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4FEATURES OF INTERNAL DISEASES OCCURRING IN CHILDREN WITH
DISABILITIES AT BOARDING SCHOOLS
1 2 Dildora S. Tulyaganova, Feruza L. Azizova
12
, Tashkent Medical Academy, Uzbekistan. Tashkent https://doi.org/10.5281/zenodo.8367033
Abstract. Characteristics of internal diseases in children living in boarding houses for disabled children, including the level of medical care provided to children by doctors and paramedics based on the results of dispensers, medical history and survey results of disabled children (n-451) during 2018-2020, observation conclusions and recommendations were developed based on the analysis of the results. Diseases of the nervous system (68, 7%) were the most common concomitant diseases among disabled children in boarding schools.
Proposals were made to improve nursing care for disabled children and improve the quality of life of disabled children.
Key words: children with disabilities, boarding school, nurses, somatic disease.
Аннотация. Характеристика внутренних заболеваний у детей, проживающих в домах-интернатах для детей-инвалидов, включая уровень медицинской помощи, оказываемой детям медицинскими сестрами, основана на результатах диспансеризации, истории болезни и результатах обследования детей-инвалидов (n-451) в течение 20182020 гг. На основе анализа были разработаны выводы наблюдения и рекомендации о результатах. Заболевания нервной системы (68,7%) были наиболее распространенными сопутствующими заболеваниями среди детей-инвалидов в школах-интернатах.
Были внесены предложения по улучшению сестринского ухода за детьми-инвалидами и улучшению качества жизни детей-инвалидов.
Ключевые слова: дети с ограниченными возможностями, школа-интернат, медицинские сестры, соматическое заболевание.
Anntotsiya. Nogiron bolalar uchun internat uylarida yashovchi bolalarda ichki kasalliklarning tavsifi, shu jumladan hamshiralar tomonidan bolalarga ko'rsatiladigan tibbiy yordam darajasi 2018-2020 yillar davomida tibbiy ko'rik natijalari, tibbiy tarix va nogiron bolalarni (n-451) tekshirish natijalariga asoslangan. Natijalar. Asab tizimi kasalliklari (68,7%) maktab-internatlarda nogiron bolalar orasida eng ko'p uchraydigan kasalliklar edi.
Nogiron bolalarni parvarish qilishni yaxshilash va nogiron bolalarning hayot sifatini yaxshilash bo'yicha takliflar kiritildi.
Kalit so'zlar: nogiron bolalar, maktab-internat, hamshiralar, somatik kasallik.
Relevance. Today in Uzbekistan, disability, especially among children is considered as an important medical and social problem in the indicators of public health. A comprehensive in-depth study of the prevalence causes and delay of disability allows the development of complex measures to address and reduce these problems [1]. The diseases of the nervous system and sensory organs take the first place, mental illnesses - the second place and congenital anomalies -the third place among the causes of childhood disability. The importance of evaluating this indicator is pre-determined by the prevalence and structure of childhood disability, on the one hand, the most important features of the health of the population of the region, and on the other hand, the creation of necessary conditions for the development of disabled children. As a result of the consequences of disability, parents' taking their disabled children under their care leads to
a reduction of labor resources in social spheres, or as a result of transferring them to the care of a boarding institution, additional tasks are created for the social protection system [2].
There are special boarding schools and boarding houses for disabled children in the republic. Their activities are strictly controlled by the government. The development and effectiveness of public systems and non-governmental organizations that provide assistance to disabled children, as well as services responsible for the implementation of policies are important for the prevention of disability among children [4, 5]. Preventing the concomitant diseases that are common in mentally retarded children in boarding school conditions and taking measures with an individual approach, treating doctor and medical nurse are the urgent tasks of medical care. According to the analysis of individual maps of children, taking into account their place of residence, gender and age, the dynamics of morbidity of the same amount can be observed. In the development of materials on children's diseases, a list of classes and names of diseases according to ICD-10 (International Classification of Diseases) were used [3,5,18]. After statistical processing of a number of indicators, at this stage of the research, we can provide a detailed description of the morbidity of children in separate boarding institutions, during the years of observation, depending on the gender and age of children [6,10,12]. Inhibitions in the physical development of children educated in boarding schools are more often associated with multifaceted (sensory, cognitive, emotional, etc.) effects of negative mental and physical deprivation [7]. Facing the necessary vital needs for a child is, first of all, communication with parents, their care and patronage. Despite the physically favorable conditions for the child's stay in a residential institution, there are strong psycho-emotional conditions that a child deprived of a family necessarily experiences, and this, in turn, it leads to the development of certain diseases [8,9]. Disability reduces life expectancy and increases serious health problems together with diseases [11].
