|Year : 2020 | Volume
| Issue : 2 | Page : 112-116
Knowledge assessment among caregivers about various allergic disorders in a hospital-based pediatric outpatient department in North India
Paramita Paul1, Yatish Singh1, Neeraj Gupta1, Poojan Agarwal2, Anil Sachdev1, Dhiren Gupta1
1 Department of Pediatrics, Sir Ganga Ram Hospital, New Delhi, India
2 Department of Pathology, Sir Ganga Ram Hospital, New Delhi, India
|Date of Submission||12-Jun-2020|
|Date of Acceptance||25-Aug-2020|
|Date of Web Publication||20-Nov-2020|
Dr. Neeraj Gupta
Department of Pediatrics, Sir Ganga Ram Hospital, Pediatric Reception, Ward 6, Ground Floor, Rajinder Nagar, New Delhi - 110 060
Source of Support: None, Conflict of Interest: None
CONTEXT: Various types of allergic disorders are increasing worldwide. The diagnostic and treatment facilities are limited compared to their vast magnitude. Lack of awareness among caregivers and beneficiaries could be one of the critical factors for inadequate management especially in developing countries.
AIM: This study aims to evaluate the knowledge among caregivers about various allergic disorders in a pediatric setup.
SUBJECTS AND METHODS: Caregivers of children, presenting for their illness at pediatric outpatient department of a tertiary care hospital of North India, were recruited over 6 months' period using a 22-item prevalidated questionnaire.
STATISTICAL ANALYSIS USED: Sigma Plot Software version 12.
RESULTS: Among the 1000 participants, majority (94%) had some knowledge about allergy. Doctors were major source (55%) of information. More than half (53%) believed it to be contagious. House dust (70%) and food additives (24%) were considered major allergens. Seasonal variations (54%) and environmental pollution (48%) were considered the most common aggravating factors while steam inhalation (14%), yoga (11%), and air purifiers (10%) helped in symptom reduction. Skin and respiratory symptoms were a common knowledge amongst many study participants. Only 8% were aware about skin tests for allergy diagnosis. Alternative medicine was the treatment of choice among two-third of people. Oral route was preferred over inhaled medicines.
CONCLUSION: The current study highlights limited knowledge and existence of misconceptions regarding allergic disorders in general population necessitating the need to improvise awareness campaigns.
Keywords: Allergy, awareness, caregivers, knowledge, misconceptions
|How to cite this article:|
Paul P, Singh Y, Gupta N, Agarwal P, Sachdev A, Gupta D. Knowledge assessment among caregivers about various allergic disorders in a hospital-based pediatric outpatient department in North India. Indian J Allergy Asthma Immunol 2020;34:112-6
|How to cite this URL:|
Paul P, Singh Y, Gupta N, Agarwal P, Sachdev A, Gupta D. Knowledge assessment among caregivers about various allergic disorders in a hospital-based pediatric outpatient department in North India. Indian J Allergy Asthma Immunol [serial online] 2020 [cited 2021 Nov 28];34:112-6. Available from: https://www.ijaai.in/text.asp?2020/34/2/112/300921
| Introduction|| |
The prevalence of various allergic disorders is rising worldwide, affecting about 400 million (rhinitis), 300 million (asthma), and 250 million (food allergies) people across the globe and is one of the top 10 reasons for visit to primary care physicians., Developing countries like India have also shown a similar upsurge in these disorders recently, partly due to better control over infectious diseases and partly due to improved understanding of allergies among health-care workers. The spectrum of allergic disorders affects multiple systems and can manifest as asthma, rhino-sinusitis, conjunctivitis, anaphylaxis, drug, food, occupational and insect allergy, eczema, urticaria, and angioedema. As per a recent estimate, approximately 20%–30% of the total Indian population suffers from at least one of the allergic disorders at a given time. The reported prevalence of allergic rhinitis and asthma, in Delhi alone, was 10% and 1% six decades back, which has increased exponentially to 30% and 15%, respectively., These figures under-estimate the true prevalence of allergies due to lack of awareness among both physicians and general public, and scarcity of reliable diagnostic modalities in this part of the world. Despite the huge magnitude of the problem, very little is known about the public perception to the diagnosis and the impact of allergies on individuals, their families and communities.,
Allergic disorders are often misdiagnosed (both over and under diagnosed) and improperly treated, creating considerable clinical and economic burden on individuals and families. It thus adversely affects the psychosocial wellbeing, quality of life and attributes to increasing health care costs. Moreover, an individual may have multiple manifestations involving more than one system either simultaneously or sequentially. This demands an integrated approach to appropriate diagnosis and management. There have been few studies regarding knowledge assessment of parents and care givers about asthma, allergic rhinitis, eczema, food allergies and anaphylaxis, across the globe.,,, Deb et al., did a clinic-based similar study in eastern India. The awareness about common allergic symptoms with availability of diagnostic and therapeutic modalities, among families, is an unmet need in most of the developing countries.
