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Boateng EA, Bisiw MB, Agyapomah R, Enyemadze I, Kyei-Dompim J, Kumi SP, Boakye DS. A qualitative study on the experiences of family caregivers of children with End Stage Kidney Disease (ESKD). Biopsychosoc Med 2024; 18:17. [PMID: 39152453 PMCID: PMC11328486 DOI: 10.1186/s13030-024-00314-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 08/07/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Family caregivers, mostly parents, are greatly involved in the care of their children with end stage kidney disease (ESKD) globally. Yet, the experiences of these caregivers and the demands placed on them by the caregiving role have not been explored or documented in Ghana. This study explored how caregiving affects the psychological, physical, social, and spiritual well-being of family caregivers of children with end stage kidney disease (ESKD) in Ghana. METHODS A phenomenological approach with the purposive sampling technique was used to gather data from 12 family caregivers of children with ESKD at a pediatric renal unit in Ghana. A semi-structured interview guide was constructed based on the constructs of the City of Hope Quality of Life (QoL) Family Caregiver Model and the research objectives. Colaizzi's thematic analysis approach was utilized to analyze data for this study. Themes were organized under the domains of the chosen model, and a new theme outside these domains was also generated. RESULTS The majority of the family caregivers experienced anxiety, fear, uncertainty, and hopelessness in response to the children's diagnosis and care. The thought of the possibility of the children dying was deeply traumatizing for our participants. Most participants reported bodily pains and physical ailments because of lifting and caring for the children. Financial constraint was also a key issue for all the family caregivers. Most of them received diverse support from their families and loved ones. Due to the demanding nature of the care, most family caregivers had to change or quit their jobs. They coped with the challenges through prayers, participating in religious activities, and being hopeful in God for healing. CONCLUSION All the family caregivers had their psychological well-being compromised as a result of the challenges they encountered physically, socially, and spiritually. Continuous psychosocial support, funding support, and review of policies on leave for civil workers with children diagnosed with ESKD are urgently required.
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Affiliation(s)
| | - Mabel Baaba Bisiw
- Department of Nursing, School of Nursing and Midwifery, KNUST, Kumasi, Ghana
| | | | | | - Joana Kyei-Dompim
- Department of Midwifery, School of Nursing and Midwifery, KNUST, Kumasi, Ghana
| | - Samuel Peprah Kumi
- Department of Nursing, School of Nursing and Midwifery, KNUST, Kumasi, Ghana
- Nurses' Training College, Sampa, Ghana
| | - Dorothy Serwaa Boakye
- Department of Health Administration and Education, University of Education, Winneba, Ghana
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2
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Mamven M, Adejumo OA, Edeki IR, Oyedepo DS, Ngoka SC, Ummate I, Abdu A, Tuko MT, Adeyeye LA, Loskurima U, Fasaanu A, Madu NC, Angbazo D. Perspectives of relatives of patients with end-stage kidney disease on kidney sources, commercial kidney donation, and barriers to living kidney donation in Nigeria: a qualitative study. J Nephrol 2024:10.1007/s40620-024-02019-1. [PMID: 39012427 DOI: 10.1007/s40620-024-02019-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/22/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Kidney transplantation is the best mode of kidney replacement therapy. However, the shortage of organ donations has been a major challenge globally. Relatives of patients with end-stage kidney disease (ESKD) are potential kidney donors. We explored their perspectives about kidney donation, kidney commercialisation, and barriers to kidney donation. METHODS In-depth interviews were conducted among 28 relatives of ESKD patients across the six geopolitical zones and Federal Capital Territory of Nigeria. The interview focused on potential sources of kidney donors, kidney commercialisation and barriers to kidney donation. ATLAS.ti version 9.0.22.0 was used for data analysis. RESULTS Mean age of the study participants was 41.57 ± 14.55 years; 54% were females, 60.7% were married, 93% had tertiary education and 75% were first degree relatives of ESKD patients. There were 7 themes and 28 subthemes generated in this study. The potential sources of kidney donors identified by the study participants included commercial, hospital, family and non-family member donors. While some opined that a family member is the best choice as a kidney donor, others preferred a commercial donor. The majority of those interviewed do not believe that it is wrong to purchase a kidney, and would be willing to do so. Identified factors that promote kidney commercialisation were unwillingness of a family member to donate, having the financial capacity to purchase a kidney, non-fitness of family members to donate. Identified barriers to kidney donation were age, poor health status, polygamy, perceived poor expertise of the medical team, perceived risk of the procedure, parental influence and religious beliefs. CONCLUSIONS The majority of participants lacked correct information about kidney donation. Implementation of educational program policies and laws regulating and reinforcing ethical principles of kidney donation and transplantation should be ensured.
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Affiliation(s)
- Manmak Mamven
- Department of Internal Medicine, University of Abuja, Gwagwalada, Abuja, Nigeria
| | | | - Imuetinyan Rashida Edeki
- Department of Internal Medicine, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - Dapo Sunday Oyedepo
- Department of Internal Medicine, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | | | - Ibrahim Ummate
- Department of Internal Medicine, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
| | - Alhaji Abdu
- Department of Internal Medicine, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Bauchi State, Nigeria
| | - Moses Tari Tuko
- Department of Internal Medicine, Federal Medical Centre, Birnin Kebbi, Kebbi State, Nigeria
| | | | - Umar Loskurima
- Department of Internal Medicine, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
| | - Ayodeji Fasaanu
- Department of Internal Medicine, Afe Babalola University Teaching Hospital, Ado Ekiti, Ekiti State, Nigeria
| | - Nwokedi Chinedu Madu
- Department of Internal Medicine, University of Abuja, Gwagwalada, Abuja, Nigeria
| | - Dorcas Angbazo
- National Assembly Health Service Directorate, Abuja, Nigeria
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Bamgboye EL. Kidney Transplantation in Sub-Saharan Africa: History and Current Status. KIDNEY360 2023; 4:1772-1775. [PMID: 37962555 PMCID: PMC10758520 DOI: 10.34067/kid.0000000000000293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/19/2023] [Indexed: 11/15/2023]
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Davis SO, Zubair A, Igbokwe M, Abu M, Chiedozie CA, Sanni Q, Jesuyajolu D. A Scoping Review of Kidney Transplantation in Africa: How Far have We Come? World J Surg 2023; 47:2113-2123. [PMID: 37160654 DOI: 10.1007/s00268-023-07042-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2023] [Indexed: 05/11/2023]
Abstract
INTRODUCTION Kidney transplantation is a life-saving treatment for end-stage kidney disease (ESKD) patients. However, access to this treatment in Africa lags behind other regions, leading to significant disparities in care. We aimed to analyse the indications, demographics, and outcomes of kidney transplantation in Africa. METHOD We conducted a systematic review of studies from PubMed, Google Scholar, and African Journal Online using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We pooled and analysed data on procedure type, graft outcomes, donor type, prophylaxis, post-operative complications, and survival from 33 eligible studies. RESULT The most common causes of ESKD requiring transplantation were glomerulonephritis and nephroangiosclerosis. Open nephrectomy was the predominant surgical approach (95%). Living donors accounted for 56.3% (4221) of all donors, with 68.5% being related to the recipient. Cadaveric donors accounted for 43.7% (3280) of transplants. Graft rejection was the most common surgical complication (39.44%), and 60.49% of patients developed hypertension in the follow-up period. CONCLUSION Our study highlights the potential of kidney transplantation to improve the lives of ESKD patients in Africa. However, further research and infrastructure development are necessary to make this treatment more widespread and successful.
