<p>Pre-Transition Readiness in Adolescents and Young Adults with Four Chronic Medical Conditions in South East Nigeria – An African Perspective to Adolescent Transition</p>

Abstract

Introduction:When a child reaches a certain age, he or she moves over to the adult physician. For this to maximally benefit the child, there has to be a process of equipping the child with skills required for taking on more responsibilities. Transitioning involves a process in which the adolescent with chronic illness is prepared ahead of time to enable them to eventually transfer to adult care with good outcomes. In high-income countries with wellorganized health financing, the transitioning process begins as early as 12 years. In Africa, this process is not as organized and most hospitals would write a referral letter once the child turns 18 and transfer to adult clinic. In four of our chronic disease clinics (asthma, HIV, sickle cell anaemia and chronic kidney diseases) patients up to 24 years old are still attending the paediatric clinics. Understanding transition readiness among African adolescents remains a gap. Our findings will form a basis for informed practices for adolescent clinics in African countries. Methods: This was a descriptive cross-sectional study of pre-transition readiness in adolescents and young adults with chronic illnesses attending four outpatient specialist clinics in a tertiary hospital in Enugu Nigeria. This was done using the validated STARx Questionnaire. Total scores were computed and scores nearer the upper limit of 90 were acceptable, while mean subdomain scores of 4 and above were considered as optimal level of transition readiness. Demographic and clinical data were also collected. Acceptability to move on to adult-oriented care was documented using binary response (yes/no). Cross tabulations were done, and likelihood ratios obtained for predictors of acceptability of transition. Significant value was set at p-value of ≤0.05. Results: A total of 142 adolescents and young adults aged 12 to 24 years were studied. There were 38.0% (54), 24.6% (35), 22.5% (32) and 14.8% (21) from HIV, sickle cell anaemia, asthma and nephrology clinics, respectively. Their mean age was 15.6 years ± 2.4, and 48.6% (69) were male. The mean total transition readiness score was 56±14 and this was not nearer the higher spectrum of total scores obtainable. Highest mean scores (3.7) occurred in the knowledge subdomain while least mean score (2) was noted in the use of medication reminders. The males had highest scores in the knowledge subdomain while the females were better informed about medication adherence and were more inquisitive about their chronic illness. Only about 37% (53) of the adolescents and young adults welcomed the idea of moving on to adult-care clinics. Children who had less frequent emergency hospital visits and better treatment outcome accepted the idea of transfer to adult care. Irrespective of the age all participants had suboptimal subdomain scores. High scores did not influence the participants' choice to embrace transfer to adult care.

Transition Preparation and Satisfaction of Care Among Adolescents and Young Adults With Sickle Cell Disease at the Ghana Institute of Clinical Genetics

“…Regardless of whether they received preparation, participants reported satisfaction with the overall transition experience and their care at the adult SCD clinic. This perspective contrasts US-based and Nigeria-based studies of AYAs with SCD, where most participants preferred their pediatric clinic as a source of SCD care 14,19,25. These differences may in part be attributable to variations in age of transfer and patient experiences about accessibility and quality of adult care.…”

“…This perspective contrasts US-based and Nigeria-based studies of AYAs with SCD, where most participants preferred their pediatric clinic as a source of SCD care. 14,19,25 These differences may in part be attributable to variations in age of transfer and patient experiences about accessibility and quality of adult care. To our knowledge, prior studies assessing the impact of transition preparation for patients with SCD on experiences or other outcomes in SCD in Africa have not been reported.…”

Hungarian Linguistic, Cross-Cultural and Age Adaptation of Transition Specific Questionnaires in Patients with Inflammatory Bowel Disease

“…The STARx tool was validated by Ferris et al for adolescents with various chronic conditions in the US and [ 17 ], although not yet adapted, is used in different countries, such as Nigeria [ 49 , 50 ]. Ayuk et al measured the pre-transition readiness of Nigerian adolescents with various chronic illnesses and concluded that regardless of age, transitional readiness and willingness were suboptimal [ 49 ].…”

“…The STARx tool was validated by Ferris et al for adolescents with various chronic conditions in the US and [ 17 ], although not yet adapted, is used in different countries, such as Nigeria [ 49 , 50 ]. Ayuk et al measured the pre-transition readiness of Nigerian adolescents with various chronic illnesses and concluded that regardless of age, transitional readiness and willingness were suboptimal [ 49 ]. Eluri et al gathered that patients with eosinophilic esophagitis and eosinophilic gastroenteritis were less aware of the transition and their transition readiness was below that of patients with different conditions [ 50 ].…”

Transitioning Adolescents with Perinatally Acquired HIV from Paediatric to Adult Centered Care: Caregivers’ Perspective

“…Several studies in low and middle income countries (LMIC) have investigated the transition to adult care of adolescents with chronic medical conditions such as sickle cell disease and asthma [23][24][25]. A few studies involving ALHIV have focused on transition readiness assessment [26], patient and healthcare providers' perspectives on transition and some have investigated transition programs [12,27].…”