Revista de la Sociedad Boliviana de Pediatría
Print version ISSN 1024-0675
PAVLICICH, Viviana and BENITEZ, Carlos. Inﬂuence of previous consultation with non-medical personnel on morbidity and mortality in hospitalised children. Rev. bol. ped. [online]. 2006, vol.45, n.3, pp. 191-200. ISSN 1024-0675.
Objetivos: Primary Objective: To determine whether a previous consultation (PC) with a curandero(***) has an effect on morbidity (days of hospital stay and complications) and mortality in children admitted to hospital for lower respiratory tract infection (LRI) or acute diarrhea. Secondary objective: to compare the inﬂuence of the PC with those of the pediatrician, the general practitioners, nurses and pharmacists. Material and methods: Analytical, prospective cohort design. One hundred thirty children were included, with age range from 1 month to 5 years, admitted for acute diarrhea or LRI between August 2003 and March 2004 at the National Hospital of Itauguá. Frequency calculations were done as univariate analysis, contingency tables as bivariate and logistic regression for independent variables as multivariate. The X2 and Fisher’s exact test were used for the difference between nominal variables, the Mann-Whitney or Wilcoxon test for continuous or ordinals. Results: One hundred seventeen patients went to 176 previous consultations: Pediatrician: 63 (35.7%), curandero: 44 (25%), General Practitioner: 44 (25%), Nurse 16 (9%) and pharmacist 9 (5.1%). Many (39.2%) of PC were not with a physician. Severity on admission was greater in patients who had consulted with the curandero (p=0.004) and with the pharmacist (p=0.001). Complications increased when the child had consulted more than twice with the curandero (OR 2.6; RR 1.6). Sixty eight patients used 49 types of herbs alone or in combination, with no increase in complications (p=0.2) with 3.8 more days in hospital. The average hospital stay in days was: With no PC: 5.3 days (SD 3.2), curandero 17.2 days (SD 16), general practitioner 13.5 (SD 15.5), pediatrician 11.6 days (SD 14). The number of days in hospital increased when symptoms began 3 or more days before admission. There were more complications in children who had had PC (p=0.003). Six patients died; these had had 26 consultations, 16 of which with an empiricist. Multivariate analysis showed that consultation with the curandero was an independent risk factor for complications (p=0.006) and length of hospitalisation (p=0.02). Conclusion: A previous consultation with the curandero increased morbidity in hospitalised patients due to a delay in consultation and worse conditions on admission. Patients with the lowest morbidity were those who consulted directly in the hospital before admission.
Keywords : empiricists; consultations; acute diarrhea; pneumonia.