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Affiliation(s)
| | | | - Martin Igbokwe
- Urology, Surgery Interest Group of Africa, Lagos, Nigeria
| | - Moses Abu
- Urology, Surgery Interest Group of Africa, Lagos, Nigeria
| | | | - Quadri Sanni
- Urology, Surgery Interest Group of Africa, Lagos, Nigeria
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5
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Muacevic A, Adler JR, Muoka MO, Faponle AE, Igbokwe MC, Anosike I, Onwuasoanya UE, Olatise AT, Vasanth KR. Successful Third Kidney Transplantation in a Nigerian Kidney Transplant Center: A Case Report. Cureus 2022; 14:e32521. [PMID: 36654568 PMCID: PMC9838681 DOI: 10.7759/cureus.32521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Patients with end-stage renal disease have limited options in the course of their management. Kidney transplantation (KT) remains the gold standard for the management of renal replacement therapy. There is increasing evidence supporting the viability of third and fourth KTs. Due to the complexities of carrying out a successful third KT and the scarcity of living organ donors, it is not a common procedure in Nigeria's few renal transplant centres. To date, there is no reported case of a successful third KT in Nigeria. Here, we present the first reported case of a third KT carried out in Nigeria on a 44-year-old hypertensive, hepatitis B-infected, non-diabetic male patient. He had the first living donor KT eight years ago, which he lost due to poor immunosuppressive medication adherence. He then had a second living donor, KT, four years ago. Both KTs were from altruistic donors and were performed in the same hospital outside Nigeria. He developed allograft nephropathy after receiving the AstraZeneca COVID-19 vaccine 16 months ago and lost the second graft as a result. He was worked up and transplanted at our centre. Third kidney transplantation can be performed successfully despite the challenges of human leukocyte antigen (HLA) sensitization, antibiotic resistance, and surgical placement of the graft.
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Lang JJ, Lombardi CV, James IA, Da Rocha-Afodu DB, Okwuonu CG, Ekwenna OO. A Payer’s Perspective: A Comparison and Simulation of the Costs of Hemodialysis Versus Living Donor Kidney Transplant for Patients With End-Stage Renal Disease in Nigeria. Transpl Int 2022; 35:10662. [PMID: 35935273 PMCID: PMC9348811 DOI: 10.3389/ti.2022.10662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/03/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Jacob J. Lang
- Department of Urology and Transplantation, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States
| | - Conner V. Lombardi
- Department of Urology and Transplantation, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States
| | - Iyore A. James
- Surgical Specialists of Charlotte, Matthews, NC, United States
| | - David B. Da Rocha-Afodu
- Department of Urology and Transplantation, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States
| | - Chimezie G. Okwuonu
- Department of Internal Medicine, Nephrology Unit, Federal Medical Centre, Umuahia, Nigeria
| | - Obi O. Ekwenna
- Department of Urology and Transplantation, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States
- *Correspondence: Obi O. Ekwenna,
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Igbokwe MC, Asaolu SO, Muoka MO, Olatise OO. Impact of COVID-19 on renal replacement therapy: perspective from a Nigerian renal transplant centre. Pan Afr Med J 2022; 42:90. [PMID: 36034001 PMCID: PMC9379428 DOI: 10.11604/pamj.2022.42.90.33387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/25/2022] [Indexed: 11/04/2022] Open
Abstract
Introduction COVID-19 has had a huge impact on the health system and the world at large. Patients with kidney failure are a select group which have been affected significantly by the scourge of the disease. In the COVID-19 era, renal replacement therapy (RRT) in the form of dialysis and kidney transplantation required modifications in many centres in order to maintain high quality care and reduce infection rates among this susceptible group of patients. The objectives were to describe some of the challenges experienced in one of the leading renal care centres in Nigeria during the height of the COVID-19 pandemic and analyse the impact of practice changes on select outcomes. Methods a retrospective cross-sectional review of haemodialysis activities and kidney transplantation among chronic kidney disease patients was done over a 15-month period ranging from April, 2019 to June, 2021. Data was extracted from the electronic media record (EMR) and analysed using SPSS version 22. Results there was an initial significant drop in the number of haemodialysis sessions and kidney transplant surgeries by 16.7% and 66% respectively in the first 2 months of COVID-19 in our centre following the national lockdown. The mean monthly kidney transplant rate was 9±3.29 before the COVID-19 and the national lockdown, this figure reduced to 3.0±0.1 during the lockdown. Activities however normalized at 6 months following the initial lockdowns have remarkable exceeded pre-COVID numbers as at early 2021. Conclusion after the initial drop in numbers of patients for haemodialysis and renal transplantation, there was an increase in numbers in the following months. It was instructive to put several steps in place in order to continue to offer high level RRT in the COVID-19 pandemic. RRT can safely be practiced in the COVID-19 pandemic.
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Affiliation(s)
- Martin Chukwudum Igbokwe
- Urology Unit, Department of Surgery, Zenith Medical and Kidney Centre, Abuja, Nigeria,,Corresponding author: Martin Chukwudum Igbokwe, Urology Unit, Department of Surgery, Zenith Medical and Kidney Centre, Abuja, Nigeria.
| | | | - Michael Obinna Muoka
- Department of Clinical Research, Zenith Medical and Kidney Centre, Abuja, Nigeria
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Foluke Bosun-Arije S, Chibuzor Nwakasi C, Ekpenyong M, Serrant L, Esther Sunday-Abel T, Ling J. A nurse-led conceptual model to inform patient-centred, type 2 diabetes mellitus management in public clinical settings. J Res Nurs 2021; 26:763-778. [PMID: 35251284 PMCID: PMC8894752 DOI: 10.1177/17449871211021137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Globally, there is an increased need to provide patient-centred care for people
diagnosed with type 2 diabetes mellitus. In Nigeria, a poorly financed health system has
worsened the difficulties associated with managing type 2 diabetes mellitus in clinical
settings, causing a detrimental effect on patient-centred care. Aims We aimed to develop a conceptual model to promote patient-centred type 2 diabetes
mellitus care in clinical settings. We explored nurses’ contextual perceptions of
clinical practices and operations in light of type 2 diabetes mellitus management across
public hospitals in Lagos, Nigeria. Identifying a nurse-led intervention is critical to
care optimisation for people diagnosed with type 2 diabetes mellitus. Methods We adopted a qualitative approach. Using the constant comparison method and
semi-structured questions and interviewed practice nurses, with over one year’s
experience and who were working in public hospitals across Lagos, Nigeria. The framework
method was used to analyse the data obtained. Results Nurses provided insight into four areas of patient-centred type 2 diabetes mellitus
management in clinical settings: empowering collaboration; empowering flexibility;
empowering approach; and empowering practice. Nurses discussed an empowering pathway
through which health settings could provide patient-centred care to individuals
diagnosed with type 2 diabetes mellitus. The pathway entailed the integration of macro,
meso and micro levels for patient management. Nurses’ accounts have informed the
development of a conceptual model for the optimisation of patient care. Conclusions The model developed from this research sits within the patient-centred care model of
healthcare delivery. The research sits within the patient-centred care model of
healthcare delivery. inform patient-centred care, not only in countries with poorly
financed healthcare systems, but in developed countries with comparatively better
healthcare.
