Knowledge, attitudes and practices of health professionals in management of pain in aids patients at Polokwane/ Mankweng Hospital complex, Limpopo Province
This study was initiated as part of a quality improvement project on pain management at Polokwane/Mankweng Hospital Complex (PMHC). This is the first part of the project, which involved a baseline study to assess the knowledge, attitude and practice of doctors working in the two hospitals in managing pain in HIV/AIDS patients. Admissions due to the AIDS epidemic have continued to rise over the years, with a quarter of admission in medical wards being attributed to AIDS related diseases1. The survey was conducted at Polokwane/Mankweng Hospital Complex. One hundred and twenty questionnaires were distributed, and 52% of the doctors returned the completed questionnaires. The objectives of the study were as follows: 1. To determine the level of knowledge of doctors in PMHC about pain in AIDS patients. 2. To determine the attitudes of doctors in PMHC regarding pain management in AIDS patients. 3. To determine their practice regarding prescribing analgesics for pain in AIDS patients. 4. To determine whether the level of knowledge and their attitudes affect their prescribing practice. The level of knowledge of doctors at PMHC is low compared to previous studies 2,3,4 with a mean of 46.92%. The level of knowledge for Oncologists is not better than other specialties. The oncologists do however have better knowledge of the WHO pain ladder compared to other specialties. The doctors (56.9%) are not familiar with the WHO pain ladder, which has been in existence for over 20 years. The doctors are aware that pain management is major problem (69.2%), and that one has to aim for complete pain relief (83.1%). Community Service doctors have been found to have the lowest mean score for level of knowledge (33.92%, SD=9.44) and level of attitude (52.39%, SD=17.81). Interns on the other hand had the highest mean score for the level of attitude (80.55%, SD=19.47) and knowledge (58.33; SD=17.07). 7 Most doctors still believe that the likelihood of patients developing addiction to morphine when given for chronic pain is moderate to high (67.7%). The demographic variables had no influence on the level of knowledge, level of attitude and the practice pattern. There was a positive correlation in the level of knowledge and the level of attitude (p=0.014), as well as the practice pattern (p=0.001), which is different from what other studies obtained. The level of attitude also correlated with practice pattern (p=0.0004). Although the study has limitations, important and interesting findings have come to the fore, and have to be acted upon. Management of chronic pain and palliative care has not been part of medical training in South Africa until recently, and is still a small part of the curriculum, if at all. The need for training of doctors in pain management and palliative is evident. The Limpopo Provincial Government and PMHC have to develop a strategy on how to address the identified gaps in the knowledge, attitude and practices of doctors.
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Department of Public Health and Family Medicine