|Year : 2016 | Volume
| Issue : 1 | Page : 30-36
Factors associated with caregivers' knowledge about childhood asthma in Ilesa, Nigeria
Bankole Peter Kuti1, Kehinde Oluyori Omole2
1 Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife; Department of Paediatrics, Wesley Guild Hospital, Ilesa, Nigeria
2 Department of Paediatrics, Wesley Guild Hospital, Ilesa, Nigeria
|Date of Web Publication||6-Sep-2016|
Bankole Peter Kuti
Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Children with asthma depend on their parents/caregivers for their asthma control. The level of knowledge of these caregivers has been found to affect the control of the disease. This study aims to assess the knowledge of parents/caregivers of children with asthma and to determine the factors associated with these levels of knowledge.
Methods: Consecutive children aged 2–14 years with physician-diagnosed asthma and their caregivers who attend the pediatric chest clinic of the Wesley Guild Hospital, Ilesa, Nigeria, during a 6 months study period were recruited. Parental/caregiver's level of knowledge about childhood asthma was assessed using a 25-item Asthma Knowledge Questionnaire (AKQ) and knowledge levels were categorized into good and poor knowledge. Relevant history and examination findings were appropriately compared between those with good and poor knowledge.
Results: Fifty-two caregiver–child pairs were participated in the study. The children age ranged from 2 to 13 years with mean (standard deviation [SD]) of 6.6 (3.6) years and male:female ratio of 1.7:1. Majority (88.5%) of the children had mild intermittent asthma. Mother is the caregiver in 48 (92.3%) of participants. The mean (SD) score from the AKQ was 11.2 (3.7) which ranged from 1 to 18. The scores were significantly higher in questions related to triggers of exacerbation and quality of life of asthmatics than those related to nature, diagnosis, and treatment of the disease (P < 0.05). Twenty (38.5%) caregivers had a good score (AKQ >12) and good knowledge correlated positively with duration of diagnosis of asthma (P < 0.05). Good childhood asthma knowledge was observed among caregivers with family history of asthma, previous asthma-related hospitalization in the child, and in those with postsecondary education significantly had better knowledge of childhood asthma.
Conclusion: Caregivers' knowledge about childhood asthma in Ilesa is poor particularly as related to nature, diagnosis, and treatment. However, the presence of family history of asthma, previous asthma-related hospitalization, and high educational status in caregivers of children with asthma are significantly associated with increased knowledge about the condition. Attention should be placed on more comprehensive parental and child asthma education for successful asthma management.
Keywords: Caregivers, childhood asthma, knowledge
|How to cite this article:|
Kuti BP, Omole KO. Factors associated with caregivers' knowledge about childhood asthma in Ilesa, Nigeria. Ann Nigerian Med 2016;10:30-6
| Introduction|| |
Asthma is one of the most common chronic respiratory diseases affecting children worldwide. The prevalence of asthma is increasing over the decades in both developed and developing countries including Nigeria., The social and emotional impact of asthma on the child, caregivers, and parents cannot be overemphasized., Childhood asthma is a leading cause of school absenteeism, visit the emergency unit, and impaired quality of life., It is also a common cause of parental absence from work and increased individual, family, and governmental spending on health.,
Major goals of childhood asthma management are to ensure adequate symptoms control to reduce morbidity, school absenteeism, to ensure optimal growth and development, full participation in physical activities, and improve parental, as well as child's, quality of life.,
Ensuring optimal asthma control in children at all level entails full participation and encouragement from parents and caregivers. Appropriate asthma care includes child and parental understanding of the disease process, recognition of triggers and potential triggers of acute exacerbation, self-monitoring and self-medication including appropriate use of controllers, and relievers of symptoms when necessary and adherence to preventive measures.,
Since children depend on their parents and caregivers for their asthma control, the level of knowledge of these caregivers may therefore be important in offering quality asthma care to children with the disease. Consequently, lots of studies have been carried out to assess the level of knowledge about childhood asthma among caregivers and the factors responsible for these levels of knowledge.,,,,, Majority of these studies were done outside Nigeria, also factors influencing the level of knowledge may differ from one location to another as local experiences may influence these levels of knowledge. This study therefore aims to assess the knowledge about childhood asthma and to determine the factors associated with these levels of knowledge among caregivers of children with asthma in Ilesa, Nigeria.
| Methods|| |
This was a hospital-based cross-sectional study.
