Determinants of Interest in Nephrology Career Choice among Internal Medicine Junior Residents in Nigeria

INTRODUCTION

There has been decreased interest in postgraduate nephrology training over the years. This trend could worsen the shortage of nephrologists and inability to meet the health needs of patients with kidney diseases if not urgently addressed.

AIM

To determine interest in and determinants of nephrology career choice among junior internal medicine residents in Nigeria.

METHODOLOGY

This was a cross-sectional study that enrolled 273 junior residents in internal medicine across Nigeria. A self-administered questionnaire that was adapted from two previous studies was used for data collection.

RESULTS

The mean age of the respondents was 33.6±4.4 years with a male: female ratio of 1.8:1. This study showed that 16.8% and 21.6% of junior residents in internal medicine considered nephrology as their first and second choice area to specialize, respectively. Factors that ranked high as determinants of a decision to do nephrology were personal interest (94.3%), opportunities to perform renal procedures (93.3%), and exposure to nephrology training (85.7%). Factors that discouraged a choice of nephrology according to respondents were high mortality of renal patients (67.3%), poor outcomes of renal patients (70.2%), in ability to fund treatment by renal patients (66.1%), unsatisfactory life-work balance among nephrologists (60.7%), and late presentation of renal patients (59.0%). Others were high workload compared to available doctors (59.0%) and poor job satisfaction (55.4%). Factors that could stimulate more interest in nephrology according to respondents included creation of better working environment with adequate equipment for training (96.3%), provision of health insurance with adequate coverage for renal patients (97.4%), and increased government support for renal care services (99.3%).

CONCLUSION

There is a need to promote and sustain interest of residents in nephrology by ensuring improved survival of patients through better access to renal care, ensuring an adequate and well motivated work force, provision of adequate facilities and health insurance services.

Level of implementation of WHO COVID-19 document on rights, roles and responsibilities of health care workers in a tertiary hospital in Southwest Nigeria

Introduction

in order to curb the increasing spread of COVID-19 amongst health care workers (HCWs), the World Health Organization (WHO) released the COVID-19 Rights, Roles and Responsibilities of Health workers (COVID-19 RRRHW) policy document aimed at protecting HCWs amidst the on-going pandemic. This study determined the level of implementation of the document in a tertiary hospital in Southwest Nigeria.

Methods

this was a cross-sectional descriptive study among HCWs in a tertiary hospital in South-western Nigeria that assessed the level of implementation of the WHO COVID-19 RRRHW document using a closed ended structured questionnaire.

Results

five hundred and thirty-five HCWs participated in the study comprising 165(30.8%) males and 370(69.2%) females. Majority (87.3%) of the HCWs were 40 years and below. One hundred and sixty-three (30.5%) of the HCWs had been involved in the care of COVID-19 patients; less than 60% of the respondents were aware of the presence of an official platform for dissemination of information on suspected or confirmed cases of COVID-19 and 435(81.3%) were aware of hospital training on Infection Prevention and Control (IPC); 191(35.7%) have had uninterrupted supplies of personal protective equipment(PPE) and IPC materials; 211(39.4%) were aware of mental and counselling services in the hospital while only 106(19.8%) knew how to access these services; 289(54%) have attended IPC training and 307(57.4%) are able to don and doff PPE.

Conclusion

this study showed inadequate implementation of the WHO COVID-19 RRRHW document. There is urgent need for all stakeholders to familiarize with the document in order to ensure adequate protection of HCWs and minimize their risk of contracting COVID-19.

Knowledge, attitude and practice towards COVID-19 among workers of a tertiary hospital in Bayelsa State, Nigeria

INTRODUCTION

coronavirus disease (COVID-19) has since assumed pandemic dimensions with over 14million persons affected in 213 countries and territories worldwide as at mid-July 2020. The level of awareness and knowledge of the disease as well as the related attitude and practice amongst hospital workers could determine its extent of control. The aim of this study was to determine the knowledge, attitude and practices amongst hospital staff regarding COVID-19.

