4730.17
Recurrent and persistent hematuriaN0210.0310.0500.00
Retention of urineR3310.0300.0010.06
Unspecified urinary incontinenceR3210.0300.0010.06
Urethral strictureN3510.0310.0500.00
Urethritis and urethral syndromeN3430.0810.0520.11
Urinary tract infectionN3901915.22663.441257.18
Neurology381.04150.78231.32
Abnormalities of gait and mobilityR2630.0800.0030.17
brain atrophyNA10.0310.0500.00
Febrile ConvulsionR560100.2730.1670.40
HydrocephalousNA10.0310.0500.00
MeningitisG0310.0310.0500.00
Other disorders of brainG9310.0300.0010.06
Other disorders of brain in diseases classified elsewhereG9420.0520.1000.00
Oth symptoms and signs involving the nervous and ms systemsNA30.0820.1010.06
Other mononeuropathiesG5810.0300.0010.06
Other paralytic syndromesG8310.0300.0010.06
SeizureNA20.0500.0020.11
Somnolence, stupor and comaR4080.2230.1650.29
TremorNA10.0300.0010.06
Specific developmental disorder of motor functionF8230.0820.1010.06
Nutrition and metabolisim disorders74220.2637719.6336520.96
AnorexiaR630220.60120.62100.57
Breastfeeding misconceptionsNA10.0300.0010.06
Cow's milk allergyNA10.0300.0010.06
Deficiency of other nutrient elementsE61110.3070.3640.23
Dietary calcium deficiencyE5850.1420.1030.17
Disorders of glycoprotein metabolismE7710.0310.0500.00
Failure to thriveR62.51501.37241.25261.49
Food allergyNA20.0500.0020.11
Lactose intoleranceE7350.1420.1030.17
Milk protein allergyNA10.0310.0500.00
Nutritional deficiencyNA10.0310.0500.00
Other nutritional deficienciesE6341911.4422911.9219010.91
Other vitamin deficienciesE5650.1420.1030.17
Protein-calorie malnutrition of moderate and mild degreeE4450.1410.0540.23
Retarded development following protein-energy malnutritionE45862.35351.82512.93
Sequelae of malnutrition and other nutritional deficienciesE64170.4690.4780.46
Suboptimal breastfeedingNA60.1620.1040.23
Unspecified protein-calorie malnutritionE4690.2520.1070.40
Unspecified severe protein-calorie malnutritionE4350.1410.0540.23
Vitamin D deficiencyE55902.46462.39442.53
Oncology10.0300.0010.06
HemangiomaNA10.0300.0010.06
Ophthalmology1062.89552.86512.93
ConjunctivitisH10862.35442.29422.41
Stenosis and insufficiency of lacrimal passagesH045150.4190.4760.34
Hypopigmented lesions on eyelidsNA10.0310.0500.00
Other disorders of conjunctivaH1110.0310.0500.00
Disorders of lacrimal systemH0430.0800.0030.17
Other Diseases431.17281.46150.86
Teething painNA3290.79180.94110.63
Delayed teethingNA10.0310.0500.00
Drug allergyNA20.0510.0510.06
Edema, not elsewhere classifiedR6030.0820.1010.06
Enlarged lymph nodesR5940.1130.1610.06
Malaise and fatigueR5340.1130.1610.06
Otolaryngology113931.1063232.9050729.12
Nonsuppurative otitis mediaH6590124.6050226.1339922.92
Suppurative and unspecified otitis mediaH66310.85180.94130.75
Other disorders of external earH61320.87170.88150.86
Otitis externaH60130.3580.4250.29
Acute tonsillitisJ03511.39331.72181.03
Streptococcal, TONSILLITISJ030441.20241.25201.15
Acute suppurative otitis mediaH660270.74130.68140.80
Eczema of external auditory canalL30320.0520.1000.00
snuffling or snortingNA20.0510.0510.06
DeafnessNA10.0310.0500.00
Otitis media, unspecifiedH669100.2740.2160.34
External auditory canal abscessNA10.0310.0500.00
Ear canal obstructionNA10.0310.0500.00
Stenosis and insufficiency of lacrimal passagesH04510.0310.0500.00
Foreign body in the noseNA10.0310.0500.00
Nasal dischargeNA20.0520.1000.00
Disorders of external ear in diseases classified elsewhereH6260.1610.0550.29
Nasal dischargeNA20.0520.1000.00
Impacted cerumenH61220.0500.0020.11
Other and unspecified hearing lossH9110.0300.0010.06
EczemaL30310.0300.0010.06
Otitis media in diseases classified elsewhereH6720.0500.0020.11
Foregin body in the earT1610.0300.0010.06
Poisoning240.66120.62120.69
Bacterial foodborne intoxicationA0530.0810.0520.11
Chlore poisoningNA10.0300.0010.06
Detergent poisoningNA10.0300.0010.06
Oil poisoningNA10.0300.0010.06
Oth bacterial foodborne intoxications, NECA0530.0810.0520.11
Petroleum poisoningNA20.0500.0020.11
Sequelae of poisoning by drugs, medicaments and biological substancesT9620.0510.0510.06
Toxic injestionNA10.0310.0500.00
Venom of other arthropods/ Insect biteT634100.2780.4220.11
Respiratory diseases262171.57151478.81110763.58
Acute bronchiolitisJ2166818.2438920.2527916.03
Acute bronchitisJ201253.41623.23633.62
Acute laryngitisJ040100.2770.3630.17
Acute laryngitis and tracheitisJ04130.3570.3660.34
Acute obstructive laryngitis [croup] and epiglottitisJ0520.0520.1000.00
Acute pharyngitisJ02872.38572.97301.72
Acute sinusitisJ0140.1130.1610.06
Acute upper resp infections of multiple and unsp sitesJ06431.17251.30181.03
AsthmaJ4543611.9130916.091277.29
BronchiectasisJ4740.1130.1610.06
Bronchitis, not specified as acute or chronicJ4090.2540.2150.29
Chronic diseases of tonsils and adenoidsJ3510.0310.0500.00
Chronic laryngitis and laryngotracheitisJ3740.1140.2100.00
Chronic rhinitis, nasopharyngitis and pharyngitisJ3160.1620.1040.23
Chronic sinusitisJ3230.0820.1010.06
CoughR05250.68110.57140.80
Diseases of vocal cords and larynx, not elsewhere classifiedJ38120.33100.5220.11
Hypertrophy of tonsils with hypertrophy of adenoidsJ35320.0520.1000.00
Influenza due to other identified influenza virusJ1085523.3543822.8041723.95
Laryngeal spasmJ385170.46100.5270.40
NASOPHARYNGITIS, Common coldJ001293.52703.64593.39
Edema of larynxJ38430.0820.1010.06
Other diseases of upper respiratory tractJ39140.3880.4260.34
PneumoniaJ18170.46120.6250.29
Pneumonia due to oth infectious organisms, NECJ1610.0310.0500.00
Pneumonia in diseases classified elsewhereJ1710.0310.0500.00
Pulmonary edemaJ81110.30100.5210.06
Streptococcal pharyngitisJ020912.48552.86362.07
Unspecified chronic bronchitisJ4290.2530.1660.34
Respiratory disorders in diseases classified elsewhereJ9930.0810.0520.11
Acute respiratory distress syndromeJ8020.0510.0510.06
Foregin body inhalationNA20.0510.0510.06
EmphysemaJ4310.0310.0500.00
LaryngomalaciaNA40.1100.0040.23
Bacterial pneumonia, not elsewhere classifiedJ1520.0500.0020.11
Other respiratory disordersJ9810.0300.0010.06
Other interstitial pulmonary diseasesJ8410.0300.0010.06
Allergic rhinitis, unspecifiedJ30410.0300.0010.06
Abnormalities of breathingR0610.0300.0010.06
Viral pneumonia, not elsewhere classifiedJ1210.0300.0010.06
Trauma / Injury150.4160.3190.52
Drowning and nonfatal submersionT75110.0300.0010.06
Ecchymosis on the chestNA10.0310.0500.00
Ecchymosis on the footNA10.0300.0010.06
Ecchymosis on the geniral areaNA10.0300.0010.06
Ecchymosis on the handNA10.0300.0010.06
Ecchymosis on the headNA40.1120.1020.11
Ecchymosis on the noseNA10.0300.0010.06
Fall downNA10.0310.0500.00
Fall from, out of or through building or structureW1310.0300.0010.06
Head ecchymosisNA10.0300.0010.06
Other fall from one level to anotherW1710.0310.0500.00
Unspecified fallW1910.0310.0500.00
Toddlers (above 1 to 4 years)Total number of patients2383Total number of diagnoses5443
TotalMale (1267 patients)Female (1116 patients)
DiagnosisICD-10 codeFrequancyPercentage among age groupFrequancyPercentage among age groupFrequancyPercentage among age group
Cardiology90.3860.4730.27
Cardiac murmurs and other cardiac soundsR0170.2950.3920.18
Heart FailureI5010.0410.0800.00
Other cardiac arrhythmiasI4910.0400.0010.09
Dermatology1636.84846.63797.08
Allergic contact dermatitisL23291.22171.34121.08
Alopecia areataL6310.0400.0010.09
Atopic dermatitisL2010.0410.0800.00
CellulitisL0340.1710.0830.27
Cutaneous abscess, furuncle and carbuncle, unspecifiedL02970.2940.3230.27
Diaper [napkin] dermatitisL22401.68141.10262.33
DrynessNA10.0400.0010.09
EczemaL30320.0820.1600.00
Erythema multiformeL5110.0410.0800.00
ImpetigoL01180.76120.9560.54
Infective dermatitis/Eczematoid dermatitisL303110.4640.3270.63
LeishmaniasisB5530.1310.0820.18
Skin wortNA10.0410.0800.00
Other and unspecified dermatitisL3020.0810.0810.09
Other disorders of skin and subcutaneous tissueL9830.1320.1610.09
Pilonidal cyst and sinusL0510.0400.0010.09
Pityriasis roseaL4240.1720.1620.18
PruritusL2920.0820.1600.00
Rash and other nonspecific skin eruptionR21160.67100.7960.54
Scalp infectionNA10.0410.0800.00
TineaNA10.0410.0800.00