In pediatric population, parent's perception about their child's illness is a significant factor influencing acceptance of the disease and compliance to therapy. The objective of current study was to assess basic knowledge and awareness about allergies, among caregivers of children presenting to the pediatric outpatient department (POPD) of a tertiary care referral hospital in North India. This effort might be helpful in better planning and thus improving the health-care infrastructure and educational activities in this part of the developing world.
| Subjects and Methods|| |
This cross-sectional study was conducted over a 6 months' period (September 2019–February 2020), at a tertiary care multi-specialty referral hospital in North India after approval from hospital's ethical committee. Caregivers accompanying children attending the general POPD were eligible to participate in the study. Children from birth to 18 years of age and belonging to lower and upper lower socioeconomic status as per Modified Kuppuswamy scale  attend the general POPD. Caregivers, above 18 years, who consented for their participation in the study and those who were able to understand either Hindi or English were included.
A self-structured questionnaire (Bilingual-English and Hindi) was administered to the caregivers. The questionnaire was designed based upon current understanding of allergic disorders. It contained 22 questions with multiple close and open-ended options, focusing on awareness about various allergic symptoms, potential triggers, availability of diagnostic, preventive, and therapeutic options. The aforesaid questionnaire was prevalidated with a pilot study. No attempt was made to correct a wrong answer or response until the completion of the questionnaire by a caregiver. Data were analyzed using Sigma Plot Software version 12 (Systat Software, Inc., San Jose California USA, www.systatsoftware.com). Continuous variables were normally distributed and reported as mean and standard deviation (SD). Categorical variables were described using percentage.
| Results|| |
A total of 1000 participants were enrolled during the study duration. Their age varied from 18 to 55 years (mean ± SD = 32.5 ± 2.47 years) with female preponderance (female: male ratio = 1.2:1). Majority of the participants belonged to Delhi (56%) and adjoining North Indian states of Uttar Pradesh (8%) and Haryana (7%).
Source of information
Ninety-four percent people were aware about the term “allergy” [Table 1] and 658 (70%) of them considered it as a disease. Physicians played a major role (55%) in imparting knowledge about allergic disorders. The other sources were friends and family members (24%) and social media (21%).
Majority (53%) of the participants considered it as a contagious disease with air-borne transmission being the most common route. Around one-third of participants were unaware about the mode of transmission. Only 11% knew that allergic disorders have a familial tendency.
Majority of the caregivers attributed allergy to house dust (70%), seasonal variation (54%), and pollution (48%). The contribution of outdoor environment was mentioned out of proportion when compared against indoors. This highlights emphasis on various parameters like air quality index and pollen count by physicians and social media. Only 14% knew about indoor polluting agents with some contribution of house dust mites. Processed foods were held responsible by one-fourth of the study group. Among natural food items, allergy was mainly attributed to eggs, milk, nuts, banana, and rice. Most of the caregivers were not sure about measures to overcome allergic symptoms.
Eight hundred and thirty-eight (89%) respondents were aware about either skin, nasal, or chest symptoms. Few participants highlighted fever (19%), eye congestion (7%), or gastrointestinal symptoms (5%) as a manifestation of allergy. 65% of people were aware that allergies can be life-threatening.
Half of the study population thought that allergies can be diagnosed by blood test while only 8% were aware about skin prick test. Forty-eight percent of the participants were not having any knowledge about availability of any allergy tests.
Treatment and prevention
Two-third of the participants preferred alternative medicine such as Ayurveda, Homeopathy, and Unani. Many people followed home-based remedies such as steam inhalation (26%), honey (18%), aloe-vera (8%), and gargles (7%) during various allergic manifestations. When questioned about preferred mode of treatment, aerosol mode of therapy was accepted by only 16% of people. Larger proportion (42%) preferred oral route for therapy.
Majority (63%) believed in achieving permanent cure through either Ayurveda or Homeopathy. The concept of immunotherapy was almost nonexistent among the study population.
