Knowledge, attitude and practices of postoperative nausea and vomiting management among medical practitioners in Muhimbili National Hospital

Abstract

Background: Postoperative nausea and vomiting (PONV) is an easily overlooked problem in postsurgical patients. The incidence of untreated PONV is reported to range from 30% to 80% worldwide. At MNH the incidence of PONV has been reported to be 17.3% only for elective general surgical cases. PONV in most cases is the cause of severe distress and less satisfaction to patients from surgery and anesthesia. Even though PONV is mostly self-limiting and non-fatal but it could result in significant morbidity. Aim of the study: This study aimed to assess medical practitioners‟ knowledge, attitude, and practices on PONV at MNH from February to April 2021. Methodology: This was a hospital-based cross-sectional study where a questionnaire was given to medical practitioners in anesthesia and surgical departments. The questionnaire aimed to assess the practitioners‟ knowledge of PONV, their attitude toward PONV, and their practices of PONV management. Each questionnaire was coded and data entry was performed manually into SPSS version 20 for analysis. Descriptive analysis was conducted for demographic data. Binary logistic regression analysis was done to see the independent effect of predictors on the dependent variables. Predictors with statistical significance with P-value≤ 0.25 were modeled by multivariable logistic regression analysis. The measure of association was Odds ratio with 95% confidence interval and a P-value≤0.05 was considered statistically significant. Results: A total of 165 questionnaires were distributed and those returned and properly filled were 151. Generally, practitioners had poor knowledge of PONV where only 38.4% of them had good knowledge. Practitioners from the anesthesia department were more knowledgeable compared to those from general surgery (P=0.001). Also the majority of practitioners had a negative attitude toward PONV where only 35.8% of practitioners viewed PONV to be an important problem in their clinical practice. Practitioners from otorhinolaryngology were more likely to have a positive attitude compared to those from general surgery (P=0.009), followed by practitioners from the anesthesia department (P=0.039). Having a positive attitude did not affect the level of knowledge (P=0.266). PONV risk assessment was done by 49.3% of the respondents. Good knowledge was associated with practice of PONV risk assessment (P=0.009). A multimodal approach in managing PONV was applied by 58.9% of practitioners. Practitioners with a positive attitude were more likely to apply a multimodal approach compared to those with a negative attitude (P=0.042). Conclusion: Generally medical practitioners have poor knowledge of PONV, and a negative attitude towards PONV. Having a good knowledge of PONV and a positive attitude toward it leads to better management of PONV patients. Postoperative satisfaction of surgical patients can be improved if practitioners are knowledgeable about PONV and have a positive attitude toward it.