నైరూప్య

Study of behavioral problems in Thalassemia major children from 6 year to 18 years of age at CRGH and associated hospitals of RD Gardi Medical College Ujjain (MP)

Shatanshi Shukla*, Mamta Dhaneria

Background: Thalassemias are a heterogeneous group of genetic disorders that result from a decreased synthesis of alpha or beta chains of Hemoglobin (Hb). Hemoglobin serves as the oxygencarrying component of the red blood cells. It consists of two proteins, an alpha, and a beta. If the body does not manufacture enough of one or the other of these two proteins, the red blood cells do not form correctly and cannot carry sufficient oxygen; this causes anemia that begins in early childhood and lasts throughout life. In India, health care providers are more concerned with medical management of thalassemia, probably because till about two decades ago, the life span of thalassemic children was limited and the medical problems of the disease were so severe that all other aspects of the illness and its management were neglected. There are many researches done regarding the clinical profile in thalassemia patients but there was no study done the behavioral problems and psychological problems in thalassemia major patients in central India especially Ujjain in MP. Hence, this study was done to assess the behavioral problems in thalassemia children and the factors affecting them. Material and Methods: This cross-sectional study was done on thalassemia major children who are registered for regular blood transfusion at the thalassemia ward of CRGH between January 2019 to February 2020. Children whose parents/attending guardians who do not give consent were excluded from the study. Total 180 thalassemia patients were enrolled between 6 years and 18 years of age group. All patients had undergone CBCL scoring system which is child behavior checklist. Total 113 questionnaire were asked to parents and/or adolescent patients who could understand various questions. The patients were divided according to their behavioral problems which were classified as internalizing problems and externalising problems. All Statistical analysis done with the help of statistical software SPSS 21.0 version. Results: Prevalence of behavioral problems increase when age increase (p value=0.000). Prevalence of behavioral problems was directly correlated with bad (poor) scholastic performance (p=0.000). More duration of illness was associated with prevalence of behavioral problems in 15.7% thalassemic children (p=0.000). 42.8% had bad (poor) scholastic performance. 38.9% had >3 years duration of illness. 41.1% thalassemic children had more duration of school absenteeism. 83.9% had CBCL score (t score) <65 that is they did not have any behavioral problems. 10.0% had CBCL score between 65-70 that means they were suffering from borderline behavioral issue. 6.1% had CBCL total score >70that means having clinically significant behavior problems. Conclusion: The present study shows that behavioral problems prevalence is very high in patients with multitranfused thalassemia major. Therefore periodic assessment of these children for any psychiatric morbidity will help in early diagnosis and treatment. Hence it would improve the mental health and would make them cope with thalassemia and its complex and lifelong management regimen and hence a better quality of life.