Peer-reviewed article
An iceberg I can’t handle: a qualitative inquiry on perceptions towards paediatric rheumatology among healthcare workers in Kenya
ANGELA NYANGORE MIGOWA, Sasha Bernatsky, Anthony K. Ngugi, Helen Foster, Peter G. Muriuki et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study explored how healthcare workers in Kenya perceive and manage children with rheumatic diseases. Researchers conducted focus groups with 68 healthcare workers across different cadres in six regions and found significant knowledge gaps about paediatric rheumatology. Healthcare workers reported feeling inadequate and frustrated due to the complexity of diagnosis, lack of training, and absence of clear clinical pathways. The study highlights the need for targeted education and better health system support to enable early diagnosis and appropriate referral of children with rheumatic disease.
Key points
- Knowledge gaps about paediatric rheumatology are widespread among all cadres of healthcare workers in Kenya
- Healthcare workers described feeling helpless, frustrated, inadequate and incompetent when managing paediatric rheumatology patients
- Perceived complexity of diagnosis and management, combined with lack of clear clinical pathways, contributes to delayed diagnosis
- Some healthcare workers viewed paediatric rheumatology cases as unique learning opportunities despite negative feelings
- 50% of participants worked in public health facilities, suggesting the problem affects both public and private sector services
Limitations
This is a qualitative study based on focus group discussions and does not measure actual diagnostic or referral practices or patient outcomes. The study cannot determine whether observed knowledge gaps translate to specific harms or delays in individual cases.
Abstract
BACKGROUND: Delay in diagnosis and access to specialist care is a major problem for many children and young people with rheumatic disease in sub-Saharan Africa. Most children with symptoms of rheumatic disease present to non-specialists for care. There is an urgent need to understand and scale-up paediatric rheumatology knowledge and skills amongst non-specialist healthcare workers to promote early diagnosis, prompt referral, and management. PURPOSE: We evaluated the knowledge, attitudes and practices towards diagnosis and care of paediatric rheumatology patients among health care workers in Kenya. METHODS: We conducted 12 focus group discussions with clinical officers (third-tier community health workers) nurses, general practitioners and paediatricians across 6 regions in Kenya. Interviews were conducted on zoom, audio-recorded, transcribed, and analysed using NVIVO software. RESULTS: A total of 68 individuals participated; 11 clinical officers, 12 nurses, 10 general practitioners, 27 paediatricians and 7 others. Most (n = 53) were female, and the median age was 36 years (range 31-40 years). Fifty per cent of the participants (34 of 68) worked in public health facilities. Our study revealed gaps in knowledge of paediatric rheumatology amongst healthcare workers which contributes to delayed diagnosis and poor management. Healthcare workers reported both positive and negative attitudes towards diagnosis and care of paediatric rheumatology patients. Perceived complexity and lack of knowledge in diagnosis, management and lack of health system clinical pathways made all cadres of healthcare workers feel helpless, frustrated, inadequate and incompetent to manage paediatric rheumatology patients. Positive attitudes arose from a perceived feeling that paediatric rheumatology patients pose unique challenges and learning opportunities. CONCLUSION: There is an urgent need to educate healthcare workers and improve health systems to optimize clinical care for paediatric rheumatology patients.