Assessment of Caregivers'Awareness about Home Care of Neutropenia among Children with Leukemia at Oncology Wards in Baghdad City

Abstract

Objective(s): to assess the awareness of caregiver about homecare neutropenia among children with leukemia at oncology wards, and to find out relationship between level of awareness of caregivers and demographic variable. A descriptive study carried out at Baghdad City from1st of February 2018 to 30th of September 2018. Non-probability sample of (50) males and females caregivers was selected from the oncology wards in Child Welfare, Child’s Central, Al-Kadhmiya and Baghdad Teaching Hospital. To achieve the purposes of the study, a questionnaire format was designed and constructed by the researcher depending on the extensive review of available, related literatures and studies. The first part is related to caregivers’ demographic characteristics and the second part (three domains) is related to daily activities of caregivers about home care neutropenia among children with leukemia at oncology wards. Data were analyzed through the application of descriptive statistical analysis (Frequency, Percentage, Mean and Standard deviation) and inferential statistic (significance and correlation coefficient). The study revealed that the majority percentage of caregiver’s responses toward personal hygiene domain were 82% don’t know about use a moisturizers to prevent dry skin, also 60% don’t know that use of mouth wash contain alcohol was contraindicated for child. © 2018, Indian Journal of Public Health Research and Development. All rights reserved.

Full text

Assessment of Caregivers’ Awareness about Home Care of
Neutropenia among Children with Leukemia at Oncology
Wards in Baghdad City
Asmahan Qasim Mohammed1, Shahznan Hassan Badr2, Marwah Salah Muslem3
1Master in Nursing Science, College of Nursing, University of Baghdad, Iraq, 2 Master in Nursing Science,
College of Nursing, Alameed University, Iraq, 3 College of Nursing, University of Baghdad, Iraq
ABSTRACT
Objective(s): to assess the awareness of caregiver about homecare neutropenia among children with leukemia
at oncology wards, and to nd out relationship between level of awareness of caregivers and demographic
variable. A descriptive study carried out at Baghdad City from1st of February 2018 to 30th of September
2018. Non-probability sample of (50) males and females caregivers was selected from the oncology
wards in Child Welfare, Child’s Central, Al-Kadhmiya and Baghdad Teaching Hospital. To achieve the
purposes of the study, a questionnaire format was designed and constructed by the researcher depending
on the extensive review of available, related literatures and studies. The rst part is related to caregivers’
demographic characteristics and the second part (three domains) is related to daily activities of caregivers
about home care neutropenia among children with leukemia at oncology wards. Data were analyzed through
the application of descriptive statistical analysis (Frequency, Percentage, Mean and Standard deviation) and
inferential statistic (signicance and correlation coefcient). The study revealed that the majority percentage
of caregiver’s responses toward personal hygiene domain were 82% don’t know about use a moisturizers
to prevent dry skin , also 60% don’t know that use of mouth wash contain alcohol was contraindicated for
child.
Keywords: Assess; Awareness; Caregivers’; Neutropenia; Home care
INTRODUCTION
Neutropenia is a blood condition (granulocyte
disorder), that characterized by a deciency of
neutrophils which is a type of white blood cell that
defends the body against bacterial and fungal infections.
They are made in bone marrow and contain microscopic
granules with proteins (enzymes) that digest invading
bacteria viruses, fungi, and parasites 1. If the child has
neutropenia, close attention should be given to personal
hygiene, like hand washing in order to decrease the risk
of infection. Many factors can share the onset of low
level of neutrophils such as some types of chemotherapy,
cancers that affect the bone marrow directly such as
leukemia lymphoma, and myeloma 2. Infections are the
major cause of mortality and morbidity in children. The
risk of infections is principally related to the intensity
and duration of the immune suppressive chemotherapy
3. Caregivers of children with neutropenia require
knowledge, skills, and judgment to carry out the tasks
of care for their sick children. Caregivers may help the
patient with daily tasks such as bathing, eating, cleaning
the home and preparing meals. Also, caregivers must
have jobs to handle the requirements and support the
needs of their children who require such assistance
and this care helps them stay at home versus living in a
facility 4. The capacity of caregivers to take on the care
of the child with neutropenia may have a signicant
inuence on both health outcomes and cost. Children
suffer from many health problems and complications as
a result of the disease process or the course of treatment.
The caregivers may have more knowledge and skills for
managing their children illness 5. The care of children
with neutropenia is a complex procedure that requires the
Corresponding author:
Asmahan Qasim Mohammed.
Master in Nursing Science, College of Nursing,
University of Baghdad, Iraq

