Published: 2022-09-22

Common chronic conditions in pediatric primary care

Shada Murshed Alharbi, Abdulelah Ahmad Alluheybi, Arif Aedh AlHarbi, Latifa Khalifa Alkaabi, Kholoud Mesfer Alshahrani, Khairiyyah Khalid Farrash, Saleh Mohammed Alothman, Abeer Haider Alhaider, Farah Abdulkareem Almomen, Aysha Salah Albusaiteeni, Nouriyah Haider Arishi


Chronic health conditions comprise illnesses as well as physical disabilities that last longer than 12 months and limit the patient’s usual activity. The prevalence of chronic illnesses and disabilities in children and adolescents has more than doubled in the last 60 to 70 years. Common chronic conditions encountered among children across the globe include bronchial asthma, cystic fibrosis, diabetes mellitus, epilepsy, and developmental disabilities like cerebral palsy, in addition to congenital and heredofamilial conditions including certain hemolytic anemias and genitourinary disorders endemic to Saudi Arabia and the Middle East. Factors implicated in the shift in child health epidemiology from acute to chronic illnesses include better availability of diagnostic tools, improved specialized care access for pediatric patients suffering from complex congenital disorders, neoplasms, and premature births, and especially in case of disadvantaged populations, environmental factors like unhealthy living conditions, food insecurity and poor perinatal health. The two most common chronic conditions of childhood and adolescence managed by primary care physicians around the world and in Saudi Arabia are asthma and diabetes. Common risk factors across various diseases are urbanization, poor lifestyle, and consanguinity. The research on childhood-onset diseases and their different phenotypes in Saudi Arabia is scarce and confined largely to a few highly prevalent conditions at present.


Children, Chronic, Asthma, Diabetes, Developmental disorders, Primary care

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Van Der Lee JH, Mokkink LB, Grootenhuis MA, Heymans HS, Offringa M. Definitions and measurement of chronic health conditions in childhood: a systematic review. JAMA. 2007;297(24):2741-51.

Halfon N, Newacheck PW. Evolving notions of childhood chronic illness. JAMA. 2010;303(7):665-6.

McPherson M, Arango P, Fox H. A new definition of children with special health care needs. Pediatrics. 1998;102(1 Pt 1):137-40.

Schellevis FG, van der Velden J, van de Lisdonk E, Van Eijk JTM, van Weel Cv. Comorbidity of chronic diseases in general practice. J Clin Epidemiol. 1993;46(5):469-73.

Van den Akker M, Buntinx F, Metsemakers JF, Roos S, Knottnerus JA. Multimorbidity in general practice: prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases. J Clin Epidemio. 1998;51(5):367-75.

Uijen AA, van de Lisdonk EH. Multimorbidity in primary care: prevalence and trend over the last 20 years. The European journal of general practice. 2008;14(1):28-32.

Britt HC, Harrison CM, Miller GC, Knox SA. Prevalence and patterns of multimorbidity in Australia. Med J Aus. 2008;189(2):72-77.

Van Oostrom SH, Picavet HSJ, Van Gelder BM. Multimorbidity and comorbidity in the Dutch population–data from general practices. BMC public health. 2012;12(1):1-9.

Brett T, Arnold-Reed DE, Popescu A. Multimorbidity in patients attending 2 Australian primary care practices. Ann Family Med. 2013;11(6):535-42.

Al-Qurashi MM, El-Mouzan MI, Al-Herbish AS, Al-Salloum AA, Al-Omar AA. Age related reference ranges of heart rate for Saudi children and adolescents. Saudi Med J. 2009;30(7):926-31.

Al-Turki Y. Overview of chronic diseases in the Kingdom of Saudi Arabia. Saudi Med J. 2000;21(5):499-500.

Organization WH. World health statistics 2020; 2020.

Ng SW, Zaghloul S, Ali H, Harrison G, Popkin BM. The prevalence and trends of overweight, obesity and nutrition‐related non‐communicable diseases in the Arabian Gulf States. Obesity reviews. 2011;12(1):1-13.

Katooa NE. Resilience of Saudi families with chronically ill children, RMIT University. 2014.