Eating habits of children with mental retardation or developmental disabilities include eating high-calorie foods, unbalanced diets , increased cravings for food leads to the tendency to overeating, difficulty of controlling an appetite, a lack of exercise and self-management skills [14]. As a result, various diseases develop due to obesity. In particular, children with mental retardation and emotional and behavioral disorders often show signs of functional developmental disorders due to low cognitive ability, so early studying of this system is required [13].
Material and methods. Dispenser control analysis results, medical history of n-451(2018-2020) disabled children were studied and a questionnaire was conducted on children's health among doctors and nurses (41) in Tashkent city.
Results and discussion. A complete selection of materials on individual cards (f. 025 /u) for determining the state of health of children allows us to give a complete description of the incidence of these contingents. At the same time, children with disabilities, in addition to the main disease that causes disability, often have a high probability of contracting acute or chronic diseases that worsen the quality of life of children, negatively affecting their physical and mental state, which means that it requires a lot of responsibility from the health worker.
The boarding school for disabled children consists of 3 departments , in which the 1st department consists of walking children (239), the 2nd department consists of crawling children (97), the 3rd department consists of bedridden children's departments (1- table).
Table 1
Structural indicators of the boarding house for disabled children in 2020
Including: Total number of children Girls Boys
Total 451 183 268
Walking children 239 85 154
Crawling children 97 52 45
Bedridden children 115 69 46
4-10 age 122 67 55
10-14 age 254 119 135
14-18 age 75 35 40
Children with disabilities (94,6%) in the boarding school are mentally retarded, and they have F1 (Moderate Mental Retardation) and F2 (Severe Mental Ret,3%) than girls, and the level of F73 (Profound mental retardation) showed a difference (27%) (Figure 1).
Figure 1. Indicators of the level of mental retardation of children with disabilities according to (ICD-10).
In addition, a medical examination is undergone in all children twice a year. In order to monitor the dispensary, doctors of a narrow specialty (pediatricians, dentists, otolaryngologists, endocrinologists, orthopedic traumatologists, ophthalmologists) from the attached district medical institutions visit the boarding house and conduct a medical examination of all children at boarding school. In this case, each child is examined thoroughly , the medical history is studied, the indicators of growth and development are compared over the years, and the results are recorded. With the doctor's recommendation, it is sent for analysis and other tests. The conducted dispensary is summarized on the results of observation and analysis, and according to it,
treatment measures are prescribed to each children by specialists based on medical standards.
Disabled children of the boarding school are under the constant supervision of a doctor, and in addition, they are undergone an in-depth medical examination twice a year. All information describing children's health status is included in individual cards (f. 025/u).
According to the results of the in-depth examination conducted in 2020, 94,9% of the total (451) children have disabilities due to congenital anomalies, of which 53,3% (268) are boys, 46,6% (183) are girls. Among concomitant diseases, nervous system diseases (12,4%), anemia (11,9%) and ischemic heart diseases (7%) showed higher rates than other diseases. It was followed by diseases of the gastrointestinal system (4,6%) and upper respiratory tract (ENT) (3,9%), endocrine diseases (1,3%) (Table 2).
