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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 6  |  Issue : 2  |  Page : 42-46

Knowledge of foreign-body aspiration in children among caregivers in Kano Nigeria


1 Department of Otorhinolaryngology, Aminu Kano Teaching Hospital, Kano, Nigeria
2 Department of Medical Microbiology and Parasitology, Bayero University, Kano, Nigeria
3 Department of Otorhinolaryngology, Bayero University, Kano, Nigeria

Date of Web Publication20-Mar-2019

Correspondence Address:
Dr. Abdul Akeem Adebayo Aluko
Department of Otorhinolaryngology, Bayero University, Kano
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ajt.ajt_11_18

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  Abstract 


Background: Foreign-body aspiration (FBA) remains a life-threatening condition that is a frequent cause of accidental death in children below the age of 5 years worldwide. This study was carried out to evaluate the knowledge of FBA in children among caregivers and to determine the sociodemographic factors affecting their knowledge.
Settings and Design: This was a descriptive cross-sectional study design that was carried out at the pediatric outpatient department of Aminu Kano Teaching Hospital, Kano, Nigeria.
Methodology: Institutional ethical clearance was obtained from the ethical committee of the same hospital. Using systematic sampling technique, all data collected using a semi-structured questionnaire was analyzed with Statistical Product and Service Solutions (SPSS) version 23 and statistical significance was set at value of P < 0.05, at 95% of confidence interval.
Results: A total of 266 participants were recruited for this study. Forty percent were within the age group of 25–34 years, predominantly females (63.9%), majority (81.6%) were of the Hausa-Fulani ethnic group, most (83%) were married and 86.3% had formal education. In general, there was good knowledge (68.4%) of FBA to be more in children, but only 13.9% knew that toys and other nonfood materials as potential objects of aspiration by children and 47.4% knew that they should not give groundnuts/seeds or small toys to children <3 years. Marital status, gender, and the level of education were found to be statistically significantly (P < 0.05) associated with knowledge of FBA.
Conclusion: Although there was good knowledge that FBA occurs more in children, there was very poor knowledge about potential objects of aspiration that are not food substances. Therefore, different strategies in creating awareness through proper health education on the dangers of FBA should be adequately explored.

Keywords: Caregivers, children, foreign-body aspiration, knowledge


How to cite this article:
Mahmud A, Mohammed Y, Aluko AA. Knowledge of foreign-body aspiration in children among caregivers in Kano Nigeria. Afr J Trauma 2017;6:42-6

How to cite this URL:
Mahmud A, Mohammed Y, Aluko AA. Knowledge of foreign-body aspiration in children among caregivers in Kano Nigeria. Afr J Trauma [serial online] 2017 [cited 2019 Jul 20];6:42-6. Available from: http://www.afrjtrauma.com/text.asp?2017/6/2/42/254632




  Introduction Top


Foreign-body aspiration (FBA) is the act of inhaling foreign objects into the respiratory tract.[1] It is a frequent cause of accidental death in children below the age of 5 years worldwide and it is considered a true emergency in the pediatric age group.[2]

Only a few cases of actual aspirations are witnessed by parents or caregivers in which there was a definite history of FBA accompanied by choking and coughing bouts.[3] However, since children are often allowed to play on their own unsupervised, most cases are unwitnessed resulting in doubtful history;[3] thus, it is not uncommon for children to be treated for other disorders such as persistent fever, asthma, or recurrent pneumonia for a long period by pediatricians who are usually the primary physicians leading to delayed diagnosis and referral.[4] It is pertinent to note that the diagnosis of FBA is mainly clinical; however, imaging studies help immensely to confirm the diagnosis, especially when the history is not classical. Sophisticated investigations such as computerized tomography scan, magnetic resonance imaging, and diagnostic bronchoscopy that are usually needed to confirm the suspicion of FBA are not readily available/affordable in developing countries such as Nigeria. Clinicians, therefore, rely on history and examination findings to make a diagnosis, caregivers knowledge, and the awareness of FBA is thus very imperative. The duration of lodgment of foreign bodies range from <24 h to >6 months, and this depends on the knowledge of the primary doctor and on the awareness of the parents.[5] Delayed diagnosis (>24 h) of an inhaled foreign body (FB) is associated with a 2.5 times higher rate of serious acute complications than when the inhaled FB is diagnosed early, within 24 h.[6]

