BACKGROUND:
Primary immune deficiency (PID) comprises more than 330 diseases, in which alterations in the immune system cause greater predisposition towards infections, autoimmune phenomena, allergies, and neoplasms. The early diagnosis of PID prevents the development of complications and improves the quality of life in children with PID. The lack of medical knowledge is identified in many countries as the probable cause for late diagnosis and under diagnosis of PID.
SUBJECTS AND METHODS:
This is a cross-sectional study conducted in two platforms, a paper and a Google form questionnaire during the period from Jan 2020 to August 2020. We studied knowledge, attitude, and practice of physicians regarding PID in children. The knowledge questionnaire included 10 clues to PID diseases, 5 questions for each of the diagnosis, syndromes associated with PID as well as vaccination of children with PID. Another 5 questions for each of attitudes and practice of physicians toward PID were also surveyed.
RESULTS:
Out of 203 participants, there were 11 (5.4%) trainee doctors, 68 (33.5%) senior residents, 59 (29.1%) general practitioners, and 65 (32%) specialists. Only 29 (14.3%) of participants believe that all 10 clues for PID are true. While 67 (37.9%) of participants knew 5 clues and less for PID. The knowledge about the clues of PID was significantly higher among trainee doctors, senior residents, and specialist doctors in comparison to general practitioners. Also, trainee doctors and senior residents knew more clues in comparison to specialist doctors. Both specialists and senior residents have an attitude indicator (AI) mean of 3 ± 1 while trainees and general practitioners have AI mean of 2±1, and again general practitioners have a lower attitude for PID. In multiple linear regressions, the effect of independent variables knowledge indicator (KI) and attitude indicator (AI) were significantly affecting the practice.
CONCLUSION AND RECOMMENDATION:
PID is still underestimated by physicians regarding warning signs and diagnosis. General practitioners lack a lot of knowledge for PID and that affects their attitude and practice. We recommend increase awareness among PHCCs physicians especially GP doctors for PID warning signs and diagnostic tips.
|
- Modell V, Knaus M, Modell F, Roifman C, Orange J, Notarangelo LD. Global overview of primary immunodeficiencies: a report from Jeffrey Modell Centers worldwide focused on diagnosis, treatment, and discovery. Immunol Res. 2014; 60:132–44.
- Bousfiha AA, Jeddane L, Ailal F, Benhsaien I, Mahlaoui N, Casanova JL, et al. Primary immunodeficiency diseases worldwide: more common than generally thought. J Clin Immunol. 2013;33:1–7.
- Boyle JM, Buckley RH. Population prevalence of diagnosed primary immunodeficiency diseases in the United States. J Clin Immunol. 2007;27:497–502.
- Espinosa-Rosales FJ, Condino-Neto A, Franco JL, Sorensen RU. Into action: Improving access to optimum care for all primary immunodeficiency patients. J Clin Immunol. 2016;36:415–17.
- Joshi AY, Iyer VN, Hagan JB, St Sauver JL, Boyce TG. Incidence and temporal trends of primary immunodeficiency: a population-based cohort study. Mayo Clin Proc. 2009;84:16–22.
- Modell V, Quinn J, Ginsberg G, Gladue R, Orange J, Modell F. Modeling strategy to identify patients with primary immunodeficiency utilizing risk management and outcome measurement. Immunologic research. 2017;65:713-20.
- Mohammadzadeh I, Moazzami B, Ghaffari J, Agha mohammadi A, Rezaei
- Primary immunodeficiency diseases in Northern Iran. Allergologia et immunopathologia. 2017 ;45:244-50.
- Boyarchuk O, Lewandowicz-Uszyńska A, Kinash M, Haliyash N, Sahal I, Kovalchu k Physicians’ awareness concerning primary immunodeficiencies in the Ternopil Region of Ukraine. Pediatria Polska—Polish Journal of Paediatrics. 2018;93:221–28.
- Boyarchuk O, Kinash M, Hariyan T, Bakalyuk Evaluation of knowledge about primary immunodeficiencies among postgraduate medical students. Archives of the Balkan Medical Union. 2019;54:11–19.
- Nourijelyani K, Aghamohammadi A, Salehi Sadaghiani M, Behniafard N, Abolhassani H, Pourjabar S, et al. Physicians awareness on primary immunodeficiency disorders in Iran. Iran J Allergy Asthma Immunol. 2012;11:57–64.
- Wood P, Stanworth S, Burton J, Jones A, Peckham D, Green T, et al. UK Primary Immunodeficiency Network. Recognition, clinical diagnosis and management of patients with primary antibody deficiencies: a systematic review. Clin Exp Immunol. 2007;149:410–23.
- Hariyan T, Kinash M, Kovalenko R, Boyarchuk O. Evaluation of awareness about primary immunodeficiencies among physicians before and after implementation of the educational program: A longitudinal study. PLoS One.2020 May 29;15:1-10.
- Al-Herz, W., Zainal, M.E., Salama, M. et al. Primary Immunodeficiency Disorders: Survey of Pediatricians in J Clin Immunol. 2008; 28:379– 83.
- Dantas EO, Arandaa CS, Rêgo AM, Tavares FS, Severo Ferreira JF, de Quadros MA,etal.Doctors’ awareness concerning primary immuno deficiencies in Brazil. Allergol Immunopathol (Madr). 2015; 43:272– 78.
- Orange JS, Seeborg FO, Boyle M, Scalchunes C, Hernandez-Trujillo V. Family Physician Perspectives on Primary Immunodeficiency Front Med (Lausanne). 2016;3:12.
- Waltenburg R, Kobrynski L, Reyes M, Bowen S, Khoury MJ. Primary immunodeficiency diseases: practice among primary care providers and awareness among the general public, United States, 2008. Genetics in Medicine. 2010;12:792-800.
- Mahlaoui N, Warnatz K, Jones A, Workman S, Cant A. Advances in the Care of Primary Immunodeficiencies (PIDs): from Birth to Adulthood. J Clin Immunol. 2017;37:452-60.
- Sullivan KE. Pathogenesis of pediatric rheumatologic diseases. Pediatric Clinics. 2018;65:639-55.
|
