Indian J Pediatr 1992; 59 : 239-247
Attitude of Children Towards Medication and Health in Urban and Rural Schools of Tamii Nadu Abhijit Sinha Roy Steel Autho~ty of India Lid, Salem Steel Plan~ Salem (Tamil Nadu ) In most cases of Pediatric practice, medicine is prescribed to the child without taking into consideration his likes and dislikes. The medicines are usually thrust upon them. Though our foremost aim is to cure the patient, we should give due importance to make the process of cure as comfortable as possible. Keeping this in mind, opinion poll of around nine hundred school students from rural and urban population of age ranging from 11 years to 16 years was taken. The result is analysed and suggestion is given to rationalise the treatment for better compliance.
Key Words: Medication; Children's attitude. In most cases of medical practice, the patients opinion regarding medication is not taken into consideration. It is admitted that cure of the patient is of foremost priority, but it is equally important to make the process of cure as comfortable as possible. If an alternative effective method of treatment is available and if it is found that children prefer it, then it should be definitely given weight. The aim of the study is to find out a suitable alternative mode of treatment, which is effective, congenial and of the child's choice.
students, 639 were from urban and rest from rural schools, with 534 students being males and 360 females. Multiple choice questions pertaining to attitude towards medication, were given both in English and the local language. The answers to these questions were fed to the personal computer and results analysed in various combinations likeagewise, sexwise and urban/rural ratiowise. The results are shown in separate tables. TABLg1 Order of Preference About the Type of Oral Medicine
MATERIAL AND METHODS Eight hundred and ninety four students from rural and urban population were subjected to the opinion poll. Of the
A = Capsule, B =Tablet, C = Liquid, D = Powder. Total Participants: 895 All age groups, Both urban and rural, Both sexes
Reprint requests : Dr. Abhijit Sinha Roy, Specialist Incharge (Pediatrics), Steel Authority of India Ltd., Salem Steel Plant, Salem- 636 013 239
A
B
C
D
163 20.69%
265 33.63%
306 38.83%
54 6.85%
240
THE INDIAN JOURNAL OF PEDIATRICS
Vol. 59, No. 2
T~r~ 2. Choice in The Time of Taking Medicine. A = Before food, B =After food; n = 898. Urban Age Group
Rural
Boys A
Girls B
A
Boys B
B
0 8 (0.0) (100.0)
4 (20.0)
16 (80.0)
7 (6.7)
97 (93.3)
59 (12.9)
397 (87.1)
21 166 27 34 7 6 (11.2) (88.8) (44.3) (55.7) (53.8) (46.2)
85 (20.1)
337 (79.9)
29 (12.3)
148 (16.5)
750 (83.5)
0 4 3 0 (0.0) (100.0) (100.0) (0.0)
13-14 No. %
31 211 (12.8) (87.2)
5 (10.9)
A
Girls A
11-i2 No. %
15-16 No. 30 131 % (I8.6) (81.4) Total No. 61 346 % (15.0) (85.0)
Total*
B
1 4 (20.0) (80.0)
41 16 48 (89.1) (25.0)(75.0)
207 (87.7)
A
B
44 86 14 111 (33.8)(66.2)(11.2)(88.8)
*Includes both sexes in urban and rural areas T~Lr 3. Choice Between : Effective and less Effective Oral Medicine B. Effective oral medicine but bad in taste A. Less effective oral medicine but good in taste
Total ParticipantS: 896
Urban Age Group
Rural
Boys A
Girls B
A
Total
Boys B
Girls
A
B
A
B
1
4
3
5
A
B
11-12 No. 1 2 % 33.3% 66.7% 13-14 No. 79 162 % 32.8% 67.2%
1
2
6
13
33.3% 8 17.4%
66.7% 38 82.6%
20.0% 80.0% 37.5% 62.5% 26 38 45 59 40.6% 59.4% 43.3% 56.7%
31.6% 158 34.7%
68.4% 297 65.3%
15-16 No. 42 119 % 26.1% 73.9%
37 19.8%
150 80.2%
20 41 3 t0 32.8% 67.2% 23.1% 76.9%
102 24.2%
320 75.8%
Total No. 122 283 '% 30.1% 69.9%
46 19.5%
190 80.5%
47 83 51 74 36.2% 63.8% 40.8% 59.2%
266 29.7%
630 70.3%
DISCUSSION To the question related to the type of oral medication required (Table 1) it is seen that both urban and rural children irrespective