Table 2
Results of dispensary medical examination conducted in 2018-2020
Diseases Total number of children n -1353 abs. %
Boys Girls Total
abs. abs. % abs. %
1. Congenital anomalies 654 483,3 630 465,6 1284 949,0
2. Anemia 87 64,3 75 55,4 162 119,7
3. Gastrointestinal diseases 33 24,3 30 22,1 63 46,5
4. Diseases of lower respiratory organs 9 6,6 12 8,8 21 15,5
5. Diseases of upper respiratory organs 30 22,1 24 17,7 54 39,9
6. Endocrine diseases 6 4,4 12 8,8 18 13,3
7. Eye diseases 6 4,4 6 4,4 12 8,8
8. Ischemic heart diseases 60 44,3 12 8,8 96 70,9
9. Oncological diseases 6 4,4 3 2,2 9 6,6
10. Diseases of the urinary system 21 15,5 33 24,3 54 39,9
Nervous diseases
11. 93 68,7 75 55,4 56 41,3
Total 1005 742,3 912 673,5 1829 1351,4
As part of dispensary observation of disabled children, if any disease is suspected, the medical history is studied and the necessary examinations (USD, ECG, ECHO, blood and urine) are ordered. According to the conclusion of the dispenser of 2020, anemia is the most common concomitant disease , in which a general blood analysis was taken from 451 children, and anemia was detected in 54 (11,9%) children. Among them, 35 (64%) had anemia of the first degree, 15 (27,7%) had the second degree, and 4 (7,4%) had the third degree of anemia. Anemia in children occurs not as an independent disease, but as a complication of another disease. Therefore, it is necessary to find the factor that causes anemia and eliminate it.
According to the ECG analysis, the signs of functional cardiopathy were revealed in 4,2% of 451 children. Today the advances in the field of cardiopathy in children allow an accurate diagnosis and complete treatment of cardiopathy even in very difficult cases. Secondary cardiopathy in children often occurs against the background of infectious diseases. It is caused by the introduction of the virus into the heart tissue, which contributes to the development of various pathologies. In this case, the best prevention is to treat the infectious diseases in time and to keep the child's immunity at a high level.
166 children suspected of some internal disease were ordered to undergo an ultrasound examination, of them in 57 children (12,6%) were revealed various pathologies. The results of ultrasound analysis showed that chronic pyelonephritis was observed in 3,9% of children, 12 of them (2,6%) were boys and 6 (1,3%) - girls (Table 3).
Table 3
Results of ultrasound examination (2020)
n-451
Identified pathologies Total % Boys % Girls %
Chronic pyelonephritis 18 4.0 12 2,6 6 1,3
Chronic enterocolitis 15 3.3 8 1,7 7 1,5
Chronic cholecystitis 10 2.2 6 1,3 4 0,8
Gastroduodenitis 8 1.7 4 0,8 4 0,8
Chronic pancreatitis 3 0.6 2 0,4 1 0,2
Reactive pancreatitis 3 0.6 2 0,4 1 0,2
Chronic pyelonephritis were recorded in 3,7% of children in their individual medical history prior to the analysis and chronic pyelonephritis was diagnosed in 1 child after dispensary observation,
A questionnaire was carried out from the continuous monitoring of the health of disabled children in the boarding school by a nurse and nannies assigned to disabled children in order to assess the quality of medical care. According to him, 5,7% of the nurses answered that they are not satisfied with the constant monitoring of the children's health, and 94,2% are satisfied with the constant monitoring (Fig. 2).
94,2%
Satisfactory
Partial unsatisfactory
Figure 2. Nurse monitoring the health of disabled children assessment by nannies
According to the results of the questionnaire received from the parents of disabled children at the boarding school, they are satisfied (84%) with the provision of medical care by the nurse, but some parents answered that they are not satisfied (16%) (Fig. 3). It should be mentioned here that only 40% of 100% of the parents who visit the boarding school in order to see their child and get information about their health state.
Figure 3. Satisfaction with the quality of medical care according to the results of the questionnaire received from the parents of disabled children
Also the parents consider the existing of medical equipment in the institution, the state of medical and social services aimed at children to be satisfactory. However, the level of using of computers or tablets in nursing work is very low (20%), and there is not existed an electronic documentary system.
Conclusion. Of the 451 children in the boarding school, mental illnesses were revealed in 94,6%, of which 53,3% (268) are boys, and 46,6% (183) are girls. According to the results of the dispensary, the most common diseases were diseases of the nervous system (68,7%) and anemia (anemia 64,3%). According to the ECG analysis, the signs of functional cardiopathy were noted
[ПРОЦЕНТ]
■ Satisfies
■ Does not satisfy
84%
in 19 children. Ultrasound diagnostic analysis was ordered for 166 children, according to which 57 children were diagnosed with various pathologies, the results of the analysis were sent to the doctor. The level of satisfaction with nursing medical services is high among nannies and children's parents, but some errors are observed in the nursing process.
