Knowledge and Attitude of Community Pharmacists Toward Cow Milk Protein Allergy Complications and Treatment in Children: A Cross-Sectional Study in Sudan

Figures & data

Table 1 Socio-Demographic Characteristics of Respondents (N: 332)

Variable	Number	Percentage
Experience as a community pharmacist
Less than 1 year	47	14.8%
1–5 years	152	47.8%
6–10 years	77	24.2%
11–15 years	22	6.9%
More than 15 years	20	6.3%
Post-graduation study
Yes	119	37.4%
No	199	62.6%

Table 2 Knowledge of Respondents Toward Complications of Cow Milk Protein Allergy

Knowledge of Complications of CMPA	Yes	No	I do not know
	Frequency (%)	Frequency (%)	Frequency (%)
Cow’s milk protein allergy (CMPA) can be a life-threatening condition.	236 (74.2%)*	33 (10.4%)	49 (15.4%)
CMPA is associated with multiple protein allergies. (eg Gluten, soy, meat, and egg allergies).	190 (59.7%)*	61 (19.2%)	67 (21.1%)
CMPA has been associated with various food allergies. (eg allergy to some fruits and vegetables).	114 (35.8%)*	104 (32.7%)	100 (31.4%)
Allergic children are deficient in calcium and iron.	164 (51.6%)*	71 (22.3%)	83 (26.1%)
CMPA can cause the following repeated symptoms that do not respond to medicines:
Constipation	146 (45.9%)*	98 (30.8%)	74 (23.3%)
Diarrhea	260 (81.8%)*	24 (7.5%)	34 (10.7%)
Tremor	73 (23%)	79 (24.8%)*	166 (52.2%)
Reflux	174 (54.7%) *	41 (12.9%)	103 (32.4%)
Visual disturbances	67 (21.1%)	86 (27%)*	165 (51.9%)
Bloody stool	98 (30.8%)*	97 (30.5%)	123 (38.7%)
g) Headache	129 (40.6%)	66 (20.8%)*	123 (38.7%)
Shortness of breath	184 (57.9%)*	53 (16.7%)	81 (25.5%)
Eczema	189 (59.4%)*	43 (13.5%)	86 (27%)
Irritability and persistent crying in infants	256 (80.5%)*	15 (4.7%)	47 (14.8%)
The severity of symptoms varies among children, ranging from mild to severe, requiring hospitalization.	275 (86.5%)*	22 (6.9%)	21 (6.6%)
If there is no diet control, symptoms might become more severe.	295 (92.8%)*	5 (1.6%)	18 (5.7%)

Notes: *The correct response.

Table 3 Knowledge of Respondents Toward Treatment of Cow Milk Protein Allergy

Variable	Frequency	(%)
The first step in the treatment of cow milk protein allergy is:
Allergen* elimination from a child’s or a nursing mother’s food	126	39.6%
Giving the child (or the nursing mother) normal food (not special for allergy) and antihistamines to the child to manage allergy symptoms.	36	11.6%
Giving the child (or the nursing mother) normal food (not special for allergy) and giving the child protein-free milk formula.	122	38.4%
I do not know.	34	10.7%
For a child with cow’s milk protein allergy, the type of milk formula that can be used is:
*Extensively hydrolyzed casein formula (EHCF) or Amino Acid formula (AAF)	79	24.8%
Partially hydrolyzed formula (HA)	36	11.3%
Lactose-free formula (LF)	126	39.6%
I do not know.	77	24.2%
Vitamins are essential for children with CMPA. Which one of the following is true about pharmaceutical formulations of vitamins?
All brands contain proteins that can cause allergies.	33	10.4%
All brands are free of protein allergens.	80	25.2%
*Some brands contain proteins that can cause allergies, while others do not.	95	29.9%
I do not know if some brands contain proteins that may cause allergies or not.	110	34.6%
For the treatment of a child with CMPA, a strict diet with additional prohibited products for a period of time is required. The prohibited products include:
*Certain types of shampoos, Soaps, and body creams.	69	21.7%
Some types of textiles.	22	6.9%
Some types of perfume	11	3.5%
Topical formulations are safe for children with CMPA.	216	67.9%

Notes: *Any substance that may cause allergic reaction in subjects with cow milk protein allergy.