This study was carried out at the pediatric chest clinic of the Wesley Guild Hospital (WGH), Ilesa, Nigeria, over a 6 months period (July to December 2015). The clinic is run once a week by a team of clinicians including a pediatric pulmonologist assisted by resident doctors and other staff. The clinic attends to 15–20 children with infectious and noninfectious respiratory conditions per week.
The WGH is a tertiary annexe of the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife. The hospital is one of the main referral centers providing general and specialized pediatric care for the communities of Osun, Ondo, and Ekiti States of South West Nigeria. Ilesa, where the hospital is located, is the largest town in Ijesaland and is situated on latitude 7° 35' N and longitude 4° 51' E and is about 200 km North-East of Lagos.
All children aged 2–14 years with physician-diagnosed asthma and/or history of recurrent episodes of cough, wheezing, chest tightness, and shortness of breath which resolves spontaneously or with the use of bronchodilators. Informed consent and assent were obtained from the caregivers and older children, respectively. Other inclusion criteria for the study were having attended the chest clinic for a minimum of 3 months and caregivers must have at least primary education with ability to read and write so that they can independently read and fill the questionnaire as much as possible without having to interpret the questions to the local languages of the study participants.
Sociodemographic information was obtained from the caregiver–patient pair. These included age, sex, and age at diagnosis of asthma in the child. Family and personal history of other allergic conditions were obtained. Parental and family history of asthma was also obtained. The severity of asthma at the first visit to the clinic before treatment was commenced was determined and was categorized into mild intermittent, mild, moderate, and severe persistent based on the Global Initiative for Asthma (GINA) guidelines; the caregivers were asked about the frequency of daytime symptoms, nighttime sleep disturbance, and days with limitation of activities due to asthma during the past month. The parental socioeconomic class was determined using the method described by Oyedeji. This is based on a rank assessment of the occupations and highest educational qualification of both parents. Professionals with postsecondary education were ranked as upper class, while unskilled laborers or petty traders with no formal education or primary education were ranked as a lower social class. The level of asthma control for the study participants was assessed according to the GINA guidelines.
Asthma Knowledge Questionnaire
The level of caregivers' asthma knowledge for this study was assessed using a 25-item knowledge questionnaire about childhood asthma. The validated question with adequate internal consistency (Cronbach's alpha of 0.69) has four domains which assess knowledge about symptoms and pathogenesis (questions 1, 6, 15, and 19); childhood asthma triggers (3, 4, 14, 17, 20, and 21); nature of the disease and its course (2, 8, 9, 11, 12, 13, 18, and 25); and diagnosis and treatment (5, 7, 10, 16, 22, 23, and 24). The Asthma Knowledge Questionnaire (AKQ) was self-administered by the caregiver–patient pair assisted where necessary by trained study assistants.
This study was approved by the Ethics and Research Committee of the OAUTHC, Ile-Ife, with the protocol number ERC/2015/02/12.
This was done using the Statistical Programme for Social Sciences (SPSS) software version 17.0 (SPSS Inc., Chicago 2008, IL, USA) and WinPEPI ®. Categorical variables such as sex, severity of asthma, and asthma control were summarized using proportions and percentages, while continuous variables such as age of the children and caregivers, duration since asthma was diagnosed, and level of caregivers' knowledge about childhood asthma were summarized using mean and standard deviations (SDs) for normally distributed variables and median and interquartile ranges (IQR) for nonnormally distributed ones. Differences between continuous variables were analyzed using Student's t-test, while categorical variables were analyzed using Pearson's Chi-square test and Fisher's exact test as appropriate (with Yate's correction where applicable). Pearson or Spearman rho was used to assess the correlations between caregivers' scores in the AKQ and other continuous variables. The level of significance at 95% confidence interval was taken at P < 0.05.
| Results|| |
Over the study period, 52 caregiver–patients pairs who met the inclusion criteria participated in the study.
Sociodemographic and general information of the study participants
Age and sex of study participants
The age of the children with asthma ranged from 2 to 13 years with mean (SD) of 6.6 (3.6) years and male preponderance of 1.7:1 male:female ratio. Twenty-four (46.2%) of the children were <5 years [Table 1]. The caregivers' age ranged from 25 to 64 with a mean (SD) age of 38.6 (9.1) years. Mother is the caregiver in 46 (88.5%), father in 5 (9.6%), and grandmother in 1 (1.9%) of the respondents.
|Table 1: Sociodemographic characteristics and general information about the children with asthma and their parents/caregivers knowledge|
Click here to view
Age at diagnosis
The median (interquartile IQR) age when the study participants were diagnosed to be asthmatic ranged from 2 to 12 years with a median (IQR) of 3.0 (1.0–6.0) years. The median (IQR) period of living with asthma (time since diagnosis of asthma) among the children was 1.75 (1.0–3.4) years; this ranged from 3 months to 11 years. One–half of the children were diagnosed <2 years before the study period [Table 1].