of sex, preferred liquid medication. The trend to prefer liquid medicine is more for the girls. To choose from the liquid, tablet, capsule and powder medicine, the majority of them (38.83%) chose liquid medicine
ROY : A'YITFUDE OF CHILDREN TOWARDS MEDICAl.ION AND ItEALTH
241
TARL~4. Choice Between : Painful and Less Painful Injections, Total Participants: 892 Urban Age group
Boys
Rural Girls
Total
Boys
Girls
(too) A
B
A
B
A
B
A
B
A
B
1
3
2
1
2
3
6
2
11
9
25.0%
75.0%
66,7%
33.3% 40.0%
60.0% 75.0% 25.0%
55.0%
45.0%
13-14
118 49.0%
123 51.0%
33 75.0%
11 34 25.0% 53.1%
30 59 45 46.9% 56.7% 43.3%
244 53.9%
209 46.1%
15-16
70 43.5%
91 56.5%
81 44.0%
103 38 56.0% 62.3%
23 6 7 37.7% 46.2% 53.8%
195 46.5%
224 53.5%
Total
189 46.6%
217 53.4%
116 50.2%
115 74 49.8% 56.9%
56 71 54 43.1% 56.8% 43.2%
450 59.4%
442 49.6%
11-12
A=Less painful injection twice daily for five clays i.e, ten injections B =Painful injection once daily for five days i.e. five injections T~L~ 5. Choice Between Taking Preventive Injections and on Getting the Disease, Total Participants: 895 Urban Age group (too)
Boys
Rural Girls
Total
Boys
A
B
A
B
A
B
11-12
3 75.0%
1 25.0%
2 66.7%
1 5 33.3% 100.0%
13-14
214 88.8%
27 11.2%
44 95.7%
2 4.3%
15-16
137 85.1%
24 14.9%
168 90.8%
Total
354 87.2%
52 12.8%
214 91.5%
Girls A
A
B
0 8 0 0.0% 100.0% 0.0%
18 90.0%
2 10.0%
58 90.6%
6 9.4%
4 3.8%
416 91.4%
39 8.6%
17 9.2%
55 90.2%
6 13 0 9.8% 100.0% 0.0%
373 88.8%
47 11.2%
20 8,5%
118 90.8%
12 9.2%
807 90.2%
88 9.8%
100 96.2%
121 96.8%
B
4 3.2%
A = Full course of preventive injections; B =Treatment only on getting the disease closely followed by tablets. W i t h this b a c k g r o u n d d a t a we can presume that liquid medicine is still the drug of choice a m o n g s t children. Presently
m a n y c o m p a n i e s have c o m e out with the chewable tablets. It has the m a i n a d v a n t a g e of exact dosage and avoidance of adding water to dry p o w d e r to m a k e it syrup. T h e
242
THE INDIAN JOURNAL OF PEDIATRICS
Vol. 59, No. 2
TABLE6. Opinion on Health Tonic Effect on a Normal Person, Total Participants: 892 Urban Age group (mo)
Boys
Rural Girls
Total
Boys
A
B
A
B
A
11-12
4 100.0%
0 0.0%
2 66.7%
1 4 33_3% 80.0%
13-14
180 74.7%
61 25.3%
25 58.1%
15-16
108 67.1%
53 32.9%
Total
292 71.9%
114 28.1%
Girls B
A
B
A
B
1 4 4 50.0% 50.0% 50.0%
14 70.0%
6 30.0%
18 50 41.9% 78.1%
14 99 21.9% 95.2%
5 4.8%
354 78.3%
98 21.7%
136 73.5%
49 49 26.5% 80.3%
12 9 4 19.7% 69.2% 30.8%
302 71.9%
118 28.1%
163 70.6%
68 103 29.4% 79.2%
27 112 13 20.8% 89.6% 10.4%
670 75.1%
222 24.9%
A =Makes him more healthy B = H a s no such effect T~
7. PreferenCe of Source of Vitamins for Daily Usage, Total Participants : 896 Urban
Age Group (too)
Boys
Rural Girls
Total
Boys
A
B
A
B
A
11-12
3 75.0%
1 25.0%
3 100.0%
0 5 0.0% 100.0%
13-14
180 74.4%
62 25.6%
35 77.8%
15-16
130 80.7%
31 19.3%
Total
313 76.9%
94 23.1%
Girls B
A
B
A
B
0 8 0 0.0% 100.0% 0.0%
19 95.0%
1 5.0%
10 48 22.2% 75.0%
16 98 25.0% 94.2%
6 5.8%
361 79.3%
94 20.7%
159 85.9%
26 55 14.1% 90.2%
6 13 0 9.8% 100.0% 0.0%
357 85.0%
63 15.0%
197 84.5%
36 108 15.5% 83.1%
22 119 16.9% 95.2%
737 82.3%
158 17.6%
6 4.8%
A =Natural source B = Medicines like vitamin cap~les, tonics etc. d r a w back of the dry syrup can be o v e r c o m e if m a n u f a c t u r e r s b r i n g out products which has h o m o g e n e o u s constitution thus giving u n i f o r m d o s a g e p e r unit m e ~ u r e m e n t ,
W i t h this, the m e d i c i n e will b e c o m e m o r e a c c e p t a b l e to children. Alternatively, the tablets should b e so f o r m u l a t e d that it gets dissolved i m m e d i a t e l y to m a k e a liquid
ROY : ATrrI'UDE OF CHILDRENTOWARDS MEDICATIONAND HEALTH