Tinea barbae and tinea capitisB35010.0400.0010.09
Tinea capitisNA10.0410.0800.00
UrticariaL50110.4660.4750.45
VitiligoL8010.0400.0010.09
Endocrinology180.7670.55110.99
Growth hormone deficiencyNA10.0400.0010.09
HypoglycemiaNA10.0410.0800.00
Other disorders of thyroidE0710.0400.0010.09
Short statureR62.52140.5960.4780.72
Gastroenterology35414.8617713.9717715.86
Abdominal and pelvic painR10190.8040.32151.34
Abdominal Colic/Other and unspecified abdominal painR104251.05100.79151.34
Abscess of anal and rectal regionsK6110.0410.0800.00
Anal fissure, unspecifiedK60220.0820.1600.00
Cellulitis and abscess of mouthK122200.84151.1850.45
Coeliac diseaseK900261.09120.95141.25
ConstipationK590140.5940.32100.90
Diseases of salivary glandsK1110.0400.0010.09
Disord of GB, biliary trac and pancreas in dis classd elswhrK8710.0400.0010.09
DyspepsiaR101100.4250.3950.45
Fissure and fistula of anal and rectal regionsK6030.1300.0030.27
Foreign body injestionNA20.0800.0020.18
Functional dyspepsiaK3020.0810.0810.09
GI bleedingNA10.0410.0800.00
Inguinal herniaK4070.2960.4710.09
Intestinal malabsorptionK90140.5960.4780.72
Nausea and vomitingR11371.55151.18221.97
Oth symptoms and signs involving the dgstv sys and abdomenR1970.2920.1650.45
Other and unsp noninfective gastroenteritis and colitisK52401.68211.66191.70
Other diseases of anus and rectumK6270.2940.3230.27
Other diseases of digestive systemK9210.0410.0800.00
Other diseases of lip and oral mucosaK1380.3430.2450.45
Other diseases of liverK7620.0810.0810.09
Other diseases of stomach and duodenumK3110.0400.0010.09
Other functional intestinal disordersK5920.0800.0020.18
Periapical abscess without sinusK04710.0410.0800.00
Recurrent oral aphthaeK120552.31312.45242.15
Stomatitis and related lesionsK12401.68292.29110.99
Symp and signs specifically assoc w sys inflam and infctR6510.0410.0800.00
Ulcerative colitisK5110.0400.0010.09
Umbilical herniaK4210.0400.0010.09
Unspecified jaundiceR1720.0810.0810.09
Hematology & Immunology1044.36655.13393.49
Anemia, unspecifiedD649381.59231.82151.34
Other nutritional anemiasD53331.38211.66121.08
Folate deficiency anemiaD52241.01131.03110.99
Acquired hemolytic anemiaD5910.0410.0800.00
Primary thrombocytopeniaNA10.0410.0800.00
Hemorrhagic condition, unspecifiedD69920.0820.1600.00
ThalassemiaD5620.0820.1600.00
Purpura and other haemorrhagic conditionsD6920.0820.1600.00
Other immunodeficienciesD8410.0400.0010.09
Infectious disease92938.9850740.0242237.81
Dehydration feverNA9160.6760.47100.90
AbscessesNA10.0400.0010.09
Acute bloody DiarrheaA09010.0410.0800.00
Acute hepatitis AB15241.01131.03110.99
Acute lymphadenitisL0410.0410.0800.00
BrucellosisA2310.0400.0010.09
Cholera/ AWD/ Suspected CholeraA00893.73473.71423.76
Dehydration feverNA9160.6760.47100.90
Diarrhea and gastroenteritis of presumed infectious originA09622.60403.16221.97
Fever of other and unknown originR501074.49473.71605.38
Gastroenteritis and colitis of unspecified originA099632.64272.13363.23
Hand, foot and mouth diseaseB08.4110.4640.3270.63
Helminthiasis/Other helminthiasesB83100.4240.3260.54
MeaslesB0510.0410.0800.00
MumpsB2660.2540.3220.18
OsteomyelitisM8620.0800.0020.18
Other bacterial intestinal infectionsA0410.0400.0010.09
Other intestinal helminthiases, not elsewhere classifiedB81140.5970.5570.63
Other protozoal intestinal diseasesA0710.0410.0800.00
Rubella [German measles]B0650.2110.0840.36
ScabiesB8650.2120.1630.27
septicaemia/SepsisA4120.0800.0020.18
Streptococcal sepsisA4010.0410.0800.00
Tinea crurisB35610.0400.0010.09
Typhoid and paratyphoid feversA0170.2960.4710.09
Unspecified intestinal parasitismB82100.4260.4740.36
Varicella chickenpoxB01110.4690.7120.18
Viral intestinal infection, unspecifiedA08445919.2627321.5518616.67
Whooping coughA3710.0400.0010.09
Musculoskeletal disorders241.01141.10100.90
Acquired deformities of fingers and toesM2020.0820.1600.00
Developmental delayNA10.0400.0010.09
DorsalgiaM5410.0400.0010.09
Enthesopathies, lower limb, excluding footM7610.0400.0010.09
Hip dislocationNA10.0400.0010.09
Juvenile osteochondrosis of hip and pelvisM9110.0410.0800.00
Other acquired deformities of limbsM2130.1330.2400.00
Other and unspecified arthropathyM1240.1730.2410.09
Other arthritisM1310.0410.0800.00
Other joint disorder, not elsewhere classifiedM2510.0400.0010.09
Other rheumatoid arthritisM0630.1300.0030.27
Seropositive rheumatoid arthritisM0550.2140.3210.09
Neonatology / congenital anomalies20.0800.0020.18
Other congenital malformations of brainQ0420.0800.0020.18
Other disturbances of cerebral status of newbornP9120.0800.0020.18
Nephrology and urology27911.71705.5220918.73
Calculus of urinary tract in diseases classified elsewhereN2220.0810.0810.09
CystitisN30391.64100.79292.60
HematuriaR3120.0810.0810.09
hydroceleNA20.0820.1600.00
Kidney calculusN20010.0400.0010.09
Noninflammatory disorders of testisN4420.0820.1600.00
Oth and unsp symptoms and signs involving the GU sysR39562.3550.39514.57
Pain associated with micturitionR3040.1720.1620.18
PolyuriaR3520.0820.1600.00
PyelonephritisN1250.2110.0840.36
Retention of urineR3310.0410.0800.00
Stress incontinenceN39310.0410.0800.00
Undescended testicleNA10.0410.0800.00
Unspecified urinary incontinenceR3230.1320.1610.09
Urinary tract infectionN3901586.63393.0811910.66
Neurology632.64322.53312.78
Abnormalities of gait and mobilityR2690.3850.3940.36
Delayed speachNA50.2140.3210.09
EpilepsyG4080.3440.3240.36
Febrile ConvulsionR56030.1310.0820.18
HeadacheR5120.0800.0020.18
Hemiplegia and hemiparesisG8110.0400.0010.09
HydrocephalusG9140.1710.0830.27
Infantile cerebral palsyG8060.2540.3220.18
Other disorders of brainG9360.2530.2430.27
Other disorders of brain in diseases classified elsewhereG9470.2920.1650.45
Other disorders of peripheral nervous systemG6410.0400.0010.09
Somnolence, stupor and comaR4040.1730.2410.09
Specific developmental disorder of motor functionF8240.1720.1620.18
Specific developmental disorders of speech and languageF8010.0410.0800.00
Oth symptoms and signs involving the nervous and ms systemsR2920.0820.1600.00
Nutrition and metabolisim disorders2058.60886.9511710.48
AnorexiaR630361.51151.18211.88
Deficiency of other nutrient elementsE6110.0400.0010.09
Dietary calcium deficiencyE5880.3420.1660.54
Disorders of glycoprotein metabolismE7710.0410.0800.00
Failure to thriveR62.51170.7190.7180.72
Other nutritional deficienciesE63482.01231.82252.24
Protein-calorie malnutrition of moderate and mild degreeE4410.0400.0010.09
Retarded development following protein-energy malnutritionE45341.43120.95221.97
RicketsNA10.0410.0800.00
Sequelae of malnutrition and other nutritional deficienciesE6460.2530.2430.27
Unspecified protein-calorie malnutritionE4650.2140.3210.09
Vitamin D deficiencyE55471.97181.42292.60
Ophthalmology582.43362.84232.06
ConjunctivitisH10492.06342.68151.34
Other disorders of conjunctivaH1130.1310.0820.18
Other inflammation of eyelidH0110.0400.0010.09
Retained (old) intraocular foreign body, magneticH44610.0400.0010.09
Stenosis and insufficiency of lacrimal passagesH04520.0810.0810.09
StyeNA30.1300.0030.27
Other Diseases391.64292.29100.90
Drug allergyNA40.1740.3200.00
Edema, not elsewhere classifiedR6020.0800.0020.18
Enlarged lymph nodesR59110.4690.7120.18
Malaise and fatigueR5330.1320.1610.09
Oth noninfective disorders of lymphatic vessels and nodesI8910.0400.0010.09
Pain, unspecifiedR5230.1330.2400.00
Teething painNA3120.5090.7130.27
Upper incisors stainsNA10.0410.0800.00
Otolaryngology103643.4757845.6245841.04
Nonsuppurative otitis mediaH6564326.9837029.2027324.46
Streptococcal, TONSILLITISJ0301134.74574.50565.02
Acute tonsillitisJ031777.431078.45706.27
Suppurative and unspecified otitis mediaH66251.05120.95131.16
Other disorders of external earH61130.5560.4770.63
Otitis media, unspecified/otitis fungiH66930.1320.1610.09
Disorders of external ear in diseases classified elsewhereH6290.3850.3940.36
Acute suppurative otitis mediaH660160.6790.7170.63
Foreign body in the noseNA50.2140.3210.09
Otitis media, unspecifiedH66930.1320.1610.09
snuffling or snortingNA10.0410.0800.00
Impacted cerumenH61220.0810.0810.09
Allergic rhinitisJ30410.0410.0800.00