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Affiliation(s)
| | | | - Mandu Ekpenyong
- Research Fellow, Department of Nursing, Manchester Metropolitan University, UK
| | - Laura Serrant
- Professor, Department of Nursing, Manchester Metropolitan University, UK
| | | | - Jonathan Ling
- Professor, Faculty of Health Sciences and Wellbeing, University of Sunderland, UK
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9
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Next-generation sequencing in patients with familial FSGS: first report of collagen gene mutations in Tunisian patients. J Hum Genet 2021; 66:795-803. [PMID: 33654185 DOI: 10.1038/s10038-021-00912-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/09/2021] [Accepted: 02/16/2021] [Indexed: 11/08/2022]
Abstract
Focal segmental glomerulosclerosis (FSGS) is a histological lesion with many causes, including inherited genetic defects, with significant proteinuria being the predominant clinical finding at presentation. FSGS is considered as a podocyte disease due to the fact that in the majority of patients with FSGS, the lesion results from defects in the podocyte structure. However, FSGS does not result exclusively from podocyte-associated genes. In this study, we used a genetic approach based on targeted next-generation sequencing (NGS) of 242 genes to identify the genetic cause of FSGS in seven Tunisian families. The sequencing results revealed the presence of eight distinct mutations including seven newly discovered ones: the c.538G>A (p.V180M) in NPHS2, c.5186G>A (p.R1729Q) in PLCE1 and c.232A>C (p.I78L) in PAX2 and five novel mutations in COL4A3 and COL4A4 genes. Four mutations (c.209G>A (p.G70D), c.725G>A (p.G242E), c.2225G>A (p.G742E), and c. 1681_1698del) were detected in COL4A3 gene and one mutation (c.1424G>A (p.G475D)) was found in COL4A4. In summary, NGS of a targeted gene panel is an ideal approach for the genetic testing of FSGS with multiple possible underlying etiologies. We have demonstrated that not only podocyte genes but also COL4A3/4 mutations should be considered in patients with FSGS.
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Eke FU, Ladapo TA, Okpere AN, Olatise O, Anochie I, Uchenwa T, Okafor H, Ibitoye P, Ononiwu U, Adebowale A, Akuse R, Oniyangi S. The current status of kidney transplantation in Nigerian children: still awaiting light at the end of the tunnel. Pediatr Nephrol 2021; 36:693-699. [PMID: 32974728 DOI: 10.1007/s00467-020-04753-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Kidney transplantation (KT) is the gold standard treatment for children with chronic kidney disease stage 5 (CKD5). It is easily accessible in well-resourced countries, but not in low/middle-income countries (LMICs). We present, a multicentre experience of paediatric KT of children domiciled in Nigeria. We aim to highlight the challenges and ethical dilemmas that children, their parents or guardians and health care staff face on a daily basis. METHODS A multicentre survey of Nigerian children who received KTs within or outside Nigeria from 1986 to 2019 was undertaken using a questionnaire emailed to all paediatric and adult consultants who are responsible for the care of children with kidney diseases in Nigeria. Demographic data, causes of CKD5, sources of funding, donor organs and graft and patient outcome were analysed. Using Kaplan-Meier survival analysis, we compared graft and patient survival. RESULTS Twenty-two children, aged 4-18 years, received 23 KTs, of which 12 were performed in Nigeria. The male-to-female ratio was 3.4:1. Duration of pre-transplant haemodialysis was 4-48 months (median 7 months). Sixteen KTs were self-funded. State governments funded 3 philanthropists 4 KTs. Overall differences in graft and patient survival between the two groups, log rank test P = 0.68 and 0.40, respectively were not statistically significant. CONCLUSIONS The transplant access rate for Nigerian children is dismal at < 0.2%. Poor funding is a major challenge. There is an urgent need for the federal government to fund health care and particularly KTs. Graphical Abstract.
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Affiliation(s)
- Felicia U Eke
- University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria.
| | - Taiwo A Ladapo
- Lagos University Teaching Hospital, Lagos, Lagos State, Nigeria
| | - Augustina N Okpere
- University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - Olalekan Olatise
- Zenith Medical Centre, Abuja, Federal Capital Territory, Nigeria
| | - Ifeoma Anochie
- University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - Tochi Uchenwa
- University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - Henrietta Okafor
- University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria
| | - Paul Ibitoye
- Usman Da Fodio University Teaching Hospital, Sokoto, Sokoto State, Nigeria
| | - Uchenna Ononiwu
- National Hospital, Abuja, Federal Capital Territory, Nigeria
| | | | - Rosamund Akuse
- Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Seyi Oniyangi
- National Hospital, Abuja, Federal Capital Territory, Nigeria
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11
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Khoshravesh S, Karimi-Shahanjarini A, Poorolajal J, Bashirian S, Barati M, Hamidi M, Khalili S. Socio-Cultural Factors Contributing to Being an Organ Donor in Iranian Employees. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2020; 42:171-179. [PMID: 33241985 DOI: 10.1177/0272684x20972836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS The purpose of this study was to use a culturally modified Organ Donation Model (ODM) to explore the significant factors and ways in which these factors could influence signing the donor card. METHODS This cross-sectional study was conducted among 600 employees from 57 offices in Hamadan, Iran, in 2018. Participants were selected randomly and surveyed on being a donor and their perceptions regarding signing the donor card. Structural equation modeling (SEM) was conducted to determine the inter-relationship between the studied variables. RESULTS Participants' mean age was 39.5 (SD = 7.0). 20% of participants had a signed donor card. Descriptive norms (β = 0.53, p < 0.001), non-cognitive beliefs (β=-0.33, p < 0.001), anticipated regret (β = 0.28, p < 0.001) and subjective norms (β=-0.17, p < 0.01) had significant direct effects on signing the donor card. CONCLUSION This study provides socio-culturally informed evidence on individuals' signing donor card. These factors could provide a guide to policymakers to develop the community-based interventions.
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Affiliation(s)
- Sahar Khoshravesh
- Department of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.,Students Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Akram Karimi-Shahanjarini
- Department of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.,Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Jalal Poorolajal
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.,Modeling of Noncommunicable Diseases Research Center, School of Public Health, Hamadan University of Medical, Hamadan, Iran
| | - Saeed Bashirian
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Majid Barati
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Majid Hamidi
- Organ Donation Association, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sanaz Khalili
- Department of Biostatistics and Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
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12
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Loua A, Feroleto M, Sougou A, Kasilo OMJ, Nikiema JB, Fuller W, Kniazkov S, Tumusiime P. A review of policies and programmes for human organ and tissue donations and transplantations, WHO African Region. Bull World Health Organ 2020; 98:420-425. [PMID: 32514216 PMCID: PMC7265924 DOI: 10.2471/blt.19.236992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 11/27/2022] Open
Abstract
Several resolutions, endorsed by the World Health Assembly and the United Nations General Assembly, articulate the need to improve the availability, quality and safety of organ and tissue donation and transplantation, as well as to prevent and combat trafficking in human organs. Here we assessed the implementation of these resolutions pertaining to organ and tissue donations and transplantations by sending out a questionnaire to all 47 countries in the World Health Organization African Region. From 33 countries that provided data, we identified several obstacles and challenges. Compared to other regions, there are very limited data on organ donation and transplantation. Most countries are lacking legal and regulatory frameworks, since they did not yet establish a specific or comprehensive legislation covering donation and transplantation of human organs and tissues. Countries also have a poor national capacity to perform organ and tissue transplantations and the organization and management of national programmes are weak. Funding, both from domestic and external sources, is insufficient to implement effective transplantations programmes and patients have inadequate financial protection. To address these challenges, we propose that countries and partners should develop and implement policies, strategies, plans and regulatory frameworks for all aspects of organ and tissue donations and transplantations, including fighting against organ trafficking and transplant tourism. Where donation and transplantation programmes exist, stakeholders should develop the skills of human resources, adopt technical standards and quality management procedures to improve donation and transplantation of human organs and tissues.