243
T~LF, 8, For an Illness Which Need~ a Medicine to be Taken as a Full Course for a Fixed Number of Days, Total Participants: 893 Urban Age group (,1o)
Boys
Rural Girls
A
B
A
11-12
3 75.0%
1 25.0%
2 66.7%
13-14
172 71.4%
69 28.6%
t5-16
116 72.5%
Total
291 71.9%
Total
Boys B
A
Girls B
A
B
A
B
1 5 0 5 3 33.3% 100.0% 0.0% 62.5% 37.5%
15 75.0%
5 )Z5.0%
34 73.9%
12 40 26.1% 62.5%
322 133 70.8% 29.2%
44 27.5%
127 69.0%
57 45 16 12 1 31.0% 73.8% 26.2% 92.3% 7.7%
300 71.8%
114 28.1%
163 70.0%
70 90 30.0% 69.2%
637 256 71.3% 28.7%
24 76 28 37.5% 73.1% 26.9%
40 93 32 30.8% 74.4% 25.6%
118 28.2%
A =Take the full course even if symptomntieally relieved b~fore the course is over B = Stop the medicine the moment relief is obtained preparation. Of late, few manufacturers have come out with antibiotics in sachet form. Also, few companies manufacturing lactobacillus keep their formulation in powder form. They should keep in mind the children's choice. Out of the 788 children giving their choice, only 54 opted for powder medicine. The 93% of children not opting for powder medicine should get weightage from drug manufacturers. Table 2 relates to the timing of medicine. The overaD picture from both the tab/es show that irrespective of age, sex and demography the children prefer to take medicines after food. Thus medicines which have similar instructions will have better drug compliance. Now for many diseases, single mega dose of oral medicine is tried, like Tinidazole for amoebiasis, Cotrimoxazole for urinary tract infection. These dosage forrfis have advantage of better compliance. In Table 2 we find that
though both sex like to have medicines after food, girls in particular prefer it more. Since in Indian sub-continent people are used to having two major meals a day, (if not once daily dosage form) having twice daily &rsage form like Co-trimo~azole, Cefadroxil etc., vail have better compliam:e. Now-a-,days there is a trend among Pharmaceutical Manufacturers to advertise more about the taste part. We are a~0re,of many preparations where the price is mote because of taste factor. Unforttmately for the drug manufacturers, the children are more concerned about the efficacy. As shown in Table 3, a total of 70.3% of children do not want to compromise efficacy for taste. The urban children are more aware of the efficacy and less bothered about taste. In Table 4, we asked the children to choose between less painful twice daily injection and more painful once daily
244
THE INDIANJOURNALOF PEDIATRICS
injection for five days. The choice is equivocal of above 50% in all sections. However, on agewise analysis we find that at younger age group i.e. 11 to 14 years of age group, they prefer twice daily injection irrespective of urban or rural set-up. The choice was more pronounced for urban female who wanted twice daily injections. If analysed urban/rural wise, the rural children are more inclined to have less painful twice daily injections. Probably, the younger the child, more concerned they are about the pain factor. Irrespective of once or twice daily dose they want it to be painless. Thus, while giving injections, the feasibility of spraying ethyl chloride or any other local anaesthetic spray at the injection site to make the prick painless can be thought of. When with the same choice (as in Table 4) two more choices were added (not in table) we were surprised to note that 45.12% children preferred to have a single painful injection than to have pricks daily. While hardly 9% preferred to come twice daily for 5 days to have the injections, 15.5% somewhat compromised and agreed to come for injections once a day for 5 days. However, as a second choice to painful single injection, 30.14% rather