Fungal otitis mediaNA10.0410.0800.00
Otitis externaH6070.2900.0070.63
Eustachian salpingitis and obstructionH6810.0400.0010.09
Foregin body in the noseNA10.0400.0010.09
Foregin body in the earT1630.1300.0030.27
Oth disord of mid ear and mastoid in diseases classd elswhrH7510.0400.0010.09
Foreign body in noseNA10.0400.0010.09
otic painNA10.0400.0010.09
Otitis media in diseases classified elsewhereH6750.2100.0050.45
Nasal dischargeNA10.0400.0010.09
EczemaL30310.0400.0010.09
Otitis externiaNA10.0400.0010.09
Nasal dischargeNA10.0400.0010.09
Poisoning271.13181.4290.81
Bacterial foodborne intoxicationA0530.1320.1610.09
Burns classified accord extent body involvT3110.0410.0800.00
Detergent poisoningNA20.0820.1600.00
Drug poisoningNA20.0800.0000.00
Food poisoningNA10.0410.0800.00
Petroleum poisoningNA20.0820.1600.00
Organophosphate poisoningNA10.0400.0010.09
Oth bacterial foodborne intoxications, NECA0530.1320.1610.09
Sequelae of poisoning by drugs, medicaments and biological substancesT9620.0820.1600.00
Venom of other arthropods/ Insect biteT63480.3430.2450.45
Venom of scorpion/ Scorpion biteT63220.0810.0810.09
Respiratory diseases177874.61100379.1677569.44
Acute bronchiolitisJ2131113.0519815.6311310.13
Acute bronchitisJ20451.89262.05191.70
Acute laryngitisJ040200.84141.1060.54
Acute laryngitis and tracheitisJ04120.5040.3280.72
Acute obstructive laryngitis [croup] and epiglottitisJ0540.1730.2410.09
Acute pharyngitisJ021024.28524.10504.48
Acute sinusitisJ01220.92161.2660.54
Acute upper resp infections of multiple and unsp sitesJ06281.17181.42100.90
Allergic rhinitis, unspecifiedJ30410.0410.0800.00
AsthmaJ4538015.9523818.7814212.72
Bronchitis, not specified as acute or chronicJ4070.2930.2440.36
Chronic diseases of tonsils and adenoidsJ3520.0810.0810.09
Chronic laryngitis and laryngotracheitisJ3740.1700.0040.36
Chronic rhinitis, nasopharyngitis and pharyngitisJ3160.2550.3910.09
Chronic sinusitisJ32271.13181.4290.81
CoughR07361.51191.50171.52
Diseases of vocal cords and larynx, not elsewhere classifiedJ3830.1310.0820.18
Foreign body inhalationNA20.0810.0810.09
Hemorrhage from respiratory passagesR0410.0410.0800.00
Hypertrophy of tonsils with hypertrophy of adenoidsJ353190.8090.71100.90
Influenza due to certain identified influenza virusesJ0951421.5725420.0526023.30
Influenza due to other identified influenza virusJ10451.89312.45141.25
Laryngeal spasmJ38520.0800.0020.18
NASOPHARYNGITIS, Common coldJ00572.39302.37272.42
Oedema of larynxJ38410.0410.0800.00
Other diseases of upper respiratory tractJ3960.2530.2430.27
Other respiratory disordersJ9810.0400.0010.09
PneumoniaJ18120.5070.5550.45
Pulmonary edemaJ81110.4640.3270.63
Resp cond d/t inhalation of chemicals, gas, fumes and vaporsJ6810.0400.0010.09
Respiratory disorders in diseases classified elsewhereJ9930.1320.1610.09
Streptococcal pharyngitisJ020883.69413.24474.21
Unspecified chronic bronchitisJ4250.2120.1630.27
Trauma / Injury120.5050.3970.63
Burn of first degree, body region unspecifiedT30110.0410.0800.00
Ecchymosis, site unspecifiedNA10.0410.0800.00
Ecchymosis on the faceNA20.0800.0020.18
Ecchymosis on the footNA20.0810.0810.09
Ecchymosis on the noseNA10.0400.0010.09
Hand ecchymosisNA10.0410.0800.00
Head ecchymosisNA10.0400.0010.09
Open wound of ankle and footS91010.0410.0800.00
Other and unspecified injuries of ankle and footS9910.0400.0010.09
Traf of spcf type but victim's mode of transport unknownV8710.0400.0010.09
Childhood (5 to 9 years)Total number of patients2103Total number of diagnoses3293
TotalMale (1142 patients)Female (961 patients)
DiagnosisICD-10 codeFrequancyPercentage among age groupFrequancyPercentage among age groupFrequancyPercentage among age group
Cardiology60.2950.4410.10
Cardiac murmurs and other cardiac soundsR0130.1430.2600.00
Rheumatic chorea with heart involvementI02030.1420.1810.10
Dermatology854.04393.42464.79
Allergic contact dermatitisL23130.6270.6160.62
Atopic dermatitisL2010.0510.0900.00
CellulitisL0320.1010.0910.10
Cutaneous abscess, furuncle and carbuncle, unspecifiedL02940.1910.0930.31
Diaper [napkin] dermatitisL2210.0500.0010.10
EczemaL30340.1920.1820.21
Exfoliative dermatitisL2610.0510.0900.00
Griscelli syndromeNA10.0500.0010.10
HairsutismNA20.1000.0020.21
HypopigmentationNA20.1000.0020.21
ImpetigoL0170.3330.2640.42
Infective dermatitis/Eczematoid dermatitisL30370.3330.2640.42
LeishmaniasisB5640.1900.0040.42
Localized swelling, mass and lump of skin, subcuR2210.0510.0900.00
Nail disordersL6020.1010.0910.10
Nail disorders in diseases classified elsewhereL6210.0500.0010.10
Other and unspecified dermatitisL3020.1000.0020.21
Other disorders of skin and subcutaneous tissueL9850.2420.1830.31
Other erythematous conditionsL5310.0510.0900.00
Pityriasis roseaL4250.2430.2620.21
PruritusL2910.0500.0010.10
Rash and other nonspecific skin eruptionR2180.3870.6110.10
skin wartNA10.0510.0900.00
UrticariaL5090.4340.3550.52
Endocrinology592.81272.36323.33
AmyloidosisE8510.0510.0900.00
Delay pubertyE3010.0500.0010.10
Growth hormone deficiencyNA30.1410.0920.21
Other disorders of thyroidE0730.1400.0030.31
Other metabolic disorders/ Other Endocrine nutritional and metabolic diseasesE8810.0500.0010.10
Other specified diabetes mellitusE1310.0500.0010.10
Short statureR62.52492.33252.19242.50
Gastroenterology21110.031099.5410210.61
Abdominal and pelvic painR10391.85161.40232.39
Abdominal Colic/Other and unspecified abdominal painR104170.81100.8870.73
Anal fissure, unspecifiedK60210.0500.0010.10
Cellulitis and abscess of mouthK122100.4860.5340.42
Coeliac diseaseK90070.3330.2640.42
ConstipationK59060.2930.2630.31
Diaphragmatic herniaK4410.0510.0900.00
DyspepsiaR10160.2940.3520.21
Fecal incontinenceR1520.1020.1800.00
Fissure and fistula of anal and rectal regionsK6010.0510.0900.00
Foregin body injestionNA30.1410.0920.21
Gastritis and duodenitisK2950.2410.0940.42
Gastro oesophageal reflux diseaseK21940.1940.3500.00
Genital prolapseNA10.0510.0900.00
Hemorrhoids and perianal venous thrombosisK6410.0500.0010.10
Inguinal herniaK4060.2940.3520.21
Intestinal malabsorptionK9050.2420.1830.31
Irritable bowel syndromeK5830.1400.0030.31
Nausea and vomitingR11281.33201.7580.83
Oth symptoms and signs involving the dgstv sys and abdomenR19211.00131.1480.83
Other and unsp noninfective gastroenteritis and colitisK52130.6250.4480.83
Other diseases of anus and rectumK6220.1010.0910.10
Other diseases of appendixK3810.0500.0010.10
Periapical abscess without sinusK04720.1020.1800.00
Recurrent oral aphthaeK120100.4820.1880.83
Stomatitis and related lesionsK12130.6270.6140.42
Umbilical herniaK4210.0500.0010.10
Unspecified jaundiceR1740.1900.0040.42
Hematology & Immunology542.57312.71232.39
Acquired hemolytic anemiaD5920.1010.0910.10
Anemia, unspecifiedD649160.7660.53101.04
Familial Mediterranean fever (Non-neuropathic heredofamilial amyloidosis)E85030.1420.1810.10
Favism - G6PD DeficiencyD55.010.0510.0900.00
Folate deficiency anemiaD5280.3850.4430.31
Other and unsp diseases of blood and blood-forming organsD7510.0500.0010.10
Other nutritional anemiasD53200.95141.2360.62
ThalassemiaD5620.1020.1800.00
Unspecified jaundiceR1710.0500.0010.10
Infectious disease36917.5519016.6417918.63
Acute hepatitis AB15271.28181.5890.94
BrucellosisA2340.1930.2610.10
Cholera/ AWD/ Suspected CholeraA00110.5270.6140.42
Diarrhea and gastroenteritis of presumed infectious originA09160.76100.8860.62
Fever of other and unknown originR50703.33272.36434.47
Gastroenteritis and colitis of unspecified originA099200.95131.1470.73
Hand, foot and mouth diseaseB08.410.0510.0900.00
Helminthiasis/Other helminthiasesB83170.8150.44121.25
MumpsB2610.0500.0010.10
OsteomyelitisM8610.0500.0010.10
Other bacterial intestinal infectionsA0410.0500.0010.10
Other intestinal helminthiases, not elsewhere classifiedB81251.19110.96141.46
Other protozoal intestinal diseasesA0720.1020.1800.00
Other viral hemorrhagic fevers, not elsewhere classifiedA9840.1930.2610.10
Rubella [German measles]B0620.1010.0910.10
ScabiesB8670.3350.4420.21
Scalpe infectionNA10.0500.0010.10
Scarlet feverNA10.0500.0010.10
septicaemia/SepsisA4120.1020.1800.00
Sequelae of tuberculosisB9010.0500.0010.10