METHODS

this cross-sectional study was conducted among staff of the Niger Delta University Teaching Hospital, Bayelsa State, Nigeria. A self-administered semi-structured questionnaire was adapted in assessing their knowledge, attitude and practice towards COVID-19.

RESULTS

one hundred and twenty four respondents completed the study with a mean age of 30.9 ± 6.5 years. Up to 90% of them demonstrated good knowledge of COVID-19 with regard to preventive and control measures. Approximately 90% of them practiced good hand hygiene though a lesser proportion wore face masks (51.6%) and practiced crowd avoidance (58.1%). Medical doctors had a marginally higher practice score compared with "others" (p = 0,047). Up to 98(79.0%) of respondents were scared of self-infection and 99(79.8%) were not motivated to work due to inadequate facilities, equipment and resources in 50% of cases. Knowledge of COVID-19 was positively correlated with the practices of the participants (p = 0.023).

CONCLUSION

the hospital staff lacked adequate motivation towards management of COVID-19 and were constrained for the fear of self- infection, inadequate equipment, resources and equipment despite possessing a good knowledge of the disease. There is need for concerted efforts by stakeholders in the health care industry to ensure hospital workers are adequately motivated and provided with the needed risk protection devices and resources during this pandemic.

Coronavirus infection and kidney disease: a review of current and emerging evidence

In November 2009, an outbreak of a new strain of coronavirus (later named severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was first noticed in the city of Wuhan in China, rapidly spreading to assume pandemic proportions within a short period of time. The disease was subsequently designated as coronavirus disease-19 (COVID-19). The death toll has continued to rise with grave health and socio-economic implications for individuals, families and nations globally. Although the respiratory tract is primarily involved in this disease, kidney affectation is increasingly reported and has been shown to worsen the prognosis of the disease. Current evidence shows that kidney disease is not uncommon in patients with coronavirus infection especially in those with COVID-19 and may arise from a constellation of factors such as hypotension, sepsis, rhabdomyolysis, multi-organ failure, use of nephrotoxic medications as well as direct infection in some cases. Factors associated with acute kidney injury in coronavirus infected patients may include elderly age, male sex, presence of co-morbidities as well as pre-existing chronic kidney disease and end stage renal disease. Although, there is presently no effective treatment for COVID-19, there is room for conservative management, extracorporeal therapy and renal replacement therapy. The aim of this review was to integrate current and emerging evidences on renal disease resulting from COVID-19 and the previous epidemics of coronavirus infections including the Middle East Respiratory Syndrome (MERS) and the Severe Acute Respiratory Syndrome (SARS) caused by other strains of the virus.

Prevalence of Diabetes Mellitus in a Rural, Agrarian Community in South-South Nigeria

Background: Diabetes mellitus (DM) is a global public health threat, often associated with other co-morbidities with significant morbidities and mortality. The aim of this study was to determine the prevalence of DM in a rural agrarian community in Nigeria.Methodology: This cross-sectional study, using quantitative methods, was carried out in Ayua community in Etsako West local government area of Edo state, South-South Nigeria. Structured questionnaire was intervieweradministered while socio-demographics, anthropometric data, blood pressure and weight measurements as well as random blood glucose were obtained from participants.Findings: Two hundred and sixteen participants (58 males, 158 females) completed the study with a mean age of 54.2+16.4 years. Diabetes was found in 30 (13.9%) participants and undiagnosed in 40.0% while hypertension and obesity were found in 61(28.2%) and 57(26.4%) respectively. Diabetes was independently predicted by age > 50 years (OR = 5.7) and the presence of a family history of DM (OR = 43.0) with p < 0.001 each) but not by obesity (p=0.860), hypertension (p = 0.477) or family history of hypertension (p = 0.09).Conclusion: Considering the high prevalence of DM and co-morbidities in this rural agrarian community, we recommend regular screening of adults for these conditions. Keywords: Diabetes mellitus, Hypertension, Nigeria, Rural

Knowledge, attitude and practice towards COVID-19 among workers of a tertiary hospital in Bayelsa State, Nigeria

Introduction

coronavirus disease (COVID-19) has since assumed pandemic dimensions with over 14million persons affected in 213 countries and territories worldwide as at mid-July 2020. The level of awareness and knowledge of the disease as well as the related attitude and practice amongst hospital workers could determine its extent of control. The aim of this study was to determine the knowledge, attitude and practices amongst hospital staff regarding COVID-19.