preferred to take oral medicines 4 times a day for 7 days. In Indian subcontinent it is observed that due to vague religious belief many people are against immunising their children. On questionhrg the children (Table 5 and also Table 8) it was seen that 90% of children irrespective of urban and rural setup believes in immunisations. The figure was better in rural population where superstitions and taboos are expected to be more. From this trend it is hoped that these children o n growing up will be more conscious about their children's immunity. Secondly, majority of children of all age
VoL59, No. 2
group prefer to take a preventive injection than to suffer (Table 8). A child will prefer to take a preventive injection regularly if he is prone to developing glomerulonephritis or rheumatic heart disease. We asked questions (as in Table 6 & Table 7) and we were surprised to find that about 75% children feel that they will be healthier on taking tonics. However, the same children opted to have vitamins from natural sources in case of mild vitamin deficiencies. It is thus implied that children feel that tonics are something "extra" other than vitamins etc., and take it as a magic potion. Probably the advertisements in mass media like T.V. have brought the effect. It is now a popular trick of manufacturers to show on screen - popular "heart-throb" sportsmen advertising health foods. Children even fall prey when it is publicised that some popular sports personality, (who has no technical knowledge on food and nutrition) has formulated some health food. Steps should be taken to curb unscrupulous advertisement of all purpose health food and tonics in mass media. Table No. 9 shows the way the children opt to be treated during illness. The children felt that their parents prefer consulting doctors on falling sick. While for minor ailments the children of all strata wanted to have recognised First Aid procedures, they didn't want to try blindly some medicines which was given to someone else for similar symptoms. Most of the medicines have a literature sheet enclosed meant for Medical Professionals only. On being asked (Table 10) how many children and their parents read it, it was found that almost in all cases the parents read it and the children felt it was right. It was only among the rural boys
ROY : A'I'ITI'UDE OF CIIILI)REN TOWARDS MEDICATION AND HEALTH
245
o
0 oo
o o0
~
o O~ x~
Attitude of Children Towards Medication and Health in Urban and Rural Schools of Tamii Nadu Abhijit Sinha Roy Steel Autho~ty of India Lid, Salem Steel Plan~ Salem (Tamil Nadu ) In most cases of Pediatric practice, medicine is prescribed to the child without taking into consideration his likes and dislikes. The medicines are usually thrust upon them. Though our foremost aim is to cure the patient, we should give due importance to make the process of cure as comfortable as possible. Keeping this in mind, opinion poll of around nine hundred school students from rural and urban population of age ranging from 11 years to 16 years was taken. The result is analysed and suggestion is given to rationalise the treatment for better compliance.
Key Words: Medication; Children's attitude. In most cases of medical practice, the patients opinion regarding medication is not taken into consideration. It is admitted that cure of the patient is of foremost priority, but it is equally important to make the process of cure as comfortable as possible. If an alternative effective method of treatment is available and if it is found that children prefer it, then it should be definitely given weight. The aim of the study is to find out a suitable alternative mode of treatment, which is effective, congenial and of the child's choice.