Typhoid and paratyphoid feversA0130.1420.1810.10
Unspecified intestinal parasitismB82110.5230.2680.83
Unspecified viral hepatitisB1910.0500.0010.10
Varicella chickenpoxB01150.7190.7960.62
Viral and other specified intestinal infectionsA081024.85564.90464.79
Viral intestinal infection, unspecifiedA084200.95121.0580.83
Viral meningitisA8710.0500.0010.10
Whooping coughA3720.1000.0020.21
Musculoskeletal disorders391.85272.36121.25
Acquired deformities of fingers and toesM2010.0510.0900.00
Arthropathies in other diseases classified elsewhereM1420.1000.0020.21
Biomechanical lesionsM9910.0510.0900.00
Bone painNA10.0510.0900.00
Bony pain in lower extremitiesNA10.0510.0900.00
Chronic bone painNA10.0510.0900.00
DorsalgiaM5410.0510.0900.00
Growing painsNA20.1020.1800.00
Juvenile arthritisM0810.0510.0900.00
Muscle spasm and painNA20.1010.0910.10
Osteopathies in diseases classified elsewhereM9020.1020.1800.00
Other and unspecified arthropathyM1280.3830.2650.52
Other arthritisM1330.1420.1810.10
Other disorders of boneM8910.0510.0900.00
Other disorders of muscleM6210.0510.0900.00
Other joint disorder, not elsewhere classifiedM2510.0510.0900.00
Other rheumatoid arthritisM0620.1020.1800.00
Other spondylopathiesM4810.0510.0900.00
Seropositive rheumatoid arthritisM0570.3340.3530.31
Neonatology / congenital anomalies40.1920.1820.21
Cleft palateQ3510.0510.0900.00
Congenital malformation of heart, unspecified/Other congenital malformations of heartQ24910.0510.0900.00
Developmental dysplasia of the hipNA10.0500.0010.10
Down syndromeQ9010.0500.0010.10
Nephrology and urology34216.26837.2725926.95
Calculus of ureterN20110.0500.0010.10
Calculus of urinary tract in diseases classified elsewhereN2210.0510.0900.00
CystitisN30602.85121.05484.99
HematuriaR3130.1420.1810.10
Obstructive and reflux uropathyN1310.0500.0010.10
Oth and unsp symptoms and signs involving the GU sysR39422.0060.53363.75
Other disorders of penisN4810.0510.0900.00
Other disorders of urethraN3610.0510.0900.00
Other disorders of urinary systemN3910.0510.0900.00
Pain associated with micturitionR3060.2920.1840.42
PolyuriaR35120.5760.5360.62
PyelonephritisN12120.5700.00121.25
Recurrent and persistent hematuriaN0220.1000.0020.21
renal calices congestionNA10.0500.0010.10
Retention of urineR3310.0510.0900.00
Stress incontinenceN39310.0500.0010.10
Unspecified kidney failureN1920.1020.1800.00
Unspecified renal colicN2310.0510.0900.00
Unspecified urinary incontinenceR32572.71191.66383.95
Urethral disorders in diseases classified elsewhereN3710.0510.0900.00
Urethritis and urethral syndromeN3490.4310.0980.83
Urinary tract infectionN3901265.99262.2810010.41
Neurology552.62232.01323.33
Abnormalities of gait and mobilityR2610.0500.0010.10
BELLS PALSYG51010.0500.0010.10
Convulsions, not elsewhere classifiedR5610.0500.0010.10
Delayed speachNA10.0510.0900.00
Depaquine taperingNA30.1400.0030.31
Dizziness and giddinessR4210.0510.0900.00
EpilepsyG4060.2910.0950.52
Febrile ConvulsionR56030.1420.1810.10
HeadacheR51180.8690.7990.94
HydrocephalusG9130.1430.2600.00
Infantile cerebral palsyG8020.1020.1800.00
Other disorders of brainG9340.1910.0930.31
Other disorders of brain in diseases classified elsewhereG9430.1420.1810.10
Other headache syndromesG4410.0500.0010.10
SeizureNA30.1400.0030.31
Somnolence, stupor and comaR4020.1010.0910.10
Specific developmental disorders of speech and languageF8010.0500.0010.10
Transient cerebral ischemic attacks and related syndromesG4510.0500.0010.10
Nutrition and metabolisim disorders894.23403.50495.10
AnorexiaR630592.81282.45313.23
Other nutritional deficienciesE6350.2440.3510.10
Retarded development following protein-energy malnutritionE4520.1010.0910.10
Failure to thriveR62.5130.1410.0920.21
Lactose intoleranceE7310.0510.0900.00
Unspecified protein-calorie malnutritionE4640.1930.2610.10
Vitamin D deficiencyE5530.1410.0920.21
Other vitamin deficienciesE5610.0510.0900.00
Sequelae of malnutrition and other nutritional deficienciesE6420.1000.0020.21
Dietary calcium deficiencyE5850.2400.0050.52
Deficiency of other nutrient elementsE6130.1400.0030.31
Food allergyNA10.0500.0010.10
Oncology30.1410.0920.21
Benign neoplasm of breastD2420.1000.0020.21
HemangiomaNA10.0510.0900.00
Ophthalmology251.19181.5870.73
ConjunctivitisH10231.09171.4960.62
Other disorders of eye and adnexaH5710.0500.0010.10
Retained (old) intraocular foreign body, magneticH44610.0510.0900.00
Other Diseases281.33201.7580.83
Dental abscessNA10.0500.0010.10
Drug allergyNA10.0510.0900.00
Edema, not elsewhere classifiedR6020.1020.1800.00
Enlarged lymph nodesR5980.3850.4430.31
Growing painsNA40.1930.2610.10
Malaise and fatigueR5380.3860.5320.21
Oth complications of surgical and medical care, NECT8820.1020.1800.00
Teething painNA310.0510.0900.00
Otolaryngology56126.6830326.5325826.85
Acute suppurative otitis mediaH66040.1930.2610.10
Acute tonsillitisJ031738.23998.67747.70
adenoidal hypertrophyNA10.0510.0900.00
Allergic rhinitisJ30430.1410.0920.21
Deviated nasal septumJ34210.0500.0010.10
Disorders of external ear in diseases classified elsewhereH6230.1400.0030.31
Eczema of external auditory canalL30310.0510.0900.00
EpistaxisNA40.1930.2610.10
Eustachian salpingitis and obstructionH6870.3310.0960.62
Foreign body in the earT1670.3330.2640.42
Impacted cerumenH61230.1400.0030.31
Nonsuppurative otitis mediaH651627.70867.53767.91
Other and unspecified hearing lossH9150.2430.2620.21
Other disorders of external earH6190.4330.2660.62
Otitis externaH6020.1020.1800.00
Perforation of tympanic membraneH7210.0510.0900.00
Streptococcal, TONSILLITISJ0301627.70877.62757.80
Suppurative and unspecified otitis mediaH66130.6290.7940.42
Poisoning251.19141.23111.14
Bacterial foodborne intoxicationA0550.2420.1830.31
Detergent poisoningNA10.0500.0010.10
Food poisoningNA40.1930.2610.10
Petroleum poisoningNA10.0510.0900.00
Organophosphate poisoningNA20.1020.1800.00
Oth bacterial foodborne intoxications, NECA0550.2420.1830.31
Venom of other arthropods/ Insect biteT63440.1930.2610.10
Venom of scorpion/ Scorpion biteT63230.1410.0920.21
Psychiatry diseases20.1010.0910.10
AutismNA10.0500.0010.10
Conduct disordersF9110.0510.0900.00
Respiratory diseases108251.4558851.4949451.40
Abnormalities of breathingR0610.0500.0010.10
Acute bronchiolitisJ211135.37595.17545.62
Acute bronchitisJ20180.86110.9670.73
Acute laryngitisJ040100.4880.7020.21
Acute laryngitis and tracheitisJ0450.2430.2620.21
Acute obstructive laryngitis [croup] and epiglottitisJ0520.1010.0910.10
Acute pharyngitisJ02653.09373.24282.91
Acute respiratory distress syndromeJ8010.0500.0010.10
Acute sinusitisJ01341.62171.49171.77
Acute upper resp infections of multiple and unsp sitesJ0670.3330.2640.42
Allergic rhinitisJ30430.1420.1810.10
AsthmaJ451778.421079.37707.28
Bronchitis, not specified as acute or chronicJ4030.1430.2600.00
Chronic diseases of tonsils and adenoidsJ3580.3840.3540.42
Chronic laryngitis and laryngotracheitisJ3720.1010.0910.10
Chronic rhinitis, nasopharyngitis and pharyngitisJ3140.1940.3500.00
Chronic sinusitisJ32532.52252.19282.91
CoughR05351.66242.10111.14
Deviated nasal septumJ34230.1410.0920.21
Diseases of vocal cords and larynx, not elsewhere classifiedJ3810.0500.0010.10
Foreign body in airwayNA10.0510.0900.00
Hemorrhage from respiratory passagesR0410.0510.0900.00
Hypertrophy of nasal turbinatesJ34310.0510.0900.00
Hypertrophy of tonsils with hypertrophy of adenoidsJ353271.28171.49101.04
Influenza due to other identified influenza virusJ1025612.1718015.7617618.31
Laryngeal spasmJ38520.1010.0910.10
NASOPHARYNGITIS, Common coldJ00411.95262.28151.56
Other and unspecified disorders of nose and nasal sinusesJ3430.1400.0030.31
Other diseases of upper respiratory tractJ3930.1410.0920.21
Pain in throat and chestR0710.0510.0900.00
Peritonsillar abscessJ3610.0510.0900.00
Pleural effusion, not elsewhere classifiedJ9020.1010.0910.10
PneumoniaJ18120.5760.5360.62
Pulmonary edemaJ8110.0500.0010.10
Resp cond d/t inhalation of chemicals, gas, fumes and vaporsJ6840.1910.0930.31
Streptococcal pharyngitisJ020793.76403.50394.06
Unspecified chronic bronchitisJ4210.0500.0010.10
Viral pneumonia, not elsewhere classifiedJ1210.0500.0010.10
