Asthma in the pediatric population : Level of perception among the parents and guardians

Background: Asthma in the child population is one of the leading public health problems that accounts for immense hospitalization, morbidity, and mortality throughout the world with no exception of the Middle East, including Saudi Arabia. Reports in the literature emphasize on family management of this dreadful disease among the children. Aim: The aim of this study was to investigate the knowledge and perceptions of parents/guardians about childhood asthma. Materials and Methods: Likert scale questionnaire consisting of 90 questions was served to the parents/ guardians of asthmatic children. The questionnaire scores were correlated with the number of emergency department (ED) visits by asthmatic children (r = −0.239, P =0.046). Results: Our results showed a negative correlation between ED visits by asthmatic children and their parents/guardians’ knowledge of the disease. Conclusion: Although there is a trend between the ED visits by asthmatic children and the level of parents/guardians’ awareness, our results are not conclusive, hence; further studies with a larger sample size are recommended.


INTRODUCTION
There has been a considerable increase in the global Incidence of asthma during the last few decades, the Arab world including Saudi Arabia is no exception. [1,2]Besides, enormous spread of infection, the suffering of asthma attack in children is a cause of enhanced risk of major school absenteeism, which results in future derangement of their social, psychological, and educational adjustment. [3]Increased asthma prevalence, morbidity and mortality have intensifi ed public health concern. [4][7] In a recent study, Zhao, [4] in a recent study found poor control of asthma in children is due to ignorance of the parents/guardians about the disease.Some of these lapses include exposure of the children to adverse environment, the lack of compliance with medications and visits to control asthma, which deteriorates the condition.10] A study conducted on the knowledge of mothers of asthmatic children in Aseer (Saudi Arabia) revealed that they had no knowledge of the complications of breathing exercises during asthma attacks. [11]The present study on the educational component of managing bronchial asthma stems from the relevance of awareness of the disease by the parents/guardians that can be an inhibitory factor in emergency department (ED) visits by asthmatic children.This study is a detailed investigation of our preliminary observation. [12]The concept is more signifi cant to Saudi society because of the variability in ethnic and demographic backgrounds.was the maximum of patients after considering the exclusion criteria from the total number admitted to the ED.The database system in the hospital enabled us to investigate the admission of the number of the participants.

Inclusion criteria
The parents/guardians of pediatric asthmatic patients, male or female, more than 1-year-old, who were admitted to the ED due to any asthma symptoms as a chief complaint, were included in the study.

Exclusion criteria
The parents/guardians of nonasthmatics pediatric patients and pediatric asthmatics less than 1-year-old were excluded from the study.
The pediatric asthmatic patients less than 1-year-old were included in the study of demographic data analysis only and not for correlation analysis.The admission frequency reported in our analysis was taken from the fi rst ED admission due to asthma symptoms, as reported in database system, until the end of the year 2011.To fi nd any correlation between the ED admissions and the level of knowledge about asthma, we categorized our sample into two categories; aware and not aware.Any study subject scored equal to or less than 51 (based on the 25 th quartile of the scores) was considered to be not aware, and with scored more than 51 was considered to be aware.Data were incorporated into SPSS (Statistical Package for the Social Sciences) version 20.0.1 and descriptive analysis was performed.We calculated Pearson correlation between the admission frequency and the awareness as a measure of being "aware" or "not aware."Since, the study constituted the companions associating the patients, there was no requirement of the approval of ethical consideration by the International Review Board of the King Abdullah International Medical Research Center, (National Guards).However, patients' confi dentiality was strictly observed throughout the study by using the patients' anonymous unique serial number for each subject.

RESULTS
Our sample included 90 parents/guardians, accompanying the asthmatic children to the ED of King Saud Bin Abdulaziz University.Out of the size of the sample, 95.3% were Saudis and 4.7% were Non-Saudis.Twenty-eight percent of the respondents were male and 72% females.The percentage of illiteracy among the respondents showed that 27.2% were high school graduates, and 30.6% were higher education graduates; 68.4% of the participants stated that they had enough information about asthma and 31% stated otherwise.For 70 participants (excluding children less than 1-yearold), we calculated Pearson correlation between parent awareness about asthma and the admission frequency and the analysis showed a negative correlation of (−0.239,P = 0.046) between the two variables, which means that the higher the participants score, the less likely are their asthmatic children to have frequent emergency admissions or visits due to asthma.The highest score limit was 85/85, and the lowest was 17/85.However, the maximum score in our study was 71, and minimum was 34 with a mean score of 53 (standard deviation = 7.1).

