|Year : 2015 | Volume
| Issue : 1 | Page : 14-17
Knowledge and attitude of nurses in North-Western Nigeria toward teething
Aliyu Ibrahim1, Teslim O Lawal2, Adewale Ashimi3
1 Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University Kano, Kano, Nigeria
2 Consultant Paediatrician, Federal Medical Centre, Birnin Kebbi, Kebbi, Nigeria
3 Department of Obstetrics and Gnaecology, Federal Medical Centre, Birnin Kudu, Jigawa, Nigeria
|Date of Web Publication||4-Jun-2015|
Dr. Aliyu Ibrahim
Department of Paediatrics, Aminu Kano Teaching Hospital, Kano
Source of Support: None, Conflict of Interest: None
Background: Community health workers, nurses, and doctors have misconception on teething, resulting in inappropriate medical advice and unnecessary prescriptions. Hence, sound knowledge of the teething process is imperative for proper parental education. This study aims to determine the knowledge and attitude of nurses in north-west Nigeria toward teething. Materials and Methods: It was a cross-sectional study of nurses conveniently sampled in two health facilities in Nigeria. Results: Three hundred and twenty-four nurses were involved comprising 230 (71%) females and 94 (29%) males. Two hundred and eighty-five (88.0%) of the respondents believed teething was associated with systemic symptoms; however, most of the respondents would advice for further medical care for symptoms they attributed to teething. Fever was the most prevalent symptom believed to be associated with teething, followed by loss of appetite and loose stools. However, their gender (X 2 = 0.956, df = 2, P = 0.62), age (X 2 = 0.551, df = 6, P = 0.99), number of years post qualification (X 2 = 6.258, df = 4, P = 0.181), and number of children (X 2 = 6.406, df = 4, P = 0.17) had no relationship with their perception toward teething symptoms. Two hundred and eighty (86.4%) of the respondents will give prescription for teething symptoms and teething powder was the most common teething drug prescribed. Eighty percent of the respondents believed teething remedies are effective. Conclusion: Teething myths are common among nurses in north-western Nigeria; therefore, efforts should be made to eradicate these through effective continuous medical education programs.
Keywords: Knowledge, north-west Nigeria, nurses, practice, teething myths
|How to cite this article:|
Ibrahim A, Lawal TO, Ashimi A. Knowledge and attitude of nurses in North-Western Nigeria toward teething. Niger J Exp Clin Biosci 2015;3:14-7
| Introduction|| |
Teething is an innocuous process signified by eruption of the deciduous teeth. ,, It occurs usually between 6-36 months during the period of emergence of primary dentition.  Myths and controversies have been associated with this process. Many cultures associate teething with systemic symptoms such as drooling of saliva, vomiting, fever, and diarrhea.  Similarly, health professionals are not left out; they at times give incorrect advice and medications for teething. ,,,
Most cadres of health professionals associate teething with systemic symptoms. Wake et al.,  reported that 85% of the respondents in their study consisting of general practitioners, pediatricians, dentists, pharmacists, and nurses associated teething with systemic symptoms. Similarly, Bankole et al.,  in their study among nurses reported that 82.1% and 61.4% of nurses believed teething was associated with fever and diarrhea, respectively; 71.7% and 54.4% of them recommended analgesic and teething powder, respectively, though the exact number of nurses who believed teething was associated with systemic symptoms was not quoted in that study. It was recognized that large number of them believed teething was associated with systemic symptoms. , Denloye et al.,  in their study among community workers reported that 60% of them associated teething with systemic complaint. Nurses and community health workers are important for effective healthcare delivery especially at the grass-root level where they are often responsible for the supervision of maternity homes and primary healthcare centers; therefore, their level of awareness and perceptions on health-related matters can easily be transmitted to the populace. Therefore, evidence-based knowledge of the teething process is imperative for proper parental education. Therefore, this study seeks to determine the knowledge and attitude of nurses in health facilities in Birnin Kudu and Birnin Kebbi toward the teething process with a view to ensure proper evidence-based knowledge on the teething process.
| Materials and Methods|| |
This study was cross-sectional, conducted between April and September 2014. This involved nurses working with Federal Medical Center (FMC) Birnin Kebbi, Kebbi State and FMC, Birnin Kudu, Jigawa State. The sample sized was calculated using statistical formula for descriptive study;  based on a prevalence of 60%,  from earlier study, a sample size of 368 was calculated. The total population of nurses from both institution was 550 (350 and 200 from FMC Birnin Kudu and FMC Birnin Kudu, respectively); therefore, 234 and 134 questionnaires were distributed to FMC Birnin Kudu and FMC Birnin Kudu, respectively. However, 350 questionnaires were returned; of these 224 and 126 questionnaires were from FMC Birnin Kebbi and FMC Birnin Kudu, respectively; furthermore, 10 and 16 questionnaires from FMC Birnin Kebbi and FMC Birnin Kudu, respectively, were excluded because of incomplete information. The respondents were consecutively enrolled till the desired sample size was achieved. The questionnaire was structured and pretested consisting of both open- and close-ended questions. It was self-administered by the respondents. Relevant information on their socio-demographic characteristics, knowledge about teething, symptoms associated with it, and common remedies recommended by nurses for teething complaints were extracted.
