1
|
Yılmaz Aİ, Pekcan S, Eyüboğlu TŞ, Hangül M, Arslan H, Kılınç AA, Çokuğraş H, Arık E, Keskin Ö, Özdemir A, Ersoy M, Ersoy A, Köse M, Özsezen B, Ünal G, Ercan Ö, Girit S, Oksay SC, Gökdemir Y, Karadağ B, Şen V, Çakır E, Yüksel H, Tekin MN, Aslan AT. Comparison of refugee patients with cystic fibrosis and their counterpart children from Turkey during the war. Eur J Pediatr 2024; 183:1831-1838. [PMID: 38265526 PMCID: PMC11001702 DOI: 10.1007/s00431-024-05431-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 01/25/2024]
Abstract
Since the outbreak of the Syrian civil war in 2011, the population of Arab refugees in Turkey has rapidly increased. While cystic fibrosis (CF) is believed to be rare among Arabs, recent studies suggest it is underdiagnosed. This study aims to present the demographic, clinical, and genetic characteristics of CF patients among Arab refugees in Turkey. Additionally, a comparison is made between the findings in the National CF Registry 2021 in Turkey (NCFRT) and the refugee CF patient group. The study included refugee patients between the ages of 0 and 18 years who were diagnosed with CF and received ongoing care at pediatric pulmonology centers from March 2011 to March 2021. The study examined demographic information, age at diagnosis, age of diagnosis of patients through CF newborn screening (NBS), presenting symptoms, CF transmembrane conductance regulator (CFTR) mutation test results, sputum culture results, weight, height, and body mass index (BMI) z score. Their results were compared with the NCFRT results. The study included 14 pediatric pulmonology centers and 87 patients, consisting of 46 (52.9%) boys and 41 (47.1%) girls. All of the patients were Arab refugees, with 80 (92%) being Syrian. All the patients were diagnosed in Turkey. The median age at diagnosis of patients was 22.33 (interquartile range, 1-258) months. The median age of diagnosis of patients through NBS was 4.2 (interquartile range, 1-12) months. The median age of older patients, who were unable to be included in the NBS program, was 32.3 (interquartile range, 3-258) months. Parental consanguinity was observed in 52 (59.7%) patients. The mutation that was most frequently found was F508del, which accounted for 22.2% of the cases. It was present in 20 patients, constituting 32 out of the total 144 alleles. There was a large number of genetic variations. CFTR genotyping could not be conducted for 12 patients. These patients had high sweat tests, and their genetic mutations could not be determined due to a lack of data. Compared to NCFRT, refugee patients were diagnosed later, and long-term follow-up of refugee CF patients had significantly worse nutritional status and pseudomonas colonization. Conclusion: Although refugee CF patients have equal access to NBS programs and CF medications as well as Turkish patients, the median age at diagnosis of patients, the median age of diagnosis of patients through NBS, their nutritional status, and Pseudomonas colonization were significantly worse than Turkish patients, which may be related to the difficulties of living in another country and poor living conditions. The high genetic heterogeneity and rare mutations detected in the refugee patient group compared to Turkish patients. Well-programmed NBS programs, thorough genetic studies, and the enhancement of living conditions for refugee patients in the countries they relocate to can have several advantages such as early detection and improved prognosis. What is Known: • Children who have chronic diseases are the group that is most affected by wars. • The outcome gets better with early diagnosis and treatment in patients with Cystic Fibrosis (CF). What is New: • Through the implementation of a newborn screening program, which has never been done in Syria previously, refugee patients, the majority of whom are Syrians were diagnosed with cystic fibrosis within a duration of 4 months. • Despite equal access to the newborn screening program and CF medications for both Turkish patients and refugee patients, the challenges of living in a foreign country have an impact on refugees.
Collapse
Affiliation(s)
- Aslı İmran Yılmaz
- Department of Pediatric Pulmonology, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Sevgi Pekcan
- Department of Pediatric Pulmonology, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey.
