|
 
 |
| ORIGINAL ARTICLE |
|
| Year : 2019 | Volume
: 8
| Issue : 2 | Page : 98-104 |
|
Assessment of caregivers' knowledge and behavior in the management of pediatric asthma in Jazan, Saudi Arabia
Ahmed A Albarraq
Department of Clinical Pharmacy, Pharmacy Practice Research Unit, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| Date of Web Publication | 13-Sep-2019 |
Correspondence Address:
Dr. Ahmed A Albarraq
Department of Clinical Pharmacy, Pharmacy Practice Research Unit, College of Pharmacy, Jazan University, Jazan
Saudi Arabia
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/sjhs.sjhs_6_19
Objectives: The knowledge and behavior of caregivers are playing a significant role in preventing and managing the emergency conditions of disease or disorder suffered by their children. Pediatric asthma is one such severe health disorder, which cripples the child from regular activities and exerts enormous stress on parents if not appropriately managed with adequate knowledge and skills in the initial stage of onset. This research paper, thus, is aimed to appraise the caregivers' knowledge and behavior (n = 250) of asthmatic children admitted to general hospitals in Jazan province, Kingdom of Saudi Arabia, about the cause, prognosis, and therapy of asthma in preventing and handling emergency asthmatic attacks in their children. Materials and Methods: Caregivers were interviewed with the help of a questionnaire (35 items) about pediatric asthma. The questionnaire was adapted from the Chicago Community Asthma Survey. Results: The results revealed that information regarding complications of pediatric asthma, behavioral skills, and knowledge on its management that are required to practice during an emergency was very little among the caregivers of asthmatic children. Lack of proper education, insufficient knowledge of asthma, underprivileged socioeconomic class, and substandard living conditions came out as reasons for poor knowledge and behavior among them. Conclusion: The study recommends that there is an urgent and pressing need to educate caregivers and provide continuous training on the right practice during asthma attacks to take proper and efficient care of their children.
Keywords: Asthma, attitudes, children, developing countries, Jazan, knowledge, practices
How to cite this article:
Albarraq AA. Assessment of caregivers' knowledge and behavior in the management of pediatric asthma in Jazan, Saudi Arabia. Saudi J Health Sci 2019;8:98-104 |
| Introduction | |  |
Pediatric asthma, a chronic disease, has a substantial impact on the health-care system and is responsible for frequent visits to the emergency room and hospital admittance. Asthma is one among the top thirty diseases with the highest burden and ranked 19th and 26th in terms of death and disability, respectively, in the KSA.[1],[2],[3] With a growing trend of globalization and urbanization, there is an exponential increase in the rate of asthma worldwide.[4] The World Health Organization recognizes asthma as the most critical health problem in the world.[5],[6] In the KSA, asthma prevalence varies from place to place. In Dammam, the prevalence rate is 7%, whereas, in the capital city of Riyadh, the incidence rises up to 12%.[3] Among schoolchildren of urban localities of Abha, the asthma prevalence was found around 9%.[7] In a study based on different communities residing in the province of Asir, KSA, it was observed that the higher altitude region has around 6.9% rate of pediatric asthma, whereas, it was 19.5% among the children residing at sea level.[8],[9] Studies show that the prevalence of childhood asthma increased in the KSA; in 1986, the incidence was 8%, but in 1995, it increased to 23%.[10] Another study showed that Jazan and Taif have the highest prevalence of asthma, 24% and 23%, respectively, among all Saudi Arabian provinces.[11] Low and substandard adherence to asthmatic medications among children is the major problem, and studies suggest that adherence to the prescribed medicine is only 50%.[12] Effective treatment of bronchial asthma among children requires proper attention of parental (caregivers) behavior toward their asthmatic children along with several other ways of understanding and improving their beliefs and behavior. The young children depend on their caregivers to make their decisions about their health. It, therefore, is at the discretion of the caregivers to decide if the child should be taken to an emergency care unit or any other appointment of preventive care. Previously conducted studies have demonstrated a relationship between compliance toward asthmatic medications as well as parental beliefs.[13] The aim of the current study, therefore, is to assess the knowledge and behavior of the caregivers of pediatric asthmatic patients regarding the cause, prognosis, and therapeutic management of asthma, with the purpose of later adapting educative strategies to favor a robust and long-lasting improvement in its treatment management in the province of Jazan, Saudi Arabia.