students, 639 were from urban and rest from rural schools, with 534 students being males and 360 females. Multiple choice questions pertaining to attitude towards medication, were given both in English and the local language. The answers to these questions were fed to the personal computer and results analysed in various combinations likeagewise, sexwise and urban/rural ratiowise. The results are shown in separate tables. TABLg1 Order of Preference About the Type of Oral Medicine
MATERIAL AND METHODS Eight hundred and ninety four students from rural and urban population were subjected to the opinion poll. Of the
A = Capsule, B =Tablet, C = Liquid, D = Powder. Total Participants: 895 All age groups, Both urban and rural, Both sexes
Reprint requests : Dr. Abhijit Sinha Roy, Specialist Incharge (Pediatrics), Steel Authority of India Ltd., Salem Steel Plant, Salem- 636 013 239
A
B
C
D
163 20.69%
265 33.63%
306 38.83%
54 6.85%
240
THE INDIAN JOURNAL OF PEDIATRICS
Vol. 59, No. 2
T~r~ 2. Choice in The Time of Taking Medicine. A = Before food, B =After food; n = 898. Urban Age Group
Rural
Boys A
Girls B
A
Boys B
B
0 8 (0.0) (100.0)
4 (20.0)
16 (80.0)
7 (6.7)
97 (93.3)
59 (12.9)
397 (87.1)
21 166 27 34 7 6 (11.2) (88.8) (44.3) (55.7) (53.8) (46.2)
85 (20.1)
337 (79.9)
29 (12.3)
148 (16.5)
750 (83.5)
0 4 3 0 (0.0) (100.0) (100.0) (0.0)
13-14 No. %
31 211 (12.8) (87.2)
5 (10.9)
A
Girls A
11-i2 No. %
15-16 No. 30 131 % (I8.6) (81.4) Total No. 61 346 % (15.0) (85.0)
Total*
B
1 4 (20.0) (80.0)
41 16 48 (89.1) (25.0)(75.0)
207 (87.7)
A
B
44 86 14 111 (33.8)(66.2)(11.2)(88.8)
*Includes both sexes in urban and rural areas T~Lr 3. Choice Between : Effective and less Effective Oral Medicine B. Effective oral medicine but bad in taste A. Less effective oral medicine but good in taste
Total ParticipantS: 896
Urban Age Group
Rural
Boys A
Girls B
A
Total
Boys B
Girls
A
B
A
B
1
4
3
5
A
B
11-12 No. 1 2 % 33.3% 66.7% 13-14 No. 79 162 % 32.8% 67.2%
1
2
6
13
33.3% 8 17.4%
66.7% 38 82.6%
20.0% 80.0% 37.5% 62.5% 26 38 45 59 40.6% 59.4% 43.3% 56.7%
31.6% 158 34.7%
68.4% 297 65.3%
15-16 No. 42 119 % 26.1% 73.9%
37 19.8%
150 80.2%
20 41 3 t0 32.8% 67.2% 23.1% 76.9%
102 24.2%
320 75.8%
Total No. 122 283 '% 30.1% 69.9%
46 19.5%
190 80.5%
47 83 51 74 36.2% 63.8% 40.8% 59.2%
266 29.7%
630 70.3%
DISCUSSION To the question related to the type of oral medication required (Table 1) it is seen that both urban and rural children irrespective
of sex, preferred liquid medication. The trend to prefer liquid medicine is more for the girls. To choose from the liquid, tablet, capsule and powder medicine, the majority of them (38.83%) chose liquid medicine
ROY : A'YITFUDE OF CHILDREN TOWARDS MEDICAl.ION AND ItEALTH
241
TARL~4. Choice Between : Painful and Less Painful Injections, Total Participants: 892 Urban Age group
Boys
Rural Girls
Total
Boys
Girls
(too) A
B
A
B
A
B
A
B
A
B
1
3
2
1
2
3
6
2
11
9
25.0%
75.0%
66,7%
33.3% 40.0%
60.0% 75.0% 25.0%
55.0%
45.0%
13-14
118 49.0%
123 51.0%
33 75.0%
11 34 25.0% 53.1%
30 59 45 46.9% 56.7% 43.3%
244 53.9%
209 46.1%
15-16
70 43.5%
91 56.5%
81 44.0%
103 38 56.0% 62.3%
23 6 7 37.7% 46.2% 53.8%
195 46.5%
224 53.5%
Total
189 46.6%
217 53.4%
116 50.2%
115 74 49.8% 56.9%
56 71 54 43.1% 56.8% 43.2%
450 59.4%
442 49.6%
11-12
A=Less painful injection twice daily for five clays i.e, ten injections B =Painful injection once daily for five days i.e. five injections T~L~ 5. Choice Between Taking Preventive Injections and on Getting the Disease, Total Participants: 895 Urban Age group (too)
Boys
Rural Girls
Total
Boys
A
B
A
B
A
B
11-12
3 75.0%
1 25.0%
2 66.7%
1 5 33.3% 100.0%
13-14
214 88.8%
27 11.2%
44 95.7%
2 4.3%
15-16
137 85.1%
24 14.9%
168 90.8%
Total
354 87.2%
52 12.8%
214 91.5%
Girls A
A
B
0 8 0 0.0% 100.0% 0.0%
18 90.0%
2 10.0%
58 90.6%
6 9.4%
4 3.8%
416 91.4%
39 8.6%
17 9.2%
55 90.2%
6 13 0 9.8% 100.0% 0.0%
373 88.8%
47 11.2%
20 8,5%
118 90.8%
12 9.2%
807 90.2%
88 9.8%
100 96.2%
121 96.8%
B
4 3.2%
A = Full course of preventive injections; B =Treatment only on getting the disease closely followed by tablets. W i t h this b a c k g r o u n d d a t a we can presume that liquid medicine is still the drug of choice a m o n g s t children. Presently
