Complementary and alternative medicine (CAM) is widely used especially in Asia including for childhood asthma. The use of CAM could influence adherence to evidence-based (E-B) medicine. We explored the views of carers of Malaysian children with asthma regarding the use of CAM for childhood asthma, and its relationship with self-reported adherence to E-B medicine. We used a screening questionnaire to identify children diagnosed with asthma from seven suburban primary schools in Malaysia. Informed consent was obtained prior to the interviews. We conducted the interviews using a semi-structured topic guide in participants’ preferred language (Malay, Mandarin, or Tamil). All interviews were audio-recorded, transcribed verbatim and coded using Nvivo. Analysis was performed thematically, informed by the Necessity-Concerns Framework. A total of 46 carers (16 Malays, 21 Indians, 9 Chinese) contributed to 12 focus groups and one individual interview. We categorised participants’ as ‘Non-CAM’; ‘CAM’; or ‘combination’ user. Cultural practices and beliefs in the efficacy of CAM resulted in widespread use of CAM. Most carers used CAM as ‘complementary’ to E-B medicine. Concerns about dependence on or side effects of E-B treatment influenced carers’ decisions to rely on CAM as an ‘alternative’, with an important minority of accounts describing potentially harmful CAM-use. Healthcare professionals should discuss beliefs about the necessity for and concerns about use of both E-B medicine and CAM, and provide balanced information about effectiveness and safety. The aim is to improve adherence to regular E-B preventer medication and prevent delays in seeking medical advice and harmful practices associated with CAM.

ObjectiveWe aimed to explore the views of Malaysian children with asthma and their parents to enhance understanding of early influences on development of self-management skills.DesignThis is a qualitative study conducted among children with asthma and their parents. We used purposive sampling and conducted focus groups and interviews using a semi-structured topic guide in the participants’ preferred language. All interviews were audio-recorded, transcribed verbatim, entered into NVivo and analysed using a grounded theory approach.SettingsWe identified children aged 7–12 years with parent-reported, physician-diagnosed asthma from seven suburban primary schools in Malaysia. Focus groups and interviews were conducted either at schools or a health centre.ResultsNinety-nine participants (46 caregivers, 53 children) contributed to 24 focus groups and 6 individual interviews. Children mirrored their parents’ management of asthma but, in parallel, learnt and gained confidence to independently self-manage asthma from their own experiences and self-experimentation. Increasing independence was more apparent in children aged 10 years and above. Cultural norms and beliefs influenced children’s independence to self-manage asthma either directly or indirectly through their social network. External influences, for example, support from school and healthcare, also played a role in the transition.ConclusionChildren learnt the skills to self-manage asthma as early as 7 years old with growing independence from the age of 10 years. Healthcare professionals should use child-centred approach and involve schools to facilitate asthma self-management and support a smooth transition to independent self-management.Trial registration numberMalaysian National Medical Research Register (NMRR-15-1242-26898).

Children with poor asthma control have poor health outcomes. In Malaysia, the Malays have the highest asthma prevalence and poorest control compared to other ethnicities. We aimed to explore Malay children with asthma and their parents' perceptions on asthma and its control. We conducted focus group discussions (FGD) using a semi-structured interview guide. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Sixteen children and parents (N = 32) participated. The perception of asthma was based on personal experience, cultural and religious beliefs, and there was mismatch between children and parents. Parents perceived mild symptoms as normal, some had poor practices, raising safety concerns as children were dependent on them for self-management. Conflicting religious opinions on inhaler use during Ramadhan caused confusion in practice. Parents perceived a lack of system support towards asthma care and asthma affected quality of life. Urgent intervention is needed to address misconceptions to improve asthma care in children.

Introduction Approximately 85 children per year die because of maltreatment in the UK. Over 600,000 children are referred to social care. In 2012, 42,700 children were on the Child Protection Plan (CPP). Aim 1. To identify the pattern of various forms of child abuse. 2. To assess our compliance with national guidelines to improve our service. Methods Retrospective review of 8 audits completed over 8 years. Data was collected from 2005 – 2012 from 555 cases referred to our service. Prospective audit proformas, case files, Electronic Patient records, NAI medical reports and peer review minutes were used. Results On average, 70% of assessments were completed at rapid access clinics. Cases showed bruising (45%), bite marks (4%), burns (5%) and abrasions/cuts (7%). Referrals were made mostly by Social care (74%), GPs (7%) and A&E (5%), and were due to physical abuse (90% v 60%) and neglect (7% v 25%) in 2005 v 2012 respectively, as awareness of various forms of abuse, increased. Consent for assessment improved over time (28% in 2005 v 97% in 2012). In 2005 assessments were carried out in various locations; by 2012 all cases were assessed in the hospital setting. Assessments were made by Consultants in 22% v 39% cases, Paediatric trainees in 5% v 48% and CMOs in 72% v 13% of cases in 2005 v 2012 respectively. The uptake of investigations (19% v 36%) and photographs (22% v 97%) improved between 2005 to 2012 respectively. The outcomes of assessment showed 30% were conclusive NAI whilst 11% were neglect. The number of children on the CPP increased from 186 to 323 over time, and our number of LAC increased to over 500. In 2012, a new flagging system was introduced to alert physicians to children on the CPP. 85% of children known to the CPP are now flagged as such. Conclusions Significant changes and improvements in our safeguarding system were seen over this 8 year period as a result of these audits. National recommendation compliance also improved as a result of various local and joint policies, peer review supervision forums and various commissioned staff training courses.