Parental/caregivers knowledge of the dangers associated with FBA and how to avoid these may be important[7],[8] and increase in awareness of FBA among caregivers has been shown to decrease the morbidity, mortality, and the incidence of this disease.[5] In Nigeria, the management of FBA is highly challenging due to the lack of awareness among parents who are the primary caregivers contributing to delay in diagnosis and definitive treatment.[3]

The aim of this study was to evaluate the level of knowledge of FBA in children among caregivers in Kano and to determine the sociodemographic factors affecting their knowledge.


  Methodology Top


This was a hospital-based descriptive cross-sectional study design. The sample size was determined using Fisher's formula;[9] and was calculated to be 266. Participants were recruited among the caregivers attending the pediatric out-patient department (POPD) clinic of a tertiary health institution (Aminu Kano Teaching Hospital, Kano, Nigeria) using systematic random sampling technique by finding the average of number of caregivers attending POPD per month in the past 6 months from the patients' register at the reception. This was used as the sample frame to enroll the participants into the study and the sample interval (nth selection = ) was calculated to be 9. A random start used as the first participant was selected between 1 and sampling interval by simple random sampling (using ballot method) and subsequent participants were selected by repeatedly adding the sampling interval. All caregivers were included except those that declined consent, caregivers that are below 18 years old and those with children that had FBA presently or previously. The definition of knowledge of FBA for this study refers to the correct response of participants to the knowledge items in the structure questionnaire schedule regarding objects breathed into the respiratory system that are not normally present. The knowledge was ranked; very poor (0%–20%), poor (21%–40%), fair (41%–60%), good (61%–80%), and very good (81%–100%).

Ethical clearance was obtained from the Institutional Ethical Review Committee of the Hospital. The study protocol was explained to the participants. Subsequently, an informed consent was obtained and respondents appended their signatures/thumbprints on the consent form. Confidentiality of the respondents was strictly ensured. The study was carried out according to the Declaration of Helsinki.[10]

A designed interviewer-administered semi-structured questionnaire that was translated into the local language of the participants, was used for data collection and pretested for validation. The questionnaire was administered by a researcher. International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) for windows, Version 23.0. software (Armonk, NY: IBM Corp) was used for statistical analysis and results were summarized using frequencies, percentages, and graphic representations. The Chi-square test was used to determine the relationship between the factors associated with the knowledge regarding FBA and statistical significance was set at P < 0.05, at 95% confidence interval (CI). Multivariate analysis was performed to test the associations of the significant variables. The hospital setting (tertiary health institution) where this research was carried out may be a limitation to the study.


  Results Top


A total of 266 participants were recruited for this study. The age range of the participants was 17–81 years (mean age = 34.8 ± 10.7 years) and about 40% were within the age group of 25–34 years. Most, 170 (63.9%) were female and 96 (36.1%) were male. Majority, 175 (65.8%) were Hausas and 220 (82.7%) of the participants were married. Most, 231 of the participants (86.8%) had formal education, whereas the rest 35 (13.2%) had Islamic or no formal education. One hundred and twenty (45.1%) were Traders, whereas 83 (31.2%) were civil servants and 83 (23.7%) were housewives. The sociodemographics are shown in [Table 1].
Table 1: Distribution of respondents according to socio-demographic status

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Only 84 (31.6%) of the participants were not aware of FBA being common in children, whereas about two-third, 182 (68.4%) admitted that children were more at risk of FB aspiration. One hundred and fifty-six (58.6%) had the knowledge regarding the aspiration of groundnuts and other nuts or food substances by children, but only 27 (13.9%) know that toys and other nonfood materials as potential objects of aspiration by children. Less than half of the participants 126 (47.4%) knew that they should not give groundnuts/seeds or small toys to children <3 years.

Furthermore, majority of the participants recognized choking 195 (73.3%) and cough 192 (72.2%) as symptoms of FBA, respectively.