Recommendation. Conducting the lectures, science based medical information and news about measures to monitor the health level of disabled children and improve the quality of life. Introduction of an electronic system in order to improve the nurse's activities and monitor the health level of disabled children electronically.
REFERENCES
1. F.L. Azizova. Comparative assessment of the incidence of pupils of specialized boarding schools for hearing-impaired and deaf-mute children // Medical Journal of Uzbekistan. -Tashkent, 2014. - №5. - P. 51-54 (14.00.00; №8).
2. Anaeva L.A., Zhetishev R.A., Krymukova M.A., Atskanova B.L. Dynamics of prevalence and nosological structure of childhood disability in Kabardino-Balkaria // Fundamental research. 2014. - № 10-9. -P. 1680-1684.
3. Avdeeva M.S., Tulyakova O.V., Yurchuk O.A. Evaluation of motor qualities and skills of first-graders // Hygiene and sanitation . - 2008. № 2. P.78-80.
4. Baranov A.A., Albitsky V.Yu., Zelinskaya D.I., Terletskaya R.N. Disability of the child population of Russia // M.: Center for the Development of Intersectoral Programs, 2008. -240 p. (Series "Social Pediatrics"; Issue 7). Zorina I.G. Features of the psychophysiological status of schoolchildren studying in educational institutions of various types. // Hygiene and sanitation. - 2008 № 3 P.75-77.
5. Zorina I.G. Features of the psychophysiological status of schoolchildren studying in educational institutions of various types. // Hyg. and san. 2008 № 3 P.75-77.
6. Zyuzina N.E. The state of health of adolescents in economically "prosperous" families and health programs. // Hygiene and sanitation. -2005 №4 p.46-49.
7. Fefelova V. V. et al. Comparative analysis of the physical development of children with the same degree of mental retardation brought up in a family and in a boarding school: scientific publication // Morphology. - Completion of pub., 2016. - Book 150 №5. - p. 53-57. -Bibliogr.: 16.
8. Kulakova E.V., Bogomolova E.S., Kiseleva A.S. Features of the physical development of schoolchildren brought up in social and rehabilitation institutions and families // Postgraduate doctor. 2013. № 2. P. 33-38.
9. Paveliev I.G. Age dynamics of parameters of physical development of children and adolescents-orphans aged 8-18 years // 2014. № 9 P. 105-109.
10. Shaykhova G.I., Azizova F.L., Avezova G.S. Level and structure of morbidity of children brought up in specialized boarding schools // Bulletin.tma.uz 2018.№1, P. 110
11. Di Nuovo SF, Buono S. Psychiatric syndrome comorbid with mental retardation:
12. difference in cognitive and adaptive skills. J Psychiatr Res. 2007;41(9):795-800.
13. Fairthorne J., Jacoby P., Bourke J. et al. The onset of maternal psychiatric illness after childbirth with intellectual disability: a retrospective cohort study // J. Psychiatr. Re. - 2015. Actively participated. 61. - P. 223-230.
14. Harvey, W. J., & Reid, G. (2003). Attention-deficit/hyperactivity disorder: A review of research on movement skill perfor- mance and physical fitness. Adapted Physical Activity Quarterly, 20 (1), 1-25.
15. Lee, B. J. (2007). Effects of participation in an after-school physical activity program on the body composition of students with intellectual disability. Journal of Adapted Physical Activity, 15 (3), 167-181.
16. Miller L.S. Kiernan M.T.,.. Developmental and nutritional status of internationally adopted children. // Arch.Pediatr.2015 -Vol. 149, №1 P. 40-44.
17. Serap Balci,Hamiyet Kizil Zihinsel engelli 9ocugu olan ailelerin ya§adigi gu9luklerin ve aile yukunun belirlenmesi // Psixiatriya hamshirasi Jurnal,C 124, TypKHa 2019
18. Nabiyeva G.A. Imkoniyati cheklangan bolalarning ta'lim-tarbiya olishlari //«SCIENTIFIC PROGRESS» Scientific Journal / Volume: 1, ISSUE: 5, 369-b, 2021
19. WHO. The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research (World Health Organization, Geneva, 1993).
