Nigerian Journal of Paediatrics

1Parental knowledge and impact on growth in children with congenital heart diseases in Aminu Kano Teaching Hospital

Niger J Paediatr 2016; 43 (3):162 – 165

ORIGINAL

Asani MO

Parental knowledge and impact on

Aliyu I

Gambo S

growth in children with congenital

heart diseases in Aminu Kano

Teaching Hospital

DOI:http://dx.doi.org/10.4314/njp.v43i3.1

Accepted: 8th August 2015

Abstract : Objectives: Parental

and three parents recruited in this

knowledge of a child’s heart dis-

study, ninety-one (88.3%) of the

Asani MO

(

)

ease, treatment and prevention of

parents knew the correct cardiac

Aliyu I, Gambo S

complications may promote a

diagnosis. which had no statisti-

Department of Paediatrics,

Cardiology unit. Aminu Kano Teaching

better health related behavior to-

cally significant association with

Hospital, Kano. Nigeria.

wards the care of the child. Most

their educational status. There was

Email: ohikhenaasani@yahoo.co.uk

of these children often present

statistically significant association

with failure to thrive which the

between

maternal educational

parents may not associate with the

status and ability to name the

medications (X = 27.01, df=12,

disease.

This study is aimed at

determining the knowledge of

p=0.008). A total of sixty nine

parents of children with congeni-

(67%) children have a WAZ score

tal heart disease (CHD) and the

of ≤ −2 and <3 while forty five

impact of the disease on their

(43.7%) have an HAZ of ≤ −2.

growth.

Conclusion: Adequate knowledge

Methods: This was a cross sec-

will ensure better compliance to

tional study consisting of parents

medications which can reduce

and children with CHD attending

morbidity and early mortality be-

the Pediatric Cardiology Clinic of

fore surgical intervention. There-

Aminu Kano Teaching Hospital.

fore continuous patient/caregiver

Relevant information was gotten

education is imperative for their

from pre-tested questionnaires-

long time survival because even

containing data such as age, an-

surgery may not completely elimi-

thropometric parameters, educa-

nate all complications associated

tional level of parents and knowl-

with it.

edge of their children’s cardiac

defect.

Keywords: Congenital heart dis-

Results: Out of the one hundred

ease, Parental knowledge, growth.

Introduction

Good nutritional practice is also important in improving

their growth. This is particularly important because

The importance of adequate knowledge of diseases espe-

most of these children fail to thrive due to anorexia, in-

cially those that are chronic by the patients and their

creased respiratory rate, increased metabolism, oedema

care givers cannot be overemphasized. The resulting

with easy satiety and the natural course of many con-

change in health behavior is expected to maximize their

genital heart diseases..

health benefits, which is achieved through educating

This study is therefore aimed at determining the knowl-

their care givers who are often the biological parents.

edge of parents of children with congenital heart disease

Congenital heart diseases constitute a major burden

concerning the disease and the impact of the disease on

among children with cardiovascular disease. It still re-

growth, amongst patients attending Paediatric cardiol-

mains a major cause of morbidity and mortality particu-

ogy outpatient clinic of Aminu Kano Teaching Hospital

larly in resource limited countries.

3,4

This is because

in Kano.

90% of cardiac care facilities are located in high income

countries, serving only 7% of the world's population.

Parental knowledge of a child’s heart disease, treatment

and prevention of complications may promote a better

Subjects and Methods

health related behavior towards the care of the child. A

better understanding will improve compliance with

This study was cross sectional and was conducted from

treatment and ensure avoidance of risky behaviors.

April 2013 to April, 2014. The study population con-

163

sisted of parents and children with congenital heart dis-

Table 1: Common congenital cardiac defects among children

eases attending the Pediatric Cardiology Clinic of

of the study population

Aminu Kano Teaching Hospital. With relevant informa-

Defect

Frequency

Percent

tion was gotten from pre-tested questionnaires- contain-

VSD

49.5

ing demographic data such as age, educational level, the

ASD

7.8

parents were obtained and knowledge of their children’s

cardiac defect and anthropometric parameters of the

TOF

13.6

children. These were corroborated with the patient’s

PDA

3.9

medical records.

Others

25.2

Parents of children with congenital heart disease attend-

Total

103

100.0

ing the pediatric cardiology clinic for at least 6 months

were included; however those that refused consent were

VSD- ventricular septal defect; ASD= atrial septal de-

excluded, similarly those whose children had other

fect; TOF= tetralogy of Fallot; PDA= patent ductus arte-

chronic morbidity such as Down’s syndrome, Cerebral

riosus; Others = Atrioventricular septal defects, tricuspid

palsy were excluded.

atresia, complex congenital cardiac defects etc

Ethical clearance for the conduct of the study was ob-

Care-giver knowledge of cardiac defect and medications

tained from Ethicals Committee of Aminu Kano Teach-

ing Hospital Kano and informed consent was obtained

Out of the one hundred and three parents recruited in

from the subjects/parents. Anthropometric measure-

this study. Ninety-one (88.3%) of the parents were able

ments of weight, length were done by the investigators

to correctly mentioned the diagnosis of their wards’ car-

assisted by two trained clinical assistant. The values

diac defect and this had no statistically significant asso-

were plotted on standardized World Health Organization

ciation with their educational status. While 27 (26.2%)

