|Year : 2015 | Volume
| Issue : 1 | Page : 47-51
Knowledge and attitude of parents toward oxygen therapy and nasogastric tube feeding in tertiary health centers in Nigeria
Ibrahim Aliyu1, Chika Duru2, Mohammed Abdulsalam1, Lawal O Teslim3
1 Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
2 Department of Paediatrics, Niger Delta University Teaching Hospital, Yenagoa, Bayelsa, Nigeria
3 Department of Paediatrics, Federal Medical Centre, Birnin Kebbi, Kebbi, Nigeria
|Date of Web Publication||4-Jun-2015|
Dr. Ibrahim Aliyu
Department of Paediatrics, Aminu Kano Teaching Hospital, Kano
Source of Support: None, Conflict of Interest: None
Background: Feeding sick children by mouth at times may be difficult. Therefore, alternative methods such as nasogastric tube feeding may come handy. Similarly, oxygen therapy is life saving; however, there are concerns of parental refusal of these treatments. Therefore, this study seeks to determine the level of acceptance of these treatments and factors responsible for treatment refusal if any. Materials and Methods: This study was cross-sectional and 202 mothers whose children were on or had nasogastric tube feeding and oxygen therapy were recruited. Results: Most of the respondents' accepted nasogastric tube feeding and oxygen administration on their children despite the fact that most were not counseled (66.8% and 61.4%, respectively). The most common reason for declining nasogastric tube feeding was the belief that it may occlude the airway while those who declined oxygen therapy was because they believed it may result in death. Most of those that accepted nasogastric tube feeding also accepted oxygen therapy (X 2 = 32.031, df = 1, P = 0.00). The educational status of the respondents had no significant relationship with acceptance of nasogastric tube feeding (X 2 = 3.245, df = 3, P = 0.36) and also oxygen therapy (X 2 = 0.487, df = 3, P = 0.92). Furthermore, their age and number of children had no influence on their decision on acceptance of nasogastric tube feeding or oxygen therapy. Similarly, ethnicity and occupational status had no statistically significant relationship on acceptance of oxygen or nasogastric tube feeding. Conclusion: The acceptance of nasogastric tube feeding and oxygen therapy is very encouraging and was not affected by maternal age, ethnicity, or educational qualification.
Keywords: Maternal acceptance, nasogastric tube feeding, oxygen therapy, treatment refusal
|How to cite this article:|
Aliyu I, Duru C, Abdulsalam M, Teslim LO. Knowledge and attitude of parents toward oxygen therapy and nasogastric tube feeding in tertiary health centers in Nigeria. Niger J Exp Clin Biosci 2015;3:47-51
|How to cite this URL:|
Aliyu I, Duru C, Abdulsalam M, Teslim LO. Knowledge and attitude of parents toward oxygen therapy and nasogastric tube feeding in tertiary health centers in Nigeria. Niger J Exp Clin Biosci [serial online] 2015 [cited 2019 Jan 18];3:47-51. Available from: http://www.njecbonline.org/text.asp?2015/3/1/47/158167
| Introduction|| |
Feeding is an integral part of pediatric care; children need energy for growth and development; more so sick children need more energy to meet the hyper-catabolic state associated with most illnesses. Therefore, efforts are made to ensure sick children get the desired calories and micronutrients. ,, This occasionally may not be met through oral intake due to the prevailing circumstance of the sick child such as loss of appetite or an associated loss of consciousness; therefore, other modalities of feeding such as use of oro-, nasogastric feeding tubes (NGT) becomes imperative.