Methods

this cross-sectional study was conducted among staff of the Niger Delta University Teaching Hospital, Bayelsa State, Nigeria. A self-administered semi-structured questionnaire was adapted in assessing their knowledge, attitude and practice towards COVID-19.

Results

one hundred and twenty four respondents completed the study with a mean age of 30.9 ± 6.5 years. Up to 90% of them demonstrated good knowledge of COVID-19 with regard to preventive and control measures. Approximately 90% of them practiced good hand hygiene though a lesser proportion wore face masks (51.6%) and practiced crowd avoidance (58.1%). Medical doctors had a marginally higher practice score compared with “others” (p = 0,047). Up to 98(79.0%) of respondents were scared of self-infection and 99(79.8%) were not motivated to work due to inadequate facilities, equipment and resources in 50% of cases. Knowledge of COVID-19 was positively correlated with the practices of the participants (p = 0.023).

Conclusion

the hospital staff lacked adequate motivation towards management of COVID-19 and were constrained for the fear of self- infection, inadequate equipment, resources and equipment despite possessing a good knowledge of the disease. There is need for concerted efforts by stakeholders in the health care industry to ensure hospital workers are adequately motivated and provided with the needed risk protection devices and resources during this pandemic.

Level of implementation of WHO COVID-19 document on rights, roles and responsibilities of health workers in a tertiary hospital in Southwest Nigeria

Introduction

in order to curb the increasing spread of COVID-19 amongst health care workers (HCWs), the World Health Organization (WHO) released the COVID-19 Rights, Roles and Responsibilities of Health workers (COVID-19 RRRHW) policy document aimed at protecting HCWs amidst the on-going pandemic. This study determined the level of implementation of the document in a tertiary hospital in Southwest Nigeria.

Methods

this was a cross-sectional descriptive study among HCWs in a tertiary hospital in South-western Nigeria that assessed the level of implementation of the WHO COVID-19 RRRHW document using a closed ended structured questionnaire.

Results

five hundred and thirty-five HCWs participated in the study comprising 165(30.8%) males and 370(69.2%) females. Majority (87.3%) of the HCWs were 40 years and below. One hundred and sixty-three (30.5%) of the HCWs had been involved in the care of COVID-19 patients; less than 60% of the respondents were aware of the presence of an official platform for dissemination of information on suspected or confirmed cases of COVID-19 and 435(81.3%) were aware of hospital training on Infection Prevention and Control (IPC); 191(35.7%) have had uninterrupted supplies of personal protective equipment(PPE) and IPC materials; 211(39.4%) were aware of mental and counselling services in the hospital while only 106(19.8%) knew how to access these services; 289(54%) have attended IPC training and 307(57.4%) are able to don and doff PPE.

Conclusion

this study showed inadequate implementation of the WHO COVID-19 RRRHW document. There is urgent need for all stakeholders to familiarize with the document in order to ensure adequate protection of HCWs and minimize their risk of contracting COVID-19.

Blood Pressure Changes among Patients Undergoing Hemodialysis in Yenagoa, Nigeria

INTRODUCTION

Hemodialysis (HD) is a common modality of renal replacement therapy in Nigeria. Despite its usefulness, it may have complications such as intra-dialytic hypotension (IDH) and intra-dialytic hypertension (IDHTN), both of which may impact negatively on the patient. The aim of the study was to examine blood pressure (BP) changes during HD, to determine the frequency of IDH and IDHTN in patients undergoing HD, and to possibly identify associated factors.

MATERIALS AND METHODS

The study design was a retrospective review of records of patients who had HD in the Rainbow Dialysis Center, a foremost private dialysis center in Bayelsa State. The records of all adults who had HD in the center from June 2014 to June 2018 were reviewed. Data retrieved include sociodemographics, type and cause of renal disease, and clinical and laboratory parameters such as BPs, packed cell volume, urea, and creatinine.