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Affiliation(s)
- André Loua
- World Health Organization Regional Office for Africa, Cite du Djoue, P.O. Box 06, Brazzaville, Congo
| | - Margot Feroleto
- Department of International Health, Georgetown University, Washington, DC, United States of America
| | - Aissatou Sougou
- World Health Organization Regional Office for Africa, Cite du Djoue, P.O. Box 06, Brazzaville, Congo
| | | | - Jean Baptiste Nikiema
- World Health Organization Regional Office for Africa, Cite du Djoue, P.O. Box 06, Brazzaville, Congo
| | - Walter Fuller
- World Health Organization Regional Office for Africa, Cite du Djoue, P.O. Box 06, Brazzaville, Congo
| | - Stanislav Kniazkov
- World Health Organization Regional Office for Africa, Cite du Djoue, P.O. Box 06, Brazzaville, Congo
| | - Prosper Tumusiime
- World Health Organization Regional Office for Africa, Cite du Djoue, P.O. Box 06, Brazzaville, Congo
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13
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Insuffisance rénale terminale au Maghreb et en Afrique : panorama des programmes de transplantation au Maghreb et en Afrique. Nephrol Ther 2020; 16:171-176. [DOI: 10.1016/j.nephro.2019.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 08/27/2019] [Indexed: 11/24/2022]
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14
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Ulasi II, Ijoma C, Onodugo O, Arodiwe E, Okoye J, Onu U, Ijoma U, Ifebunandu N, Afolabi O, Nwobodo U. Posttransplant Care of Kidney Transplant Recipients and Their Donors in Nigeria. EXP CLIN TRANSPLANT 2019; 17:50-56. [PMID: 30777523 DOI: 10.6002/ect.mesot2018.l44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Kidney transplantation is not readily available in low-resource settings because of poor health structure, dearth of experts, and pervading poverty. Although many centers now offer kidney transplant, patients still travel outside Nigeria for this service for many reasons and many return home without a detailed medical report. MATERIALS AND METHODS Medical records of individuals who underwent kidney transplant in Nigeria and elsewhere and who were presently receiving posttransplant care or had received such care from 2002 to 2018 at 4 Nigerian hospitals were retrospectively reviewed and analyzed. RESULTS Of 35 patients (30 males; 85.7%) analyzed (mean ages of 42 ± 16 and 47 ± 8 years for men and women, respectively; P = .54), common primary kidney diseases included hypertension (27.2%), glomerulonephritis (24.2%), and diabetes mellitus/hypertension (18.3%). Most patients received transplants in India (48.6%), with others in Nigeria (23.0%) and Pakistan (8.6%). Relationships to recipient were unrelated (28.5%), living related (22.9%), and unknown (48.6%). Less than 30% of recipients had care details in their hospital records. Almost all transplant patients were treated with prednisolone (81.8%); cyclosporine (40.0%), mycophenolate mofetil (31.4%), tacrolimus (20.0%), and azathioprine (9.1%) were also used. Complications were documented in 88.9%, with 57.0% due to bacterial infections/sepsis. Many (88.9%) had more than 2 complications. In follow-up, median first transplant duration was 24 months (interquartile range, 6-44). Of total patients, 25.7% were still alive, 17.1% had died, and 54.2% were lost to follow-up. Follow-up data for only 2 donors were available. CONCLUSIONS Lapses in follow-up care of kidney transplant recipients and donors continue in lowresource settings where transplant tourism is still rife, resulting in poor graft/patient survival. Adherence to transplant guidelines is advocated. We propose a transplant stratification model according to level of development and resources of countries or regions. This model will encourage customizing strategies for improving patient outcomes.
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Affiliation(s)
- Ifeoma I Ulasi
- From the Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria; and the Department of Medicine, Federal Teaching Hospital, Abakaliki, Nigeria
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Bosun-Arije FS, Ling J, Graham Y, Hayes C. A systematic review of factors influencing Type 2 Diabetes Mellitus management in Nigerian public hospitals. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2019. [DOI: 10.1016/j.ijans.2019.100151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Carrero JJ, Hecking M, Chesnaye NC, Jager KJ. Sex and gender disparities in the epidemiology and outcomes of chronic kidney disease. NATURE REVIEWS. NEPHROLOGY 2018. [PMID: 29355169 DOI: 10.1038/nrneph.2017.181.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Improved understanding of sex and gender-specific differences in the aetiology, mechanisms and epidemiology of chronic kidney disease (CKD) could help nephrologists better address the needs of their patients. Population-based studies indicate that CKD epidemiology differs by sex, affecting more women than men, especially with regard to stage G3 CKD. The effects of longer life expectancy on the natural decline of glomerular filtration rate (GFR) with age, as well as potential overdiagnosis of CKD through the inappropriate use of GFR equations, might be in part responsible for the greater prevalence of CKD in women. Somewhat paradoxically, there seems to be a preponderance of men among patients starting renal replacement therapy (RRT); the protective effects of oestrogens in women and/or the damaging effects of testosterone, together with unhealthier lifestyles, might cause kidney function to decline faster in men than in women. Additionally, elderly women seem to be more inclined to choose conservative care instead of RRT. Dissimilarities between the sexes are also apparent in the outcomes of CKD. In patients with predialysis CKD, mortality is higher in men than women; however, this difference disappears for patients on RRT. Although access to living donor kidneys among men and women seems equal, women have reduced access to deceased donor transplantation. Lastly, health-related quality of life while on RRT is poorer in women than men, and women report a higher burden of symptoms. These findings provide insights into differences in the underlying pathophysiology of disease as well as societal factors that can be addressed to reduce disparities in access to care and outcomes for patients with CKD.
