Background: IBS in adults is an important economic burden. The economic impact of functional abdominal pain (AP) in children has not been studied. Aims: To assess the direct cost of outpatient consultations for AP in Uruguay. Methods: The study was done at the Unidad Coronaria Movil based on: a) size: largest institution providing exclusively outpatient care - house calls (HC) and outpatient visits (OP)- b) low selection bias due to inability to afford care. The patients pay a monthly fee and no charge for consultations. This avoids missing patients who do not consult to avoid transportation or visit charges. Sample: 21,145 children (10,391 girls, 10,754 boys), 7.2 % of children of the entire selected age group in Montevideo, the largest city in Uruguay (38.6% of country's population). We analyzed: a) chief complains and outcome of all HC of children 4-14 years of age- 2002-05, b) all OP for the same group-2005, c) prescriptions and medication cost of 100 consecutive consultations for AP, d) transportation costs, physician and nurses expenses, telephone operator, and IV solutions. Results: a) HC: Total HC: 125,945; GI related: 18,103 (14.4%); AP: 4,760 (26.3%). AP resulted in 121(2.5%) admissions. b) OP: GI: 1,892; AP: 378. Total outpatient consultations- 2005: 1,677 (79 AP consults/thousand children/year). Prescriptions: 1.1 prescriptions/consultation. Calculated costs: U$15 for OP and U$17 for HC. Medications: U$6/consultation. Average total expense: U$22.6/consultation. Discussion: To contextualize the economic impact, we provide economic data from Uruguay. Minimum monthly wage 2005: U$82.5. Per capita government yearly health expenditure 2005: U$450. Our investigation did not measure other direct costs: laboratory, radiological, endoscopic evaluations, self-medication and inpatient expenses and indirect costs: childcare and foregone earnings of parents missing work. Conclusions: AP constitutes an important economic burden to the health care system in Uruguay.
Purpose: Functional abdominal pain in children is common and is associated with psychosocial dysfunction and decreased quality of life. To determine the prevalence of pediatric abdominal pain and its impact on psychological wellbeing and school absences. Methods: Prospective cohort study (12/2005–06/2006). Gastrointestinal and other symptoms were assessed weekly with validated self-report questionnaires. Anxiety, depression, functional disability, quality of life, somatization, coping, school absenteeism and medical care use were also assessed. Two public schools. All 3rd–8th grade (495) children were invited to participate. 237 students (48%) (11.8 years, 134 girls) entered the study. An average of 209 children responded weekly. All participants completed the study. Complete data were obtained on 4,606 (89%) out of 5,175 possible questionnaires. Results: An average of 72% of children reported > 1 somatic symptom and 45% > 1 gastrointestinal symptom each week. Headache was the most common complaint at 42%. Weekly prevalence of abdominal pain was 38% and 90% of children reported abdominal pain at least once. Abdominal pain persisted for > 4 consecutive weeks in 52% of all children and was associated with higher anxiety (P < 0.001) and depression (P < 0.001) scores, and worse quality of life (P < 0.001). Twenty-eight percent of children missed school for abdominal pain (average 2.3 days) and 10% of parents with children who reported abdominal pain missed work (average 1.9 days). Presence of abdominal pain (P < 0.001) was independently associated with school absences. Psychological and demographic variables were not associated with absences. Four children (2%) sought medical attention and one underwent testing because of abdominal pain. Conclusion: Abdominal pain is common in school age children and is associated with worse quality of life, psychological co-morbidities, school absenteeism and parental work absences.
Background: Functional abdominal pain (AP) is a common cause of consultation in children. Adult and pediatric studies have shown a higher prevalence of irritable bowel syndrome in females. There are no studies on consulting behavior for AP in South American children. Aims: To analyze the pattern of AP consultations in children in Uruguay. Methods: An observational study of outpatient consultations. We reviewed all records of house call visits of the largest institution in Uruguay exclusively providing outpatient care. Study period: 2002-2005. Sample size: 21,145 children (girls 49%), 4-14 years old, 7.2 % of age appropriate children of Montevideo (largest city). Statistical analysis: Two tailed chi-square test to determine significance. Age and gender difference calculations were related to number of subjects in each category. Results: 125,945 house calls (girls 46%). There was a significant predominance of boys in GI and girls in AP consultations. GI consultations: 18,103: girls 8,973, boys 9,130 (P < 0.05). AP consultations: 4,760 (26%) girls 2,501, boys 2,259 (P < 0.01). In children group 4-8 there was a significant predominance of GI consultations in boys (girls 3,899, boys 5,460) P < 0.001, but no difference in AP consultations: girls 1,247, boys 1,215 (P < 1). In children 9-14, there was a significant predominance of AP consultations in girls (girls 1,254, boys 1,044) P < 0.001. An analysis by age group revealed a peak rate of consultations for AP in patients 7-9 years of age. The pattern of consultation for AP reveals a female predominance in older children similar to what is found in adults. No gender predominance was found in younger children. Peak age for consultation was 7-9 years. Age-related hormonal or behavioral changes could explain our findings. Conclusions: There is a higher rate of consultation for AP in females particularly in children older than 9 years in South American children.