Five hundred and ninety (63%) participants believed that allergy can be prevented by employing face-mask (31%), avoiding smoking (16%), and installing air purifiers (11%).
| Discussion|| |
The prevalence of allergic diseases has increased dramatically in recent decades at the global level. Despite a rapid rise in many educational programs, caregivers' knowledge still lags behind the current understanding of disease and its management.
Source of information
In our study, majority of the caregivers accompanying the sick children were female (55%). The trend is similar to previous Indian surveys where female respondents dominated the sample. The major source of information was from doctors (55%) similar to an observation by Lai et al. where 42% parents had heard about asthma from physicians. However, the results point towards a poor level of communication between parents and doctors. As parental perception is a significant factor in the management of allergic disorders, their education through improved physician-parent communication is desired especially for female caregivers such as mothers and grandmothers who are often involved with the child care practices.
Seventy percent people accepted allergy as a disease but with considerable gaps in knowledge and misconceptions. The perception of allergy as a contagious disease (53%) is a significant observation. A previous study in Chennai over the last decade documented almost similar findings about asthma. Awareness about dust as major aeroallergen and pollution being a major aggravating factor is in concordance to previous KAP studies in India on asthma.,, This correct knowledge about common triggers of allergy can be used to our advantage during patient education programs. However, indoor allergen exposure including role of house dust mites was a lesser known fact unlike findings of Rastogi et al. The prevalence of food allergy in infancy has increased to 10% particularly in western regions and is more common among children than in adults. At the global level, Codex stated that cereals containing gluten, egg, soy, milk, peanuts, tree nuts, fish and shellfish are the eight common food allergens (Codex, 1985). Children in the UK were found to be most commonly affected by milk, eggs, and peanut allergy. In our study, we found that egg (27%), milk (12%), and nuts (12%) were most common food allergens. However, misconceptions such as processed food, food additives, banana, and even rice being a food allergen need to be corrected. These misconceptions reinforce the role of social media and nongovernmental organizations in educating the masses. The formulation of national programs, conducting continuing medical education programs and frequent reminders, such as newsletters and stage dramas, are the initial steps in improving knowledge and awareness in the community.
Rhinitis is a major allergic manifestation which is frequently ignored both by the patients and doctors, due to lack of awareness. Our study too showed ignorance about the nasal and chest symptoms of allergy among majority of the participants. Parents are the lead informant about their child's symptoms; this inadequate knowledge will lead to delay in diagnosis and treatment which will indirectly lead to increased disease burden.
Skin prick test is the gold standard investigation for common immunoglobulin E-mediated allergic disorders  but unfortunately, people were either not aware about any available diagnostic methods or have heard about utility of blood tests probably due to maleducation both by physicians and social media.
Treatment and prevention
Parents held diverse views regarding the treatment. There was a general tendency to seek help from alternative forms of medicine such as Ayurveda, Homeopathy, and Unani. Because the study was a hospital-based study, this figure should be an underestimate of the real situation in community. This reinforces the well-known tendency to seek help of alternative medicine to cure chronic ailments. In addition, people have a fear that modern medicines are very “strong” or produce “heat” in the body and are harmful in the long run. It is a common misconception that aerosol therapy is the end to the road  and this scenario remains unchanged in our study too. Only 16% of the study population preferred aerosol form of therapy. In spite of being most effective and rapidly acting, the notion that these devices are harmful or addictive and daily use impairs the child's growth still prevails in the majority.
Two-third of the people believed that allergy can be cured though majority prefer alternative form of medicine and have no knowledge about immunotherapy and modern methods of therapy. As more people were aware about outdoor pollution, they prefer use of face mask and avoidance of smoking as main preventive measure.
This study reveals a spectrum of knowledge, aptitude, and practices regarding allergies among the sample population at large. Although our study has certain limitations including the study being single center and hospital based with a predominant focus on the lower strata of society, the results are an eye opener and can very well guide us for need of targeted awareness measures in the developing world. The study also highlights an unmet need of physician education about various allergic disorders.
| Conclusion|| |
Information about allergy has not percolated enough among caregivers of children in our setting. Knowledge about the prevailing perception in the community would be the first step in achieving this. Parental education through improved physician-parent communication is necessary which should be supplemented by a responsible social media, so that caregivers can become partners in management of their child's illness. This effort might help in augmenting awareness; eliminate social stigma and misconceptions in the community regarding allergies.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Pawankar R. Allergic diseases and asthma: A global public health concern and a call to action. World Allergy Organ J 2014;7:12.