Parental socioeconomic class
Majority (50.0%) of the caregivers were from middle class, 42.3% from the upper class, with only four (7.7%) from low social class. Twenty-five (48.1%) of the caregivers had postsecondary education, 13 (25.5%) had secondary education, while 14 (26.9%) had only primary education.
Family history of asthma and atopy
About one-third (16) of the children had a family history of asthma, which included at least one of the parents in 7 (13.6%) of the children. Seventeen children (32.7%) had associated atopic diseases including allergic conjunctivitis in 13 (25.0%), and allergic rhinitis and dermatitis in 2 (3.8%) each.
Previous asthma-related hospital admissions
Seventeen (32.7%) of the children had previous asthma-related hospitalizations, which was once in 13 (25.0%), and two or more previous asthma-related hospital admissions in 4 (7.7%) of the children.
Severity of chronic asthma
Majority of the children 46 (88.5%) had mild intermittent asthma, 4 (7.7%) had mild persistent, and 2 (3.8%) had moderate persistent. None of the children had severe persistent asthma.
Level of asthma control
About two-thirds (35) of the children had well-controlled asthma, the rest had (32.7%) had suboptimal asthma control which was partly controlled in 14 (26.9%) and uncontrolled in 3 (5.8%) of the children during the study period.
Level of caregivers' knowledge about childhood asthma
The rate of correct responses to the AKQ is highlighted in [Table 1]. The score of the caregivers from the AKQ ranged from 1 to 18 (4.0–72.0%) correct answers of the 25 items in the questionnaire. The mean (SD) score was 11.2 (3.7). Twenty (38.5%) of the respondents had good scores defined as AKQ score >12, while about two-thirds had poor knowledge about childhood asthma. Items with the highest rates of correct answers were those related to living normal life with adequate treatment (92.3%) and exercise inducing asthmatic attack (86.5%). Those with the lowest rates of correct answers were 'bronchodilators reducing inflammation” (5.8%) and use of peak flow meter (7.7%).
The level of knowledge (scores from the AKQ) correlated positively with the duration of the children's living with asthma (Spearman rho 1.232; P = 0.044). However, no significant correlation between the scores (level of knowledge) and the age of the children (Pearson's correlation 0.152, P = 0.282), caregivers' age (Pearson's correlation 0.097, P = 0.494), and parental social class (Pearson's correlation − 0.089, P = 0.529).
Domain of knowledge
Caregivers had better knowledge about the triggers of childhood asthma than nature, symptoms, diagnosis, and treatment of childhood asthma [Table 2].
Significantly, the level of knowledge of caregivers concerning triggers of childhood asthma was higher than their knowledge about diagnosis and treatment of asthma (mean [SD] scores 38.0 [7.8] vs. 15.7 [12.6]; t = 3.75; P = 0.003) also their knowledge about asthma triggers is higher than their knowledge concerning symptoms and pathogenesis (38.0 [7.8] vs. 20.6 [8.1]; t = 3.41; P = 0.009) and nature and course of the disease (38.0 [7.8] vs. 22.3 [14.5]; t = 2.39; P = 0.034).
Factors associated with caregivers' level of knowledge about childhood asthma
Caregivers' attainment of postsecondary education is significantly associated with good knowledge about childhood asthma as 15 (60.0%) of the 25 caregivers who had postsecondary school education compared to 5 (18.5%) of the remaining 27 caregivers with education attainment less than postsecondary school education had good knowledge of childhood asthma (χ2 = 4.711; df = 1; P = 0.030). Similarly, the family history of asthma is significantly associated with good caregivers' knowledge about childhood asthma as 10 (62.5%) of the 16 children with family history of asthma compared to 10 (27.8%) of the remaining 36 children with no family history of asthma had good caregivers' score (good knowledge) of childhood asthma (χ2 = 4.216; df = 1; P = 0.040). Likewise, previous asthma-related hospitalization in the children was significantly associated with good caregivers' knowledge about childhood asthma (58.8% vs. 28.6; χ2 = 4.424; df = 1; P = 0.035).