Indian Journal of Public Health Research & Development, December 2018, Vol. 9, No. 12 1097
use of specialized knowledge of the mothers. To enhance
knowledge of mothers concerning the disease, causes,
cure and prevention. The knowledge will eventually
become an indispensable tool that can be shared to others
and will never go out of style. Appropriate care and
assessment of children with neutropenia is an important
part for improvement the health status of the children
and decreased the complication 6.
MATERIALS AND METHOD
A descriptive study was carried throughout the
period from1st of February 2018 to 30th of September
2018. Non-probability sample of (50) caregivers about
home care neutropenia among children with leukemia
at oncology ward in Child Welfare, Child’s Central, Al-
Kadhmiya and Baghdad Teaching Hospital. To achieve
the purposes of the study, a questionnaire format was
designed and constructed by the researcher depending
on the extensive review of available, related literatures
and studies. The study instruments (questionnaire)
consisted of two major parts. The rst part was related
to caregivers’ demographic characteristics such as
age, gender, educational level, employment, degree of
kinship, source of knowledge, income, and the second
part was related to daily activities of caregivers about
home care neutropenia among children with leukemia at
oncology wards. It consisted of three domains (personal
hygiene, health and safety of family, and life style).
Each domain had 12 items about different aspect of the
related domains.The questionnaire was rated on a three
likert scale (know, uncertain, and don’t know) and was
scored as 3 for (know), 2 for(uncertain), and 1 for (don’t
know). The validity of the questionnaire was established
through a panel of (10) experts of different specialties
related to the eld of the present study. They were asked
respectively to review the questionnaire for clarity and
adequacy in order to achieve the present study objective.
Study sample was excluded .Data were analyzed
through the application of descriptive statistical analysis
(Frequency, Percentage, Mean and Standard deviation)
and inferential statistic(signicance and correlation
coefcient) and by using SPSS version 20.
RESULTS AND DISCUSSION
The present study revealed that 92% of the sample
were females and 64.0% of the caregivers were mothers.
These results agreed with a study done by Scarpelli, et al.
(2008) who indicated that the higher percentage of their
sample 76% was mothers. The caregivers were mostly
the patient’s spouse, partner or closest relatives, and
females were more tuned to the caring function at home
7. The current study revealed that 40% of the sample
were at age ranging 20-30 years old. These results
disagreed with a study done by Al-Jauissy (2010) who
indicated that the higher percentage of caregivers age
were between 19 to 50 years old(8). With regards to
caregivers level of education the present study showed
that20% each level were literate and Intermediate school
graduates. These results agreed with a study done by
Alexander (2009) who reported that the majority of
parents were not having much education, and he found
that 25% were illiterate and 45% have their education
till grade ten 9. The present study showed that 86% of the
study sample was unemployed. These results agreed with
a study done by Al-Jauissy (2010) who indicated that the
most of caregivers’ occupation 76.3% were housewives.
This result indicated that the main occupation of females
in our society was being housewives 8. The present
study found that 44.0% of the caregivers got knowledge
related to awareness from nurses. The results of this
study disagreed with results obtained by Al- Ibady
(2011) who demonstrated that nurses themselves didn’t
get information from any resource also include a high
percentage 52.5%(10). This could be due to the nature of
the nurses are considered closer to patients, in addition
to spend more time with patients. The current study
showed that 40% of the families were having a barely
sufcient income to cover their expenses. The results
of this study disagree with results obtained by Atlanta,
et al. (2008) which mentioned that the majority of
cancer caregivers were belong to the lower socio
economic status class . The concerns relating to the
family’s wellbeing change in role and responsibilities,
relocation, travelling, difculty arranging blood and
its products, and nancial difculties facing after the
diagnosis of leukemia 11. Also, agreed with a study done
by by Scarpelli, et al. (2008) which mentioned that the
cancer caregivers were living with intermediate socio
economic status class 7. The current study showed
that the majority of the caregiver’s response toward
personal hygiene domain were 82% don’t know about
use a moisturizers to prevent dry skin , also 60% don’t
know that the use of mouth wash contain alcohol was
contraindicated for child . These results agree with study
done by Hasan , et al.(2011) , who conducted a study on
assessment of home care management for caregiver’s
having leukemic adolescent patient in Erbil city which

