An iceberg I can’t handle: a qualitative inquiry on perceptions towards paediatric rheumatology among healthcare workers in Kenya

Abstract

Background Delay in diagnosis and access to specialist care is a major problem for many children and young people with rheumatic disease in sub-Saharan Africa. Most children with symptoms of rheumatic disease present to non-specialists for care. There is an urgent need to understand and scale-up paediatric rheumatology knowledge and skills amongst non-specialist healthcare workers to promote early diagnosis, prompt referral, and management. Purpose We evaluated the knowledge, attitudes and practices towards diagnosis and care of paediatric rheumatology patients among health care workers in Kenya. Methods We conducted 12 focus group discussions with clinical officers (third-tier community health workers) nurses, general practitioners and paediatricians across 6 regions in Kenya. Interviews were conducted on zoom, audio-recorded, transcribed, and analysed using NVIVO software. Results A total of 68 individuals participated; 11 clinical officers, 12 nurses, 10 general practitioners, 27 paediatricians and 7 others. Most (n = 53) were female, and the median age was 36 years (range 31–40 years). Fifty per cent of the participants (34 of 68) worked in public health facilities. Our study revealed gaps in knowledge of paediatric rheumatology amongst healthcare workers which contributes to delayed diagnosis and poor management. Healthcare workers reported both positive and negative attitudes towards diagnosis and care of paediatric rheumatology patients. Perceived complexity and lack of knowledge in diagnosis, management and lack of health system clinical pathways made all cadres of healthcare workers feel helpless, frustrated, inadequate and incompetent to manage paediatric rheumatology patients. Positive attitudes arose from a perceived feeling that paediatric rheumatology patients pose unique challenges and learning opportunities. Conclusion There is an urgent need to educate healthcare workers and improve health systems to optimize clinical care for paediatric rheumatology patients.

Bridging gaps: A qualitative inquiry on improving paediatric rheumatology care among healthcare workers in Kenya.

“…Our participants reiterated the above themes by highlighting the paucity of health workers as evidenced by the long queues and wait times experienced by patients (19). They further highlighted that lack of knowledge in paediatric rheumatology makes them fearful and avoidant of these patients (19). This demoralizes them and results in patients being 'pushed on' through the health system without getting any signi cant help (19).…”

“…In a systematic review by Blacklock and colleagues on the impact of contextual factors on the effect of interventions to improve health worker performance in sub-Saharan Africa, they identi ed three staffrelated themes namely: absolute shortages of staff, the inadequacy of existing knowledge and skills, and erosion of personal motivation to effect change (25). Our participants reiterated the above themes by highlighting the paucity of health workers as evidenced by the long queues and wait times experienced by patients (19). They further highlighted that lack of knowledge in paediatric rheumatology makes them fearful and avoidant of these patients (19).…”

“…This was an exploratory qualitative study involving 12 focus group discussions conducted between September and November 2021 among 68 healthcare workers (HCWs) including clinical o cers, nurses, general practitioners, and paediatricians with study methods as outlined in our previous publication (19).…”

“…They further highlighted that lack of knowledge in paediatric rheumatology makes them fearful and avoidant of these patients (19). This demoralizes them and results in patients being 'pushed on' through the health system without getting any signi cant help (19). This is exacerbated by high staff turnover, inadequate initial basic education, and lack of ongoing training (25) .…”

Muscle Energy Technique Versus Passive Manual Soft Tissue Therapies on Planter Fasciitis: A Systemic Review

“…Tightness of Achilles tendon, soleus, and gastrocnemius and weakness of intrinsic foot muscles are the functional risk factors that strains the plantar fascia and limits the dorsiflexion 7 . As planter fascia serves to provide dynamic shock absorption and help in the longitudinal arch, 8 so the risk of developing PF are increased in individual with pes planus (flat feet or low arch), pes cavus (high arches) and other anatomical risk factors are excessive femoral anteversion, excessive lateral tibial torsion, over-pronation and leg length discrepancy 9 .…”