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Affiliation(s)
- Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Centre for Gender Medicine, Karolinska Institutet, Nobels Väg 12A, BOX 281, 171 77 Stockholm, Sweden
| | - Manfred Hecking
- Department of Internal Medicine III, Clinical Division of Nephrology and Dialysis, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Nicholas C Chesnaye
- European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105AZ Amsterdam, Netherlands
| | - Kitty J Jager
- European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105AZ Amsterdam, Netherlands
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Carrero JJ, Hecking M, Chesnaye NC, Jager KJ. Sex and gender disparities in the epidemiology and outcomes of chronic kidney disease. Nat Rev Nephrol 2018; 14:151-164. [PMID: 29355169 DOI: 10.1038/nrneph.2017.181] [Citation(s) in RCA: 435] [Impact Index Per Article: 72.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Improved understanding of sex and gender-specific differences in the aetiology, mechanisms and epidemiology of chronic kidney disease (CKD) could help nephrologists better address the needs of their patients. Population-based studies indicate that CKD epidemiology differs by sex, affecting more women than men, especially with regard to stage G3 CKD. The effects of longer life expectancy on the natural decline of glomerular filtration rate (GFR) with age, as well as potential overdiagnosis of CKD through the inappropriate use of GFR equations, might be in part responsible for the greater prevalence of CKD in women. Somewhat paradoxically, there seems to be a preponderance of men among patients starting renal replacement therapy (RRT); the protective effects of oestrogens in women and/or the damaging effects of testosterone, together with unhealthier lifestyles, might cause kidney function to decline faster in men than in women. Additionally, elderly women seem to be more inclined to choose conservative care instead of RRT. Dissimilarities between the sexes are also apparent in the outcomes of CKD. In patients with predialysis CKD, mortality is higher in men than women; however, this difference disappears for patients on RRT. Although access to living donor kidneys among men and women seems equal, women have reduced access to deceased donor transplantation. Lastly, health-related quality of life while on RRT is poorer in women than men, and women report a higher burden of symptoms. These findings provide insights into differences in the underlying pathophysiology of disease as well as societal factors that can be addressed to reduce disparities in access to care and outcomes for patients with CKD.
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Affiliation(s)
- Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Centre for Gender Medicine, Karolinska Institutet, Nobels Väg 12A, BOX 281, 171 77 Stockholm, Sweden
| | - Manfred Hecking
- Department of Internal Medicine III, Clinical Division of Nephrology and Dialysis, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Nicholas C Chesnaye
- European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105AZ Amsterdam, Netherlands
| | - Kitty J Jager
- European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105AZ Amsterdam, Netherlands
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Abstract
BACKGROUND Diabetes is a noncommunicable disease that has attained great significance in the sub-Saharan region, with Nigeria being the most affected. Many persons with the condition suffer a reduced life expectancy and quality of life. Diabetes places an extra burden on the individuals and families affected, especially for the majority of patients unable to access quality health care. OBJECTIVE To describe the elements of diabetes management in Nigeria, areas for improvement, and proposed strategies to optimize care. METHODS A systematic literature search was performed on diabetes in Nigeria. Local and nonindexed literature, PubMed, and Google Scholar were used to source information on the subject. FINDINGS Diabetes-related morbidity and mortality continue to increase due to population expansion, urban migration, declining physical activity, and dietary factors. The organization of diabetes care is poorly coordinated, especially at the primary and secondary tiers of the public health care system, with consequent poor outcomes. Thus life expectancy (just about 50 years), which is low in the region, is further reduced by the double jeopardy of communicable (eg, tuberculosis, HIV/AIDS, and malaria) and noncommunicable diseases, such as diabetes and its closely related comorbidity, hypertension. CONCLUSIONS The way forward is to improve maternal and child care, promote screening of at-risk populations, and develop strategies for primary prevention and early intervention to optimize glycemic control. Greater commitment to health care by the government and nongovernmental organizations and greater awareness by Nigerians should facilitate the desired improvements in disease prevention and glycemic control in those who are already affected.
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Affiliation(s)
- Olufemi A Fasanmade
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria.
| | - Samuel Dagogo-Jack
- Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, TN
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End Stage Renal Disease—A Nephrologist’s Perspective of Two Different Circumstances as Typified by Kidney Transplantation Experience in a Nigerian Hospital Versus a Large US Medical School. Healthcare (Basel) 2017. [PMCID: PMC5618159 DOI: 10.3390/healthcare5030031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Renal transplantation is the sine qua non consummate form of renal replacement therapy (RRT) for end stage renal disease (ESRD). Despite the increasing ESRD burden worldwide, developing countries continue to experience a gross lack of RRT options for its teeming citizens with ESRD. This report is a demonstration of a nephrologist’s experience and dilemma trying to make sense of the yawning disparity between RRT options, especially renal transplantation, as it applies to the citizens of the USA versus the citizens of Nigeria. The limited three-year experience of renal transplantation at Garki Hospital, located in Abuja, the capital of Nigeria, which is one of the very few centers carrying out renal transplantation in Nigeria, was starkly contrasted with this author’s first-hand experience at the University of Maryland Medical School, in Baltimore, Maryland, USA, as a Nephrology Fellow between 2000 and 2002. The potential role of public-private partnership (PPP) ventures in developing countries is considered as a way to help bridge this gap. Prologue: Just the other day, in late April 2017, during weekly scheduled hemodialysis rounds at one of the Mayo Clinic Dialysis Services outpatient hemodialysis units in Northwestern Wisconsin, this author was rounding on a pleasant 76-year old Caucasian widow who had been on dialysis since June 2016 for end stage renal disease (ESRD). Her other past medical history was notable for statin-induced myopathy, dyslipidemia, hyperuricemia, and gout, as well as peripheral vascular disease with previous bilateral femoral artery bypass procedures, a left knee meniscus repair, and unilateral renal artery stenosis, which was stented in November of 2013 and re-stented again in December of 2014. During the hemodialysis rounds, she had been asked how she was doing. “Today is my last day,” she had chuckled with a broad smile. She was getting a living kidney transplant in two days’ time at Mayo Clinic, Rochester. “The donor is my 49-year old daughter!” she added with an even broader smile. “I hope all goes well,” this author had intoned. “It will. It will,” she added, with glee. This tells the whole story; for the ESRD patient on thrice weekly hemodialysis, or any other renal replacement therapy (RRT) option for that matter, the act of getting a kidney transplant is a transformative phenomenon. “It is as if being born again,” one of my patients had noted previously.
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Transplant tourism among kidney transplant patients in Eastern Nigeria. BMC Nephrol 2017; 18:215. [PMID: 28679360 PMCID: PMC5498908 DOI: 10.1186/s12882-017-0635-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 06/26/2017] [Indexed: 11/30/2022] Open
Abstract
Background Transplant tourism entails movement of recipient, donor or both to a transplant centre outside their country of residence. This has been reported in many countries; and has variously been associated with organ trade. The objective of this study is to determine the frequency and pattern of transplant tourism among transplant patients in Eastern Nigeria. Methods This is a non randomized cross sectional study. All kidney transplant patients who presented at Enugu State University Teaching Hospital Parklane Enugu and Hilton Clinics Port Harcourt in Nigeria were recruited. The clinical parameters including the transplant details of all the patients were documented. The data obtained was analysed using SPSS package. Results A total of one hundred and twenty six patients were studied, 76.2% were males with M:F ratio of 3.2:1 and mean age of 46.9 ± 13.3 years. Fifty four and 58.7% of the patients were managed in a tertiary hospital and by a nephrologist respectively before referral for kidney transplant. Only 15.8% of the patients had their kidney transplant without delay: finance, lack of donor, logistics including delay in obtaining travelling documents were the common causes of the delay. Ninety percent of the patients had their transplant in India with majority of them using commercial donors. India was also the country with cheapest cost ($18,000.00). 69.8% were unrelated donors, 68.2% were commercial donors and 1.6% of the donors were spouse. All the commercial donors received financial incentives and each commercial donor received mean of 7580 ± 1280 dollars. Also 30.2% of the related donors demanded financial incentive. Conclusion Transplant tourism is prevalent in eastern Nigeria.