| Materials and Methods | | |
A survey, cross-sectional in nature, was carried out among the caregivers of asthmatic children – selected randomly – who were admitted to various general government hospitals of Jazan province from April 2016 to December 2017. The study proposal was approved by the Institutional Research Review and Ethics Committee, approval number-1749/275/37 dated 06/03/2016. Before carrying out the survey, comprehensibility, as well as validity, was assured after carefully considering the initial preliminary questions along with the specific and structured comments of the research team. The questionnaire was adapted from the Chicago Community Asthma Survey.[14] The analysis of the internal consistency was carried out by conducting a pilot test among a small group of caregivers by making use of the final version of the study questionnaire. The value of Cronbach's alpha for the knowledge and behavioral questionnaires was 0.72 and 0.78, respectively. The survey primarily collected data in two major domains of knowledge (22 items) and behaviors (14 issues) from children who have asthma. Questions related to knowledge were made up of dichotomous items (yes/no [or] true/false), which measure information related to signs and symptoms, pathophysiology, precipitating factors, and complications related to pediatric asthma. Similarly, questions related to behavior were also made up of dichotomous items (true/false or yes/no). These questions measured the caregiver's behavior during an asthmatic attack of their children and their subsequent action in preventing the attacks. Demographic as well as and background information was collected which included the children's age and gender, duration of bronchial asthma, and level of education of their caregivers (educated or not educated) along with their working status.
Selection of sample
The caregivers of children admitted with symptoms of asthma to the pediatric departments of various general hospitals in Jazan province were randomly selected, with a sample size of 250 for the study. The study included caregivers, male or female, whose child with asthmatic symptoms had been admitted to the pediatric department in any of the general hospitals in Jazan province. Pediatric patients include infants, children, and adolescents from birth up to the age of 18.
Inclusion criteria
Caregivers, male or female, of the pediatric asthmatic patients, who were admitted to the pediatric department of various general hospitals in Jazan province due to asthma problem as a principal complaint were involved in the assessment.
Exclusion criteria
- Caregivers of nonasthmatic children
- Caregivers of pediatric asthmatic patients who are not willing to participate in the study.
Data collection
The caregivers were interviewed by trained pharmacy students who had willfully agreed to participate. On an average, the time duration of each interview was 10–15 min. The caregivers were invited to partake in the study during their children's hospital stay. Informed consent was acquired from the caregivers before giving them the designed questionnaire.
Data analysis
SPSS software version 21.0 (IBM Corporation, Armonk, Newyork-10504-1722, United States) was used for data analysis. Caregivers' knowledge and behavior (“0” for poor and “1” for good) were scored; a total score for each caregiver consisting of 22 items related to knowledge along with 14 questions related to their behavior was calculated. A score ≤50% of the grand total score was deemed as having poor knowledge or behavior. For the identification of possible factors for insufficient knowledge and behavior related to pediatric asthma, a binary logistical regression analysis was done. Minimal statistical significance was fixed at P < 0.05.
| Results | | |
The study sample included males (47.2%) and females (58.8%). The mean age of the asthmatic children assessed was 7.9 years ± 2.3 standard deviation; the duration of suffering due to asthma was as follows: 16% of children <3 years; 48.4% <1 year; and 35% >1 year. Illiteracy rate of female and male caregivers was around 13.6% and 10.8%, respectively [Figure 1]. Female caregivers' knowledge about asthma was significantly poor, 57.2% (P < 0.05). The percentage of asthmatic children living in an urban area was 54.5. Low level of education and poor income (58.8%) were other socioeconomic factors associated with astmatic risk. The frequencies of asthmatic attacks were statistically significant (P < 0.05) at both day and night (in 43.2% of children), and the prevalence of asthma in siblings was found to be 41.2%. Most of the asthmatic cases found were mild in nature (70.4%; P < 0.05), and serious cases of asthmatic condition was recorded in 29.6% of children [Table 1]. | Table 1: Analysis of sociodemographic risk factors for pediatric asthma in the study sample (n=250)
Click here to view |
Caregivers' knowledge on asthma
Majority of the parents were unaware of the reasons (pathophysiology) associated with pediatric asthma, but were aware of the precipitating factors. It was acknowledged by female caregivers that the precipitating factors for asthma could be - common dust mites (89.2%), tobacco (81.6%), animal dander (48.8%), cold air (43.2%), and cold drink (31.6%) [Figure 2]. Pulmonologist (63.6%) was the regular person who treated the children who have bronchial asthma. Majority of the caregivers (52.0%) seek help from the doctors during their children's asthmatic attack, and 41.6% of asthmatic children were treated by using inhalers [Table 2]. | Table 2: Caregivers' knowledge and behavior toward treating asthma in children
Click here to view |
Caregivers' behavior toward asthmatic children
It was observed that all caregivers (100%) agreed that they gave appropriate medicines, whereas more than 50% of them practiced massaging their children's chest; 72% of the parents also let their child cough to clear mucus from their lungs. Around 73.2% of the caregivers minimized their children's movements during an asthmatic attack [Table 3], whereas 18.2% of them sought medical advice. Majority of the caregivers properly cleaned their houses to remove dust (62.0%); 58% of them tried to prevent their children from extreme exhaustion; and 51.6% treated bouts of common cold. It was observed that the behavior practiced to the least possible extent (19.6%) was the breathing exercises (taught by an experienced physiotherapist).
