Prevalence of pain and adequacy of analgesic prescription among children admitted at Trans Nzoia County Referral Hospital, Kenya

Abstract

Background: Pain is an unpleasant sensory experience associated with actual or potential tissue damage. There‟s a high prevalence of 78% established from a study at Kenyatta National Hospital. Undertreating pain has severe psychological and physiological consequences. Despite the high prevalence and established effects of pain, it is often inadequately managed. This study determined the prevalence of pain, adequacy of prescription as per WHO analgesic ladder and identified gaps in analgesia care whose utility can guide institution-based protocol development. Objective: To determine the prevalence of pain and adequacy of analgesic prescription among children admitted at Trans-Nzoia County Referral Hospital (TCRH) pediatric wards. Methods: A mixed method cross-sectional study at TCRH pediatric wards carried out between May 2019 to October 2019. A total of 928 children admitted to pediatric wards meeting inclusion criteria were enrolled and screened for presence of pain. Every second patient presenting with pain was systematically sampled for assessment of severity using the Faces Pain Scale-Revised and adequacy of analgesic prescription. A total of 384 children sampled. Treatment sheets were reviewed to check for prescribed analgesics and compared with WHO analgesic ladder to obtain the adequacy of prescription. Key Informant Interviews and Focused Group Discussions were conducted after completion of quantitative data collection. Descriptive statistics were used for continuous variables and frequency listings for categorical data. Logistic regression was used to examine for association of independent variables( age, pain score, cadre of staff, diagnosis and procedure) with prescription adequacy. Multivariate logistic regression was done to determine significant independent variables. A p-value of <0.05 was considered statistically significant at 95% confidence interval. Qualitative data was thematically analyzed. Results: Pain observed in 764 (82.3%) children. Mild pain reported in 137(35.7%), moderate pain in 191(49.7%) and severe pain in 56(14.6%). Adequacy of prescription in dosing was found in 57(16.7%) with 117(34.2%) of prescriptions being underdose and 168(49.1%) overdose. Adequacy in choice of analgesia as per WHO analgesic ladder was found in 163(42.4%), 211(55%) being under-prescribed and 10(2.6%) overprescribed. Pain score was statistically significant in association with prescription adequacy (P-value < 0.001, AOR= 30.8 moderate pain and 69.8 severe pain, CI=5.175-183.07). Drug availability, staffing and knowledge on pediatric pain management were some of the factors determining drug prescription in the facility. Conclusion: Prevalence of pain among children admitted at TCRH is very high, occurring in 4 out of 5 children. Most of the children reported moderate pain. There is low adequacy of analgesic prescription with majority of prescriptions being overdose. Severity of pain, drug availability, staffing and knowledge on pediatric pain management were the major factors associated with analgesic prescription. Recommendation: Ensure availability of appropriate analgesics in the facility. Training of healthcare workers on pediatric pain management and development of pediatric pain management protocols should be advocated to ensure appropriate analgesic prescriptions are done.