DISCUSSION
Likert scale was followed to frame the questionnaire.The total number of questions were 17 classifi ed into three categories as per recommendations of the original questionnaire article, [13] the categories being the myths and beliefs regarding asthma, level of knowledge about the disease and knowledge about the associated aspects of asthma.Each category was scored separately and then the sum of all categories was calculated.

First category
First category, myths and beliefs regarding asthma, contained seven questions, each question with a score of 1-5 (total score: 35).Scores were fairly average [Table 1].When questions were analyzed separately, it was found that most of the participants (62%) believed that it was the best to go to the ED no sooner the child gets an attack of asthma, irrespective of the magnitude of the symptoms [Figure 1].5][16][17][18][19]

Second category
The second category, level of knowledge about the disease, consisted of 6 questions with a total score of 30.The results showed the fact that people had knowledge about asthma components even though they lack skills for managing the disease.Most of the fi ndings were linear with a fairly knowledgeable population [Table 2].[22][23] This can be explained on the basis of the presence of other factors such as weather, genetic elements, family history and some other social/ pathological triggers. [12,13]

Third category
This category is about knowledge of the associated aspects of asthma.It contained 4 questions with a total score of 20.The results showed that the parents tend to limit child's social and physical activities because of asthma [Tables 3 and 4] even if it could be easily managed with a course of Bronchodilators. [24]gure

Sum of all categories
The sum of all categories showed a total score of 85 in the questionnaire.Our result indicated that most of the participants were aware of asthma that was an unexpected observation.The reason for this observation is probably a small sample size in this study.This also indicates that our result is not conclusive in nature, but only provides a signifi cant insight into the trends of our study population [Figure 2].

Correlation of the association between parents/ guardians awareness and ED visits
Calculating the 25 percentiles (25 th Q) yielded a score of 51, which showed a strong negative correlation between the sum of scores of all categories and patients frequent admissions to ED (r = −0.239,P = 0.046).This frequent admission trend can also be explained on the basis of the low score of the participants [Table 5 and Figure 3].

CONCLUSION
Asthma is one of the most commonly diagnosed diseases in pediatric ED.Most of the asthmatic children brought to the ED are due to recurrent and uncontrolled asthma symptoms.The health care providers like RT, RN and physicians have a good opportunity to educate the parents/guardians of the asthmatic children and increase their level of awareness about the proper control and management of asthma exacerbation that prevents further complications and unnecessary ED admissions.In general, the scores of individual categories were fairly acceptable.Furthermore, negative association was found between the ED visits and the total score of the categories.Nevertheless, the inconclusive results obtained in this study might be related to the small sample size.We recommend further studies to be conducted on a larger sample size to prove signifi cant correlation between the level of knowledge of parents/ guardians of asthmatic children and ED visits.

RECOMMENDATION
Based on our fi ndings, we recommend implementation of an educational program in our pulmonary rehabilitation center for better management of the disease and to lower the chance of frequent ED visits and frequent admissions.Furthermore, well-aware parents/guardians and lower ED visits/admissions would imply good Asthma control and better life quality.
Journal of Medicine and Public Health | Jan-Mar 2015 | Vol 5 | Issue 1

1 :Table 2 :
Figure 1: Trend of the parents/guardians of asthmatic children to visit emergency department at the time of asthma attack

Figure 2 :
Figure 2: Distribution of questionnaire scores

Figure 3 :
Figure 3: Correlation between previous emergency department visits and questionnaire score

Table 1 : Mean scores of the fi rst category
SD = Standard deviation International Journal of Medicine and Public Health | Jan-Mar 2015 | Vol 5 | Issue 1

Table 5 : Correlation between ED visits and questionnaire score Statistical analysis Correlations Previous ED visits All categories
ED = Emergency department