m a n y c o m p a n i e s have c o m e out with the chewable tablets. It has the m a i n a d v a n t a g e of exact dosage and avoidance of adding water to dry p o w d e r to m a k e it syrup. T h e
242
THE INDIAN JOURNAL OF PEDIATRICS
Vol. 59, No. 2
TABLE6. Opinion on Health Tonic Effect on a Normal Person, Total Participants: 892 Urban Age group (mo)
Boys
Rural Girls
Total
Boys
A
B
A
B
A
11-12
4 100.0%
0 0.0%
2 66.7%
1 4 33_3% 80.0%
13-14
180 74.7%
61 25.3%
25 58.1%
15-16
108 67.1%
53 32.9%
Total
292 71.9%
114 28.1%
Girls B
A
B
A
B
1 4 4 50.0% 50.0% 50.0%
14 70.0%
6 30.0%
18 50 41.9% 78.1%
14 99 21.9% 95.2%
5 4.8%
354 78.3%
98 21.7%
136 73.5%
49 49 26.5% 80.3%
12 9 4 19.7% 69.2% 30.8%
302 71.9%
118 28.1%
163 70.6%
68 103 29.4% 79.2%
27 112 13 20.8% 89.6% 10.4%
670 75.1%
222 24.9%
A =Makes him more healthy B = H a s no such effect T~
7. PreferenCe of Source of Vitamins for Daily Usage, Total Participants : 896 Urban
Age Group (too)
Boys
Rural Girls
Total
Boys
A
B
A
B
A
11-12
3 75.0%
1 25.0%
3 100.0%
0 5 0.0% 100.0%
13-14
180 74.4%
62 25.6%
35 77.8%
15-16
130 80.7%
31 19.3%
Total
313 76.9%
94 23.1%
Girls B
A
B
A
B
0 8 0 0.0% 100.0% 0.0%
19 95.0%
1 5.0%
10 48 22.2% 75.0%
16 98 25.0% 94.2%
6 5.8%
361 79.3%
94 20.7%
159 85.9%
26 55 14.1% 90.2%
6 13 0 9.8% 100.0% 0.0%
357 85.0%
63 15.0%
197 84.5%
36 108 15.5% 83.1%
22 119 16.9% 95.2%
737 82.3%
158 17.6%
6 4.8%
A =Natural source B = Medicines like vitamin cap~les, tonics etc. d r a w back of the dry syrup can be o v e r c o m e if m a n u f a c t u r e r s b r i n g out products which has h o m o g e n e o u s constitution thus giving u n i f o r m d o s a g e p e r unit m e ~ u r e m e n t ,
W i t h this, the m e d i c i n e will b e c o m e m o r e a c c e p t a b l e to children. Alternatively, the tablets should b e so f o r m u l a t e d that it gets dissolved i m m e d i a t e l y to m a k e a liquid
ROY : ATrrI'UDE OF CHILDRENTOWARDS MEDICATIONAND HEALTH
243
T~LF, 8, For an Illness Which Need~ a Medicine to be Taken as a Full Course for a Fixed Number of Days, Total Participants: 893 Urban Age group (,1o)
Boys
Rural Girls
A
B
A
11-12
3 75.0%
1 25.0%
2 66.7%
13-14
172 71.4%
69 28.6%
t5-16
116 72.5%
Total
291 71.9%
Total
Boys B
A
Girls B
A
B
A
B
1 5 0 5 3 33.3% 100.0% 0.0% 62.5% 37.5%
15 75.0%
5 )Z5.0%
34 73.9%
12 40 26.1% 62.5%
322 133 70.8% 29.2%
44 27.5%
127 69.0%
57 45 16 12 1 31.0% 73.8% 26.2% 92.3% 7.7%
300 71.8%
114 28.1%
163 70.0%
70 90 30.0% 69.2%
637 256 71.3% 28.7%
24 76 28 37.5% 73.1% 26.9%
40 93 32 30.8% 74.4% 25.6%
118 28.2%
A =Take the full course even if symptomntieally relieved b~fore the course is over B = Stop the medicine the moment relief is obtained preparation. Of late, few manufacturers have come out with antibiotics in sachet form. Also, few companies manufacturing lactobacillus keep their formulation in powder form. They should keep in mind the children's choice. Out of the 788 children giving their choice, only 54 opted for powder medicine. The 93% of children not opting for powder medicine should get weightage from drug manufacturers. Table 2 relates to the timing of medicine. The overaD picture from both the tab/es show that irrespective of age, sex and demography the children prefer to take medicines after food. Thus medicines which have similar instructions will have better drug compliance. Now for many diseases, single mega dose of oral medicine is tried, like Tinidazole for amoebiasis, Cotrimoxazole for urinary tract infection. These dosage forrfis have advantage of better compliance. In Table 2 we find that
though both sex like to have medicines after food, girls in particular prefer it more. Since in Indian sub-continent people are used to having two major meals a day, (if not once daily dosage form) having twice daily &rsage form like Co-trimo~azole, Cefadroxil etc., vail have better compliam:e. Now-a-,days there is a trend among Pharmaceutical Manufacturers to advertise more about the taste part. We are a~0re,of many preparations where the price is mote because of taste factor. Unforttmately for the drug manufacturers, the children are more concerned about the efficacy. As shown in Table 3, a total of 70.3% of children do not want to compromise efficacy for taste. The urban children are more aware of the efficacy and less bothered about taste. In Table 4, we asked the children to choose between less painful twice daily injection and more painful once daily