Statistical analysis of probable precipitating factors
[Table 4] demonstrates the results of binomial logistic regression analysis for potential impactful factors and determinants of caregivers' knowledge regarding pediatric asthma. To identify likely precipitating factors, a univariate analysis was done with the help of their crude odds ratio, subsequently followed by a binomial multivariate logistic regression analysis with an adjusted odds ratio. Modeling of knowledge suggested the most important independent predictors of experience to be the frequency of an asthmatic attack, asthma, age, and duration of asthma. The adjusted odds ratio was calculated after pooling all the independent variables. However, the crude odds ratio was calculated for individual independent variables. Therefore, the odds of being familiar with asthma compared to asthma-uneducated parents increased by a factor of 5.29 if the child in the family had asthma, which was achieved only after accurately controlling the additional variables of the model. Other variables were not significant in the multivariate logistic regression. The value for crude odds ratio was obtained for each independent variable and compared with its respective adjusted value. Crude odds ratios were determined while considering the effect of only one predictor; however, adjusted odds ratio acknowledged when more variables were included in the analysis (confounder variables for the said relationship). | Table 4: Determinants of poor caregivers' knowledge and behavior toward pediatric asthma
Click here to view |
| Discussion | | |
Prevalence of pediatric asthma differs from place to place. Similarly, even within Saudi Arabia, its prevalence varies among different geographical regions. With a constant increase in its incidence, the morbidity and mortality associated with this disease seem to increase.[15],[16],[17],[18],[19],[20],[21]
Excellent caregivers' knowledge and understanding of pediatric asthma and the medicines used in its treatment were associated with improved outcomes and effective disease control.[22] Level of education of the caregivers, insufficient knowledge on pediatric asthma, underprivileged socioeconomic class, and substandard living conditions came out as the reasons for the poor behavior among parents in managing the pediatric asthma. There is an urgent and pressing need for educating caregivers of pediatric asthmatic patients to promote the required knowledge and practices to take proper and efficient care for their children.
In the current study, it was demonstrated that a significant relationship exists between caregivers' knowledge about pediatric asthma and their behavior toward its management. The cause for nonadherence toward the treatment of bronchial asthma was found out to be intricate involving numerous cultural, psychological, as well as social factors. Furthermore, the results of the current study have brought forward some significant insufficiencies in caregivers' knowledge toward pediatric asthma. It might be attributed to the shortage of useful, well-planned, and well-structured programs for asthmatic children and their caregivers. Patient education, developing and improving self-management skills, is usually not given its due importance by the physicians. As these attributes require a lot of time, dedication, and diligence, they typically tend to be ignored by the physicians.[23],[24]
With regard to the question assessing the caregivers' action toward managing asthma of their child, most of them responded either by going to the doctor or by giving appropriate medications. Majority of the caregivers answered that they sought professional help and in some cases, social support during an asthmatic attack of their children. The behavior that was least practiced during asthmatic attacks was the breathing exercise. The data highlight the lack of knowledge regarding the significance of breathing exercises during an asthmatic attack, which could further be attributed either toward the lack of education of the caregivers from the doctor's side or the incapacity of the children themselves to practice these breathing exercises. Regular practice of these exercises not only helps in strengthening the respiratory muscles but also dramatically helps in reversing an exacerbated asthmatic attack.[25]
With the increase in the knowledge and understanding of the risk factors associated with pediatric asthma, there is also a significant increase in the ways of preventing it. A greater focus has to be laid on the behavior of caregivers in the family. It requires proper and effective planning and development of efficient educational as well as behavioral interventions, coping, and adjustment that will render new knowledge of primary prevention into an actual decline in the preponderance of pediatric asthma.[26],[27] There is an urgent and pressing need for educating caregivers to gain the required knowledge on asthma and its management and behavior, coping, and adjustment to take proper and efficient care of their children.