Deb A, Mukherjee S, Saha BK, Sarkar BS, Pal J, Pandey N, et al
. Profile of patients with allergic rhinitis (AR): A clinic based cross-sectional study from Kolkata, India. J Clin Diagn Res 2014;8:67-70.
Bhattacharya K, Sircar G, Dasgupta A, Gupta Bhattacharya S. Spectrum of allergens and allergen biology in India. Int Arch Allergy Immunol 2018;177:219-37.
Viswanathan R. Definition, incidence, aetiology and natural history of asthma. Indian J Chest Dis 1964;6:108-24.
Anonymous. All India Coordinated Project on Aeroallergens and Human Health Report. New Delhi: Ministry of Environment and Forests; 2000.
Chhabra SK, Gupta CK, Chhabra P, Rajpal S. Prevalence of bronchial asthma in schoolchildren in Delhi. J Asthma 1998;35:291-6.
Grant EN, Turner-Roan K, Daugherty SR, Li T, Eckenfels E, Baier C, et al
. Development of a survey of asthma knowledge, attitudes, and perceptions: The Chicago community asthma survey. Chicago asthma surveillance initiative project team. Chest 1999;116:178S-83S.
Van Sickle D, Wright AL. Navajo perceptions of asthma and asthma medications: Clinical implications. Pediatrics 2001;108:E11.
Bousquet J, Bousquet PJ, Godard P, Daures JP. The public health implications of asthma. Bull World Health Organ 2005;83:548-54.
Roncada C, Cardoso TA, Bugança BM, Bischoff LC, Soldera K, Pitrez PM. Levels of knowledge about asthma of parents of asthmatic children. Einstein (Sao Paulo) 2018;16:eAO4204.
Urrutia-Pereira M, Mocellin LP, de Oliveira RB, Simon L, Lessa L, Solé D. Knowledge on asthma, food allergies, and anaphylaxis: Assessment of elementary school teachers, parents/caregivers of asthmatic children, and university students in Uruguaiana, in the state of Rio Grande do Sul, Brazil. Allergol Immunopathol (Madr) 2018;46:421-30.
Lagercrantz B, Persson Š, Kull I. Healthcare seems to vary a lot”: A focus group study among parents of children with severe allergy. J Asthma 2017;54:672-8.
Deshpande D, Phan H, Borgstrom M, Miller R, Brown M. Caregiver knowledge as a predictor of length of stay in children hospitalized with asthma exacerbations. Ann Allergy Asthma Immunol 2018;121:S9.
Wani RT. Socioeconomic status scales-modified Kuppuswamy and Udai Pareekh's scale updated for 2019. J Family Med Prim Care 2019;8:1846-9.
] [Full text]
Rastogi D, Madhok N, Kipperman S. Caregiver asthma knowledge, aptitude, and practice in high healthcare utilizing children: Effect of an educational intervention. Pediatr Allergy Immunol Pulmonol 2013;26:128-39.
Lai A, Kumar L, Malhotra S. Knowledge of asthma among parents of asthmatic children. Indian Pediatr 2002;32:649-55.
Shivbalan S, Balasubramanian S, Anandnathan K. What do parents of asthmatic children know about asthma? An Indian perspective. Indian J Chest Dis Allied Sci 2005;47:81-7.
Al-Haddad N, Al-Ansari SS, Al-Shari AT. Impact of asthma education program on asthma knowledge of general practitioners. Ann Saudi Med 1997;17:550-2.
Osborne NJ, Koplin JJ, Martin PE, Gurrin LC, Lowe AJ, Matheson MC, et al
. Prevalence of challenge-proven IgE-mediated food allergy using population-based sampling and predetermined challenge criteria in infants. J Allergy Clin Immunol 2011;127:668-760.
Soon JM. Food allergen knowledge, attitude and practices among UK consumers: A structural modelling approach. Food Res Int 2019;120:375-81.
Silva CM, Barros L. Asthma knowledge, subjective assessment of severity and symptom perception in parents of children with asthma. J Asthma 2013;50:1002-9.
Gupta N, Agarwal P, Sachdev A, Gupta D. Allergy testing An overview. Indian Pediatr 2019;56:951-7.
Gupta SK, Sen Mazumdar K, Gupta S, Sen Mazumdar A, Gupta S. Patient education programme in bronchial asthma in India: Why, how, what and where to communicate? Indian J Chest Dis Allied Sci 1998;40:117-24.