Similarly oxygen (O 2 ) saves life; it ensure efficient metabolism of substrate for energy production. Therefore, its lack may result in fatal outcome. O 2 therapy are utilized at homes and hospitals. ,,
A child's hospitalization is stressful to parents/caregivers and medical procedures such as nasogastric tube insertion, lumbar puncture, bone marrow aspiration may further elicit parental anxiety and distress, at times resulting in treatment refusal. ,, This concern has generated intense debate on whether caregivers should be allowed to be present during such medical procedures. , However, parental participation in care of their sick children which is part of family-centered care is currently viewed as the cornerstone of modern pediatric nursing care.  Therefore, getting an informed consent with effective counseling and reassurance by healthcare professional will significantly ameliorate these worries. , There is dearth of information on parental/caregiver perception of O 2 therapy and nasogastric tube feeding; this study therefore hopes to explore common barriers to acceptance of nasogastric tube feeding and O 2 therapy by parents/caregivers of sick children admitted in two health facilities in Nigeria with the view of determining common hindrances to nasogastric tube feeding and O 2 therapy acceptance by parents/caregivers.
| Materials and Methods|| |
This was a prospective cross-sectional study involving parents caring for sick children in the Emergency Unit and Pediatric Medical Ward, of the Department of Pediatrics of Niger Delta University Teaching Hospital, Yenagoa, Bayelsa State and Murtala Mohammed Specialist Hospital, Kano, Kano State, respectively, which was done between June and September 2014. Two hundred and two subjects were selected; 101 each from the respective institutions. The subjects were consecutively recruited until the desired sample size was achieved. This study included parents of children aged 0-12years who had nasogastric tube feeding and O 2 therapy during admission. However, parents that refused consent to the study were excluded. Permission to conduct this study was obtained from the Ethics Committee of both institutions and written consents were obtained from the parents.
Structured and pretested questionnaires were administered by well-trained house-officers and medical officers, relevant information on the subjects socio-demographic characteristics, knowledge, and acceptance of nasogastric tube feeding and O 2 therapy, such as if they have been informed on the usefulness of nasogastric tube feeding and O 2 therapy and their fears concerning nasogastric tube feeding and O 2 therapy, were obtained. The acceptance rates of nasogastric tube feeding and O 2 therapy were 75% and 70%, respectively, in the pilot study.
Data entry and analysis were done using computer software Statistical Package for Social Sciences (SPSS) version 16 (Chicago, Illinois, USA). Qualitative variables were summarized, frequency tables were constructed, and percentages were calculated. Chi-squared test of significance was adopted for comparing categorical variables and P-value less than 0.05 was accepted as statistically significant.
| Results|| |
Two hundred and two mothers were enrolled in this study; 33 (16.3%) of the mothers were less than 25 years, 107 (53.0%) were between 25 and less than 40 years while 62 (30.7%) were more than 40 years.
Thirty-nine (19.3%) of the mothers had primary school certificate, 80 (39.6%) had secondary school certificate, 36 (17.8%) had tertiary qualification while 47 (23.3%) had no formal education.
Most of the respondents accepted nasogastric tube insertion and feeding and O 2 administration in their children. Among those who did not accept nasogastric tube feeding, the most common reason for decline was the perception that it could occlude the airway and worsen the primary illness while among those that declined O 2 therapy, most believed that it could result in death of the child. However, 66.8% and 61.4% of the respondents whose children were on NGT and O 2 , respectively, were not counseled on the need for these therapy and more would had accepted these therapies if they were adequately informed of their usefulness [Table 1].
|Table 1: Attitude of parents toward nasogastric tube feeding and oxygen therapy|
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[Table 2] showed that most of those that willingly accepted nasogastric tube feeding also accepted O 2 therapy and this association was statistically significant (X 2 = 32.031, df = 1, P = 0.00).
|Table 2: Comparing acceptance of nasogastric tube feeding and oxygen therapy|
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[Table 3] showed that the educational status of the respondents had no statistically significant relationship with acceptance of nasogastric tube feeding (X 2 = 3.245, df = 3, P = 0.36) and also O 2 therapy (X 2 = 0.487, df = 3, P = 0.92). Furthermore, their age and number of children had no influence on their decision on nasogastric tube feeding or O 2 therapy.
|Table 3: The educational status and acceptance of nasogastric tube feeding and oxygen therapy|
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Most mothers of between 25- and less than 40-year age-group accepted nasogastric tube feeding and O 2 therapy though these were not statistically significant. Furthermore, most of those with between one and less than five children accepted nasogastric tube feeding and O 2 therapy. However, these were not statistically significant (X 2 = 1.668, df = 2, P = 0.43; X 2 = 0.668, df = 2, P = 0.72) [Table 4].