The greater number of the participants, 163 (61%) had knowledge that children should not be allowed crying, laughing, talking, and running with an object/food in the mouth as preventive for FBA as shown in [Figure 1].
Figure 1: Knowledge of foreign body aspiration

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Knowledge of place for treatment and first aid at home

Nearly half 124 (47%) of the participants had knowledge about first aid methods at home, whereas more than one-third were not. Others were not sure. A significant number 107 (40%) of the respondents will attempt FB removal at home, whereas the rest had the knowledge that it should be at the hospital as shown in [Figure 2].
Figure 2: Knowledge on mode of intervention

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Knowledge of foreign-body aspiration versus sociodemographics

Test of statistical association between knowledge of FBA and sociodemographic variables showed that there was no statistically significant association with age of the participants (χ2 = 1.563, and P > 0.05), ethnicity (χ2 = 2.405, P = 0.662) and occupation (χ2 = 0.777, P = 0.678), but there was statistically significant association with gender (χ2 = 9.109, P = 0.003), marital status (χ2 = 4.666, P = 0.031), and educational level (χ2 = 6.450, P = 0.011) as shown in [Table 2].
Table 2: Between sociodemographic variables and knowledge of foreign body aspiration

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Predictors of knowledge of foreign-body aspiration

Variables found to be statistically associated with knowledge were considered for multivariate analysis to eliminate cofounders. The most significant predictors were found to be education level (P = 0.03, adjusted odds ratio [AOR] =0.54, 95% CI = 0.248–0.942) and gender (P = 0.022, AOR = 1.903, 95% CI = 1.095–3.305).


  Discussion Top


A significant number, (63.9%) of the participants were females similar to the study in Saudi Arabia.[11] FBA is a life-threatening condition associated with significant morbidity and mortality, especially in children.[7],[12] The higher prevalence of FBA in the pediatric population is mainly due to the lack of molar teeth resulting in difficulty in chewing, due to poor swallowing coordination in pediatric age group, due to the curiosity of children that makes them explore their orifices putting anything into their ear, nose, or the oral cavity and due to the carelessness or lack of awareness of the parents/caregivers.[7],[12],[13]

Majority of the participants (68.4%) could appreciate that FBA cases were seen mostly in younger children, similar to what other researchers[3],[7],[14],[15],[16] reporting FBA cases have demonstrated.

Findings from this study revealed more than half of the respondents (52.6%) encourage giving nuts and seeds to children <3 years old without restriction. This is similar to findings reported by Higuchi et al.[8] asserting that fewer mothers knew about peanuts and small toys as a cause of FBA. Furthermore, many participants despite having some level of education did not recognize the danger of nuts and seeds as potential objects that can be aspirated by children. This is in agreement with findings by Al-Qudehy et al.[11] who found that 80% of college graduate parents did not identify peanuts as a cause of FBA. Complications were mostly seen with the aspiration of nuts, seeds, berries, peas, corn, beans, fish, and bones as these objects stimulate an inflammatory reaction within a few hours making their extraction extremely difficult.[16] Other objects inhaled with potential hazards include button batteries and sharp pins. Button batteries induce thermal and electrical burns along the airway, and if the narrow negative pole lies posteriorly, the risk of perforation with mediastinitis, trachea-esophageal fistula formation, especially when extraction is delayed.

Majority of participants identified choking (73.3%) and cough (72.2%) as a pointer to suspected FBA, this was similar to the findings by Passàli et al.[16] and Singh et al.,[2] where they reported choking, cough and breathlessness as cardinal pointers of suspected FBA, though breathlessness was not considered in this study. However, Higuchi et al.[8] reported that most mothers lack the knowledge on how or make a timely diagnosis of aspiration leading to serious consequences. Targeted questions regarding the history of choking and cough should be asked when children present with wheezing, recurrent pneumonia, unexplained cough or persistent fever refractory to medical therapy and parental recall of choking or gagging events followed by a cough is highly suspicious of FBA. Timely diagnosis is critical in ensuring the optimal clinical course of FBA.

There was statistically significant association between female gender, married marital status, higher (tertiary) level of education of participants, and the knowledge of FBA. However, only gender and the level of education of the participants were independent predictors of the knowledge of FBA in children.


