Knowledge, Attitudes and Practices Among Caregivers of Children With Sickle Cell Disease at Kenyatta National Hospital (KNH)

Abstract

Background: SCD is a genetic hemoglobin disorder that is of global health importance. It affects 20-25 million people globally and up to 85% are children born in Africa. In some parts of Kenya, 4.5% of newborns are born with sickle cell disease. There is a growing prevalence of this condition especially in sub-Saharan Africa. Despite advancement in knowledge of SCD and its management there are still knowledge gaps among parents of children with sickle cell disease. Comprehensive SCD care requires embodiment of a health education program for caregivers to improve their insight of the disease, its complications and prevention of adverse disease outcomes. Inadequate caregivers’ knowledge negatively affects the quality of life of children with SCD. Study Objectives: To assess the level of knowledge, attitudes, and practices of caregivers in recognizing and managing acute symptoms and preventing complications of SCD among paediatric patients in KNH. Methods: The study employed a prospective cross-sectional design to assess the knowledge, attitudes, and practices among caregivers on recognition of acute symptoms of SCD and prevention of complications among Paediatric patients with SCD seen at KNH. The study was conducted over three months in 2022. The study units are the wards involved with care of SCD patients, namely; general Paediatric wards (3A, 3B, 3C), and the Paediatric haemato-oncology clinic. Collection of data utilized an interviewer-administered questionnaire from the participants who gave informed consent. Consecutive sampling was used to reach a minimum required sample size of 135, calculated using Fisher’s formula. The key outcomes of interest were the aspects of knowledge (good vs poor), the favourable or unfavourable attitudes, and practices (good vs poor) on Sickle Cell Disease. The data were analyzed using R version 4.1.2, and presented as frequencies and proportions for categorical data. Correct responses were given a score of one. Knowledge, attitudes and practices were calculated as a percentage, and a score of <60% (poor), (60-79%) moderate and (≥80%) good. Results: This study involved a total of 135 participants with a response rate of 100%. The respondents were caregivers of children with sickle cell disease attending the outpatient clinic at Kenyatta National Hospital. Of the respondents, 78.5% were females (106 out of 135) while the rest were males. The median age of the respondents was 32.0 years with an interquartile range of 28 to 37 years. The proportion of the respondents from urban areas was 99.3% (134 out of 135) while the rest were from rural areas. Majority of the respondents were married 74.8% (n = 101), 17.8% (n = 24) were single while the rest were divorced. In terms of education, 39.3% (n = 53) were secondary school leavers, 31.8% (n = 43) had a diploma. Results on knowledge scores revealed that 90% of the caregivers had adequate knowledge. 48% (95% CI 38%, 58%) of the respondents achieved a good score, 42% (95% CI 32%, 55%) got a fair score and 10% (95% CI 5%, 18%) got a poor score. On the overall attitude score, 90% (95% CI 83%, 95%) of the respondents got a good score, 4% (95% CI 1.2, 10.5) got a fair score and 6% (95% CI 2.5, 13.1) got a poor score. On overall practice score when caring for children with SCD, 43% (95% CI 33, 53) of the respondents got a good score, 41% (95% CI 31, 51) got a fair score and 16% (95% CI 9.7, 25) got a poor score. Conclusion and Recommendations: The overall knowledge score on acute symptoms of sickle cell disease and how to prevent complications was good. Majority of caregivers had good attitude towards Sickle Cell Disease and its management. Practice scores were good for most of the recommended practices however only 20.7% (n=28) had provided supplementary immunization to their children. There was a positive correlation between knowledge and practice therefore knowledge enhancement may improve practice.