Table 4 Attitude of Respondents Toward Cow Milk Protein Allergy

Attitude	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
	Frequency (%)	Frequency (%)	Frequency (%)	Frequency (%)	Frequency (%)
Before dispensing medicine to a child, the pharmacist should ask the parent if this child has any allergies.	216 (67.9%) *	85 (26.7%) *	11 (3.5%)	5 (1.6%)	1 (0.3%)
Flavoring agent in a certain pharmaceutical brand can cause an allergy in a child who has multiple food allergies	84 (26.7%)*	168 (52.8%) *	38 (11.9%)	25 (7.9%)	3 (0.9%)
Partially hydrolyzed formula (HA) is the best option for lactose intolerance and CMPA.	20 (6.3%)	120 (37.7%)	128 (40.3%)	40 (12.6%)*	10 (3.1%)*
Your recommendation to a mother of a child allergic to cow’s milk protein is to avoid giving him any milk, milk products, or products that could be contaminated with milk.	106 (33.3%) *	133 (41.8%) *	27 (8.5%)	41 (12.9%)	11 (3.5%)
To avoid meat allergy as much as possible, a recently diagnosed child with CMPA should avoid meat for at least six months.	39 (12.3%)	140 (44%)	107 (33.6%)	26 (8.2%) *	6 (1.9%) *
For mild to moderate CMPA, an extensively hydrolyzed formula (EHF) is the best choice.	32 (10.1%) *	125 (39.3%) *	116 (36.5%)	39 (12.3%)	6 (1.9%)
Amino Acid Formula (AAF) is the safest milk formula for CMPA-positive.	26 (8.2%) *	121 (38.1%) *	121 (38.1%)	42 (13.2%)	8 (2.5%)
For a new baby whose older brother has CMPA, partially hydrolyzed formula (HA) is the best option. This is your recommendation for mothers.	24 (7.5%) *	145 (45.6%) *	92 (28.9%)	54 (17%)	3 (0.9%)
Capsules are preferable to tablets for a breastfeeding mother of a child with CMPA and a meat allergy.	26 (8.2%)	88 (27.7%)	113 (35.5%)	67 (21.1%)*	24 (7.5%) *

Notes: *The positive attitude.

Table 5 Association Between Socio-Demographic Characteristics of Respondents and Knowledge of Complications and Knowledge of Treatment Toward Cow Milk Protein Allergy

Experience	Knowledge of Complications Toward CMPA*			P-value	Knowledge of Treatment for CMPA			P-value
	Low	Average	High		Low	Average	High
Less than 1 year	22 (46.8%)	11 (23.4)	14 (29.8%)	0.486	30 (63.8)	12 (25.5%)	5 (10.6%)	0.911
1–5 years	68 (44.7%)	40 (26.3%)	44 (26.9%)		98 (64.5%)	38 (25%)	16 (10.5%)
6–10 years	23 (29.9%)	27 (35.1%)	27 (35.1%)		53 (68.8%)	16 (20.8%)	8 (10.4%)
11–15 years	9 (40.9%)	8 (36.4%)	5 (22.7%)		13 (59.1%)	8 (36.4%)	1 (4.5%)
More than 15 years	7 (35%)	5 (25%)	8 (40%)		13 (65%)	4 (20%)	3 (15%)
Post-graduation study
Yes	52 (43.7%)	28 (23.5%)	39 (32.8%)	0.299	78 (65.5%)	24 (20.2%)	17 (14.3%)	0.118
No	77 (38.7%)	63 (31.7%)	59 (29.6%)		129 (64.8%)	54 (27.1%)	16 (8%)

Notes: *CMPA: cow milk protein allergy.

Table 6 Association Between Socio-Demographic Characteristics of Respondents and Attitude Toward Cow Milk Protein Allergy

Years of Experience	Attitude		P-value
	Negative	Positive
Less than 1 year	33 (70.2%)	14 (29.8%)	0.540
1–5 year	86 (56.6%)	66 (43.4%)
6–10 year	46 (59.7%)	31 (40.3%)
11–15 year	14 (63.6%)	8 (36.4%)
More than 15 years	13 (65%)	7(35%)
Post-graduation study
Yes	72 (60.5%)	47 (39.5%)	0.971
No	120 (60.3%)	79 (39.7)

Table 7 Association Between Knowledge of Treatment and Knowledge of Complication with Attitude Toward Cow Milk Protein Allergy

Knowledge of the Treatment of CMPA*	Attitude		P- value	Knowledge of Complications of CMPA	Attitude		P- value
	Negative	Positive			Negative	Positive
Low	125 (60.4%)	82 (39.6%)	0.927	Low	71 (55%)	58 (45%)	0.219
Average	48 (61.5%)	30 (38.5%)		Average	56 (61.5%)	35 (38.5%)
High	19 (57.6%)	14 (42.4%)		High	65 (66.3%)	33 (33.7%)

Notes: *CMPA: cow milk protein allergy.