Trauma / Injury110.5280.7030.31
Burn of first degree, body region unspecifiedT30110.0500.0010.10
Ecchymosis on the armNA10.0500.0010.10
Ecchymosis on the faceNA20.1010.0910.10
Ecchymosis on the pelvisNA10.0510.0900.00
Ecchymosis on the thighNA10.0510.0900.00
Ecchympsis on the handNA10.0510.0900.00
Heatstroke and sunstrokeT67030.1430.2600.00
Traf of spcf type but victim's mode of transport unknownV8710.0510.0900.00
Early teenage (10 to 14 years)Total number of patients988Total number of diagnoses1598
TotalMale (455 patients)Female (533 patients)
DiagnosisICD-10 codeFrequancyPercentage among age groupFrequancyPercentage among age groupFrequancyPercentage among age group
Cardiology20.2000.0020.38
Cardiac murmurs and other cardiac soundsR0100.0000.0020.38
Dermatology383.85214.62173.19
ImpetigoL0150.5151.1000.00
EczemaL30320.2020.4400.00
Allergic contact dermatitisL2330.3020.4410.19
Pityriasis roseaL4220.2010.2210.19
UrticariaL5070.7130.6640.75
Infective dermatitis/Eczematoid dermatitisL30340.4020.4420.38
Other disorders of skin and subcutaneous tissueL9810.1010.2200.00
VitiligoNA10.1010.2200.00
Alopecia AreataL6310.1010.2200.00
Scalp infectionNA10.1010.2200.00
Rash and other nonspecific skin eruptionR2120.2020.4400.00
Other and unspecified dermatitisL3010.1000.0010.19
Nail disordersL6010.1000.0010.19
PsoriasisL4010.1000.0010.19
Cutaneous abscess, furuncle and carbuncleL0240.4000.0040.75
Unspecified contact dermatitisL2510.1000.0010.19
Pilonidal cyst and sinusL0510.1000.0010.19
Endocrinology787.89327.03468.63
Short statureR62.52747.49316.81438.07
Wilson's diseaseNA10.1010.2200.00
Disorders of puberty, not elsewhere classifiedE3010.1000.0010.19
Growth hormone deficiencyNA10.1000.0010.19
Delay pubertyE3010.1000.0010.19
Gastroenterology12312.45459.897814.63
Abdominal Colic/Other and unspecified abdominal painR104141.4271.5471.31
Nausea and vomitingR11141.4271.5471.31
Anal fissure, unspecifiedK60210.1010.2200.00
Recurrent oral aphthaeK12090.9120.4471.31
Other and unsp noninfective gastroenteritis and colitisK5260.6151.1010.19
Gastritis and duodenitisK2930.3020.4410.19
Abdominal and pelvic painR10343.4461.32285.25
ConstipationK59020.2010.2210.19
Flatulence and related conditionsR1410.1010.2200.00
DyspepsiaR10180.8140.8840.75
Irritable bowel syndromeK5830.3010.2220.38
Cellulitis and abscess of mouthK12230.3010.2220.38
Abdominal painR1020.2020.4400.00
Other diseases of lip and oral mucosaK1310.1010.2200.00
Gastro oesophageal reflux diseaseK21910.1010.2200.00
Inguinal herniaK4010.1010.2200.00
Lactose intoleranceE7310.1010.2200.00
Ulcerative colitisK5110.1010.2200.00
Oth symptoms and signs involving the dgstv sys and abdomenR1950.5100.0050.94
Intestinal malabsorptionK9050.5100.0050.94
Other diseases of intestineK6310.1000.0010.19
Diseases of salivary glandsK1110.1000.0010.19
Foreign body injestionNA10.1000.0010.19
Other diseases of stomach and duodenumK3110.1000.0010.19
Abscess mandibleNA10.1000.0010.19
Dizziness and giddinessR4210.1000.0010.19
Other diseases of digestive systemK9210.1000.0010.19
Peptic ulcer, site unspecifiedK2710.1000.0010.19
Hematology & Immunology111.1161.3250.94
Acquired hemolytic anemiaD5910.1010.2200.00
AnemiaD64920.2010.2210.19
Favism - G6PD DeficiencyD55.010.1010.2200.00
Folate deficiency anemiaD5230.3010.2220.38
Other nutritional anemiasD5330.3010.2220.38
ThalassemiaD5610.1010.2200.00
Infectious disease16416.608318.248115.20
Viral and other specified intestinal infectionsA08525.26286.15244.50
Other intestinal helminthiases, not elsewhere classifiedB81101.0140.8861.13
Viral intestinal infection, unspecifiedA084111.1171.5440.75
Acute hepatitis AB15111.1140.8871.31
Fever of other and unknown originR50252.53143.08112.06
Cholera/ AWD/ Suspected CholeraA0050.5130.6620.38
Gastroenteritis and colitis of unspecified originA099131.3261.3271.31
Unspecified intestinal parasitismB8240.4010.2230.56
Typhoid and paratyphoid feversA0170.7130.6640.75
Helminthiasis/Other helminthiasesB8320.2020.4400.00
MumpsB2620.2010.2210.19
Diarrhea and gastroenteritis of presumed infectious originA0950.5130.6620.38
Zoster [herpes zoster]B0210.1010.2200.00
Varicella chickenpoxB0170.7130.6640.75
ScabiesB8620.2010.2210.19
Rubella [German measles]B0610.1010.2200.00
Other protozoal intestinal diseasesA0740.4010.2230.56
Hand, foot and mouth diseaseB08.410.1000.0010.19
Acute bloody DiarrheaA09010.1000.0010.19
Musculoskeletal disorders555.57204.40326.00
Acquired deformities of fingers and toesM2010.1000.0010.19
ArthralgiaNA30.3010.2210.19
arthrlagiaNA10.1010.2200.00
Arthropathies in other diseases classified elsewhereM1430.3030.6600.00
DorsalgiaM5470.7140.8810.19
growing painsNA40.4010.2230.56
Osteopathies in diseases classified elsewhereM9010.1010.2200.00
Other and unspecified arthropathyM1260.6110.2250.94
Other arthritisM1340.4010.2230.56
Other crystal arthropathiesM1120.2020.4400.00
Other disorders of muscleM6210.1010.2200.00
Other joint disorder, not elsewhere classifiedM2540.4000.0040.75
Other rheumatoid arthritisM0670.7120.4450.94
Pain, unspecifiedR5210.1010.2200.00
Recurrent fracturesNA10.1010.2200.00
Seropositive rheumatoid arthritisM0570.7100.0071.31
sprainNA20.2000.0020.38
Neonatology / congenital anomalies10.1010.2200.00
Other congenital malformations of heartQ2410.1010.2200.00
Nephrology and urology19519.74398.5715629.27
Calculus of urinary tract in diseases classified elsewhereN2210.1010.2200.00
CystitisN30131.3230.66101.88
Fecal incontinenceR1510.1000.0010.19
Hereditary nephropathy, not elsewhere classifiedN0710.1010.2200.00
Kidney calculusN20030.3000.0030.56
Noninflammatory disorders of testisN4410.1010.2200.00
Oth and unsp symptoms and signs involving the GU sysR39252.5351.10203.75
Oth disorders of kidney and ureter in diseases classd elswhrN2910.1000.0010.19
Oth disorders of kidney and ureter, not elsewhere classifiedN2820.2000.0020.38
Pain associated with micturitionR3020.2000.0020.38
PolyuriaR3510.1000.0010.19
PyelonephritisN12131.3220.44112.06
Recurrent and persistent hematuriaN0220.2000.0020.38
Renal tubulo-interstitial disord in diseases classd elswhrN1610.1000.0010.19
Retention of urineR3310.1010.2200.00
Stress incontinenceN39320.2000.0020.38
Unspecified renal colicN2340.4020.4420.38
Unspecified urinary incontinenceR32272.73102.20173.19
Urethral disorders in diseases classified elsewhereN3710.1000.0010.19
Urethritis and urethral syndromeN3460.6120.4440.75
Urinary tract infectionN390878.81112.427614.26
Neurology525.26194.18336.19
HeadacheR51222.23102.20122.25
Other paralytic syndromesG8310.1010.2200.00
Other disorders of brain in diseases classified elsewhereG9410.1010.2200.00
Dizziness and giddinessR4270.7120.4450.94
Somnolence, stupor and comaR4020.2020.4400.00
Infantile cerebral palsyG8050.5120.4430.56
EpilepsyG4070.7110.2250.94
synovitisNA10.1000.0010.19
Convulsions, not elsewhere classifiedR5610.1000.0010.19
Specific developmental disorder of motor functionF8210.1000.0010.19
MigraineG4310.1000.0010.19
Other and unspecified myopathiesG7210.1000.0010.19
HydrocephalusG9110.1000.0010.19
Other disorders of peripheral nervous systemG6410.1000.0010.19
Nutrition and metabolisim disorders333.3481.76254.69
AnorexiaR630181.8261.32122.25
Dietary calcium deficiencyE5820.2000.0020.38
Dietary zinc deficiencyE6010.1010.2200.00
Failure to thriveR62.5150.5100.0050.94
Food allergyNA10.1010.2200.00
HypocalcemiaNA10.1000.0010.19
Other nutritional deficienciesE6320.2000.0020.38
Retarded development following protein-energy malnutritionE4510.1000.0010.19
Sequelae of malnutrition and other nutritional deficienciesE6420.2000.0020.38
Ophthalmology131.3291.9840.75
ConjunctivitisH10111.1171.5440.75
Other disorders of optic [2nd] nerve and visual pathwaysH4710.1010.2200.00
Other inflammation of eyelidH0110.1010.2200.00
Other Diseases353.54214.62142.63
Drug allergyNA20.2000.0020.38
Edema, not elsewhere classifiedR6010.1000.0010.19
Enlarged lymph nodesR5960.6151.1010.19
Growing painsNA30.3010.2220.38
Illness, unspecifiedR6910.1000.0010.19
Malaise and fatigueR53222.23153.3071.31
Otolaryngology20120.349220.2210920.45
Streptococcal, TONSILLITISJ030626.28275.93356.57
Nonsuppurative otitis mediaH65444.45224.84224.13