shows the majority of caregivers had poor practices
regarding preparing meals, with poor practice regarding
oral hygiene 12. The present study revealed that the high
percentages of caregiver’s response about health safety
domain were 78% don’t know about use mouth wash
which contain alcohol item. And 62% of caregiver’s
response were don’t’ know about avoid putting natural
plants inside the house. Also 46.0% don’t’ know about
do not use suppositories items. And showed that the
caregiver’s response toward life style domain were 64%
“don’t know that the exercise daily important for child”
item. And 54% were, Don’t know that avoiding the
sun , rain and cold . Also 42% were don’t’ know about
ensure the use of pasteurized milk. This result agree with
study done by Hasan , et al.(2011) , who found that the
caregivers of adolescent leukemia patients had decit
in knowledge and low practices regarding home care
management 12. The present study stated that there were
signicant relationships between personal hygiene and
lifestyle of family caregiver with their income. There
were signicant relationship between level of education
and source of knowledge, and also there were signicant
relationship between income and employments of the
caregivers at p ≤value 0.05. This study agrees with the
study done by Scalone, et al .(2008) which stated that
there is no signication relationship between age of
mothers with their practice regarded desferal therapy 13.
Table 1. Socio-demographic Characteristics of caregivers among children with Leukemia
Variables Classication Frequency %
Gender Male 4 8.0
Female 46 92.0
Total 50 100
2- Age group
20-30 years 20 40.0
31-40 years 19 38.0
41-50 years 6 12.0
51-60 years 5 10.0
Total 50 100
Mean ± SD = 33.2± 12.5
3- Level of Education
Illiterate 9 18.0
Literate 10 20.0
Primary school 9 18.0
Intermediate school 10 20.0
Secondary school 6 12.0
Institute graduate 3 6.0
College and above graduate 3 6.0
Total 50 100
4- Employment
Unemployed 43 86.0
Freelancers 5 10.0
Government employee 1 2.0
Retired 1 2.0
Total 50 100
5- Degree of kinship
Mother 32 64.0
Father 4 8.0
Sister 2 4.0
Aunt 7 14.0
Grandmother 5 10.0
Total 50 100

Indian Journal of Public Health Research & Development, December 2018, Vol. 9, No. 12 1099
Table 2. Caregiver’s Responses toward Personal Hygiene Domains
No Items
Know Don’t Know
f % f %
1Hand washing with soap and antibacterial, especially before and after eating,
using the bathroom, playing, touching animals and others 44 88.0 6 12.0
2 Daily bathing, especially during summer 41 82.0 9 18.0
3 Use a moisturizer to prevent dry skin 9 18.0 41 82.0
4 Genital areas of the male and female hygiene after urination and defecation 49 98.0 1 2.0
5 Use an electrical razor instead of using ordinary razor 24 48.0 26 52.0
6 Pruning the hair and nails once every two weeks to ensure cleanliness 32 64.0 18 36.0
7 Wearing clean clothes, and change underwear every day 48 98.0 2 4.0
8Dental oss prohibited 20 40.0 30 60.0
9 Not sharing eating’s’ utensils with others 30 60.0 20 40.0
10 Avoid any injuries or scratching to the skin 36 72.0 14 28.0
11 Use a toothbrush after meals and before going to sleep 35 70.0 15 30.0
Table 3. Caregiver’s Responses toward Health Safety Domain
No Items Know Don’t Know
f % f %
1Avoid approaching people suffering from colds and u - Measles -
smallpox - or any other type of infection. 41 82.0 9 18.0
2Avoid crowded places as markets and places of public entertainment. 30 60.0 20 40.0
3
See the doctor immediately when: increase in temperature than 38º
Celsius-difculty in breathing, pain-blood in urine or stool. 39 78.0 11 22.0
4Keep the house clean. 42 84.0 8 16.0
5Do not use suppositories. 27 54.0 23 46.0
6 No vaccinations only after doctor consultation. 47 94.0 3 6.0
7 Wash hands before and after eating. 47 94.0 3 6.0
8Shoes should be left at door mats 42 84.0 8 16.0
9 Avoid contact with the stool or urine 47 94.0 3 6.0
10 Avoid putting natural plants inside the house. 19 38.0 31 62.0
11 Do not use mouthwash which contains alcohol. 11 22.0 39 78.0
12 No pets inside the house 28 56.0 22 44.0

