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Validation of a Swahili Pediatric Pain Scale in Tanzania: An Observational Study
Stephen Rineer1, Patrick T McGann2, Chausiku Paschal3
1Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
Purpose:
Limited data are available on the validation or use of culturally and language-specific pediatric self-report pain scales in Sub-Saharan Africa despite the high burden of pain affecting children.
Design:
An observational study was conducted to determine the discriminant and convergent validity of two self-report pain scales in Tanzania translated into Swahili: Faces Pain Scale-Revised (FPS-R) and Color Analog Scale (CAS).
Methods:
Children aged 5-18 years in the outpatient clinic and inpatient wards at Bugando Medical Center in Mwanza, Tanzania, were eligible. The FPS-R and CAS were translated into Tanzanian Swahili. Discriminant validity was assessed before, during, and after venipuncture using analysis of variance. Convergent validity between the two scales and between parental and child reports was assessed using Spearman correlation.
Results:
A total of 107 children were enrolled (56% male, median age 8 years, interquartile range = 6.5-11). A majority (73%) had sickle cell disease. Serial assessments around venipuncture were completed in 46 children, and 74 child-parent dyads were assessed for pain burden, caregiver correlation, and scale preference. Median scores before, during, and 5 and 30 minutes after venipuncture documented an expected increase and decrease in pain over time (p < .001) in both the FPS-R and CAS. The correlation between FPS-R and CAS was r = 0.972 and p < .001. The correlation between parent and child was r = 0.849 and p < .001. Most caregivers (85%) and children (92%) preferred the FPS-R.
Conclusions:
The FPS-R was preferred and the parent pain report correlated with the child report.
Clinical Implications:
The Tanzanian Swahili FPS-R and CAS are valid pediatric pain assessment tools.