|Table 4: The impact their age-ranges and the number of children have on acceptance of nasogastric tube feeding and oxygen therapy|
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Similarly, their ethnicity and occupational status had no statistically significant relationship on acceptance of O 2 of nasogastric tube feeding [Table 5].
|Table 5: The impact of ethnicity and occupational status on acceptance of nasogastric tube feeding and oxygen therapy|
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Furthermore, religion had no influence on the acceptance of nasogastric tube feeding and O 2 therapy as shown in [Table 6].
|Table 6: Impact of religion on acceptance of nasogastric tube feeding and oxygen therapy|
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| Discussion|| |
The sighting and witnessing of nasogastric tube insertion may be quite scary to parents. Furthermore, nasogastric tube feeding and O 2 therapy are wrongly associated with complications by parents. Therefore, it may not be surprising encountering parents rejecting them. This study therefore determined the level of parental awareness and knowledge of these modalities of therapy.
Most mothers in this study were of the 25-40-years bracket which was similar to other studies involving nursing mothers-because they constitute the child-bearing age-group , and most had at least primary school certificate qualification, which varied from most previous reports from Nigeria which were indicative of poor school enrolment and completion amongst Nigerian women and girls; , this maybe because this study was conducted in urban areas.
Interestingly, most mothers accepted nasogastric tube insertion and feeding despite the fact that many were not counseled on the usefulness of such therapy and surprisingly almost the same numbers of mothers that accepted nasogastric tube feeding also accepted O 2 therapy. Among those who rejected nasogastric tube feeding and O 2 therapy, 71% of them would have accepted O 2 therapy and nasogastric tube insertion and feeding if they were properly counseled which was the similarly experience of Langton et al.  and Neiderman et al.  Furthermore, their age, educational status, occupation, ethnicity, and number of children had no influence on their acceptance of nasogastric tube feeding and O 2 therapy. However, these observations may not be unconnected with their level of awareness because most mothers had at least completed primary school education and were also living in urban areas. Negative believes on nasogastric tube feeding and O 2 may be related to past experiences; these treatments are frequently used in very sick patients and if in the process death occurs, it is not uncommon of them to wrongly attribute it to either the O 2 therapy or the nasogastric tube insertion. The report of Langton et al.  and Stevenson et al.  among Malawian parents and children showed how scared most parents are once O 2 is administered on their children. However with education and counseling, their confidence and acceptance of O 2 therapy significantly increased. Similarly Neiderman et al.  in their study showed that the acceptance rate of nasogastric tube feeding by parents was high, similarly to the findings in this study especially when they understood the indications and parents are willing to accept prolonged nasogastric tube and more invasive feeding procedures if adequately informed of their benefits. ,, Therefore, this study clearly shows that if parents are properly counseled their acceptance rates will be significantly increased. Healthcare professionals should therefore see parents/patients as partners in ensuring effective healthcare delivery. Furthermore patients/parents have the right to ask for explanation on any treatment given to them or their wards and it should not be seen as an intrusion into our practices. Therefore, with effective communication and better understanding most barriers in healthcare delivery will be surmounted.
| Conclusion|| |
Most mothers will accept nasogastric tube feeding and O 2 therapy; and proper counseling of parents will further increase their acceptance rates. Furthermore, the educational status, ethnicity, occupational status, and number of children of the mothers had no influence on the acceptance of these treatment modalities.
| References|| |
increase the risk of respiratory morbidity? Arch Dis Child 2006;91:478-82.
den Broeder E, Lippens RJ, van ′t Hof MA, Tolboom JJ, Sengers RC, van den Berg AM, et al
. Nasogastric tube feeding in children with cancer: The effect of two different formulas on weight, body composition, and serum protein concentrations. JPEN J Parenter Enteral Nutr 2000;24:351-60.