The data obtained were analyzed using Statistical Package for Social Sciences (SPSS, Chicago Ill; USA) version 16.0. Categorical variables were summarized and presented as frequency tables and percentages were calculated; while Chi square test of significance for establishing association between categorical variables was done with P - value less than 0.05 being accepted as statistically significant.
| Results|| |
Questionnaires from 324 nurses were analyzed comprising 230 (71%) females and 94 (29%) males. Most of the respondents were in the age range of 25-39 years and were mainly between 5-10 years post qualification as trained nurses [Table 1].
Two hundred and eighty-five (88.0%) of the respondents believed teething was associated with systemic symptoms. Most of the respondents would advise parents to seek for further medical care for the symptoms they attributed to teething. Seventeen (5.2%) respondents claimed they had recorded patient loss to teething problems [Table 2].
[Table 3] illustrates that fever was the most common symptom believed to be associated with teething, followed by loss of appetite, then loose stools while skin rash was the least common symptom reported among these group of healthcare workers.
|Table 3: Common complaints associated with teething among the study population|
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Although most female nurses especially those in the age of 25-39 years, who were less than 5-years post qualification from nursing school and had two children or more believed teething was associated with systemic symptoms; however, their gender, age, number of years post qualification, and number of children had no statistically significant relationship with their perception of teething symptoms (X 2 = 0.956, df = 2, P = 0.62; X 2 = 0.551, df = 6, P = 0.99; X 2 = 6.258, df = 4, P = 0.18; X 2 = 6.406, df = 4, P = 0.17, respectively) [Table 4] and [Table 5].
|Table 5: Influence of age, years' post qualification, and number of children on teething perceptions|
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The parents of the respondents were the most common source of information on teething, followed by the nursing school while their grandparents and their personal experiences were among the least common sources of information on the teething process [Table 6].
|Table 6: Common sources of teething information witnessed among study population|
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Two hundred and eighty (86.4%) of the respondents will give medical prescription for teething symptoms; however, teething powder was the most common teething remedy prescribed, followed by 67 (20.7%) of the respondents who prescribed antibiotics for teething; but the least remedy was the use of clean cloth for soothing; however, 259 (80.0%) of the respondents believed that teething remedies were effective [Table 7].
| Discussion|| |
Controversies surrounding teething in the medical literature has being in existence since the periods of Hippocrates, Aristotle.  Hippocrates in his submission attributed ailments like vomiting, diarrhea, convulsion, meningitis, and even tetanus to teething.  However, some of these misconceptions persist till this day despite easy access to current medical literatures with evidences to the contrary. ,
This study showed that teething myths still persist among nurses in Nigeria; 88% of the nurses associated systemic symptoms with teething; therefore, there is no significant change from previous report by Bankole et al.,  but this figure is alarming when compared to Ispa et al.'s study which documented teething misconception in 48% of health workers in New Zealand.  This is worrisome because nurses and community health workers are closer to parents and are better positioned to properly educate them on common health issues such as teething. Therefore, if they are not correctly informed, there is the danger of a simple process like teething resulting in health mishap. Fever and loss of appetite were still the most common illnesses attributed to teething by nurses, which was similar to Bankole et al.'s report.  However, most nurses agreed to advice parents to seek for further medical assistance in cases of supposed teething complaints; this is promising because it avails the healthcare system the opportunity to further evaluate these children and educate the parents appropriately. Surprisingly, most of the respondents were informed on the teething process by their parents and grandparents compared to only 22% who were taught at nursing school. This shows the strong family ties common in African societies and this could have a negative effect in health-related matters  and despite their level of education and exposure, they still held on to these teething myths. Teething powder was the most common remedy prescribed by nurses unlike in Bankole et al.  which reported analgesics as the commonest. However, more nurses prescribed antibiotics in this study, which should heighten our concern regarding emergence of antibiotics-resistant microbes. Though only one respondent recommended cloth for soothing, this should be of concern because this may serve as a medium of infection resulting in diarrhea, which will be wrongly attributed to teething. It is a cause for concern that most teething remedies are readily available over the counter and some mothers readily resort to self-medication.  Some teething powders and syrups contain opiates and antihistamines which are contraindicated in children less than 2 years,  because of their association with child death; such as the case of "my pickin" controversy, which led to the death of 84 Nigerian children. , Therefore, the 5.2% of those reported child loss in this study may be related to some of this harmful practices and complications arising from these remedies.
However, their ages, number of years post-qualification, and gender did not influence their perception on teething. Finally, efforts should be put in place for provision of continuous medical education programs for healthcare providers; this will ensure that healthcare providers are better position to provide effective healthcare services.
| Conclusion|| |
Teething myths are still prevalent among nurses in north-western Nigeria; some of these myths may undermine the severity of those attributed illnesses. However, most nurses agreed on the need for parents of sick children to seek for further medical care for teething-related health issues; this will therefore avail the parents the opportunity for further care and counseling by other health professionals. Provision of continuous medical education programs is imperative and will curtail these misconceptions.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]