STATISTICAL ANALYSIS USED

Data were analyzed with SPSS version 20.0. Data were presented in tabular forms. Variables were expressed as mean with standard deviation, frequencies, and percentages. The means were compared using Student's t-test or analysis of variance where appropriate. Chi-square test was used to compare proportions. Statistical significance was set at P < 0.05.

RESULTS

One hundred and thirty-six cases were recruited for the study. IDH and IDHTN were found in 16.9% and 16.2% of the patients, respectively. There was no significant difference between the mean predialysis and postdialysis systolic, diastolic, mean arterial BP, or pulse pressure (P > 0.05). Older age was positively and significantly associated with IDHTN (P = 0.047).

CONCLUSIONS

IDH and IDHTN were prevalent among the patients studied, with the latter being slightly more likely to occur with advancing age. There is a need for adequate BP monitoring and management during HD.

Prevalence of hypertension and its correlates among employees of a tertiary hospital in Yenagoa, Nigeria

BACKGROUND

Hypertension (HTN) is a common medical problem with increasing prevalence and dire consequences. Considering the relative proximity of hospital workers to health care delivery, one may expect a better control of HTN and associated risk factors in this population. The objective of the current study was to determine the prevalence of HTN and risk factors among hospital employees in a Nigerian tertiary hospital.

MATERIALS AND METHODS

All employees of the Federal Medical Center, Yenagoa (Bayelsa State, Nigeria) were invited for a HTN screening exercise on the world kidney day on March 14, 2013. A total of 231 participants completed this cross-sectional study. Data was obtained with a pre-tested interviewer-administered structured questionnaire while blood pressure was taken with an Accoson sphygmomanometer. Anthropometry was done using standardized protocols. Urine and blood were analyzed for glucose. HTN was defined as blood pressure >140/90 or prior diagnosis or use of antihypertensives. Data was entered, stored and analyzed with Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA) version 20.

RESULTS

The crude and age-adjusted prevalence of HTN among the hospital employee was 21.3% and 23.8% respectively. Age, marital status, educational level, body mass index, waist circumference (WC) and waist hip ratio showed significant association with HTN in the univariate analysis. However, in multivariate regression analysis, only older age and abnormal WC predicted HTN.

CONCLUSION

The prevalence of HTN among the hospital employees compared with reports in other population and was predicted by advancing age and abnormal WC. The study underscores the need for introduction of HTN screening programs among hospital employees especially staff that are older with truncal obesity.

Hypertension and Diabetes Self-care Activities: A Hospital Based Pilot Survey in Benin City, Nigeria

AIMS AND OBJECTIVES

The burden of hypertension and diabetes is on the increase globally with its attendant complications. Although self-care activities are critical to the successful management of both conditions, there are only a few reports on such activities, especially in this part of the world. This pilot study was therefore undertaken to assess the self-care activities among hypertensive and diabetic patients in Benin City.

PATIENTS AND METHODS

Hypertensive and diabetic patients were consecutively recruited from the out- patient department of the University of Benin Teaching Hospital. The questionnaires were developed based on past assessment scales such as the Hypertension Self-Care Activity Level Effects (H-SCALE) and the Summary of Diabetes Self-Care Assessment (SDSCA) for hypertensive and diabetic participants respectively.

RESULTS

A total of 85(32 hypertensive, 24 diabetic and 29 co-morbid hypertensive diabetic) participants completed the study. Only 14 (16.5%) subjects had good self-care practice, 39 (45.9%) had fair practice while poor self-care practice was found in 32 (37.6%) subjects. Adherence to medications, clinic adherence, use of self-monitoring devices, regular exercising and dietician contact were generally low. However, only a relatively few subjects smoked tobacco or took significant alcohol.

CONCLUSION

The health-related self-care practice among the patients was generally not good. There was no significant difference in the overall level of self-care among hypertensive, diabetic patients or those with co-morbid conditions. There is need for more aggressive health education aimed at improving the current health-related self-care habits among these patients.