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Exploring caregiver burden experienced by family caregivers of patients with End-Stage Renal Disease in Nigeria. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2017. [DOI: 10.1016/j.ijans.2017.11.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Amira CO, Bello BT. Do the Benefits of Transplant Tourism Amongst Nigerian Patients Outweigh the Risks? A Single-Center Experience. Int J Organ Transplant Med 2017; 8:132-139. [PMID: 28924461 PMCID: PMC5592100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Transplant tourism (TT) is the term used to describe travel outside one's country of abode for the sole purpose of obtaining organ transplantation services. OBJECTIVE This study describes the characteristics and outcomes of kidney transplant tourists who were followed up in our institution. METHODS A retrospective study was conducted on patients who underwent kidney transplantation outside the country and were followed up in our institution from 2007 to 2015. RESULTS 26 patients were followed up; 19 (73%) were males. The mean±SD age of patients was 40.5±10.3 years. The majority (n=20) of the transplantations were carried out in India. Living-unrelated transplants were most common (54%). Complications encountered were infections in 11 (42%) patients, new-onset diabetes after transplantation in 9 (35%), chronic allograft nephropathy in 8 (31%), biopsy-proven acute rejections in 3 (12%), and primary non-function in 2 (8%). 1-year graft survival was 81% and 1-year patient survival was 85%. CONCLUSION Kidney transplant tourism is still common among Nigerian patients with end-stage renal disease. Short-term graft and patient survival rates were poorer than values recommended for living kidney transplants. We therefore advise that TT should be discouraged in Nigeria, given the availability of transplantation services in the country, and also in line with international efforts to curb the practice.
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Affiliation(s)
- C. O. Amira
- Nephrology Unit, Department of Medicine, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria,Correspondence: Christiana Oluwatoyin Amira, Department of Medicine, College of Medicine, University of Lagos, PMB 12003, Idi-Araba, Lagos, Nigeria, Tel: +234-802-855-4566, E-mail:
| | - B. T. Bello
- Nephrology Unit, Department of Medicine, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
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Okafor UH. Kidney transplant in Nigeria: a single centre experience. Pan Afr Med J 2016; 25:112. [PMID: 28292075 PMCID: PMC5325483 DOI: 10.11604/pamj.2016.25.112.7930] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 10/20/2016] [Indexed: 12/03/2022] Open
Abstract
Introduction Kidney transplant is the preferred renal replacement therapy for patients with end stage kidney disease. However management of patients with kidney transplant in resource poor countries is evolving and groaning under several mental, financial and infrastructural challenges. The objective of the study is to evaluate the management of patients with kidney transplant in a kidney care Centre in Nigeria. Methods This was a non-randomized prospective study. The study population were post-transplant patients presenting between 1st August 2010 and 31st December 2014.The biodata, pre and post-transplant details of these patients were documented. The data was analysed using SPSS Vs 17. Results A total of 47 patients were studied with M: F ratio of 4:1, the mean age was 45.4 ± 13.6 years. Chronic glomerulonephritis, hypertension, diabetes mellitus and HIV related kidney disease were the commonest cause of CKD. Financial constraint delayed transplant in 66% and non-availability of donor in 17.2%. About 90% of the transplants were in India and 81% either financed the transplant either directly or through a relation. There was no cadaveric transplant and about 70% of the donors were not related. Tacrolimus, mycophenolate and prednisolone were most frequently used immunosuppressive combination. The one and three years graft survival were 95.3% and 67.6% respectively while corresponding patients survival were 97.7% and 82.4% respectively. Septicaemia, acute rejection and urinary tract infection were most common complications. Conclusion Management of patients with kidney transplant has good prospect despite the challenges.
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Braga LSDS, Moratelli L, Carminatti M, Marsicano EO, Colugnati FAB, Sanders-Pinheiro H. Low-Activity Kidney Transplant Center, A Single-Center Experience: Early Care as a Major Challenge. EXP CLIN TRANSPLANT 2016; 14. [PMID: 27364327 DOI: 10.6002/ect.2015.0345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES In many countries, some kidney transplants are performed in small centers, from which clinical data are rarely specifically reported. The aim of this study was to describe patient and graft survival rates and their correlates in a low-activity kidney transplant center. MATERIALS AND METHODS We performed a retrospective cohort study of all patients who underwent transplant between January 2002 and May 2012 at a university hospital. Patient, graft, and death-censored graft survival rates were assessed with Kaplan-Meier analyses and compared by log-rank test, with associated factors analyzed by Cox proportional hazards modeling. RESULTS Among a total of 162 patients, the mean age was 41.8 ± 13.5 years, and 92% received a living-donor graft. At 1, 3, and 5 years, patient survival was 88.6%, 86%, and 82.9%. Graft survival was 86.9%, 83%, and 77%, and death-censored graft survival was 98.1%, 96.6%, and 92.9% at the same time points. Most graft losses were due to patient death from infection and occurred within the first year after transplant. After adjustment, age over 42 years (hazard ratio of 3.94; 95% confidence interval, 1.39-11.13), deceased donor graft (hazard ratio of 11.41; 95% confidence interval, 1.2-108.35), and higher average education (hazard ratio of 4.96; 95% confidence interval, 1.01-24.32) were independently associated with graft loss. CONCLUSIONS The observed patient and graft survival rates were similar to those described in large databases; however, early mortality remains a major challenge. Improving posttransplant care is a key issue to increasing survival in small transplant centers.
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Affiliation(s)
- Luciane Senra de Souza Braga
- From the Division of Nephrology, Federal University of Juiz de Fora Hospital, and the Interdisciplinary Center for Studies and Research in Nephrology (NIEPEN), Juiz de Fora, Minas Gerais, Brazil
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Ekuma AE, Oduyebo OO, Efunshile AM, Konig B. SURVEILLANCE FOR VANCOMYCIN RESISTANT ENTEROCOCCI IN A TERTIARY INSTITUTION IN SOUTH WESTERN NIGERIA. Afr J Infect Dis 2016; 10:121-126. [PMID: 28480447 PMCID: PMC5411987 DOI: 10.21010/ajid.v10i2.8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Enterococci are responsible for up to 12% of cases of healthcare associated infections worldwide and cause life threatening infections among critically ill patients. They show intrinsic and acquired resistance to a wide range of antimicrobial agents. Glycopeptide resistance is due to vanA, vanB, vanC, vanD, vanE, vanG and vanL genes. OBJECTIVES To determine the carriage rate of VRE among patients on prolonged hospitalization in Lagos University Teaching Hospital, assess the antimicrobial resistance pattern of VRE, identify factors associated with VRE colonization and describe the genetic determinants of enterococcal resistance to Vancomycin. METHODS VRE were isolated from rectal swabs collected from patients hospitalized for seven days or more in Lagos University Teaching Hospital and identified by Matrix Assisted Laser Desorption Ionization (MALDI) and Polymerase Chain Reaction (PCR). Antimicrobial susceptibility testing was performed by E-test. PCR assay for Vancomycin resistance genes was also performed. Data on demographic and risk factors collected by questionnaire was tested for significance using Chi square. RESULTS Thirteen of 319 patients surveyed were colonized with VRE; one with vanA E. faecium, two with vanB E. faecium, ten with E. gallinarum and one with E. casseliflavus. Univariate analysis for risk factors associated with VRE colonization was only significant for the ward of admission. Only one VRE isolate showed full resistance to Vancomycin and Teicoplanin. Three were resistant to Ampicillin and nine to Ciprofloxacin but all were susceptible to Linezolid. High-level resistance to Gentamicin was found in four VRE isolates. CONCLUSION There is a low prevalence of VRE in Lagos University Teaching Hospital which may be spreading among patients in affected wards.