No significant associated was found between the sex, age of the children and the caregivers, and duration since asthma was diagnosed in the children, parental socioeconomic class, family history of atopy, and the level of caregivers' knowledge about childhood asthma [P < 0.05, [Table 1]. Although more proportion of caregivers whose children/wards had well-controlled asthma score high in the AKQ with good knowledge of childhood asthma compared with those with suboptimal asthma control, the difference was not significant [Table 3].
|Table 3: The rate of correct responses to the Asthma Knowledge Questionnaire by the parents/caregivers of the children with asthma|
Click here to view
| Discussion|| |
This study has presented data on the level of knowledge of caregivers about childhood asthma highlighting the factors associated with good asthma knowledge among them. The general level of knowledge about childhood asthma among caregivers of the children studied was poor as only 20 (38.5%) of the caregivers had satisfactory knowledge using the validated AKQ. This finding is similar to reported poor level of knowledge among caregivers of children with asthma in a Portuguese population using the same AKQ. Similarly, low level of knowledge had also been reported among caregivers of children with asthma from tertiary centers in Thailand  and Malaysia. However, the level of knowledge about childhood asthma was relatively high among the cohort of caregivers studied in a New York Hospital using a different AKQ with majority 66.7% having satisfactory knowledge about asthma though the score is higher among Hispanics than African Americans. This may be related to higher level of education and general higher exposure among caregivers in New York more than in developing countries.
The level of knowledge among caregivers in the present study was found to be higher in questions related to triggers of asthma exacerbation in their children than in questions related to diagnosis and treatment, as well as pathogenesis and nature of the disease. Severe deficit of knowledge was observed particularly in questions related to the use of peak flow meter, rescue bronchodilators, and nature of the disease. This finding was similarly observed by Silva and Barros  in Portugal, Bahari and Nik Mat  and Fadzil and Norzila  in Malaysia, and Raheem et al. in Nigeria. This may be related to the nature of asthma education given to caregivers and children with asthma. Most often during asthma education sessions with caregivers and children with asthma, more emphasis is placed on recognition and avoidance of triggers of acute exacerbation which is easier to appreciate by the caregivers than more confusing explanation of the pathogenesis and nature of the disease. Moreover, the perception and experience of the caregivers about childhood asthma may affect their belief about the nature and pathogenesis of the disease. For instance, more than 80% of the respondents in the present study believe that asthma is a primarily emotional or psychological problem and 50% did not know that asthma is due to inflammation of the lung.
Acquisition of postsecondary education was significantly associated with good asthma knowledge in this study. This is similar to reports by Silva and Barros, Ho et al., and Fadzil and Norzila  where high parental education was also reported to be associated with good asthma knowledge. This may be related to the capacity of caregivers with postsecondary education and high health literacy rate  to independently seek more knowledge about the disease than those with lower educational qualifications. However, Prapphal et al. in Thailand found no significant association between the educational attainment of caregivers and their baseline level of asthma knowledge. This may be related to high level of asthma awareness media campaign which may have raised the level of knowledge of the populace in the Thailand population where the study was carried out.
The family history of asthma, as well as previous asthma-related hospitalization in their children, often increases the awareness of caregivers to childhood asthma. This was found to be significantly related to good asthma knowledge in this study. This is similar to report by Henry et al. from England. Positive family history of asthma, especially in the parents and/or other siblings, often leads to more awareness of the disease thereby increasing the knowledge-seeking behavior of the caregivers toward the disease. The number of the previous admission however does not correlate with the level of knowledge of the caregivers.
Worthy of note in this study is that sociodemographic characteristics of the children with asthma and their caregivers were not significantly related to caregivers' level of knowledge about childhood asthma. This finding was corroborated by reports from other studies.,,,, Also of importance is that the degrees of asthma severity assessed using GINA classification  was not significantly related to the level of caregivers' asthma knowledge. This is similarly reported by other workers.,, This may be explained by the fact that assessment of childhood asthma severity is based mainly on parental reports which may be affected by the poor parental perception of asthma symptoms in their children  and difficulties in parental recognition of symptoms in their children.