The limitation could be that the responses given by the caregivers might not reflect the exact problems faced by the diseased. In addition, a group of responsible and sincere pharmacy students, PharmD interns, were trained to collect the information, hoping that they might have collected authentic and correct information from the caregivers of the asthmatic children without any bias.
The study implies that there is an urgent need of educating the caregivers about the disease; management of emergency situations; administration of emergency medicines such as inhalers; taking care of chronic asthmatic conditions apart from creating awareness about how to avoid precipitating factors of the disease; and importance of personal hygiene and maintenance of cleanliness around the dwelling area. It may immensely benefit the society if all the health-care institutions of the respective regions in coordination with hospital staff along with the support of the government organize various educational activities for asthmatic patients and the caregivers on top priority to reduce the burden of the disease.
| Conclusion | | |
This study implies that in places at sea level like Jazan, there arises a pressing and an urgent need for developing additional rigorous screening programs that can help in identifying cases of asthma at the level of primary health care. Public awareness as well as general education programs should be encouraged and should be tailored to improve the knowledge and behavior not only of the health-care professionals but also of the caregivers whose children have bronchial asthma so that it can effectively and efficiently be managed.
Acknowledgment
The author would like to thank Prof. David Banji, Dr. Sarfaraz Ahmad, Dr. Mohammed Sayed Ahmad, Dr. Siddig Ibrahim Abdel Wahab, Mr. Syed Nabeel Kashan, Mr. Ali Namazi, Mr. Salem Abuardheyan, Mr. Yahya Homadi, and Mr. Mohammed Ogdy for their support for conducting the study.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Miller GF, Coffield E, Leroy Z, Wallin R. Prevalence and costs of five chronic conditions in children. J Sch Nurs 2016;32:357-64.  |
| 2. | Memish ZA, Jaber S, Mokdad AH, AlMazroa MA, Murray CJ, Al Rabeeah AA, et al. Burden of disease, injuries, and risk factors in the Kingdom of Saudi Arabia, 1990-2010. Prev Chronic Dis 2014;11:E169. |
| 3. | Avallone KM, McLeish AC, Luberto CM, Bernstein JA. Anxiety sensitivity, asthma control, and quality of life in adults with asthma. J Asthma 2012;49:57-62. |
| 4. | Bhuia MR, Nwaru BI, Weir CJ, Sheikh A. Models for estimating and projecting global, regional and national prevalence and disease burden of asthma: Protocol for a systematic review. BMJ Open 2017;7:e015441. |
| 5. | Moradi-Lakeh M, El Bcheraoui C, Daoud F, Tuffaha M, Kravitz H, Al Saeedi M, et al. Prevalence of asthma in Saudi adults: Findings from a national household survey, 2013. BMC Pulm Med 2015;15:77. |
| 6. | Gajanan G, Padbidri VS, Chaudhury A. Assessment of knowledge and attitude of parents towards the allergy and bronchial asthma in their children. Inter J Med Public Health 2016;6:121-5. |
| 7. | Al Ghobain MO, Al-Hajjaj MS, Al Moamary MS. Asthma prevalence among 16- to 18-year-old adolescents in Saudi Arabia using the ISAAC questionnaire. BMC Public Health 2012;12:239. |
| 8. | To T, Stanojevic S, Moores G, Gershon AS, Bateman ED, Cruz AA, et al. Global asthma prevalence in adults: Findings from the cross-sectional world health survey. BMC Public Health 2012;12:204. |
| 9. | Alsowaidi S, Abdulle A, Bernsen R. Prevalence and risk factors of asthma among adolescents and their parents in Al-Ain (United Arab Emirates). Respiration 2010;79:105-11. |