Acute tonsillitisJ03686.88296.37397.32
Otitis externaH6040.4020.4420.38
EpistaxisNA20.2010.2210.19
Foreign body in earT1610.1010.2200.00
Other disorders of external earH6120.2020.4400.00
Acute suppurative otitis mediaH66010.1010.2200.00
Other disorders of middle ear and mastoidH7410.1010.2200.00
Suppurative and unspecified otitis mediaH6630.3020.4410.19
Allergic rhinitisJ30440.4020.4420.38
Other inflammation of eyelidH0110.1010.2200.00
OtalgiaNA10.1010.2200.00
Disorders of external ear in diseases classified elsewhereH6210.1000.0010.19
Oth disord of mid ear and mastoid in diseases classd elswhrH7510.1000.0010.19
Foregin body in the noseNA20.2000.0020.38
Impacted cerumenH61230.3000.0030.56
Poisoning222.23143.0881.50
Scorpion bitesNA10.1010.2200.00
Venom of other arthropods/ Insect biteT63420.2020.4400.00
Bacterial foodborne intoxicationA0550.5140.8810.19
Oth bacterial foodborne intoxications, NECA0550.5140.8810.19
Food poisoningNA50.5120.4430.56
Detergent poisoningNA10.1010.2200.00
Organophosphate poisoningNA20.2000.0020.38
Sequelae of poisoning by drugs, medicaments and biological substancesT9610.1000.0010.19
Psychiatry diseases20.2010.2210.19
anxiety disordersF4110.1000.0010.19
AutismNA10.1010.2200.00
Respiratory diseases41542.0020945.9320638.65
Acute bronchiolitisJ21353.54214.62142.63
Acute bronchitisJ2060.6140.8820.38
Acute laryngitisJ04010.1010.2200.00
Acute laryngitis and tracheitisJ0460.6100.0061.13
Acute pharyngitisJ02363.64153.30213.94
Acute respiratory distress syndromeJ8010.1000.0010.19
Acute sinusitisJ01303.04163.52142.63
AsthmaJ45696.984910.77203.75
BronchiectasisJ4720.2010.2210.19
Chronic diseases of tonsils and adenoidsJ3530.3010.2220.38
Chronic rhinitis, nasopharyngitis and pharyngitisJ3110.1010.2200.00
Chronic sinusitisJ32292.9491.98203.75
CoughR0590.9130.6661.13
Deviated nasal septumJ34210.1010.2200.00
Hemorrhage from respiratory passagesR0410.1000.0010.19
Hypertrophy of tonsils with hypertrophy of adenoidsJ35330.3020.4410.19
Influenza due to other identified influenza virusJ1014214.377015.387213.51
Laryngeal spasmJ38510.1000.0010.19
NASOPHARYNGITIS, Common coldJ00141.4240.88101.88
Other diseases of upper respiratory tractJ3920.2000.0020.38
PneumoniaJ1820.2000.0020.38
Streptococcal pharyngitisJ020202.02112.4291.69
Unspecified chronic bronchitisJ4210.1000.0010.19
Trauma / Injury70.7130.6640.75
Ecchymosis on the backNA10.1000.0010.19
Ecchymosis on the chestNA10.1000.0010.19
Ecchymosis on the footNA10.1010.2200.00
Ecchymosis on the noseNA10.1010.2200.00
Fracture of mandibleS02610.1000.0010.19
Heatstroke and sunstrokeT67010.1010.2200.00
Superficial injury of ankle, foot and toesS9010.1000.0010.19
Late teenage (15 to 19 years)Total number of patients1822Total number of diagnoses3488
TotalMale (36 patients)Female (1785)
DiagnosisICD-10 codeFrequancyPercentage among age groupFrequancyPercentage among age groupFrequancyPercentage among age group
Dermatology50.2712.7840.22
Other disorders of skin and subcutaneous tissueL9810.0500.0010.06
Other and unspecified dermatitisL3010.0500.0010.06
Infective dermatitis/Eczematoid dermatitisL30310.0512.7800.00
HypertrichosisL6810.0500.0010.06
CellulitisL0310.0500.0010.06
Endocrinology120.66513.8970.39
Delay pubertyE3030.1600.0030.17
Short statureR62.5270.38513.8920.11
Type 1 diabetes mellitusE1020.1100.0020.11
Gastroenterology643.51411.11603.36
Abdominal and pelvic painR10261.4300.00261.46
Anal fissure, unspecifiedK602100.5500.00100.56
ConstipationK59010.0500.0010.06
Fissure and fistula of anal and rectal regionsK6020.1100.0020.11
Gastritis and duodenitisK2930.1612.7820.11
Haemorrhoids, unspecifiedK64920.1100.0020.11
Hemorrhoids and perianal venous thrombosisK6410.0500.0010.06
Nausea and vomitingR1160.3312.7850.28
Oth symptoms and signs involving the dgstv sys and abdomenR1910.0512.7800.00
Other and unsp noninfective gastroenteritis and colitisK5270.3800.0070.39
Other diseases of intestineK6310.0500.0010.06
Other diseases of stomach and duodenumK3110.0500.0010.06
Stomatitis and related lesionK1210.0500.0010.06
Ulcerative colitisK5110.0500.0010.06
Unspecified jaundiceR1710.0512.7800.00
Gynecology / Obstetrics158787.1000.00158788.91
Abortion - unspecifiedNA10.05NANA10.06
Abortion - incompleteNA10.05NANA10.06
Abortion - threatenedNA20.11NANA20.11
Abortion - spontaneousO03160.88NANA160.90
Intra-uterine fetal deathNA10.05NANA10.06
Absent, scanty and rare menstruationN91804.39NANA804.48
AmenorrheaNA80.44NANA80.45
Complications following (induced) termination of pregnancyO0410.05NANA10.06
Complications of the puerperium, not elsewhere classifiedO9010.05NANA10.06
Delayed mensesNA130.71NANA130.73
Dysmenorrhea, unspecifiedN94.6110.60NANA110.62
Excessive, frequent and irregular menstruationN921085.93NANA1086.05
Female infertility, unspecifiedN97231.26NANA231.29
Female pelvic inflam disorders in diseases classd elswhrN7400.00NANA00.00
Hemorrhage in early pregnancyO2060.33NANA60.34
Infections of genitourinary tract in pregnancyO2380.44NANA80.45
Inflammatory disorders of breastN6120.11NANA20.11
Benign neoplasm of ovaryD2710.05NANA10.06
Benign neoplasm of breastD2410.05NANA10.06
MastitisNA10.05NANA10.06
Menopausal and other perimenopausal disordersN9540.22NANA40.22
Oth disord of brst/lactatn assoc w pregnancy and the puerpO9210.05NANA10.06
Other abnormal products of conceptionO0210.05NANA10.06
Other abnormal uterine and vaginal bleedingN93140.77NANA140.78
Other disorders of breastN6430.16NANA30.17
Infection of vagina and vulvaN76814.45NANA814.54
Other noninflammatory disorders of uterus, except cervixN8510.05NANA10.06
Other noninflammatory disorders of vulva and perineumN9000.00NANA00.00
Unspecified ovarian cystsN83.2110.60NANA110.62
VaginismusNA30.16NANA30.17
PregnancyNA118364.93NANA118366.27
Infectious disease120.66616.6760.34
Fever of other and unknown originR5030.1612.7820.11
Gastroenteritis and colitis of unspecified originA09950.2725.5630.17
Other intestinal helminthiases, not elsewhere classifiedB8110.0512.7800.00
Viral and other specified intestinal infectionsA0810.0512.7800.00
Viral intestinal infection, unspecifiedA08420.1112.7810.06
Musculoskeletal disorders150.8200.00150.84
DorsalgiaM54140.7700.00140.78
Other and unspecified arthropathyM1210.0500.0000.00
Nephrology and urology1407.6800.001407.84
Calculus of urinary tract in diseases classified elsewhereN2210.0500.0010.06
CystitisN3040.2200.0040.22
Oth and unsp symptoms and signs involving the GU sysR3940.2200.0040.22
Pain associated with micturitionR3010.0500.0010.06
Unspecified renal colicN2340.2200.0040.22
Unspecified urinary incontinenceR3210.0500.0010.06
Urethritis and urethral syndromeN34221.2100.00221.23
Urinary tract infectionN3901035.6500.001035.77
Neurology70.3825.5650.28
Dizziness and giddinessR4210.0500.0010.06
EpilepsyG4010.0500.0010.06
ConvulsionR56010.0500.0010.06
HeadacheR5120.1112.7810.06
MigraineG4320.1112.7810.06
Nutrition and metabolisim disorders50.2712.7840.22
AnorexiaR63020.1100.0020.11
Other nutritional deficienciesE6330.1612.7820.11
Other Diseases291.5900.00291.62
Malaise and fatigueR53291.5900.00291.62
Otolaryngology110.6025.5690.50
Streptococcal, TONSILLITISJ03020.1112.7810.06
Otitis externaH6010.0512.7800.00
Acute tonsillitisJ0330.1600.0030.17
Nonsuppurative otitis mediaH6510.0500.0010.06
Other and unspecified disorders of Eustachian tubeH6910.0500.0010.06
Acute suppurative otitis mediaH66010.0500.0010.06
EpistaxisNA10.0500.0010.06
VertigoNA10.0500.0010.06
Poisoning10.0512.7800.00
Venom of other arthropods/ Insect biteT63410.0512.7800.00
Respiratory diseases301.651438.89160.90
Acute bronchiolitisJ2130.1612.7820.11
Acute bronchitisJ2010.0500.0010.06
Acute laryngitis and tracheitisJ0410.0500.0010.06
Acute pharyngitisJ0230.1600.0030.17
Acute sinusitisJ0110.0500.0010.06
AsthmaJ4570.38411.1130.17
Chronic sinusitisJ3220.1112.7810.06
CoughR0510.0512.7800.00
Influenza due to other identified influenza virusJ1090.49616.6730.17
Other and unspecified disorders of nose and nasal sinusesJ3410.0512.7800.00
Unspecified chronic bronchitisJ4210.0500.0010.06
Trauma / Injury10.0500.0010.06
Heatstroke and sunstrokeT67010.0500.0010.06

