A cross-sectional survey among parents to report challenges and barriers in the administration of medicines to children in United Arab Emirates

Introduction

The literature shows that infectious diseases are the foremost common reason behind significant morbidity and mortality in early childhood; this is similar in developed economies where populations have high-quality housing and access to high-quality medical care.¹ In Africa, the top three fatalities of children under the age of five are pneumonia, diarrhea, and malaria. For children from low-income families, primary prevention of these illnesses is difficult. To reduce child deaths, accurate identification and rapid treatment with good therapy are critical.²

Uneducated mothers and children delivered at home had lower healthcare utilization for diarrhea and cough.³ Some long-standing issues have persisted, resulting in unacceptably high illness rates. Because of a lack of worldwide funding, feasible control methods have only lately been established. Vaccine-preventable diseases continue to be poorly controlled in many regions of the developing world.⁴

Over-the-counter medications have become a significant issue in children. The absence of parental training, poor counseling, and lack of knowledge are the leading cause of medicine errors. Some studies also showed that the parents did not use the correct equipment to administer the medications.⁵ According to the findings, a considerable majority of parents did not use the proper equipment to deliver medicines, utilized non-prescription pharmaceuticals, did not administer medications at the appropriate intervals, and blended medication into foods.⁶

One of the practices in pediatrics is to mix the medicine with food. The use of bodily strength is known as forced administration. When children have a low tolerance for unpleasant tastes, open administration is used. Many parents crushed the capsules or tablets, mixed them with yogurt or meal, or dissolved them in water.⁷

After analyzing different studies among children, there was no data on challenges and barriers in the administration of medicines among children in this region because of the diverse environmental issues and challenges in the UAE. The objective of this study is to determine the parents reported administration practices and challenges and barriers in the administration of medicines among children in the UAE.

Methods

Results

The study reported a response rate of 73.2%. A total of 399 participants were invited, among them, 248 consented and completed the survey questionnaire. To treat their children more quickly, a portion of parents (22.2%) reported giving medicines in higher doses than prescribed by the doctor. When the child recovered, nearly two-thirds of the parents (46%) said they disposed of the remaining amount of medicines, while 53.6% kept it for later use.

Twenty-two percent of parents reported treatment failure due to oral drug administration. Twenty-four points two failed to administer liquid medications. A section of parents (22.2%) reported that they gave drugs in doses higher than prescribed by the doctor to treat their children more quickly. Sixty-four point five percent of parents used drugs without a prescription from a doctor. Around 47.6% of those who were interviewed reported that their children had swallowing problems during the administration of oral medications, where multiple difficulties were the most common in 40.7% of the cases.

Discussion

This study looks at parents' practices when giving their children oral medication at home. Our research uncovered incorrect practices such as self-medication practices, using multiple medicines, higher dose administration, and inappropriate administration tools, in addition to obstacles, for example, multiple swallowing difficulties and treatment failures.

Many factors, including the disagreeable taste, can impact a child's acceptance and adherence to their prescriptions, and this can cause problems for parents when providing medications to their children.¹⁰ In our study, about 47.2% of parents said their children disliked taking oral medicines, in addition to 26.2 % of tablet treatment failure. Parents try a variety of solutions to solve the problem, including mixing the medicine with milk or their children's favorite food or drink. 6 percent of parents in our survey tried mixing tablets with food, 7.7 percent dissolved tablets in water or other drinks, liquid treatment failure was 24.2, 10.1 percent tried mixing liquid medicines with juice, and 2.8 percent mixed with food and milk. When medications are used with particular foods, medicine interactions and absorption may be affected.^11,12

Rabia Bushra and Nousheen Aslam, conducted a review on food-medicine Interactions. After single and frequent doses of Coca-Cola, the Cmax and AUC0-alpha of ibuprofen were dramatically enhanced, indicating improved ibuprofen absorption. When taking ibuprofen with Coca-Cola, the daily dosage and frequency must be lowered.¹³

One should note here that there might be a correlation between parents' practice in our study regarding 41.9% self-medication by parents for their children and high prevalence of self-medication with antibiotics (53%) and sedative/hypnotics (27%) was also observed among high school students in UAE.^14,15 Self-medication, especially non-responsible self-medication, is far from being a perfectly safe activity. Incorrect self-diagnosis, delays in obtaining medical counsel when needed, and occasional but severe adverse reactions are all potential dangers of self-medication.¹⁶ Reye syndrome is a potentially fatal aspirin reaction in young infants. To avoid major adverse medication reactions, many parents are unaware that aspirin should not be administered to children under the age of 12 and should be used very carefully or not at all in adolescents aged 12–16.¹⁷

Five-point one percent crush, open and break the capsules to administer them to their children. Soft gelatin capsules containing liquid should not be chewed or split since the liquid inside could be extracted, resulting in an improper dosage. Crushing medicines may lead to side effects and toxicity.¹⁸

Dose errors are prevalent because dosing for children must be determined individually depending on the patient's age and weight. Non-standardized teaspoons and tablespoons lead to measurement errors.¹⁹ In our study, multiple tools were used (32.7%), while 10.1% of parents used teaspoons and 3.2% used tablespoons. To reduce medication errors, the findings suggest a milliliter-only norm.^20,21 Acetaminophen is the most commonly prescribed pediatric analgesic and antipyretic. There are numerous accounts of significant morbidity and mortality with repeated supratherapeutic doses in the literature.²² Furthermore, in our article, 22.2% of the parents gave their children medicines in higher quantities than the doctor suggested in an attempt to treat their children faster.

Counselling, medication administration instructions, and measurement tools are just a few of the areas that need to be considered, in addition to the sociodemographic characteristics of parents and children, when designing any future potential intervention aimed at reducing medication errors among children and young people at home.²³

The interplay of these factors - knowledge, communication, resources, and personal belief - may increase the risk of medication errors and poor health outcomes in underserved communities. These findings can be used to guide future interventions and may aid in the optimization of medication administration for pediatric patients.²⁴

Educational campaigns for responsible self-medication should be strengthened by encouraging community pharmacies to take the initiative to actively guide and educate patients about the proper use of over-the-counter medications.²⁵

Continuous efforts should be made to create age-appropriate formulations that offer both dosing flexibility and palatable taste. There is still room for improvement in terms of improving parents' health performance and increasing their knowledge of some antibiotic-related health issues.²⁶ Furthermore, because co-administration with food or liquids is still the most common method of drug administration, more detailed and explicit information about suitable vehicles should be included in the SmPC and PIL.²⁷

Conclusions

The study concluded that the parents practice inappropriate medicine administration. It is also found that parents frequently administered higher doses to treat their children quickly. Self-medication using multiple medicines is a substantial concern.

Consent

Written informed consent for publication of the participants’ details was obtained from the participants.