  Conclusion Top


It was observed that despite knowing that children are more at risk of FBA, most caregivers had poor knowledge of potential objects of aspiration that are not food substances and poor knowledge of the risk of FBA when toys, groundnuts, and other seeds are given to children <3 years. Although the knowledge of FBA was significantly associated with gender, marital status, and level of education of care-givers, only gender and the level of education were predictors of the caregiver's knowledge of FBA in children. Thus, public health education that is targeted toward these groups is recommended as prevention is a crucial step in the reduction of morbidity and mortality associated with FBA in children.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Akca SO. The effect of foreign body aspiration training on the knowledge level of pupils. Braz J Otorhinolaryngol 2016;82:408-15.  Back to cited text no. 1
    
2.
Singh A, Ghosh D, Samuel C, Bhatti W. Pediatric foreign body aspiration: How much does our community know? J Indian Assoc Pediatr Surg 2010;15:129-32.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Salisu AD, Abubakar MY. Clinical presentation and management of trachea-bronchial foreign bodies in Kano. Niger J Basic Clin Sci 2010;7:1-7.  Back to cited text no. 3
    
4.
Orji FT, Akpeh JO. Tracheobronchial foreign body aspiration in children: How reliable are clinical and radiological signs in the diagnosis? Clin Otolaryngol 2010;35:479-85.  Back to cited text no. 4
    
5.
Xuechang L, Richard E, Swai H. Airway foreign body aspirations in children at Muhimbili national hospital, Dar-es-Salaam-Tanzania. East Cent Afr J Surg 2011;16:32-9.  Back to cited text no. 5
    
6.
Iversen RH, Klug TE. Need for more clear parental recommendations regarding foreign body aspiration in children. Dan Med J 2012;59:A4498.  Back to cited text no. 6
    
7.
Asif M, Shah SA, Khan F, Ghani R. Analysis of tracheobronchial foreign bodies with respect to sex, age, type and presentation. J Ayub Med Coll Abbottabad 2007;19:13-5.  Back to cited text no. 7
    
8.
Higuchi O, Adachi Y, Adachi YS, Taneichi H, Ichimaru T, Kawasaki K, et al. Mothers' knowledge about foreign body aspiration in young children. Int J Pediatr Otorhinolaryngol 2013;77:41-4.  Back to cited text no. 8
    
9.
Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J Psychol Med 2013;35:121-6.  Back to cited text no. 9
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10.
WMA Declaration of Helsinki- Ethical Principles for Medical Research involving Human Subjects. Available from: http://www.wma.net/en/30publications/10policies/b3/17c.pdf. [Last assessed on 2017 Mar 14].  Back to cited text no. 10
    
11.
Al-Qudehy Z, Al-Sheif H, Al-Qudaihi G. Parental knowledge of foreign body aspiration: A comparative study between Saudis and other nations. J Otolaryngol ENT Res 2015;2:1-8.  Back to cited text no. 11
    
12.
Adegboye VO, Adebo OA. Epidemiology of tracheobronchial foreign bodies in Ibadan. Niger J Clin Pract 2001;4:51-3.  Back to cited text no. 12
    
13.
Falase B, Sanusi M, Majekodunmi A, Ajose I, Oke D. Preliminary experience in the management of tracheobronchial foreign bodies in Lagos, Nigeria. Pan Afr Med J 2013;15:31.  Back to cited text no. 13
    
14.
Brkic F, Umihanic S. Tracheobronchial foreign bodies in children: Experience at ORL clinic Tuzla, 1954-2004. Int J Pediatr Otorhinolaryngol 2007;71:909-15.  Back to cited text no. 14
    
15.
Kitcher ED. Foreign body inhalation: A review of patients at the Korle Bu Teaching Hospital, Accra, Ghana. West Afr J Med 2009;28:368-70.  Back to cited text no. 15
    
16.
Passàli D, Lauriello M, Bellussi L, Passali GC, Passali FM, Gregori D, et al. Foreign body inhalation in children: An update. Acta Otorhinolaryngol Ital 2010;30:27-32.  Back to cited text no. 16
    


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