Acute cystitis in children: age and regional features in Ukraine

The present study aimed to evaluate the dynamics of the incidence of acute cystitis in Ukrainian children in the regional aspect. Methods. The primary documentation is presented by the data of state and branch statistical reports of the institutions of the Ministry of Health of Ukraine for 2013-2017. There are age periods children under 14 and 15 17 years. The indicators were analyzed for Ukraine as a whole, five of its regions, and the regions that make them up. Results. At stabilization of morbidity of children till 14 years which specific weight reaches 70%, annual growth of sick teenagers (on 28,0% from 2013 to 2017) is noted. Conclusionі. Administrative areas have been identified that require increased attention from health authorities and clinicians to develop appropriate measures.

Introduction. The problem of maintaining the health of children against the background of consistently unfavorable indicators, when deviations in their health are becoming more common and pronounced, is becoming a relevant, important task of all government agencies, institutions, public organizations and society as a whole [1][2][3]. Acute infectious and inflammatory diseases endured in childhood should be considered predictors of a number of other diseases in the later age period at the stages of reproductive and working-age [4][5][6][7]. In this aspect, urinary tract infections are of interest as one of the most important problems of modern urology, and, in particular, acute cystitis, which is the most common manifestation [8][9][10]. In most cases, the infection is of ascending character, mainly affects the kidneys, and in clinical outpatient practice, patients with acute cystitis are not significantly inferior in the frequency of treatment of acute pyelonephritis. Its tendency to recur, as a feature of the clinical course, complicates the situation [11,12]. The disease takes a chronic form with all its known negative manifestations, complications, consequences [11,14]. As a result, they cause frequent visits to doctors, lead to a sharp decrease in physical and psycho-emotional activity, leave their mark on the quality of life. In fact, the above category of patients needs long-term medical and social care [11,13,14]. Therefore, detailed information on common diseases with the progressive and disabling course is usually important. Under such conditions, the need for systematic monitoring, assessment of the dynamics of those diseases in childhood, which can predict the prevalence of chronic diseases in the future, and thus timely focus on optimizing prevention, development and implementation of effective health technologies.
This study aimed to evaluate the dynamics of the incidence of acute cystitis in children in the regional aspect.
Materials and Methods. The paper presents an analysis of the incidence of acute cystitis (AC) in children based on a study of official statistics for 2013 -2017. A feature was the allocation of two age periodschildren under 14 and 15 -17 years. The dynamics of absolute and intensive indicators (per 1000 relevant population) were studied both in Ukraine as a whole and in five regions and oblasts that are part of them (Western, Central, Northeastern, Southeastern, Southern). During processing dynamic series, a standard set of indicators was involved: absolute increase (decrease), growth rate (decrease), coefficient of visibility. For comparative analysis, the mean values with their errors were calculated, and in determining their differencesthe Student's test criterion. Results. The dynamics of the total number of children registered in Ukraine with acute cystitis during 2013 -2017 in the regional aspect are presented in Table 1. Apparently, it was quite stable among children 0-14 and 15-17 years old. The slight tendency to increase them (by 0.9% to 21137 in 2017), which was observed last year, was more pronounced among adolescents (by 2.3% to 6619 and only by 0.3% to 14518 among children under 14 years). From the given data the advantage (in 2.2 times) of patients at the age of 14 years is traced. It continues in each region and ranges from 1.1 (the capital) to 3 times (Western region). The defined general picture of the whole country consists of features of changes in regions. Thus, the number of registered children (0-17 years) decreased in the Western (by 1.7%), Central (by 3.0%), North-Eastern (by 6.0%) regions and increased by 2.8% in the South-East, 15.2% in the South and 51.4% in Kyiv. In the structure of the distribution of sick children with acute cystitis, which is presented in Table 2, we find confirmation that the vast majority of them during the study period are concentrated in the Western region (in 2017 -44.7 ± 0.2%), the second and third places were occupied by Central and Southeastern (22.2 ± 0.3 and 19.0 ± 0.3%, respectively), the rest were successively occupied by the South (9.1 ± 0.2%), the North-East (3.3 ± 0.1%) and Kyiv (2.8 ± 0.1%). According to the comparative analysis of the data of the selected two age groups of children, several features are crystallized. Thus, with the similar following sequence of distribution of leading places of registered sick children 0 -14 and 15 -17 years, which account for 94.3% and 93.0%, respectively (Western, Central, South-Eastern, Southern), the dynamics of their changes have differences. A more pronounced growth rate (+ 2.3% vs. + 0.3%) of adolescents is due to an increase in cases in four administrative territories (Western by 2.9%, Central by 4.3%, Southern by 17.6%, Kyiv by 56.6%), while in the other age category in three -Southeast (10.8%), South (13.6%) and the capital (47.1%). In order to reduce the leveling of random deviations in individual years for generalization, to identify the main typical feature, the average values of the number of patients by region were calculated, as they cover the features present in the observation group (Table 3). The results of Table 3 confirm the above-mentioned similarity or difference of regional processes observed during five years in the context of two age periods of children with acute cystitis. It is only necessary to add that the situation in Ukraine is formed by three regions (Western, Central, South-Eastern), in which the most patients with acute cystitis are concentrated, namely at the age of 0 -14 years 87.3%, 15 -17 years -81.1%.