(WHO) growth charts and malnutrition was classified

of the parents were able to name one medication their

based on WHO criteria . The recommended criteria of

wards were presently taking. 53 (51.5%) could name at

the WHO are based on calculated z scores for anthro-

least two medications; 11 (10.7%) could not mention

pometric indices. Az score of ≤ 2 of the child’s Weight

any while (12 (11.7%) were not on any medication

for age (WAZ), Height for age (HAZ) or Weight for

(Table 2). There was statistically significant association

height (WHZ) represents 2 SD below the age- and gen-

between maternal educational status and ability to name

the medications (X = 27.01, df=12, p=0.008).\

der-specific median for the normal population and 3 SD

below the median cut-off if the z score is ≤ −3. A Weight

for age (WAZ), z score of between > −2 and ≤2 is indica-

Table 2: Maternal educational status and ability to correctly

tive of normal nutrition .

name medications

No education

Primary

Secondary

Total

Data Analysis

None

Statistical Package for Social Sciences (SPSS) version

1 drug

> 2 drugs

16 was used for data analysis. Quantitative variables

Total

were summarized using measures of central tendency

X =28.585, df=4, p=0.0001

(mean and standard deviation). Qualitative variables

were

summarized

using

frequency

distribution

(percentages), while test of significance using Chi

Anthropometry

squared ( λ ) test with p-value set at <0.05 was deplored.

A total of sixty nine (67%) children have a WAZ score

of ≤ −2 and <3 while forty five (43.7%) have an HAZ of

≤−2 (Tables 3 ad 4).

Results

Table 3: Weight distribution of children using z-score

Knowledge of diagnosis, treatment and outcome

Age range of patient (years)

Acyanotic congenital heart defects were the commonest

z score weight

CHD with ventricular septal defect constituting 49.5%,

(SD)

1-5

6-10

>10 Total

while tetralogy of Fallot remained the commonest cya-

>-2

notic congenital heart defect. Most of the parents

<-2- 3

(88.3%) knew the correct diagnosis of the diseases of

<-3

their children/wards. Only 35.9% of the parents believed

medication alone could correct the cardiac defect while

Total

103

64.1% believe their wards will require surgical correc-

tion of their defects.

164

Table 4: Height distribution of the children with CHD studied

instructive since all the subjects in this study have at-

using z-score

tended the clinic for a period of not less than six months.

Age range of patient

This may reflect the level of communication between

z score height

the managing team and the primary care givers and

1-5

6-10

>10

Total

probably the degree of motivation in the management by

the primary care givers. Cheuk et al who carried out a

>-2

<-2

similar study did not state the percentage of parents who

Total

103

were able to mention the number of medications their

wards’ were placed on but only stated that 44.6% knew

the correct function of the medications.

Some degree of malnutrition was found in sixty nine

Discussion

(70%) of the children. Underweight and severe malnutri-

tion were mostly seen in the 1-5 year age-group, which

compares to the age-range of malnutrition in Nigeria

In this study, most parents were aware of their wards’

diagnosis (88.3%), this was comparable to that reported

but the value is much higher than the 44 .9% reported

by Aliyu et al as the prevalent rate of malnutrition in

by Bulat et al (71%) and Al-Jarallah et al (98%) but

much higher than reported by Mahdi et al (30%) and

northern Nigeria. Our finding is lower than the 90%

reported by Okoromah et al among children with

Cheuk et al (59%). this may be because most of our

subjects had simple acyanotic congenital heart defects

congenital heart diseases in Lagos, Nigeria but higher

than the values reported by Mahdi et al (55%) and

which made explanation, comprehension and parental

Varen et al. in Sudan and Turkey respectively. These

education easy. An adequate parental knowledge of their

children’ diagnosis will aid compliance to medical man-

studies although with varying degrees of malnutrition

agement and reduce anxiety .

confirm the deleterious effects of CHD on growth.

Acyanotic congenital heart diseases such as ventricular

septal defect were most predominant while tetralogy of

Fallot was the commonest cyanotic congenital heart

defect documented in this study; this may be attributed

Conclusion

to early demise of most cases with more complex cya-

notic congenital heart diseases in the absence of early

Most parents were aware of the specific diagnosis of

surgical intervention while simple acyanotic congenital

their wards’ ailments and their medications but twenty

heart defects such as ventricular septal defect may sur-

five percent were only able to mention one medication.

vive into older age even in the absence of surgical cor-

Adequate knowledge will ensure better compliance to

rection. Only five (4.9%) of the patients had corrective

medications which can reduce early mortality before

surgery as at the time of study, which is similar to most

surgical intervention. Therefore continuous patient/

experiences in resource limited settings where surgery

caregiver education on the care of these patients is im-

can only be procured abroad and only affordable to

perative for their long time survival because even sur-

those with the resources to sponsor such trips. majority

gery may not completely eliminate all complications

of our patients were sustained on medications.

associated with it.

In this study, only 51.5% could name at least two medi-

Conflict of interest: None

cations while 26.2% were only able to mention only one

Funding: None

medication that their wards were placed on. This is quite

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