1100 Indian Journal of Public Health Research & Development, December 2018, Vol. 9, No. 12
Table 4. Caregiver’s Responses toward Life Style Domain
No Items Know Don’t Know
f % f %
1 Exercises daily and regularly . 18 36.0 32 64.0
2 Adequate sleep during the night and take a nap 34 68.0 16 32.0
3Avoid constipation by drinking water and eating food rich with bers 31 62.0 19 38.0
4 Proper diet and avoid junky food 30 60.0 20 40.0
5 Wash all fresh fruits and vegetables well before eating 44 88.0 6 12.0
6 Canned foods should be watched for date of expiration and ingredients 30 60.0 20 40.0
7 Ensure the use of pasteurized milk 29 58.0 21 42.0
8 Using clean and uncontaminated water 32 64.0 18 36.0
9 Take the medications prescribed by the doctor 41 82.0 9 18.0
10 Getting rid of extra and remained food from bed room 42 84.0 8 16.0
11 Ensure on-non participation of tooth brush from someone to another 47 94.0 3 6.0
12 Avoid the sun , rain and cold. 23 46.0 27 54.0
Table 5. Relationship between Caregiver’s Awareness and their Socio-Demographic Characteristics
Variables Age
group gender Level of
education Employments Sours of
knowledge income lives Personal
Hygiene
Health
safety
Age group
Pearson Correlation 1 -.024- .099 .067 -.178- .095 -.233- .279 .025
Sig. (2-tailed) .869 .494 .646 .217 .511 .103 .050 .863
N 50 50 50 50 50 50 50 50 50
gender
Pearson Correlation -.024- 1 -.186- -.187- -.074- .045 .028 .233 .110
Sig. (2-tailed) .869 .197 .192 .609 .758 .849 .103 .448
N 50 50 50 50 50 50 50 50 50
Level of
education
Pearson Correlation .099 -.186- 1 .387** .544** -.193- .129 .087 .091
Sig. (2-tailed) .494 .197 .005 .000 .180 .372 .550 .530
N 50 50 50 50 50 50 50 50 50
Employments
Pearson Correlation .067 -.187- .387** 1 .175 -.286-*-.166- .022 .021
Sig. (2-tailed) .646 .192 .005 .223 .044 .250 .882 .887
N 50 50 50 50 50 50 50 50 50
Sours of
knowledge
Pearson Correlation -.178- -.074- .544** .175 1 -.065- .168 .119 -.063-
Sig. (2-tailed) .217 .609 .000 .223 .652 .244 .409 .662
N 50 50 50 50 50 50 50 50 50
income
Pearson Correlation .095 .045 -.193- -.286-*-.065- 1 -.278- .377** .254
Sig. (2-tailed) .511 .758 .180 .044 .652 .051 .007 .075
N 50 50 50 50 50 50 50 50 50
Personal hygiene
Pearson Correlation .279 .233 .087 .022 .119 .377** -.069- 1 .541**
Sig. (2-tailed) .050 .103 .550 .882 .409 .007 .633 .000
N 50 50 50 50 50 50 50 50 50
Healthy safety
Pearson Correlation .025 .110 .091 .021 -.063- .254 -.054- .541** 1
Sig. (2-tailed) .863 .448 .530 .887 .662 .075 .709 .000
N 50 50 50 50 50 50 50 50 50
Life style
Pearson Correlation .223 .252 .174 .015 .110 .445** -.022- .752** .519**
Sig. (2-tailed) .120 .078 .228 .918 .446 .001 .878 .000 .000
N 50 50 50 50 50 50 50 50 50

Indian Journal of Public Health Research & Development, December 2018, Vol. 9, No. 12 1101
CONCLUSION
the majority of caregivers response toward personal
hygiene domain were 82%don’t know that the use
a moisturize to prevent dry skin item, also the high
percentage of caregivers response about health safety
domain were 78% don’t know a bout use mouth
wash which contain alcohol item. And the caregiver’s
responses toward life style domain were 42% were
don’t’ know about ensure the use of pasteurized milk.
Financial Disclosure: There is no nancial
disclosure.
Conict of Interest: None to declare.
Ethical Clearance: All experimental protocols
were approved under the College of Nursing, University
of Baghdad, Iraq and all experiments were carried out in
accordance with approved guidelines.
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