PAIN MANAGEMENT IN CHILDREN IN A TERTIARY PEDIATRIC EMERGENCY IN ETHIOPIA

Abstract

Background : Pain is a stressful experience that is considered to be a global health problem, and children are the most vulnerable and under-served population. Despite the exponential increase in scientific evidence about pediatric pain in the last few decades, there are many barriers to the transfer of knowledge to clinical practice. Consequently, children still experience unnecessary pain during hospitalization. We designed this study to assess the prevalence, evaluation and management of pain in children admitted to St Paul’s hospital millennium medical college pediatric emergency.

Methods : Institution based cross-sectional study was conducted from April to June, 2018over a period of 3 months using semi-structured questionnaire & age appropriate pain assessment tools. In addition, documentation of existence of pain, evaluation and management was made from the medical charts of each children included in the study. A total of 290 patients 1 month to 18 years of age were included in the study and data was cleaned, coded and entered to SPSS version 23 for analysis. Bivariate and multivariate analysis was done to see association between dependent and independent variables.

Result : Out of the 290 children, 206 (71%) aged 1-47 months. Male to female ratio was 1.4:1 with males comprising 57.9% of the total study population. The majority of children, 224 (77.2%) had their mothers as primary care giver. Overall prevalence of pain among children admitted to PE was 76.2%; 70% of the children had mild to moderate pain and 6.2% had severe pain based on the age appropriate assessment tools. Of those children found to be in pain, only 21.3% had documented analgesics in their order sheet, and only 7.2% of the children had analgesics documented in the Nursing sheet. Pain assessment was documented in none of the charts. Children aged >47 months were 5.5 times more likely to have pain (p-value<0.001); and children with Severe acute malnutrition (SAM), 13.5 times (p-value=0.017) and Acute gastroenteritis (AGE), 5.8x (p-value=0.036) were likely to have pain.

Conclusion: A high prevalence of pain was identified in children admitted to PE but there is poor recognition, documentation and treatment of pain