RESUMO
Background: This study aimed to investigate the factors associated with refusal of lumbar puncture (LP) in children aged 1-10 years who presented to a paediatric department in our hospital. Methods: A sample of parents and guardians of children who presented to the paediatric department were surveyed to gather information about their educational background and decision-making processes. Attending doctors were also interviewed using a questionnaire to gather their perspectives on the reasons for LP refusal in children. Attending doctors then tried to convince the parents or guardians to see if it changed their decision. Results: The study found that the majority of parents and guardians had a lower educational background, with over half being illiterate. Refusal of LP was seen most frequently in parents or guardians who were illiterate. The decision-making process was found to be heavily dependent on the father in a male-dominated society. Peer pressure and lack of knowledge were found to be factors that contributed to LP refusal. Conclusion: Refusal of a LP was linked to having a lower educational background and to societal influences in this cross-sectional study of children aged 1-10 years. More than half of the parents and guardians were illiterate, indicating that they had a lower level of education. Refusing LP was influenced by a number of factors, including social pressure and a lack of information. However, these obstacles were overcome thanks to the efforts of the attending doctors who dispelled myths and reassured the parents and guardians of the necessity and safety of the procedure. Possible roadblocks include a lack of financial resources and common misconceptions about LP. These results highlight the significance of addressing educational and societal factors to enhance children's healthcare.
RESUMO
BACKGROUND: Genetic and environmental factors are important determinants of disease distribution. Several disorders associated with ataxia are known to occur more commonly in certain ethnic groups; for example, the disequilibrium syndrome in the Hutterites. The aim of this study was to determine the ethnic and geographic distribution of pediatric patients with chronic ataxia in Manitoba, Canada. METHODS: We identified 184 patients less than 17 years-of-age with chronic ataxia during 1991-2008 from multiple sources. Their diagnosis, ethnicity and place of residence were determined following a chart review. RESULTS: Most patients resided in Manitoba (N=177) and the majority in Winnipeg, the provincial capital. Thirty five Aboriginal, 29 Mennonite and 11 Hutterite patients resided in Manitoba. The latter two groups were significantly overrepresented in our cohort. Ataxia telangiectasia, mitochondrial disorders, and non-progressive ataxia of unknown etiology associated with pyramidal tracts signs and developmental delay were significantly more common in Mennonite patients. Four of five patients with neuronal migration disorders associated with chronic ataxia were Aboriginal. Few isolated disorders with chronic ataxia occurred in the 11 Hutterite patients including a Joubert syndrome related disorder. CONCLUSIONS: Three disorders associated with chronic ataxia were more prevalent than expected in Mennonites in Manitoba. Few rare disorders were more prevalent in the Hutterite and Aboriginal population. Further research is needed to determine the risk factors underlying these variations in prevalence within different ethnic groups. The unique risk factor profiles of each ethnic group need to be considered in health promotion endeavors.Ethnie et distribution géographique de l'ataxie chronique chez des patients d'âge pédiatrique au Manitoba.
