Primary Care and General Pediatrics

Introduction: Hypertension is a major long-term health condition and it is the leading cause of premature death among adults throughout the world. Based on the use of ≥95th percentile to define hypertension, it would be expected that the prevalence of hypertension in children would be approximately 5%. Paediatric hypertension is considered as an under-diagnosed problem worldwide. This survey study was conducted to explore the extent of this issue in Kuwait.

Subjects and Methods: A questionnaire, having a brief case history of a child with increased blood pressure was prepared. The case history was followed by 15 true/false/I do not know questions directed to the attending physician. The questionnaire also solicited information on the physician’s current position and the length of his/her experience. The questionnaire was distributed to general practitioners working in 15 primary health care centers; all health districts in Kuwait were included. The same questionnaire was distributed to pediatricians working in the six main hospitals in Kuwait. Only assistant registrars and registrars were included. The questionnaire was collected in person from all participants of both groups. 

Results: A total of 127 physicians responded to the questionnaire. The responders were 69 (54%) male physicians and 58 (46%) female physicians. 44 (34.6%) of the responders were general practitioners and 13 (10.2%) were family medicine physicians working in polyclinics throw-out the country (group A). 70 (55.2%) of the responders were paediatricians working in the six main hospitals in Kuwait. In terms of years of experience 20 (15.7%) of participants have 5 years or less, 35 (27.6%) have 5 to 10 years and 72 (56.7%) have more than 10 years of experience. No statistical significance in the responses of both groups except in two questions (Q2 and Q11, p values are 0.025 and 0.0038 respectively). Q2 and Q11 reflect the knowledge of proper paediatric cuff size and proper method of diagnosing hypertension in children respectively. 

Conclusion: Our results suggest that paediatric hypertension is likely to be under-diagnosed by general practitioners due to lack of both knowledge and clinical skills in measuring blood pressure. This mandates an extensive education programmes to train general practitioners.