Acute diarrhea

We reported 1192 (17%) cases of acute diarrhea among all age groups, which make this disease the second most common illness after URTI. It was more common in boys (652 [55%]) than in girls (540 [45%]) (P = 0.008). The most frequent age groups were infants (694 [58%]) and toddlers (358 [30%]), followed by childhood (68 [6%]), early teenage (37 [3%]), neonates (30 [3%]), and then late teenage (5 [0.4%]). Acute diarrhea was far more common in people who lived in the IDP camps (58% of all cases) compared to town residents (42%), (P ≤ 0.001). Acute watery diarrhea, including cases of suspected cholera, represented 307 (25.7%) cases; however, none could be confirmed with existing resources.

Malnutrition disorders

We identified 978 (8%) cases of malnutrition among all age groups, which make it the sixth most common disease in the cohort. No sex predominance was observed, with 500 (51%) girls and 478 (49%) boys. The most common age group was infants (726 [74%]) followed by toddlers (178 [18%]), neonates (30 [3%]), childhood (28 [3%]), early teenage (13 [1%]), and late teenage (3 [0.3%]) cases. It was significantly more common in people who lived in the IDP camps (66% of all cases) than in town residents (33%) (P ≤ 0.001). SAM defined by anthropometric measurements, as described in the “Methods” section, was reported in 131 of 978 (13.4%) patients. Most were girls (80 [61%]) with 51 (39%) boys (P = 0.05). Infants were the most commonly affected group with 92 (70%) cases, followed by toddlers (34 [26%] cases), neonates (2 cases), childhood (2 cases), and 1 early teenage child. SAM was by far more common in people who lived in the IDP camp versus town residents (76% vs. 24%, P ≤ 0.001). The incidence of SAM peaked in summer associated with the peak of acute diarrheal diseases. Vitamin D deficiency was reported in 151 patients. No sex predominance was observed, with 72 (48%) cases in males and 79 (52%) cases in females. The most common age group was infants with 96 (64%) cases, followed by toddlers with 50 (33%) cases, childhood with 3 cases, and 2 cases in neonates. No condition of living was predominant, with 76 (50%) cases in patients living in the IDP camp and 75 (50%) cases in town residents.

Special conditions

Neonatal jaundice represented the most common diagnosis in the newborn age group, accounting for 30% of their visits. It was more frequent in boys (152 [59%]) than in girls (104 [41%]) (P = 0.02), with no significant difference between patients who lived in the IDP camp (146 [57%]) compared to those who resided in town (110 [43%]) (P = 0.17). The patients’ median (IQRs) age at first presentation was 11 (9–19) days. More than half (51%) of them presented between days 3 and 11. Notably, one-third of these patients had delayed presentation at the age of 15 days and beyond. Omphalitis was yet another common condition in the newborn age group, with an overall incidence of 8%. We reported 36 (53%) cases in girls and 31 (46%) cases in boys; 35 (52%) patients were living in an IDP camp, whereas 32 (48%) patients were town residents; no statistical differences were found. The mean (standard deviation [SD]) age at diagnosis was 12 (5.4) days, with median (IQRs) of 12 (3–15) days. Undifferentiated febrile illnesses (UFIs) were an important issue in this cohort of patients, especially in infants (4%) and childhood (3%) age groups. We identified 344 patients (almost 3% of total cohort) who were treated for UFIs. No statistical difference was observed in sex or living conditions. One hundred and sixty-two (47%) patients were males and 182 (53%) patients were females. One hundred and sixty-four (47%) patients lived in an IDP camp, whereas 180 (53%) were town residents. Their median (IQRs) age was 1.5 years (8 month to 4.4 years). The incidence of these illnesses peaked in July, August, and September [Figure 4].
Figure 4

Selected communicable diseases plotted over months Notice the significant seasonal changes in incidence of the URTI and infectious diarrheal diseases. URTIs peak in winter and infectious diarrhea peaks in summer. Spring season includes months of March, April, and May; summer includes June, July, and August; fall includes September, October, and November; and winter includes December, January, and February. Values represent percentage among all patients

Selected communicable diseases plotted over months Notice the significant seasonal changes in incidence of the URTI and infectious diarrheal diseases. URTIs peak in winter and infectious diarrhea peaks in summer. Spring season includes months of March, April, and May; summer includes June, July, and August; fall includes September, October, and November; and winter includes December, January, and February. Values represent percentage among all patients - Measles, mumps, rubella, and varicella (MMRV): Collectively, we reported 57 cases of MMRV infections, of them 37 cases were of varicella, 11 were of mumps, 8 were of rubella, and 1 case of measles. Thirty cases were diagnosed in patients who lived in the IDP camp and 27 cases were town residents. Toddlers age group was the most commonly affected one with 23 cases. The mean (SD) age of presentation was 5.0 (3.3) years, with median (min–max) of 3.3 (0.5–13) years. The incidence of MMRV illnesses seemed to be steadily low until December 2017 when it started to increase. - Poliomyelitis: We reported two cases of poliomyelitis, both presented with acute flaccid paralysis. The first one was in March 2017 in a 1-year-old girl who lived in an IDP camp. She was displaced from Deir ez-Zor district and her diagnosis was confirmed by laboratory tests. The second patient was identified in April 2017, a 9-year-old boy who was a town resident with a known diagnosis. - Pertussis: We reported nine cases of pertussis (eight females and one male). Four of them were diagnosed in March, one patient in April, and four patients in May. Only two patients lived in an IDP camp and seven were town residents. Their mean (SD) age was 2 (2.4) years with a median (min–max) of 0.8 (0.3–8) years, and the most commonly affected age group was the infants. The diagnosis in these cases was made based on clinical presentation and supported by the presence of leukocytosis. - Hepatitis A: We reported 69 cases of hepatitis A, of them, 31 cases were in females and 38 in males. As for living conditions, 38 of these patients lived in an IDP camp and 31 in town. Their mean (SD) age was 5.3 (3.0) years with median (min–max) of 5 (0.2–13) years. The incidence peaked in November and December 2017. The diagnosis in these cases was made based on clinical findings and supported by the presence of abnormal liver function tests, and occasionally, confirmed by definite virology markers.

Asthma

During the study period, asthma was diagnosed in 702 patients with 1090 acute episodes. Of them, 452 (64%) were in boys and 250 (36%) were in girls (P ≤ 0.001). The incidence was not different according to living conditions with 361 (52%) patients living in an IDP camp and 339 (49%) patients in town, (P = 0.52). Their age group distribution was as follows: 284 (40%) infants, 228 (32%) toddlers, 129 (18%) childhood, 52 (7%) early teenage, and 5 (0.7%) late teenage. Their median (IQRs) age was equal to 1.2 years (1 month to 3.3 years).

Pregnancy

Gynecological/obstetrical illnesses/conditions among late teenage girls represented 89% of all their visits, and pregnancy-related encounters were 66% of the total cases. We reported 1183 pregnancies in the adolescents who visited our center during the study period. Of them, 750 (63%) lived in an IDP camp and 433 (37%) were residents in town. Their mean (SD) age was 17 (1) years with median (IQRs) of 18 (17–19) years. The largest group of patients (319 [27%]) were the 18-year-old patients, followed by 19-year-olds (310 [26%]), 17-year-olds (266 [23%]), and 16-year-olds (169 [14%]). However, 15-year-olds accounted for 97 (8%) cases and 14-year-olds for 22 (2%) cases. Notably, pregnant teens who were less than 18 years old represented 48% of the total pregnant patients in this cohort. Despite their higher absolute numbers, pregnant IDP received less antenatal care visits than town residents (1.7 vs. 2.0 visits), OR (95% confidence interval) = 1.5 (1.3–1.7), (p ≤ 0.001).

Effects of seasonal changes

We observed an increased incidence of diarrheal diseases and cases of UFIs during summer and an increased incidence of URTI during winter. MMRV infections showed moderate increase during spring and early summer with a surge during December. However, the prevalence of other communicable diseases was stable throughout the year. [Figure 4] shows the incidence of selected communicable diseases plotted by time. The incidence of lower respiratory tract infection (LRTI), acute conjunctivitis, and acute hepatitis seems to be stable over the course of the year.

Effects of age

We observed differences in the incidence of certain diseases according to patient’s age. For example, the incidence of conjunctivitis was highest in neonates, malnutrition in infants, chronic anemia in toddlers, otitis media in infants and toddlers, and URTIs in childhood [Figure 5].
Figure 5

Most common diseases plotted against age group Notice how the incidence varies among age groups. For example, otitis media is highest in infants and toddlers, and malnutrition is highest in infants and neonates. URTI is the most common disease among all age groups. Values represent percentage among each age category

Most common diseases plotted against age group Notice how the incidence varies among age groups. For example, otitis media is highest in infants and toddlers, and malnutrition is highest in infants and neonates. URTI is the most common disease among all age groups. Values represent percentage among each age category

Effects of living conditions

We observed significantly higher rates of infectious diarrhea (58% of cases), chronic anemia (60% of cases), and malnutrition (66% of cases), especially the severe forms (76% of cases), among patients who lived in an IDP camp as opposed to town residents [Table 2].
Table 2

Incidence of different diseases among town residents versus refugees

Diseases/conditionsTotal numberResidents
Refugees
P value
FrequencyPercentageFrequencyPercentage
URTI4139233957179643<0.001
LRTI80435437460.681
Infectious diarrhea11925024268958<0.001
Otitis media194996149988510.637
Conjunctivitis2109847112530.481
Infectious hepatitis70324638540.660
Chronic anemia26010440156600.010
Malnutrition disorders9783293464966<0.001
Severe acute malnutrition131101773023<0.001
Incidence of different diseases among town residents versus refugees

DISCUSSION

In 2017, according to the United Nations High Commissioner for Refugees (UNHCR), 2.8 million children were displaced in Syria of a total of 6.5 million refugees, with 48% of Syrian registered refugees under 18 years of age. The United Nations International Children’s Emergency Fund (UNICEF) estimates that six million children still living in Syria are in need of humanitarian assistance and 420 thousand children living in besieged areas lack access to vital humanitarian aid. Studies have shown that IDP and refugee children are at risk of malnutrition (including severe malnutrition and death).[9,13] In 2016, the WHO reported a drop in children vaccination rates in Syria to below 60% for all vaccines.[14] This percentage may be even lower in IDP and refugee populations as accurate data are extremely difficult to obtain. Reports have shown increased incidence of deadly preventable infectious diseases such as meningitis, measles, and polio.[15] Nonetheless, quantitative studies describing nutritional and infectious status of this population are still lacking. To the best of our knowledge, this is the first quantitative description dedicated to child and adolescent health focusing on northwestern Syria in the academic literature. In this cohort, infants have surpassed all other age groups in terms of number of medical encounters (2.6 encounter per patient), whereas newborns and childhood age groups have the least (1.6 encounter per patient). Adjusting for the short time span of the neonatal period (27 days), newborn infants are the clear leading age group in encounters burden (21.6 encounter/patient/year). The contribution of male patients to the disease burden was higher throughout all age groups except in teenage, when female patients’ contribution to the burden became more prominent because of pregnancy-related issues. In the late teenage years, consultations for females outnumbered males by 50 to 1. This was mainly driven by pregnancy-related issues, making gynecologic and obstetrical presentations rank fourth among all disease/condition categories. In 2013, UNICEF reported that 21.7% of the Syrian population were aged 10–19 years, and that 10% of the females in this age group were married.[16] Assuming that this is true for the study center population, then the expected number of married teens in this population would exceed 3000. This conservative estimate indicates that the study cohort encounters (1183 pregnancies) represent no more than 35% of the potential burden. The complex social and economic factors, which promote early marriage, are exacerbated by conflict and the resultant poverty and suffering. For some families, economic drivers and a desire to protect girls drive early marriage. However, this can have significant impacts on the child brides, their pregnancies, and associated complications, their newborn infants, and societal implications. The communicable diseases, as expected, represented the major bulk of the disease burden in this cohort. It accounted for more than half of all consultations across all age groups, infants and toddlers were the most affected, a pattern not out of the norm considering the conditions of living in this region. Notably, GBD 2016 study reported the incidence of URTIs, otitis media, and diarrheal diseases among Syrian children to peak in the first year of life.[17] The observed seasonal variations of these disorders were consistent with published literature, but the incidence of some infections based on the area of residence was relatively unfamiliar. For example, infectious diarrhea was more common in IDP camp inhabitants, whereas URTIs were more likely among town residents. This finding may be partially explained by the reluctance of refugees to make the “hard” journey to the medical center for seemingly simple issues, such as URTIs, compared to more threatening ones, such as diarrhea complicated by fever and dehydration [Figure 6]. However, this finding is more likely to be associated with the unsanitary living conditions in the camp as compared to town residence, such as overcrowding, shared toilets, contaminated water supplies, and deteriorated food quality. Other infections, however, were encountered almost equally among these two groups.
Figure 6

