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Clean intermittent catheterization is a technique used to remove urine from the bladder. It involves placing a thin, flexible tube (catheter) through the urethra into the bladder to drain the urine at regular intervals throughout the day. The procedure is beneficial in protecting renal function, decreasing incontinence, limiting urinary tract infections, improving control of lower urinary tract symptoms and enhancing the quality of life for children with neurogenic bladder.
In Ethiopia, the 2016 prevalence of spina bifida and anencephaly was estimated to be 13 per 1,000 total births, with a prevention goal of 0.5 per 1,000 total births. However, there is no national data estimating the prevalence of neurogenic bladder. Given the high rate of neural tube defects in our children and our limited economic resources, CIC remains the gold standard of care we can provide without other definitive measures.
Our study aimed to evaluate the knowledge, attitude, and practice of healthcare professionals and caregivers of children with neurogenic bladder in Addis Ababa, Ethiopia, regarding clean intermittent catheterization. We used a cross-sectional study design and collected data through self-administered questionnaires. The data was analyzed using descriptive statistics with SPSS version 27.
Most of the healthcare professionals (63.6%) had good knowledge levels and exhibited a positive attitude (88%). However, the practice of most of them (72%) was poor. Only a small percentage (16.9%) had received formal training sessions, and even fewer (28.8%) felt confident in their skills to teach and treat their patients.
Among the caregivers, 61.3% achieved a good level of knowledge and 78% of them had a moderate to good attitude. However, 83.5% of them had a poor level of practice. This could be attributed to the high workload, lack of equipment, economic difficulties, and lack of practical training sessions, which were the most commonly cited reasons by healthcare professionals and caregivers.
In our resource-limited settings, we have observed negative consequences resulting from improperly conducted clean intermittent catheterization (CIC) and bladder care. To address this, we strongly recommend providing extensive training to healthcare professionals to help them understand the importance of care and equip them with adequate skills and knowledge to teach patients and their families. As a result of our study, we have collaborated with the Reach Another Foundation to develop a training manual for CIC and initiation and follow-up of oxybutynin in children with neural tube defects post-surgery in our care in Addis Ababa. We hope to extend this training to other regions of the country.