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Affiliation(s)
- Agantem Emmanuel Ekuma
- Dept. of Medical Microbiology, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Oyin O Oduyebo
- Department of Microbiology, College of Medicine; University of Lagos, Nigeria
| | - Akinwale Michael Efunshile
- Dept. of Medical Microbiology, Ebonyi State University, Abakaliki, Nigeria.,Institute of Medical Microbiology and Infectious Disease Epidemiology, University of Leipzig, Germany
| | - Brigitte Konig
- Institute of Medical Microbiology and Infectious Disease Epidemiology, University of Leipzig, Germany
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Living Kidney Donor Transplantation in a Resource-limited Country: The Ivory Coast Experience. Transplant Proc 2016; 47:1580-4. [PMID: 26293016 DOI: 10.1016/j.transproceed.2015.03.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 02/15/2015] [Accepted: 03/04/2015] [Indexed: 11/18/2022]
Abstract
Renal transplantation that offers a good quality of life still is not performed by the majority of countries of black Africa. We started a pilot project of renal transplantation in Ivory Coast 2 years ago. The present paper reports the preliminary results, difficulties related to the program, and perspectives regarding its expansion. Ten living related kidney transplantations have been performed over a 2-year period. Recipients and their respective donors were male. The mean age of the recipients was 42.8 years (22-57), and the mean age of the donors was 29.4 years (22-43). The mean number of mismatches was 3.2 (0-6). None was immunized. Recipients and donors were all EBV IgG positive and CMV IgG positive. All but 1 case were induced with basiliximab. The mean graft and patient survival time was 16.6 months (6-26). The mean cold ischemic time was 2.27 hours (1-3.32). The mean serum creatinine at discharge was 241.87 μmol/L (115.18-1063.2), at 6 months was 117.20 μmol/l (95.6-139.9), at 12 months was 104.55 μmol/L (62.02-132.9), and at 24 months was 104.55 μmol/L (62.02-132.9). The mean cyclosporine through level (C0) at 6 months was 137.57 ng/mL (70-366), at 12 months was 117.33 ng/mL (62-197), and at 24 months was 78 ng/mL. The mean cyclosporine 2-hour post-administration concentration levels (C2) at 6 months was 764.9 ng/mL (430-1421), at 12 months was 937.17 ng/mL (483-1292), and at 24 months was 690.66 ng/mL (488-853). Main complications were sepsis, adenovirus hemorrhagic cystitis, new-onset diabetes after transplantation, delayed graft function, polycythemia, and cytomegalovirus infection. No clinical rejection was diagnosed over the 2-year period. Patient and graft survival was 100% at a mean post-transplantation time of approximately 16.6 months.
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Oluyombo R, Fawale MB, Ojewola RW, Busari OA, Ogunmola OJ, Olanrewaju TO, Akinleye CA, Oladosu YO, Olamoyegun MA, Gbadegesin BA, Obajolowo OO, Soje MO, Adelaja A, Ayodele LM, Ayodele OE. Knowledge Regarding Organ Donation and Willingness to Donate among Health Workers in South-West Nigeria. Int J Organ Transplant Med 2016; 7:19-26. [PMID: 26889370 PMCID: PMC4756261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Organ transplantation program in developing countries is still significantly dwarfed. Health workers are undeniably important in the success of transplantation. OBJECTIVE To assess the knowledge and attitude of health workers toward organ donation in South-West Nigeria with a view to explaining reasons for these shortcomings. METHODS In a cross-sectional study conducted on 850 health care workers, self-administered questionnaires were used to obtain information from participants. RESULTS Of 850 participants, 766 (90.1%) returned their completed questionnaires. The mean±SD age of participants was 36.7±9.2 years. Majority (93.3%) of participants had heard of organ donation; 82.5% had desirable knowledge. Only 29.5% and 39.4% would be willing to donate and counsel potential organ donors, respectively; 36.5% would consider signing organ donation cards. Only 19.4% believed that organ transplantation is often effective and 63.4% believed they were permitted by their religion to donate. Permission by religion (OR 3.5; 95% CI 2.3 to 5.3), good knowledge (OR 2.9; 95% CI 1.4 to 5.7), readiness to sign donation cards (OR 2.6; 95% CI 1.7 to 3.8), discuss organ donation (OR 2.7; 95%CI 8.0 to 63.8), and knowing somebody who had donated (OR 2.9) independently influenced willingness to donate organ. CONCLUSION There is disparity in knowledge of organ donation and willingness to donate among health care workers. Efforts should be intensified to give comprehensive and appropriate education to health care workers about organ donation to bridge this gap.
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Affiliation(s)
- R. Oluyombo
- Renal Unit, Internal Medicine Department, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria
| | - M. B. Fawale
- Neurology Unit, Department of Internal Medicine, Obafemi Awolowo University Teaching Hospital Ile-Ife, Osun State, Nigeria
| | - R. W. Ojewola
- Urological Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - O. A. Busari
- Cardiology Unit, Department of Internal Medicine, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria
| | - O. J. Ogunmola
- Cardiology Unit, Department of Internal Medicine, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria
| | - T. O. Olanrewaju
- Renal Unit, Medicine Department, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - C. A. Akinleye
- Department of Community Medicine, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria
| | - Y. O. Oladosu
- Cardiology Unit, Department of Internal Medicine, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria
| | - M. A. Olamoyegun
- Internal Medicine Department, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Oyo state, Nigeria
| | - B. A. Gbadegesin
- Renal Unit, Department of Internal Medicine, Ladoke Akintola University Teaching Hospital, Ogbomoso, Oyo State, Nigeria
| | - O. O. Obajolowo
- Renal Unit, Internal Medicine Department, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria
| | - M. O. Soje
- Renal Unit, Internal Medicine Department, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria
| | - A. Adelaja
- Renal Unit, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria
| | - L. M. Ayodele
- Mental Health Unit, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria
| | - O. E. Ayodele
- Renal Unit, Department of Internal Medicine, Ladoke Akintola University Teaching Hospital, Ogbomoso, Oyo State, Nigeria
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Oluyombo R, Fawale BM, Busari OA, Ogunmola JO, Olanrewaju TO, Akinleye CA, Ojewola RW, Yusuf M, Obajolowo O, Soje M, Gbadegesin B. Organ Donation Among Tiers of Health Workers: Expanding Resources to Optimize Organ Availability in a Developing Country. Transplant Direct 2016; 2:e52. [PMID: 27500245 PMCID: PMC4946505 DOI: 10.1097/txd.0000000000000560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 11/03/2015] [Indexed: 11/26/2022] Open
Abstract
UNLABELLED The global increase in end organ failure but disproportional shortage of organ donation calls for attention. Expanding the organ pool by assessing and improving health workers' attitude at all levels of care may be a worthwhile initiative. METHODS A questionnaire-based cross sectional study involving tertiary, secondary, and primary health institutions in Southwestern Nigeria was conducted. RESULTS Age range was 18 to 62 (36.7 ± 9.2) years. Only 13.5%, 11.7%, and 11.2% from primary, secondary, and tertiary health centers, respectively, would definitely donate despite high level of awareness (>90%) at each level of care. Participants from primary health care are of low income (P < 0.05), and this cohort is less likely to be aware of organ donation (P < 0.05). At each level of care, permission by religion to donate organs influenced positive attitudes (willingness to donate, readiness to counsel families of potential donors, and signing of organ donation cards) toward organ donation. Good knowledge of organ donation only significantly influenced readiness to counsel donors (P < 0.05) and not willingness to donate (P > 0.05). At each level of health care, young health care workers (P < 0.05) and women (P > 0.05) would be willing to donate, whereas men show positive attitude in signing of organ donor cards (P < 0.05) and counseling of families of potential donors (P > 0.05). CONCLUSIONS Knowledge and willingness to donate organs among health care levels were not different. Considering the potential advantage of community placement of other tiers of health care (primary and secondary) in Nigeria, integrating them would be strategically beneficial to organ donation.
