Prevalence, severity and initial management of pain among children admitted in Kenyatta National Hospital general paediatric wards

Abstract

Acute pain is one of the most common adverse stimuli experienced by children, occurring as a result of injury, illness, and necessary medical procedures. Pain is associated with increased anxiety, avoidance, somatic symptoms, and increased parent distress. Despite the magnitude of effects that acute pain can have on a child, it is often inadequately assessed and treated, especially in the African setting, where resources and skills are limited and overwhelming acute life-saving events override pain management. Study Objectives To determine the prevalence, severity and initial management of pain among children hospitalized at KNH, general paediatric wards Methods This was a cross sectional study in children age 1 month to 12 years admitted in KNH general paediatric ward, within 24 hours of admission. Eligible patients were consecutively recruited into the study between October and December 2013 until a desired sample size was reached .Using a structured questionnaire and two age appropriate pain scales; Faces, Legs, Activity, Crying and Consolability scale (FLACC) for patients aged 1 - 47 months and Revised Faces Pain scale (FPS_R) for patients age 4 -12 years, data was collected on presence, location and severity of pain within the first 24 hours of admission into the ward. Patient‘s treatment sheets and nursing charts were reviewed to determine initial pain management. Results Between the months of October to December 2013, out of 503 patients in the general paediatric wards who met the inclusion criteria, 400 participants/caregivers gave consent and were enrolled to participate in the study. Participants between the age of 1 – 47 months (Younger children) were 288/400 (72%) with a median age of 10 months (IQR 3, 20) whereas participants between the age of 4 -12 years (Older children) were 112/400 (28%) with a median age of 8 years (IQR 5, 10). The male to female ratio for both age groups was 1.2:1 with males comprising 54% of the total study population. Overall prevalence of pain among children hospitalized in KNH general paediatric wards was found to be 78%.Among the younger children, 38% were found to have mild pain, 29% moderate pain and 2 % severe pain associated with clinical procedures and underlying illness. Among the older children, 12% reported mild pain, 69% reported moderate pain and 5% reported severe pain. Analgesics were provided to 59% of patients in pain, largely a single drug, most commonly paracetamol which was administered intermittently. According to the pain management index, only half of the patients in pain received adequate analgesia. Conclusion Pain is common among hospitalized children at KNH general paediatric wards occurring in 78% of the participants most (71%) of whom experience mild to moderate pain. Pain management is poor with only 50 % of patients with pain receive adequate analgesia Recommendations 1. Use of Pharmacologic (i.e. Topical analgesic creams/ spray) and non- pharmacologic interventions by the healthcare workers to reduce pain due to clinical procedures. 2. Training of health care providers on appropriate use and proper dosing of analgesics in the paediatric population.