dc.description.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. |
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