Defining “Pediatrics/Paediatrics” in East Africa: A Qualitative study exploring physicians’ definitions of paediatrics in East Africa.

Abstract

BACKGROUND

With the globalization of healthcare, it is important to have shared definitions of frequently used words, including “pediatrics/paediatrics”. International organizations, including the World Health Organization and International Federation for Emergency Medicine, commonly use the words “child” and “paediatrics” but often do not provide definitions. Our study aimed to understand how physicians in East Africa define the paediatric population and explore how these definitions impact patient care.

METHODS

This was a cross-sectional, qualitative study using semi-structured interviews. Participants were physicians that care for children in the DRC, Kenya, Ethiopia, Rwanda, Tanzania, and Uganda. Interviews were audio-recorded, transcribed, and de-identified. Coding was performed in Dedoose using open, axial, and selective coding. Themes were identified using an inductive, iterative approach. Member checking was performed.

RESULTS

25 participants were interviewed. Three themes emerged:

1. There is no standard definition of “paediatrics”.

• “There is no clearcut definition of a paediatric age group. And it depends on the person defining it.” -Ethiopian physician

1. The transition from childhood/paediatric care to adulthood includes both mental and physical development, but there are also other considerations.

• “That [defining the transition to adulthood] is really difficult, because it varies from one child to another. And it depends on this child’s exposure, this child's environment, and so many other factors.” -Ugandan physician

1. Specific settings use different definitions of paediatrics, and this directly impacts patient care.

• “If they land in an adult ward, like a 16-year-old and above. (…) There'll be a lot of discussions about the age and which ward they're supposed to go to. So that essentially leads to delays in treatment initiation.” -Kenyan physician

CONCLUSION

Ambiguity exists in the term “paediatrics” and affects patient care. It is prudent to ensure a shared understanding of the term when engaging in clinical, research, and policy work.