| 10. | Abo El-Fetoh N. Bronchial asthma in geriatric population of Arar, Northern Saudi Arabia: Prevalence and determinants. Int J Adv Res 2016;4:946-51. |
| 11. | Khawaji AF, Basudan A, Moafa A, Faqihi M, Alhazmi M, Mahnashi TA, et al. Epidemiology of bronchial asthma among children in Jazan region, Saudi Arabia. Indian J Allergy Asthma Immunol 2017;31:69-75. [Full text] |
| 12. | Conn KM, Halterman JS, Fisher SG, Yoos HL, Chin NP, Szilagyi PG. Parental beliefs about medications and medication adherence among urban children with asthma. Ambul Pediatr 2005;5:306-10. |
| 13. | Lwanga SK, Lemeshow S. Sample Size Determination in Health Studies. A Practical Manual Geneva. Geneva: World Health Organization; 1991. |
| 14. | Grant EN, Turner-Roan K, Daugherty SR, Li T, Eckenfels E, Baier C, et al. Development of a survey of asthma knowledge, attitudes, and perceptions: The Chicago community asthma survey. Chicago asthma surveillance initiative project team. Chest 1999;116:178S-83S. |
| 15. | Zhao J, Shen K, Xiang L, Zhang G, Xie M, Bai J, et al. The knowledge, attitudes and practices of parents of children with asthma in 29 cities of China: A multi-center study. BMC Pediatr 2013;13:20. |
| 16. | Bhagavatheeswaran KS, Kasav JB, Singh AK, Mohan SK, Joshi A. Asthma-related Knowledge, Attitudes, Practices (KAP) of parents of children with bronchial asthma: A hospital-based study. Ann Trop Med Public Health 2016;9:23-30. [Full text] |
| 17. | Taksande A, Jain M, Vilhekar K, Chaturvedi P. Peak expiratory flow rate of rural school children from Wardha district, Maharashtra in India. World J Pediatr 2008;4:211-4. |
| 18. | Mahboub BH, Al-Hammadi S, Rafique M, Sulaiman N, Pawankar R, Al Redha AI, et al. Population prevalence of asthma and its determinants based on European community respiratory health survey in the United Arab Emirates. BMC Pulm Med 2012;12:4. |
| 19. | Chipps BE, Zeiger RS, Borish L, Wenzel SE, Yegin A, Hayden ML, et al. Key findings and clinical implications from the epidemiology and natural history of asthma: Outcomes and treatment regimens (TENOR) study. J Allergy Clin Immunol 2012;130:332-42. e10. |
| 20. | Nashi MA. Dimensions of asthma and its treatment in the Kingdom of Saudi Arabia: literature review. Adv Res Gastroentero Hepatol 2017;5:555-62. |
| 21. | Vernon MK, Wiklund I, Bell JA, Dale P, Chapman KR. What do we know about asthma triggers? A review of the literature. J Asthma 2012;49:991-8. |
| 22. | Bianchi M, Clavenna A, Sequi M, Bortolotti A, Fortino I, Merlino L, et al. Childhood asthma management pre- and post-incident asthma hospitalization. PLoS One 2013;8:e76439. |
| 23. | Al-Binali AM, Mahfouz AA, Al-Fifi S, Naser SM, Al-Gelban KS. Asthma knowledge and behaviours among mothers of asthmatic children in Aseer, South-West Saudi Arabia. East Mediterr Health J 2010;16:1153-8. |
| 24. | Elfaki NK, Shiby AY. Risk factors associated with asthma among Saudi adults in Najran. J Clin Respir Dis Care 2017;3:133. |
| 25. | Silvers WS, Bailey HK. Integrative approach to allergy and asthma using complementary and alternative medicine. Ann Allergy Asthma Immunol 2014;112:280-5. |
| 26. | Mirzaei M, Karimi M, Beheshti S, Mohammadi M. Prevalence of asthma among Middle Eastern children: A systematic review. Med J Islam Repub Iran 2017;31:9. |
| 27. | Alatawi A. The effectiveness of asthma education approaches for children: Group versus individual education. Biomed J Sci Tech Res 2017;1:794-9. |
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]
|
Search Pubmed for