Quality of Life of Children With Chronic Cough and of Their Parents at Kenyatta National Hospital

Abstract

Background: Chronic cough is a common and frequently debilitating problem of childhood associated with high morbidity. It has been shown to negatively impact the quality of life (QoL) of both children and their caregivers. Recent development of chronic cough specific QoL tools has allowed for quantification of burden of cough on those affected. The impact of chronic cough on the QoL of Kenyan children and their parents has however not been studied, presenting a challenge in their holistic management. Objective: To assess the quality of life of children with chronic cough and QoL of their parents and to determine the clinical and socio-demographic factors associated with QoL of those affected at Kenyatta National Hospital. Methodology: Study design: Hospital based cross sectional survey. Study site: Kenyatta National Hospital. Study population: 1. Parents of children who presented with a cough lasting longer than 4 weeks. 2. Children/Teenagers aged 7-17 years who presented with chronic cough at KNH. Study procedure: i. Quantitative study: Consecutive sampling was used until a sample size of 135 was reached. A pretested questionnaire was used to collect socio-demographic and clinical data. A Parent-Proxy QoL Questionnaire for Paediatric Chronic Cough was used to assess the QoL of children and their parents. For older children/teenagers, a Child Chronic Cough QoL questionnaire was used to evaluate their QoL. ii. Qualitative study: 15 in-depth interviews were carried out via convenience sampling to explore the perception of parents. Data analysis and management: Quantitative data analysis – Done using SPSS v21. QoL scores were analysed using median (IQR) and interpreted as poor QoL (median ≤3.5) or good QoL (median >3.5). Factors associated with QoL were summarised using frequencies and percentages and compared using Chi square test. Univariate and multivariable analysis and corresponding 95% confidence intervals were used to obtain odds ratios. P value of <0.01 was statistically significant. For qualitative analysis, audio recordings were transcribed verbatim and content analysis used to arrive at themes and subthemes. xiii Results: Median age of the children was 1.1 years while that of their parents was 30 years. The overall QoL score of parents was poor with a median (IQR) of 1(1,2) and the overall QoL score of older children was poor with a median (IQR) of 2(1.5,2). Sociodemographic factors associated with extremely poor QoL included age of children ≤5years (OR 6.17, 95% CI 2.81-13.87), lower education level of parents (OR 3.64, 95% CI 1.03-12.20), monthly income (OR 7, 95% CI 2.11-21.30) and staying near a busy road (OR 2.86, 95% CI 1.19-7.42). Clinical factors included higher number of hospital consultation (OR 3.15. 95% CI 1.54-7.39) and HIV status of child (OR 8.25, 95% CI 1.43-89.77). After multivariable logistic analysis, predictors for extremely poor QoL included age of children ≤5 years (OR 11.38, 95% CI 3.85-33.64), lower education level of parent (OR 9.33, 95% CI 2.02-43.08), higher number of consultation (OR 5.32, 95% CI 2.68-24.73) and staying near a busy road (OR 3.23, 95% CI 1.19-8.75). Conclusions: Parents of children with chronic cough have poor QoL. Older children with chronic cough have poor QoL. Predictors of extremely poor QoL included younger age of children, lower education of parents, higher number of hospital consultations and outdoor air pollution (staying near a busy road).