Оригінальні наукові роботи Original Papers
In this context, data on the oblasts that make up each region are of interest. It was found that the vast majority of them in the West accounted for Lviv, Ternopil, Chernivtsi oblasts (up to 14 years -73.7%, adolescents -61.6%), in Central -Vinnytsia and Kyiv (61.5% and 70.5%, respectively), in the South-East -Dnipropetrovsk, Kharkiv (58.7% and 68.0%), in the South -Odesa, (52.0% and 64.5%, respectively). As a result, in 2017, 11,468 out of 21,137 (54.7%) children with this disease were concentrated in the eight oblasts listed above, including 7,436 (35.2%) and 4,032 (19.5%), respectively, under the age of 14 and 15 -17 years. The results of studying the dynamics of the incidence of children with acute cystitis in the age aspect by region per 1000 of the relevant population are different, which is obvious from Table 4. In general, in Ukraine, the indicators among children under 14 years of age, with a slight tendency to decrease, do not differ significantly and are lower by 2.2 -3.4 times the incidence rate among adolescents at their annual growth rate of 3.5% 9.6%, 20.7%, 28.0% by the coefficient of visibility (providing the value of 2013 for 100%). As it can be seen from Table. 4, the incidence at the age of 0 -14 years was in the range of 2.16 -2.26 per 1000 population and averaged 2.2±0.01, although from year to year it decreased by 1.8%, 2.6%, 4.4%, 1.3%, while adolescents in five years increased by 28% and were equal in 2017 to 6.13; and averaged 5.38 ± 0.2. According to the comparative analysis of the dynamics of indicators among children under 14 and 15-17 years in each region and the capital, as well as summarizing their in-dicators in the form of averages, we can conclude that in both cases the distribution of rankings is almost the same. Thus, the first four of them belong to the Western, Central, Southern and South-Eastern regions; the average levels of morbidity of children under 14 years of age and adolescents, respectively, were in the following areas, respectively: 4.34± 0.05 and 7.75 ± 0.3; 2.71±0.1 and 6.67±0.2; 1.45±0.02 and 5.33±0.3; 1.27±0.08 and 3.92±0.3 (per 1 thousand inhabitants).
In addition, the incidence of adolescents must increase from year to year in all administrative territories, and more intensively in the Southern region and Kyiv, which can be seen in the coefficient of visibility (Fig. 1).  Discussion. According to the results of analyticalsynthetic, comparative analysis of official statistics for 2013-2017 in Ukraine, it was found that adolescents are at risk due to the growth among them of acute cystitis by 28.0% to 6.13 in 2017, the value which was 2.2 -3.4 times higher than among children under 14 years of age with a tendency to decrease and were in the range of 2.16 -2.16 per 1,000 population, unfortunately, the specific information presented could not be compared with other authors. Most of them emphasize only the sufficient prevalence of pathology in the pediatric pop-ulation and refer to the lack of its accuracy [15][16][17]. In a separate publication by VV Verbytsky and co-author, it is noted that 32% of young children with urinary tract infections have acute cystitis [15]. More often there are references to the frequency of hospitalizations with urinary tract infections, the group of which includes acute cystitis, and, according to Rafalsky et al it is the most common [18]. In particular, in the structure of hospitalized nephrology hospitals, 10.0% account for cystitis and 22.0% in the structure of microbial-inflammatory diseases of the urinary system. Under such conditions, In contrast, among children under 14 there is a steady annual decrease in the level in the Western, Central, Northeastern regions, in the rest of the coun-try (Southeast, Southern regions, the Capital), in recent years there has also been an increase in morbidity (Fig. 2).  The summary of the above data shows the urgency of providing specialized care to children with acute cystitis, and the identified regions and areas that are part of them and have not only high morbidity but also stand out for their growth, dictate the need for a thorough study of the root causes of the situation and development of purposeful clinical-organizational, administrative measures. At the same time, they need to take into account the age characteristics that were discovered during the study.
Conclusions. It was found that, with the relative stabilization of registered children with acute cystitis in Ukraine in 2013-2017, the vast majority of them are under the age of 14 and only one in three cases are adolescents, with, in contrast, among the latter is charac-terized by annual growth in most areas (by 2.3% to 6619 against 0.3% to 14518). In the structure of the distribution of the total number of children with acute cystitis, regardless of age, the first three places belonged to the Western, Central, South-Eastern regions; they account for 94.3% and 93.0% of children under 14 years and adolescents with this pathology. Eight oblasts (Lviv, Ternopil, Chernivtsi, Vinnytsia, Kyiv, Dnipropetrovsk, Kharkiv, Odesa) were identified, where 11468 out of 21137 (54.2%) children with acute cystitis were concentrated in 2017. Levels of incidence of acute cystitis (per 1.000 corresponding population) of children under 14 years of age with a slight tendency to decrease ranged from 2.16 to 2.26 (average for 5 years was 2.2 ± 0.01) and were 2.2 -3.4 times less than among adolescents, who grew annually (by 28.0% from 2013 to 2017 and amounted to 6.13; an average of 5.3 ± 0.2).
Conflicts of interest. The authors have no conflict of interest regarding the materials of this article.
Authors' contributions. N. Saidakova: concept and design of the study, analysis of the obtained data.
О. Shulyak: concept and design of research, formation of conclusions.
A. Klyus: copying indicators, compiling summary tables, statistical data processing.
G. Kononova: design of the text of the work, search for sources of information on the topic. V. Grodzinskyy: work with primary documentation for 2013-2017, selection of statistical data.