Padilla GV, Grant M, Wong H, Hansen BW, Hanson RL, Bergstrom N, et al
. Subjective distresses of nasogastric tube feeding. JPEN J Parenter Enteral Nutr 1997;3:53-7.
Thilo EH, Comito J, McCulliss D. Home oxygen therapy in the newborn. Costs and parental acceptance. Am J Dis Child 1987;141:766-8.
Hudak BB, Allen MC, Hudak ML, Loughlin GM. Home oxygen therapy for chronic lung disease in extremely low-birth-weight infants. Am J Dis Child 1989;143:357-60.
Merritt TA, Pillers D, Prows SL. Early NICU discharge of very low birth weight infants: A critical review and analysis. Semin Neonatol 2003;8:95-115.
Abdulbaki MA, Gaafar YA, Waziry OG. Maternal versus pediatric nurses attitudes regarding mothers′ participation in the care of their hospitalized children. J Am Sci 2011;7:317-27.
Streisand R, Braniecki S, Tercyak KP, Kazak AE. Childhood illness-related parenting stress: The pediatric inventory for parents. J Pediatr Psychol 2001;26:155-62.
Aveyard H. The patient who refuses nursing care. J Med Ethics 2004;30:346-50.
von Baeyer CL. Commentary: Presence of parents during painful procedures. Pediatric Pain Letter: Abstracts and Commentaries on Pain in Infants. Child Adolesc 1997;5:56.
Chambers CT. The role of family factors in pediatric pain. In: McGrath PJ, Finley GA, editors. Pediatric pain biological and social contextprogress in pain research and management. 1 st
ed. Seattle: International Association for the Study of Pain (IASP) Press; 2003. p. 99-130.
Aveyard H. The requirement for consent prior to nursing care procedures. J Adv Nurs 2002;37:243-9.
Aveyard H. Implied consent prior to nursing care procedures. J Adv Nurs 2002;39:201-7.
Adedokun OA. "Marriage, re-marriage and reproduction." In: Owasanoye B, editors. Reproductive rights of women in Nigeria: The legal, Economic and Cultural Dimensions, Human Development Initiatives, Lagos: 1 st
ed. OUC Nigeria. Ltd; 1999. p. 21-45.
Oyefara JL. Age at first birth and fertility differentials among women in Osun State, Nigeria. Eur Sci J 2012;16:139-63.
Nmadu G, Avidime S, Oguntunde O, Dashe V, Abdulkarim B, Mandara M. Girl child education: Rising to the challenge. Afr J Reprod Health 2010;14:107-12.
Aja-Okorie U. Women education in Nigeria: Problems and implications for family role and stability. Eur Sci J 2013;9:272-82.
Langton J, Stevenson A, Edwards C, Kennedy N, Bandawe C. Attitudes towards oxygen: Exploring barriers to acceptance of oxygen therapy in Malawi. Arch Dis Child 2012;97:A46-7.
Neiderman M, Farley A, Richardson J, Lask B. Nasogastric feeding in children and adolescents with eating disorders: Toward good practice. Int J Eat Disord 2001;29:441-8.
Stevenson AC, Edwards C, Langton J, Zamawe C, Kennedy N. Fear of oxygen therapy for children in Malawi. Arch Dis Child 2014. Available from: http://adc.bmj.com
. [Last assessed on Dec 1].
McLaughlin M, Conforti C, McNamara J, Dorkin HL. Patient and parent acceptance of invasive nutritional therapy: Clinical results and psychosocial adjustment a 5 year follow-up study. J Am Diet Assoc 1995;97:A25.
Daniels L, Davidson GP, Martin AJ, Pouras T. Supplemental nasogastric feeding in cystic fibrosis patients during treatment for acute exacerbation of chest disease. J Paediatr Child Health 1989;25:164-7.
Greaves E, Blades M, Christie RA, Machen J, Ryecart N, Baird-Smith S. Anorexia nervosa: Nocturnal supplementary nasogastric feeding in the community. J Hum Nutr Diet 1991;4:165-9.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]