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Affiliation(s)
- Rotimi Oluyombo
- Department of Internal Medicine, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria
| | - Bimbo Michael Fawale
- Department of Internal Medicine, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | | | | | | | - Callistus Adewale Akinleye
- Department of Community Medicine, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria
| | - Rufus Wale Ojewola
- Department of Surgery, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Musah Yusuf
- Department of Internal Medicine, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria
| | - Omotola Obajolowo
- Department of Internal Medicine, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria
| | - Michael Soje
- Department of Internal Medicine, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria
| | - Babajide Gbadegesin
- Department of Internal Medicine, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria
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Abiodun M, Solarin A, Adejumo O, Akinbodewa A. Caregivers and Healthcare Workers' Willingness to Donate Kidney in Three Tertiary Institutions in Southern Nigeria. Transplant Proc 2015; 47:2810-5. [DOI: 10.1016/j.transproceed.2015.10.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 10/28/2015] [Indexed: 10/22/2022]
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Garcia-Garcia G, Jha V. Chronic kidney disease in disadvantaged populations: The case of Africa. Afr J Prim Health Care Fam Med 2015; 7:e1-e2. [PMID: 26245587 PMCID: PMC4656927 DOI: 10.4102/phcfm.v7i1.839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 03/20/2015] [Indexed: 11/10/2022] Open
Abstract
No abstract available
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Affiliation(s)
- Guillermo Garcia-Garcia
- Nephrology Service, Hospital Civil de Guadalajara, University of Guadalajara Health Sciences Center, Guadalajara.
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De Villiers M. The Family Practitioner's role in the integrated continuum of cancer care. Afr J Prim Health Care Fam Med 2015; 7:821. [PMID: 26245586 PMCID: PMC4656939 DOI: 10.4102/phcfm.v7i1.821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 01/21/2015] [Indexed: 11/01/2022] Open
Abstract
No abstract available
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Oluyombo R, Okunola OO, Olanrewaju TO, Soje MO, Obajolowo OO, Ayorinde MA. Challenges of hemodialysis in a new renal care center: call for sustainability and improved outcome. Int J Nephrol Renovasc Dis 2014; 7:347-52. [PMID: 25258555 PMCID: PMC4174020 DOI: 10.2147/ijnrd.s65835] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Nephrologists are faced with enormous challenges in the management of patients with end-stage renal disease, especially in sub-Saharan Africa, where hemodialysis is the most common modality of renal replacement therapy in the region. Therefore, we reviewed our 3 years of experience with hemodialysis services in a tertiary hospital located in a rural community of South West Nigeria. This was with a view to presenting the profile of hemodialysis patients and the challenges they face in sustaining hemodialysis. Methods We reviewed the case records and hemodialysis registers for 176 patients over the 3 years from November 2010 to December 2013. The data were analyzed using Statistical Package for the Social Sciences version 20 software. Results Of the 176 patients, 119 (66.9%) were males. The mean age of the patients was 44.87±17.21 years. Most were semiskilled or unskilled (111; 63.5%) and 29 (16.5%) were students. Twenty-six (14.8%) had acute kidney injury in the failure stage. Chronic glomerulonephritis, hypertensive nephropathy, and diabetic nephropathy accounted for 45.3%, 23.3%, and 12.1%, respectively, of patients with end-stage renal disease. Only 6.8% of patients could afford hemodialysis beyond 3 months. Conclusion Sustainability of maintenance hemodialysis is poor in our environment. Efforts should be intensified to improve other modalities of renal replacement therapy, in particular kidney transplantation, which is cost-effective in the long-term. Also, preventive measures such as education for affected patients and the general population would assist in reducing the prevalence and progression to end-stage renal disease.
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Affiliation(s)
- Rotimi Oluyombo
- Renal Unit, Internal Medicine Department, Federal Medical Centre, Ido-Ekiti, Ekiti State, Nigeria
| | - Oluyomi O Okunola
- Renal Unit, Department of Internal Medicine, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Timothy O Olanrewaju
- Renal Division, Internal Medicine Department, Faculty of Health Sciences, University of Ilorin, Ilorin, Kwara State, Nigeria
| | - Michael O Soje
- Renal Unit, Internal Medicine Department, Federal Medical Centre, Ido-Ekiti, Ekiti State, Nigeria
| | - Omotola O Obajolowo
- Renal Unit, Internal Medicine Department, Federal Medical Centre, Ido-Ekiti, Ekiti State, Nigeria
| | - Margaret A Ayorinde
- Renal Unit, Internal Medicine Department, Federal Medical Centre, Ido-Ekiti, Ekiti State, Nigeria
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Arogundade FA, Sanusi AA, Oguntola SO, Omotoso BA, Abdel-Rahman EM, Akinsola A, Balogun RA. Benefits and challenges of starting a new therapeutic apheresis service in a resource-constrained setting. J Clin Apher 2014; 29:194-8. [DOI: 10.1002/jca.21328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 05/01/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Fatiu A. Arogundade
- Department of Medicine, Renal Unit; Obafemi Awolowo University Teaching Hospitals Complex; Osun State Nigeria
| | - Abubakr A. Sanusi
- Department of Medicine, Renal Unit; Obafemi Awolowo University Teaching Hospitals Complex; Osun State Nigeria
| | - Stephen O. Oguntola
- Department of Medicine, Renal Unit; Obafemi Awolowo University Teaching Hospitals Complex; Osun State Nigeria
| | - Bolanle A. Omotoso
- Department of Medicine, Renal Unit; Obafemi Awolowo University Teaching Hospitals Complex; Osun State Nigeria
- Division of Nephrology; University of Virginia School of Medicine; Charlottesville Virginia 22908
| | - Emaad M. Abdel-Rahman
- Division of Nephrology; University of Virginia School of Medicine; Charlottesville Virginia 22908
- Department of Medicine, Renal Unit and Extracorporeal Therapies; University of Virginia Medical Center; Charlottesville Virginia 22908
| | - Adewale Akinsola
- Department of Medicine, Renal Unit; Obafemi Awolowo University Teaching Hospitals Complex; Osun State Nigeria
| | - Rasheed A. Balogun
- Division of Nephrology; University of Virginia School of Medicine; Charlottesville Virginia 22908
- Department of Medicine, Renal Unit and Extracorporeal Therapies; University of Virginia Medical Center; Charlottesville Virginia 22908
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