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THE INDIANJOURNALOF PEDIATRICS
injection for five days. The choice is equivocal of above 50% in all sections. However, on agewise analysis we find that at younger age group i.e. 11 to 14 years of age group, they prefer twice daily injection irrespective of urban or rural set-up. The choice was more pronounced for urban female who wanted twice daily injections. If analysed urban/rural wise, the rural children are more inclined to have less painful twice daily injections. Probably, the younger the child, more concerned they are about the pain factor. Irrespective of once or twice daily dose they want it to be painless. Thus, while giving injections, the feasibility of spraying ethyl chloride or any other local anaesthetic spray at the injection site to make the prick painless can be thought of. When with the same choice (as in Table 4) two more choices were added (not in table) we were surprised to note that 45.12% children preferred to have a single painful injection than to have pricks daily. While hardly 9% preferred to come twice daily for 5 days to have the injections, 15.5% somewhat compromised and agreed to come for injections once a day for 5 days. However, as a second choice to painful single injection, 30.14% rather preferred to take oral medicines 4 times a day for 7 days. In Indian subcontinent it is observed that due to vague religious belief many people are against immunising their children. On questionhrg the children (Table 5 and also Table 8) it was seen that 90% of children irrespective of urban and rural setup believes in immunisations. The figure was better in rural population where superstitions and taboos are expected to be more. From this trend it is hoped that these children o n growing up will be more conscious about their children's immunity. Secondly, majority of children of all age
VoL59, No. 2
group prefer to take a preventive injection than to suffer (Table 8). A child will prefer to take a preventive injection regularly if he is prone to developing glomerulonephritis or rheumatic heart disease. We asked questions (as in Table 6 & Table 7) and we were surprised to find that about 75% children feel that they will be healthier on taking tonics. However, the same children opted to have vitamins from natural sources in case of mild vitamin deficiencies. It is thus implied that children feel that tonics are something "extra" other than vitamins etc., and take it as a magic potion. Probably the advertisements in mass media like T.V. have brought the effect. It is now a popular trick of manufacturers to show on screen - popular "heart-throb" sportsmen advertising health foods. Children even fall prey when it is publicised that some popular sports personality, (who has no technical knowledge on food and nutrition) has formulated some health food. Steps should be taken to curb unscrupulous advertisement of all purpose health food and tonics in mass media. Table No. 9 shows the way the children opt to be treated during illness. The children felt that their parents prefer consulting doctors on falling sick. While for minor ailments the children of all strata wanted to have recognised First Aid procedures, they didn't want to try blindly some medicines which was given to someone else for similar symptoms. Most of the medicines have a literature sheet enclosed meant for Medical Professionals only. On being asked (Table 10) how many children and their parents read it, it was found that almost in all cases the parents read it and the children felt it was right. It was only among the rural boys
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245
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