Corticosteroids have been the mainstay of management for more than a half-century [11]. Findings of this study show that parental awareness of corticosteroid adverse effects and preventive measure influence the continuation of their treatment of their children. Many studies have illustrated how patient attitude and knowledge effects the continuation of their children steroid therapy and this may reduce implication of hospital stay thus leading to economic benefit [12].
In this study it was shown that the majority of participants have poor awareness on adverse effects of long term corticosteroid therapy. Sample of 217 participants out of sample population of 300 demonstrated poor awareness of adverse effects of corticosteroids. Since the male and female participants sample were not comparable awareness mothers’ verses fathers. These results were contrast with another study was done in Netherland, finding of that study have shown that parents’ awareness of adverse effect was good [13]. A similar situation, in Arab Emirates, Al Lela et al., (2014) pointed out parents’ awareness about it associated risks was poor. Most probable reason for Netherland study in contrast with our study[14], Netherland is developed country and they use new technology and educational method than Sri Lanka.
In this present research, there were statistically significant association of number of children in a family (p = 0.049) with the parental awareness of the adverse effects of corticosteroid. The parents who have less than two children had poor awareness about adverse effects of corticosteroid than the parents who have more than two children ( p < 0.05). There were statistically significant association of ethnicity (p = 0.000) with the parental awareness of the adverse effects of corticosteroid. However, majority of people had less awareness regarding the adverse effects of corticosteroid ( p < 0.05). There was no significantly association between educational level (p = 0.279), occupational participation ( p = 0.137), monthly income ( p = 0.398) the sufficiency of income level, age, height and clinical diagnosis for parental awareness of the adverse effects of corticosteroids. Because of their p value was high ( p > 0.05).
According to the present study a significant proportion of participant had a better awareness of adverse effects of increase hunger 73.3%( n = 220), susceptibility to infection 69%(n = 207), increase blood glucose level 69 .7% (n = 209), moon like face 60.3% (n = 181), central obesity 60.3% ( n = 181),increase blood pressure level 58% ( n = 174) and irritability 50.3% ( n = 151). In contrast the awareness of long term steroid therapy such as buffalo humps 26.7%(n = 80), Increase fracture tendency24.3%(n = 73), tarry colour stools 24.3%(n = 73), vision impairment24%(n = 72) and delayed wound healing 23% (n = 69) during long term corticosteroid treatment was poor. The better awareness the adverse effects like increased hunger, moon like face attributed to the parents personal experience with their own children who were on long term corticosteroid therapy. Finding of present study revealed that parent was more awareness regarding side effect of increase hunger 73.3% (n = 220) than the others. There was a similar situation found in Netherland. According to them most frequent was change in taste (61%), facial flushing (61%), feeling sick or having stomach pain and disturbance(44%) (Jongen at al., 2010). Hungry and tasty is most common personal experience in among participant’s child. So that findings were similar in both the countries.
According to the findings of study, socio demographic data, monthly income (p = 0.001) and adequacy of the income (p = 0.027) were statistically significant associated with preventive measures of adverse effects of corticosteroids. The preventive measure for adverse effects of corticosteroid also related to family income of the people, who have more income (> Rs30000)had taken many preventive methods than the family’s low incomes. Parents (p = 0.702), age(p = 0.192), number of children(p = 0.605), ethnicity(p = 0.605), education level(p = 0.123) and employment(p = 0.497) were not statistically significant in association with the preventive measures about adverse effects of corticosteroids. In this study it was noticed that, majority of parents know that the child should kept away from crowded places 70%(n = 210), if contact to chickenpox virus need immediate medical advice 67% ( n = 201).They also had vomiting 87.7%(n = 263), diarrhoea 88%(n = 264), cough 86.3%(n = 259). May be the parents are scared regarding chickenpox of the their past experience with it. So, They are very concerning about taking preventing measure from chicken pox. This may be a reason for the above result.
In the present study, researcher identify they have less awareness about vitamin D Supplement that should be given to prevent fracture (29.3%). These results were contrasts with another study done in England. Chalitsios et al., (2020) pointed out that meta-analysis demonstrate a clinically statistically significant prevention of bone loss at lumbar spine and fore arm with vitamin D and calcium in corticosteroid treatment [15]. In UK, this study done about oral corticosteroid treatment for the prevention of osteoporosis. The study highlighted that large number of people in population who are taking continuous oral steroids and shows the preventive measures for osteoporosis, are being implemented in frequently.
Findings of the present study highlighted preventive measure knowledge percentage of parental awareness of adverse effects was higher and can be accepted as adequate they have good preventive awareness. Result of parental preventive awareness was good 65.7% (n = 197).These results were contrasts with another study done in Morocco. This study done with long term glucocorticoids steroid hormone therapy. According to their result weight gain (27%) an out of (18%) patient reported episodes of treatment discontinuation [16]. It may be reason for poor knowledge about preventive measure of adverse effects of steroid therapy in Morocco.