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A RESEARCH STUDY ON

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ANORECTAL MALFORMATION

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STUDY DONE AT KNH 2020/2021 BY

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  • Rose Njoroge HSC. RN and Counseling Psychologist
  • Patrick Too.RN and Neonatal Nurse
  • Norah Mwenda.RN Peadiatric surgical ward

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Funded by Kenyatta National Hospital

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TITLE

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CHALLENGES EXPERIENCED BY CHILDREN WITH ANORECTAL MALFORMATIONS AND THE PSYCHOSOCIAL EFFECTS ON THEIR PARENTS

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OUTLINE

  • Background
  • Methodology
  • Knowledge
  • Catchment
  • Effects
  • Summary
  • Recommendations

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BACKGROUND

  • Globally ARM is 33% of all Peadiatric surgical conditions[1]

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  • ARM accounts for 40% total admissions in surgical Paediatric ward in kenyatta annually [2]

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METHODOLOGY

  • Cross-sectional descriptive

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  • The study population was 87parents of children admitted in ward 4A and those attending pediatric surgical outpatient clinic (sopc ) during the period of the study.

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KNOWLEDGE OF ARM

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Minimal Literature to examine Knowledge on ARM ,positive or negative experience in both parents and children in Africa and in Kenya [3]

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KNOWLEGE IN THE COMMUNITY

  • Majority (81.6%, n=71) of parents had never heard of this condition before while only 18.4% (n=16) had heard

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REFERRALS TO KNH

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  • Referred from 25 Counties out of 47 counties

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Majority came from the following counties

  • Nairobi county 22.7%
  • Kiambu county 10.2%
  • Machakos County 9.1%

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EFFECT ON CHILDREN EDUCATION

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  • 78.6% Had not enrolled in school despite reaching school going age

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Only 21.4 % had enrolled in school

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  • Most (78.3%, n=69) children had not reached school going age.

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PSYCHOSOCIAL EFFECTS ON THEIR PARENTS

  • Initial Shock on self diagnosis
  • Anxiety during emergency surgery for newborns
  • Prolonged Stress/Depression
  • Financial constrains,several surgeries and frequent clinics from long distance
  • Rejection and separation of families
  • Discrimination/stigmatisation.

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SUMMARY

  • Delayed ARM Diagnosis
  • Lack of knowledge in the Community
  • Serious challenges caused by ARM to the children as well as their families
  • Children born with ARM risk to miss their education or get delayed if their surgeries are delayed

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RECOMMENDATIONS

  • Diagnose at Birth

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  • Early surgical Interventions

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  • Train more surgical Personel on ARM management

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  • Devolve services to the counties

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  • Enlighten the community on ARM

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  • Psychosocial Family Centred care

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PREVIOUSLY PRESENTED

  • At Kenya Association of Peadiatric Surgeons ( KAPS) Conference at Crown Plaza Nairobi in MAY 2022
  • At NNAKNational conference in Mombasa in October 2022

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OUR REFERENCES

  • Ademuyiwa A, S. O. (2009). Determinants of mortality in neonatal intestinal obstruction in Ife, NigeAminoff, D., La Sala, E., & Zaccara, A. (2006). Follow-up of anorectal anomalies: The Italian parents’ and patients’ perspective. Journal of Pediatric Surgery, 41(4), 837–841. https://doi.org/10.1016/j.jpedsurg.2005.12.061
  • Eltayeb, A. A. (2010). Delayed presentation of anorectal malformations: The possible associated morbidity and mortality. Pediatric Surgery International, 26(8), 801–806. https://doi.org/10.1007/s00383-010-2641-2[1]
  • Gama, M., & Tadesse, A. (2018). Management of Anorectal Malformation: Experience from Ethiopia. Annals of African Surgery, 15(1). https://doi.org/10.4314/aas.v15i1.6
  • Jumbi, T., Kuria, K., Osawa, F., & Shahbal, S. (2019). The effectiveness of digital anal dilatation in preventing anal strictures after anorectal malformation repair. Journal of Pediatric Surgery, 54(10), 2178–2181. https://doi.org/10.1016/j.jpedsurg.2019.04.004 [2]
  • Kigo, C. N., & Ndung’u, J. M. (2002). Bowel function following primary repair of anorectal malformations at Kenyatta National Hospital. East African Medical Journal, 79(3), 124–127. https://doi.org/10.4314/eamj.v79i3.8889
  • Lawal, T. A. (2019). Overview of anorectal malformations in Africa. Frontiers in Surgery, 6(March), 1–10. https://doi.org/10.3389/fsurg.2019.00007[3]
  • Pruthi, G. K., & Mohta, A. (2010). Psychosocial burden and quality of life in parents of children with anorectal malformation. Journal of Indian Association of Pediatric Surgeons, 15(1), 15–18. https://doi.org/10.4103/0971-9261.69135Rintala, R. J., & Lindahl, H. G. (2001). Fecal continence in patients having undergone posterior sagittal anorectoplasty procedure for a high anorectal malformation improves at adolescence, as constipation disappears. Journal of Pediatric Surgery, 36(8), 1218–1221. https://doi.org/10.1053/jpsu.2001.25766
  • Soeda, E. (2018). Using nature and outdoor activity to improve transplant childrens adherence during transitional age-three years of experience. Advanced Practices in Nursing, 03. https://doi.org/10.4172/2573-0347-c4-027

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