The level of asthma control was not significantly related to caregivers' level of knowledge in this study, though more proportions of caregivers with children having well-controlled asthma had good knowledge as also reported by previous workers.,, This observation may be related to the fact that knowledge base about chronic illness may not necessarily translate to disease management behaviors. Perceptions, beliefs, myths, and misconceptions may also alter the disease management behaviors of caregivers toward chronic illnesses.,
We appreciate the fact that caregivers' perception of illness and psychological functioning has a significant role to play in their level of knowledge about the disease., In this study, caregivers' perception of their children asthma and their psychological functioning were not assessed. Moreover, this study may be limited by its small sample size and that we had to depend on recall of frequency and severity of asthma symptoms by caregivers in assessing these children. Nevertheless, this study has been able to highlight the level of knowledge of caregivers about childhood asthma in Ilesa and factors associated with good knowledge.
| Conclusion|| |
Caregiver's knowledge about childhood asthma in Ilesa is poor, particularly in domains related to symptoms, pathogenesis and nature, and course of the disease. Caregivers with postsecondary education, family history of asthma, and children/wards with previous asthma-related hospitalizations tend to have better knowledge. More comprehensive parental and child asthma education is hereby recommended as much as the respondents can understand to ensure a better successful childhood asthma management.
The authors acknowledged the contributions of the caregivers and children who participated in this study and the nurses and clinicians who took part in the management of the children
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bousquet J, Khaltaev AN. Global Surveillance, Prevention and Control of Chronic Respiratory Diseases: A Comprehensive Approach. Global Alliance Against Chronic 1. Respiratory Diseases. Geneva: World Health Organization; 2007.
Falade AG, Ige OM, Yusuf BO, Onadeko MO, Onadeko BO. Trends in the prevalence and severity of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema. J Natl Med Assoc 2009;101:414-8.
Yorke J, Fleming SL, Shuldham C. A systematic review of psychological interventions for children with asthma. Pediatr Pulmonol 2007;42:114-24.
Centanni S, Di Marco F, Castagna F, Boveri B, Casanova F, Piazzini A. Psychological issues in the treatment of asthmatic patients. Respir Med 2000;94:742-9.
Gandhi PK, Kenzik KM, Thompson LA, DeWalt DA, Revicki DA, Shenkman EA, et al.
Exploring factors influencing asthma control and asthma-specific health-related quality of life among children. Respir Res 2013;14:26.
Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention; 2016. Available from: www.ginasthma.org. [Last accessed on 2016 Apr 04].
Silva CM, Barros L. Asthma knowledge, subjective assessment of severity and symptom perception in parents of children with asthma. J Asthma 2013;50:1002-9.
Prapphal N, Laosunthara N, Deerojanawong J, Sritippayawan S. Knowledge of asthma among caregivers of asthmatic children: Outcomes of preliminary education. J Med Assoc Thai 2007;90:748-53.
Rastogi D, Madhok N, Kipperman S. Caregiver asthma knowledge, aptitude, and practice in high healthcare utilizing children: Effect of an educational intervention. Pediatr Allergy Immunol Pulmonol 2013;26:128-39.
Henry RL, Cooper DM, Halliday JA. Parental asthma knowledge: Its association with readmission of children to hospital. J Paediatr Child Health 1995;31:95-8.
Bahari MB, Mat NM. Parental knowledge on childhood asthma in an outpatient setting. Malays J Pharm Sci 2005;3:1-10.
Fadzil A, Norzila MZ. Parental asthma knowledge. Med J Malaysia 2002;57:474-81.
15. Oyedeji GA. Socioeconomic and cultural background of hospitalized children in Ilesa. Niger J Paediatr 1985;13:111-8.
Ho J, Bender BG, Gavin LA, O'Connor SL, Wamboldt MZ, Wamboldt FS. Relations among asthma knowledge, treatment adherence, and outcome. J Allergy Clin Immunol 2003;111:498-502.
Abramson JH. WINPEPI updated: Computer programs for epidemiologists, and their teaching potential. Epidemiol Perspect Innov 2011;8:1.
Raheem AA, Soremekun RO, Adeniyi OF. Knowledge, awareness, and practice of the use of peak flow meters by physicians in the management of asthma in children. Afr J Respir Med 2004;9:28-32.
Janson S, Reed ML. Patients' perceptions of asthma control and impact on attitudes and self-management. J Asthma 2000;37:625-40.
Yoos HL, Kitzman H, McMullen A, Sidora K. Symptom perception in childhood asthma: How accurate are children and their parents? J Asthma 2003;40:27-39.
Clark NM, Gong M, Kaciroti N. A model of self-regulation for control of chronic disease. Health Educ Behav 2001;28:769-82.
Adams CD, Brestan EV, Ruggiero KJ, Hogan MB, Wilson NW, Shigaki CL, et al
. Asthma questionnaire: Psychometric properties and clinical utility in pediatric asthma. Child Health Care 2001;30:253-70.
[Table 1], [Table 2], [Table 3]