Arabia MoHS. Saudi Arabia health statistical yearbook. Riyadh, Saudi Arabia: Ministry of Health (Saudi Arabia);2011.

Perrin JM, Bloom SR, Gortmaker SL. The increase of childhood chronic conditions in the United States. JAMA. 2007;297(24):2755-9.

Danese A, Moffitt TE, Harrington H. Adverse childhood experiences and adult risk factors for age-related disease: depression, inflammation, and clustering of metabolic risk markers. Arch Pediatr Adolesc Med. 2009;163(12):1135-43.

Levy L, Fleming J, Klar D. Treatment of refractory obesity in severely obese adults following management of newly diagnosed attention deficit hyperactivity disorder. International Journal of Obesity. 2009;33(3):326-334.

Suglia SF, Duarte CS, Sandel MT, Wright RJ. Social and environmental stressors in the home and childhood asthma. J Epidemiol Comm Health. 2010;64(7):636-42.

Cortes JB, Fernández CS, de Oliveira MB. Chronic diseases in the paediatric population: Comorbidities and use of primary care services. Anales de Pediatría (English Edition). 2020;93(3):183-93.

Oberg C, Colianni S, King-Schultz L. Child health disparities in the 21st century. Curr Prob Pediatr Adole Heal Care. 2016;46(9):291-312.

Network GA. The global asthma report 2014. Auckland, New Zealand. 2014;769:28-36.

Braman SS. The global burden of asthma. Chest. 2006;130(1):4s-12.

Sly PD, Boner AL, Björksten B, et al. Early identification of atopy in the prediction of persistent asthma in children. The Lancet. 2008;372(9643):1100-6.

Pearce N, Pekkanen J, Beasley R. How much asthma is really attributable to atopy? Thorax. 1999;54(3):268-72.

Alqahtani JM. Asthma and other allergic diseases among Saudi schoolchildren in Najran: the need for a comprehensive intervention program. Ann Saudi Med. 2016;36(6):379-85.

Al Frayh A, Shakoor Z, ElRab MG, Hasnain S. Increased prevalence of asthma in Saudi Arabia. Ann Allergy, Asthma Immunol. 2001;86(3):292-296.

Peat JK, Van Den Berg RH, Green WF, Mellis CM, Leeder SR, Wolcock A. Changing prevalence of asthma in Australian children. BMJ. 1994;308(6944):1591-6.

Al-Nahdi M, al-Frayh R, Hasnain S. An aerobiological survey of allergens in al Khobar, Saudi Arabia. Allergie et immunol. 1989;21(7):278-82.

Al Frayh A, Gad el Rab M, Hasnain S. Indoor allergen and skin reactivity in children in Saudi Arabia. Paper presented at: 9th International Congress of the Egyptian Society of Allergy and Clinical Immunology, Alexandria, Egypt. 1990.

Ingram JM, Sporik R, Rose G, Honsinger R, Chapman MD, Platts-Mills TA. Quantitative assessment of exposure to dog (Can f 1) and cat (Fel d 1) allergens: relation to sensitization and asthma among children living in Los Alamos, New Mexico. J Aller Clin Immunol. 1995;96(4):449-56.

Bener A, Al-Frayh Facharzt A, Al-Jawadi T. Parental smoking and the risk of childhood asthma. J Asthma. 1991;28(4):281-6.

Abdulbari B, TQ AJ. Prevalence of asthma among Saudi school children. 1992.

Korenyi-Both A, Korenyi-Both A, Molnar A, Fidelus-Gort R. A1 Eskan disease: desert storm pneumonitis. Military Med. 1992;157(9):452-62.

Yemaneberhan H, Bekele Z, Venn A, Lewis S, Parry E, Britton J. Prevalence of wheeze and asthma and relation to atopy in urban and rural Ethiopia. The lancet. 1997;350(9071):85-90.

Lundbäck B. Epidemiology of rhinitis and asthma. Clin Exp Aller. 1998;28:3-10.

International Diabetes F. IDF diabetes atlas global diabetes data report 2000-2045; 2021.

International Diabetes F. IDF diabetes atlas Saudi Arabia diabetes report 2000-2045; 2021.