Prevalence and determinants of cognitive impairment in patients with chronic kidney disease: a cross-sectional study in Benin City, Nigeria

BACKGROUND

Chronic kidney disease (CKD) has become a public health concern and may be complicated by cognitive impairment (CI) contributing significantly to morbidity and poor prognosis. This hospital-based study aimed at determining the prevalence and the determinants of CI among CKD patients in Nigeria.

MATERIALS AND METHODS

A total of 190 CKD patients and a 100 healthy control subjects completed this cross-sectional study. Sociodemographic data and history of common clinical features of CKD were obtained with the use of interviewer administered semi-structured questionnaires. The six-item cognitive impairment test was used for assessment of cognitive function of patients and controls.

RESULTS

The prevalence of CI in Stages 3, 4, and 5 CKD patients were 24.0%, 41.6%, and 46.2%, respectively with overall prevalence of 35.3% while only 6.0% of controls had CI (P = 0.03). The most potent determinants of CI were low hematocrit (odds ratio [OR] =3.50), low serum bicarbonate levels (OR = 2.20), and high serum urea (OR = 2.11).

CONCLUSION

CKD is associated with significant CI in Nigerian patients especially with progressive deterioration in renal function. There is a need for regular evaluation of CKD patients for cognitive deficits.

Prevalence and correlates of chronic kidney disease among civil servants in Bayelsa state, Nigeria

INTRODUCTION

Chronic kidney disease (CKD) has become a public health problem with rising incidence and prevalence world-wide. Despite the fact that Sub-Saharan Africa, including Nigeria appears to be badly hit by this epidemic, there is a paucity of data on CKD prevalence in these regions and where data exists, they are mostly hospital-based.

OBJECTIVES

The present study was carried out to determine the prevalence and correlates of CKD in an urban civil service population in Bayelsa State, Nigeria.

MATERIALS AND METHODS

A total of 179 civil servants in the Bayelsa State secretariat were screened for CKD during the World Kidney Day on March 2012. CKD was defined as estimated glomerular filtration rate <60 ml/min/1.73 m 2 body surface area and/or proteinuria. Socio-demographic data was obtained using interviewer-administered semi-structured questionnaire while anthropometric measurements were taken. Blood pressure (BP), urinalysis, serum urea and creatinine were also assessed.

RESULTS

The prevalence of CKD in the study was 7.8%. Age >50 years was associated with CKD in univariate analysis but none of age, gender, body mass index, BP or hyperglycemia independently predicted it.

CONCLUSION

The prevalence of CKD among Nigerian civil servants was fairly high and was associated with advancing age. Routine screening for CKD in this population is recommended.

Choice of medical specialties amongst final year medical students in two universities in South-South, Nigeria

Study aimed at determining the preferred medical specialties among final year medical students and the most important factor(s) influencing their choices.

METHODS

A cross-sectional questionnaire-based survey was carried out among all final year medical students from the University of Benin (UNIBEN) and the Niger Delta University (NDU). The study was done in UNIBEN in July 2011 and subsequently in NDU in March 2012.Students were asked to choose the most preferred specialty out of a list of options and to select the most important factors influencing their choice.

RESULTS

A total of one hundred and sixty seven (102 UNIBEN and 65 NDU) students completed the study. A hundred (59.9%) respondents preferred surgery-related specialties while forty nine (29.3%) preferred medicine-related specialty. Forty five (26.9%) students preferred surgery while thirty six (21.6%) preferred obstetrics and gynaecology. Internal medicine and paediatrics were preferred amongst 18(10.8%) and 10(6.0%) respondents respectively. Other specialties were chosen to a lesser degree. Personal interest in 95(56.9%) participants was the most important factor influencing choice of medical specialties.

CONCLUSION

The study highlights a general preference for core clinical specialties and surgery-related specialties especially surgery and obstetrics and gynaecology, amongst final year medical students. Personal interest was the most important factor influencing career choice. These findings have important implications for Nigeria's medical education and health care policy making.