(A) and (B) Selected pictures from the refugee camp where people live in poorly made tents, during Winter 2017, they give an idea how bad the sanitation is and how challenging transportation is

(A) and (B) Selected pictures from the refugee camp where people live in poorly made tents, during Winter 2017, they give an idea how bad the sanitation is and how challenging transportation is The IDP predominance was again observed for most of the vaccination-preventable illnesses. Pertussis infection, however, revealed a predilection toward town residents (seven of nine), which was reminiscent of URTIs distribution noted earlier. Of note was the case of the 9-year-old boy diagnosed with poliomyelitis. He had no verifiable records of his vaccination status, nonetheless, he would be expected to have full vaccination against poliomyelitis before 2011, raising the suspicion of a possible underlying immunodeficiency disorder or vaccine failure because of unidentified reason. Notably, WHO and UNICEF reported that vaccination rates among Syrian children have deteriorated remarkably over the past 7 years.[14] For example, in 2017, only 30% of infants had completed all three doses of poliomyelitis or diphtheria, tetanus, and pertussis vaccines as opposed to 80% of infants in 2010. However, despite this drop of vaccination rates, no cases of the wild poliovirus infection have been reported in Syria since 1999. Indeed, all cases reported thereafter were due to the circulating vaccine-related poliovirus type-2.[18] Importantly, no accurate data about the vaccination coverage in Atmeh were available during the study period, and it was probably the case in other parts of the country where IDP were heavily present.[19] Cases of UFIs, especially in infants and young children, accounted for almost 3% of total disease burden in this cohort, with a trend toward increased incidence in females and town residents (53%). Their peak incidence occurred in July, August, and September, in parallel with infectious diarrhea, suggested a possible etiological association that should be explored. Major limitations in diagnostic capabilities of this center are obvious, however, the impact of these limitations on UFIs rates is hard to quantify. The nutritional deficiencies and their complications, especially iron-deficiency anemia, were more encountered in the IDP (66%) and in infants and toddlers, with no gender differences in incidence rates. Almost 77% of all malnourished children were less than a year old. This could be partially attributed to the diminished quantities and deteriorated qualities of the food supplies and reduced breast milk in stressed, malnourished mothers. Furthermore, the high proportion of young mothers in this cohort (almost half are less than 18 years old) and their limited access to proper education, especially in terms of infants’ care and nutrition, make it more likely for these infants to have reduced breastfeeding and malnutrition even in the absence of drastic food shortages. More attention to maternal education along with other measures is needed to mitigate the impact of malnutrition on these infants. Cases of vitamin D and/or calcium deficiency were of special importance, they represented 18% of all nutritional deficiency cases. Anecdotally, rates of exclusive breast feeding without proper supplementations were as high as 80% in these infants. As breast milk is known to be a poor source of vitamin D, this probably played a significant role in predisposing them to vitamin D deficiency and its consequences. The cases labeled as “poisoning” were mostly in boys younger than 4 years of age. Seemingly, many patients of this category were grouped together based on a semantic association; thus, food poisoning cases were joined to “poisoning” because of insect envenomation, whereas they would have been more accurately placed along cases of gastroenteritis and other gastrointestinal conditions. Neonatal jaundice contribution to the newborn infants’ burden of disease, especially among boys and refugees, was remarkable; it accounted for 30% of this burden. Although jaundice was encountered more frequently among refugee infants as opposed to town residents, the difference was not statistically significant (P = 0.17), probably as a result of inadequate sample size. Furthermore, the fact that one-third of these patients presented at an age of 15 days and beyond argues against a simple “physiological jaundice” and suggests a pathological process induced, perhaps, by deficient breastfeeding practices complicated by dehydration. Of note, a good proportion of these infants is cared for by inexperienced young mothers. Lastly, the contribution of other diseases, such as congenital hemoglobinopathies and hemolytic disease of the newborn, to the development of this prolonged jaundice, is hard to quantify, nonetheless, it should not be discounted altogether. Cardiac illnesses were apparently underrepresented in this cohort, only 44 cases were diagnosed. Having 59% of these conditions encountered in less than 1-year-old patients is probably driven by the inability of our center to deliver the advanced services, such as surgical interventions, that older patients with more complex conditions may need. Furthermore, our data cover a period of 1 year; older patients with congenital heart diseases are more likely to be diagnosed before the study period and mostly would be followed in a specialized center. Similarly, a plausible explanation of less-than-expected rate of trauma cases in this cohort is the presence of other centers in the vicinity with trauma as their primary focus of care. Thus, it would be unwise to estimate the incidence of trauma in this population based on the figures we reported. The same caution should be exercised when it comes to psychiatric illnesses; despite the stressful conditions of these patients, which favor the development of conditions, such as depression and anxiety disorders, the psychiatric illnesses were almost absent in this cohort; only four cases were reported. This underrepresentation makes any estimate related to this category of illnesses in this population far from reality. The profound shortages of health-care workers as a result of the unsafe operational conditions are another issue that needs to be addressed. The WHO reported 678 attacks on health-care personnel and facilities between early 2014 and March 2018.[20] SEMA and other organizations reported 382 attacks in 2017, with 61 casualties and 239 seriously injured among health-care workers. This unsafe environment has led many health-care providers, especially physicians, to flee the country. In Idlib governorate, for example, there are 492 fully trained physicians (of them 61 pediatricians) who serve an estimated population of more than three million. Notably, the average physician density (physician/10,000 people) in Syria before 2011 was 14.6, which is higher than both global (13.9) and regional (12.7) ones.[21] The UNICEF report issued in 2013[16] may clarify this further. It reports that 42% of the Syrian population is younger than 18 years of age, thus, the pediatric population in the region of our study center would have exceeded 210,000 people, served by only nine pediatricians (i.e., 23,500 patients per physician), a far larger number than the reported average of 1,546 patients per pediatrician in the USA during 1990s.[22] This severe shortage led many centers to rely on physicians-in-training to fill some of these gaps.

Limitations

Several limitations in our study need to be considered. First, the recent deployment of “HealthySyriaTB” program limited the analyzed data to the year 2017 only, which made it hard to generalize some of the findings related to the incidence/prevalence of diseases. Second, the limited diagnostic capabilities and suboptimal training and staffing of this facility along with many difficulties the patients face on seeking consultation may have skewed some of the study results, such as the incidence of URTIs or UFIs. Third, the uncertainties in terms of population totals and mix make it hard to predict the future trends in actual needs and specific burdens. Lastly, as the data of this study are derived from a single medical center in the northwestern Syria, it may not reliably represent other affected areas in Syria nor the diaspora communities in the neighboring countries.

Future directions

We are expecting to complete the implementation of “HealthySyriaTB” program in all SEMA-affiliated centers within the upcoming year. We also have invited other organizations to consider using this program in their affiliated centers, should this implementation proceed as planned, the reliability and the scope of collected data will improve, leading to a positive impact on the quality of future iterations of this study. For the next years of the Healthy-Syria studies, we expect a better data collection and coding that should lead to a more accurate estimation of prevalence of vaccination-preventable diseases, malnutrition, and other communicable and chronic diseases. We are also planning to have more centers in different areas, using the program to have a more generatable picture. This should improve the health needs assessments for the IDP and responsiveness. Importantly, it can inform the public health and population health measures needed to address particular conditions in this population.

CONCLUSION

In this study, we provide a quantitative description of the burden of different diseases and conditions among children and adolescents in northwestern Syria. We found that infectious diseases represent the majority of the burden across all age groups, with URTIs, infectious diarrhea, and otitis media representing almost half of all cases in this category. There was also a high burden of nutritional deficiencies, with acute severe malnutrition that may contribute. We identify relapse of vaccination-preventable diseases including measles, mumps, and rubella, unsurprising given the decline in vaccination coverage in this area and others in Syria. The majority of infectious diarrheal diseases and malnutrition occurred in people living in IDP camps, likely related to poor sanitation and food supply. We reported a seasonal variation in the incidence of URTIs and infectious diarrhea and a high number of pregnancy and delivery in adolescents. Our findings offer some insights that could help the medical and humanitarian organizations to better understand the scope of problems encountered and how to address the most urgent needs of the impoverished and displaced people living in this region. On the basis of these findings, a number of recommendations can be made around improving sanitation and living conditions for those in the IDP camps. Improving health services for them as well as education and public health measures (for both residents and IDP) can support the health of children and adolescents. Our data on the nutritional status may not represent all cases in the catchment area and may only be the more severe cases, as such, addressing nutrition and feeding at a population level can help reduce micro- and macronutrient deficiencies. Syria’s war has led to an exodus of its health workers with those remaining being under increased pressure, some may not have been able to complete their specialty training. As such, supporting them with updated courses on conditions of particular concern, which are identified here, for example, infectious diseases, teenage pregnancies, and malnutrition can lead to improvements in the health of the populations.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.
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