KNOWLEDGE AND ATTITUDES IN RELATION TO CHILD AND ADOLESCENT MENTAL HEALTH AMONG DOCTORS AND NURSES WORKING IN PEDIATRIC UNITS AT TERTIARY HEALTH FACILITIES IN RWANDA

Abstract

Mental health problems are prevalent in pediatric patients and are often not recognized or well managed. These problems may be a reason for consultation by themselves or may develop on background of existing physical illnesses. The lack of knowledge and stigma towards Child and Adolescent Mental Health among healthcare providers can be barriers to accurate identification and treatment of mental disorders in pediatric population. For this end, sufficient knowledge of CAMH and positive attitude towards children with mental health problems is required for efficient care. The aim of this study was to determine the level of knowledge and attitudes in relation to CAMH among doctors and nurses working in pediatric units at tertiary health facilities in Rwanda. Methodology This was a cross-sectional study conducted in 3 of 4 national referral hospitals offering tertiary healthcare services in Rwanda. A total of 155 nurses and 48 doctors who were involved in patients care in pediatric units at Kigali University Teaching Hospital (KUTH), Rwanda Military Hospital (RMH), and Butare University Hospital (BUTH) were included in the study. Following written consent, participants completed a questionnaire which was designed to collect information on participants’ socio-demographic characteristics, information about knowledge of CAMH and information about attitudes towards children or adolescents with mental health problems. To each question a score was assigned such that knowledge of Child and Adolescent Mental Health was measured by considering proportions of answers to each single item or summation of scores for both knowledge measures (higher scores indicating higher level of information). Attitude was measured by considering proportions of answers to each single item or by summation scores on attitude scales such that higher scores indicate more negative attitude towards children and adolescents with mental health problems. Data were analyzed using STATA version 15. Univariate, bivariate and multiple linear regressions analyses were computed. Significance testing for all inferential tests was set at p< 0.05, two-tailed, and 95% Confidence Interval. This study was approved by Rwanda National Ethics Committee and by respective Ethics and Research Committees at KUTH, BUTH and RMH. Results A total of 199 (out of 264 target population) completed the questionnaire making a response rate of 75%. The participants comprised of 151 nurses and 48 doctors. Nurses were predominantly female (89.4%), whereas 33 (70.2 %) doctors were male. The analysis found that 95 (62.9%) nurses and 27 (56.3%) doctors believed that people with mental health problems are difficult to talk to, 46 (30.5 %) nurses and 9 (18.8%) doctors believed that people with mental disorders do not recover, 87 (57.6%) nurses and 14 (29.2%) doctors thought that mental disorders are rare in children. A total of 59 (39.1%) nurses and 22 (45.8 %) doctors did not know that spiritual attack is not a cause of mental health problems. We found also that 11 (67.3%) nurses and 13 (27.1%) doctors did not agree that mental problems can be treated by pediatricians and the awareness of mental health problems in younger children was also a challenge for 57 (38%) nurses and 16 (33.3%) doctors. Being a nurse and working at BUTH or RMH were identified as predictors of insufficient knowledge. As far as attitude is concerned, a staff of 49 (32.7%) nurses and 6(12.5%) doctors would feel that an adolescent with psychotic illness is very much dangerous and at least 58(38.4%) nurses and 6(12.5%) doctors thought very much it would be best for the adolescent’s community if he was put away in a psychiatric hospital. We also found that a large number (74.7% of nurses and 70.8% of doctors) thought that children and adolescents with mental illness can be dangerous to the society and that 58 (38.7%) nurses and 18(37.5%) doctors would be concerned if they find their children or relative walking home from school together with a child or adolescent with mental illness while 41 (27.3%) nurses and 13 (27.1%) doctors will be worried about working on the ward that admits children and adolescents with mental illness. Being a nurse, insufficient knowledge of CAMH and a shorter length of working experience were the independent predictors of negative attitudes towards children and adolescents with mental health problems. Conclusion The study highlighted that doctors and nurses working in pediatric units at tertiary hospitals in Rwanda had insufficient knowledge of Child and Adolescent Mental Health and negative attitudes towards children and adolescents with mental health problems. Among other attitudes, we can note the negative attitudes towards the management of mental illnesses in pediatric units. Working at Butare University Teaching Hospital or Rwanda Military Hospital, being a nurse and having stigmatizing attitudes were the independent predictors of insufficient knowledge of CAMH. Being a nurse and a shorter length of work experience were the independent predictors of negative attitudes towards children or adolescents with mental health problems.