Wu H, Patterson CC, Zhang X. Worldwide estimates of incidence of type 2 diabetes in children and adolescents in 2021. Diab Res Clin Pract. 2022;185:109785.

Silink M. Childhood diabetes: a global perspective. Horm Res Paediatr. 2002;57(1):1-5.

Awa WL, Fach E, Krakow D. Type 2 diabetes from pediatric to geriatric age: analysis of gender and obesity among 120183 patients from the German/Austrian DPV database. Euro J Endocrinol. 2012;167(2):245.

Liu LL, Yi JP, Beyer Jl. Type 1 and type 2 diabetes in Asian and Pacific Islander US youth: the SEARCH for Diabetes in Youth Study. Diabetes Care. 2009;32(2):S133-40.

Copeland KC, Zeitler P, Geffner M. Characteristics of adolescents and youth with recent-onset type 2 diabetes: the TODAY cohort at baseline. J Clin Endocrinol Metabol 2011;96(1):159-67.

Forsen T, Eriksson J, Tuomilehto J, Reunanen A, Osmond C, Barker D. The fetal and childhood growth of persons who develop type 2 diabetes. Ann Inte Med. 2000;133(3):176-82.

Bahakim HM, Bamgboye EA, Mahdi AH, Al-Mugeiren MM, Familusi JB. Pediatric Inpatients at the King Khalid University Hospital Riyadh, Saudi Arabia, 1985-1989. Ann Saudi Med. 1993;13(1):8-13.

Yazbak FE. Autism seems to be increasing worldwide, if not in London. BMJ. 2004;328(7433):226-227.

Winter S, Autry A, Boyle C, Yeargin-Allsopp M. Trends in the prevalence of cerebral palsy in a population-based study. Pediatrics. 2002;110(6):1220-5.

Al Salloum AA, El Mouzan MI, Al Omar AA, Al Herbish AS, Qurashi MM. The prevalence of neurological disorders in Saudi children: a community-based study. J Child Neurol. 2011;26(1):21-4.

Al-Salehi SM, Al-Hifthy EH, Ghaziuddin M. Autism in Saudi Arabia: presentation, clinical correlates and comorbidity. Transcult Psych. 2009;46(2):340-7.

Tesfa D, Tadege M, Digssie A, Abebaw S. Intrauterine growth restriction and its associated factors in South Gondar zone hospitals, Northwest Ethiopia, 2019. Arch Public Health. 2020;78:89.

Galal O. Micronutrient deficiency conditions in the Middle East region: an overview. Public Health Reviews. 2000;28(1-4):1-12.

Nasir A, Jurayyan A. Spectrum of endocrine disorders at the paediatric endocrine clinic, King Khalid university hospital, Riyadh, Kingdom of Saudi Arabia. 2012.

Al Hawsawi ZM, Al-Rehali SA, Mahros AM, Al-Sisi AM, Al-Harbi KD, Yousef AM. High prevalence of iron deficiency anemia in infants attending a well-baby clinic in northwestern Saudi Arabia. Saudi Med J. 2015;36(9):1067-70.

El-Hazmi MA, Al-Hazmi AM, Warsy AS. Sickle cell disease in Middle East Arab countries. Indian J Med Res. 2011;134(5):597-610.

Warsy AS, El-Hazmi MA. G6PD deficiency, distribution and variants in Saudi Arabia: an overview. Ann Saudi med. 2001;21(3-4):174-7.

Pandarakutty S, Murali K, Arulappan J, Al Sabei SD. Health-Related Quality of Life of Children and Adolescents with Sickle Cell Disease in the Middle East and North Africa Region: A systematic review. Sultan Qaboos Univ Med J. 2020;20(4):e280-9.

Nahhas M, Bhopal R, Anandan C, Elton R, Sheikh A. Prevalence of allergic disorders among primary school-aged children in Madinah, Saudi Arabia: two-stage cross-sectional survey. PloS one. 2012;7(5):e36848.

Hijazi N, Abalkhail B, Seaton A. Asthma and respiratory symptoms in urban and rural Saudi Arabia. Euro Resp J. 1998;12(1):41-4.