| | | | - Melih Hangül
- Pediatric Pulmonology, Adana City Training and Research Hospital, Adana, Turkey
| | - Hüseyin Arslan
- Department of Pediatric Pulmonology, Cerrahpaşa Faculty of Medicine, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Ayşe Ayzıt Kılınç
- Department of Pediatric Pulmonology, Cerrahpaşa Faculty of Medicine, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Haluk Çokuğraş
- Department of Pediatric Pulmonology, Cerrahpaşa Faculty of Medicine, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Elif Arık
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Özlem Keskin
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Ali Özdemir
- Department of Pediatric Pulmonology, Mersin City Training and Research Hospital, Mersin, Turkey
| | - Murat Ersoy
- Department of Pediatric Pulmonology, Mersin City Training and Research Hospital, Mersin, Turkey
| | - Ali Ersoy
- Department of Pediatric Pulmonology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Mehmet Köse
- Department of Pediatric Pulmonology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Beste Özsezen
- Department of Pediatric Pulmonology, Şanlıurfa Training and Research Hospital, Şanlıurfa, Turkey
| | - Gökçen Ünal
- Department of Pediatric Pulmonology, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Ömür Ercan
- Department of Pediatric Pulmonology, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Saniye Girit
- Department of Pediatric Pulmonology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Sinem Can Oksay
- Department of Pediatric Pulmonology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Yasemin Gökdemir
- Department of Pediatric Pulmonology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Bülent Karadağ
- Department of Pediatric Pulmonology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Velat Şen
- Department of Pediatric Pulmonology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Erkan Çakır
- Department of Pediatric Pulmonology, Liv Hospital, Istinye University, Istanbul, Turkey
| | - Hasan Yüksel
- Department of Pediatric Pulmonology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Merve Nur Tekin
- Department of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ayşe Tana Aslan
- Department of Pediatric Pulmonology, Faculty of Medicine, Gazi University, Ankara, Turkey
| |
Collapse
|
2
|
Tiwari SK, Sharma R, Joshi P, Lodha R, Kabra SK. Knowledge, attitude, and practices among caregivers of children with Cystic Fibrosis. Pediatr Pulmonol 2024; 59:449-457. [PMID: 38014609 DOI: 10.1002/ppul.26772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 11/01/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Caregivers have crucial role in the care of the children with Cystic Fibrosis (CF), but there is limited knowledge about their knowledge, attitude, and practices (KAP) regarding chronic disease. This pilot study aimed to validate a self-developed KAP questionnaire for caregivers of young children with CF in India and determine factors associated with KAP. MATERIALS AND METHODS A cross-sectional study was conducted among 95 caregivers of children with CF attending the specialty clinic of the pediatric outpatient department (OPD) in Northern India. Participants possessing certain characteristics such as willingness to participate and ability to understand Hindi or English language were enrolled in the study. Caregivers of children reported to the OPD with acute exacerbation requiring immediate hospitalization were excluded from the study. RESULTS The self-developed KAP questionnaire had good content validity (CVI- 0.87-1.0) and internal consistency (Cronbach's α coefficient = 0.70, 0.71, 0.75 respectively). The majority of participants belonged to the Good KAP group (85.3%), while the remaining were in the Poor KAP group (14.7%). A χ2 test showed that KAP clusters vary significantly with sociodemographic variables like gender, marital status, educational status and monthly family income (p < .05). A weak negative correlation was found between knowledge and attitude scores in the Good KAP group (p < .001). Multiple linear regression analysis showed that the KAP of the caregivers was significantly influenced by knowledge related to clinical manifestation and complications, and attitude. CONCLUSION All three sections of the KAP tool demonstrated good content validity and internal consistency. Caregivers had good knowledge, a positive attitude, and appropriate practices related to CF. However, targeted interventions are necessary to address specific areas for improvement, particularly for male caregivers with lower educational levels belonging to poor socioeconomic strata.
Collapse
Affiliation(s)
- Surya Kant Tiwari
- College of Nursing, All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, India
| | - Rimple Sharma
- College of Nursing, All India Institute of Medical Sciences, New Delhi, India
| | - Poonam Joshi
- College of Nursing, All India Institute of Medical Sciences, Kalyani, West Bengal, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sushil Kumar Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
3
|
Thomas L, John ST, Lionel BAP, Rebekah G, Kumar M, Punnen A, Varkki S. Effect of malnutrition in infants with cystic fibrosis in India: An underestimated danger. J Family Med Prim Care 2021; 10:1994-1997. [PMID: 34195137 PMCID: PMC8208186 DOI: 10.4103/jfmpc.jfmpc_2421_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/21/2021] [Accepted: 03/12/2021] [Indexed: 11/04/2022] Open
Abstract
Aims To assess the clinical profile and nutritional status of infants with cystic fibrosis (CF) and track their nutritional outcomes with treatment. Materials and Methods This retrospective study was conducted in a tertiary-care institute in South India. Demographic and clinical information were collected. The nutritional status and treatment outcome was assessed by Z-scores for weight-for-age (WAZ), length-for-age (LAZ), and weight-for-length (WLZ) at diagnosis and follow-up. Results Nineteen infants with CF had mean follow-up duration of 9.7 ± 8.7 months. There was a mean delay of 2.9 ± 2.1 months from symptom onset to diagnosis, by which time infants were severely malnourished (mean WAZ -4.68 ± 1.8). Pneumonia, summer dehydration with electrolyte abnormalities (42.1%), and a combination of anemia, hypoalbuminemia, and malnutrition (42.1%) were the predominant features. Significant weight loss had been recorded in undiagnosed infants by second month of life before symptom onset. At follow-up, there was a remarkable improvement in WAZ (P 0.001), but not LAZ and WLZ. There was a high mortality rate of 37% in these infants. Conclusions Malnutrition is a significant morbidity in infants with CF in India. There was significant improvement of WAZ with treatment, but it lagged behind the recommended targets. There is an opportunity for identification of CF infants at the time of vaccination at six and ten weeks of age, by the primary care physician and pediatrician. Screening of young infants having failure to thrive in the immunization clinic may be a strategy for early diagnosis of infants with severe CF phenotype.
Collapse
Affiliation(s)
- Leenath Thomas
- Department of Pediatrics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Shincy T John
- Department of Pediatrics, Christian Medical College, Vellore, Tamil Nadu, India
| | - B Arul P Lionel
- Department of Pediatrics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Grace Rebekah
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Madhan Kumar
- Department of Pediatrics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anu Punnen
- Department of Pediatrics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sneha Varkki
- Department of Pediatrics, Christian Medical College, Vellore, Tamil Nadu, India
| |
Collapse
|