Prevalence of pain and adequacy of analgesic prescription among children admitted at Trans Nzoia County Referral Hospital, Kenya

Abstract

Objective: To determine the prevalence and severity of pain and adequacy of analgesic prescription among children admitted at Trans-Nzoia County Referral Hospital (TCRH) pediatric wards.
Design: A sequential explanatory mixed method study.
Setting: TCRH pediatric wards.
Participants: Children aged 5-14 years admitted over a period of 6 months. Healthcare providers and managers at TCRH.
Interventions: Pain assessment using the Faces Pain Scale-Revised (FPS-R).
Outcome measures: Prevalence computed by those who reported pain versus the total screened population. Severity computed by levels of pain reported by the sampled population. Adequacy assessed by the dosing and choice of analgesic versus the WHO analgesic ladder.
Results: Out of the 928 children screened, 764 (82.33%) had pain. Among the 384 sampled, severity reported at 35.7% mild, 49.7% moderate and 14.6% severe. Adequacy of prescription in dosing determined at 16.7% with 34.2% of prescriptions being under dose and 49.1% overdose. Adequacy in choice of analgesia as per WHO analgesic ladder was at 42.45%. Pain score was statistically significant in association with prescription adequacy (P-value < 0.001, AOR= 32 moderate pain and 69.8 severe pain, CI=5.175-183.07). Drug  availability and knowledge on pediatric pain management were some of the factors determining drug prescription in the facility.
Conclusion: Prevalence of pain among children admitted at TCRH is very high, occurring in 4 out of 5 children. There is low adequacy of analgesic prescription. Pain score, drug availability, staffing and pediatric pain management knowledge were the major factors associated with analgesic prescription and administration.