Career preferences of final year medical students at a medical school in Kenya--A cross sectional study.

BACKGROUND: The World Health Organization (WHO) recommended physician to population ratio is 23:10,000. Kenya has a physician to population ratio of 1.8:10,000 and is among 57 countries listed as having a serious shortage of health workers. Approximately 52% of physicians work in urban areas, 6% in rural and 42% in peri-urban locations. This study explored factors influencing the choice of career specialization and location for practice among final year medical students by gender. METHODS: A descriptive cross-sectional study was carried out on final year students in 2013 at the University of Nairobi's, School of Medicine in Kenya. Sample size was calculated at 156 students for simple random sampling. Data collected using a pre-tested self-administered questionnaire included socio-demographic characteristics of the population, first and second choices for specialization. Outcome variables collected were factors affecting choice of specialty and location for practice. Bivariate analysis by gender was carried out between the listed factors and outcome variables with calculation of odds ratios and chi-square statistics at an alpha level of significance of 0.05. Factors included in a binomial logistic regression model were analysed to score the independent categorical variables affecting choice of specialty and location of practice. RESULTS: Internal medicine, Surgery, Obstetrics/Gynaecology and Paediatrics accounted for 58.7% of all choices of specialization. Female students were less likely to select Obs/Gyn (OR 0.41, 95% CI =0.17-0.99) and Surgery (OR 0.33, 95% CI = 0.13-0.86) but eight times more likely to select Paediatrics (OR 8.67, 95% CI = 1.91-39.30). Surgery was primarily selected because of the 'perceived prestige of the specialty' (OR 4.3 95% CI = 1.35-14.1). Paediatrics was selected due to 'Ease of raising a family' (OR 4.08 95% CI = 1.08-15.4). Rural origin increased the odds of practicing in a rural area (OR 2.5, 95% CI = 1.04-6.04). Training abroad was more likely to result in preference for working abroad (OR 9.27 95% CI = 2.1-41.9). CONCLUSIONS: The 4 core specialties predominate as career preferences. Females are more likely to select career choices due to 'ease of raising a family'. Rural origin of students was found to be the most important factor for retention of rural health workforce. This data can be used to design prospective cohort studies in an effort to understand the dynamic influence that governments, educational institutions, work environments, family and friends exert on medical students' careers.

Catalysing global surgery: a meta-research study on factors affecting surgical research collaborations with Africa.

INTRODUCTION: In December 2019, the COVID-19 pandemic highlighted the urgent need for rapid collaboration, research, and interventions. International research collaborations foster more significant responses to rapid global changes by enabling international, multicentre research, decreasing biases, and increasing study validity while reducing overall research time and costs. However, there has been low uptake of collaborative research by African institutions and individuals. AIM: To systematically review facilitating factors and challenges to collaborative surgical research studies conducted in Africa. METHODOLOGY: A meta-research review using PubMed®/MEDLINE and Embase on surgical collaboration in Africa from 1st of January 2011 to 31st of September 2021 in accordance to PRISMA guidelines. Surgical studies by collaborative groups involving African authors and sites were included (55 papers). Data on the study period, geographical regions, and research scope, facilitating factors, and challenges were extracted from the studies retrieved from the search. RESULTS: Most of the collaborations in Africa occurred with European institutions (76%). Of the 54 African countries, 63% (34/54) participated in surgical collaborations. The highest collaboration frequency occurred in South Africa (11%) and Nigeria (8%). However, most publications originated from Eastern Africa (43%). Leveraging synergies between high- and low- to middle-income countries (LMICs), well-defined structures, and secure data platforms facilitated collaboration. However, the underrepresentation of collaborators from LMICs was a significant challenge. CONCLUSION: Available literature provides critical insights into the facilitating factors and challenges of research collaboration with Africa. However, there is a need for a detailed prospective study to explore the themes highlighted further. SYSTEMATIC REVIEW REGISTRATION: PROSPERO 2022 CRD42022352115 .

Determining the quality of life of children living with epilepsy in Kenya-A cross-sectional study using the CHEQOL-25 tool.

PURPOSE: Epilepsy is a chronic neurological disorder that is often diagnosed in childhood and may negatively impact physical, social and psychological abilities. Most tools measuring quality of life (QoL) rely on parent/caregiver feedback rather than the child's perspective. CHEQOL-25 is a QoL tool that documents both child and caregiver perspectives across five domains. The primary objective was to determine the QoL of children living with epilepsy (CWE) using the CHEQOL-25 tool in a Kenyan paediatric population. Other objectives were to describe the correlation between the caregivers' and children's' perspectives and describe factors affecting QoL. METHOD: We conducted a cross-sectional study across four sites in Nairobi. Quantitative data was collected using a self-administered CHEQOL-25 questionnaire. Caregivers and their children aged 7-15 years attending neurology clinics participated in the study. We used Kappa statistics to compare child and caregiver responses. RESULTS: A total of 354 participants were interviewed (177 children and 177 caregivers). A good QoL was reported by 60.5 % of children with a similar caregiver perception of 56.5 %. Caregivers with little education and male caregivers were associated with a poor QoL (p = 0.01); other socio-demographic factors had little impact on the measured QoL of CWE. Parent and child questionnaires correlated well in terms of response in terms of interpersonal (p = 0.001) and intrapersonal (p = 0.004) domains. CONCLUSION: This study demonstrated that a good quality of life was reported by the majority of CWE and their caregivers, although some factors such as a male caregiver gender and lower level of education were associated with poor QoL.

Isolated septic non-otogenic lateral sinus thrombosis complicating nasopharyngitis in a 2-month-old infant: a case report.

Nasopharyngeal infections are among the commonest diagnosed infections in infants. Largely treated supportively, these infections are considered harmless. These can however lead to serious complications from local spread and septicemia. With local extension, inflammatory neck masses (abscesses) can swiftly lead to life-threatening complications including mediastinitis, airway compromise and sinovenous thrombosis. Here, we report a 2-month-old infant with initial rhinopharyngitis and subsequent extensive deep neck abscesses with consequent dural sinus thrombosis successfully managed with antibiotics, anticoagulants and drainage. While such cases have been presented before, it is the pathophysiology and extent of sinus thrombosis in our case that is eccentric.

Illness perception of tuberculosis (TB) and health seeking practice among urban slum residents of Bangladesh: a qualitative study.

BACKGROUND: Combating tuberculosis (TB) in urban slums is more complex than in rural areas due to reasons such as over-crowding, unhygienic living conditions and poverty. This study aimed to assess illness perception of TB and identify barriers and facilitators for health seeking practice among the residents of Badda slum, Dhaka, Bangladesh. METHODS: The Badda slum was purposively selected. Convenience sampling was carried out to select participants aged 18 years and above. Twenty two in-depth interviews, two key informants' interviews and participatory rapid appraisal (PRA) were conducted. Data were analyzed manually by using defined a priori codes and color coding of the quotes in data matrix table. RESULTS: TB was commonly recognized as Jokkha (pulmonary TB), Sas rog (disease associated to breathing) followed by TB. More females than males had knowledge about TB related illness. Very few perceived of being at risk of TB despite the high risk behavior and environment. Prime barriers for health seeking practice of TB were cost along with other barriers like prevailing stigma on TB, lack of information on service sites and unavailability of accompanying person. Training and orientation to community organizations and people, awareness on TB and free treatment through advertisements/media, community level diagnostic and home based care were identified as the facilitators for the health seeking practice of TB. CONCLUSIONS: Perceptions of TB and knowledge associated with the disease shape the health seeking practice, therefore promotion of media awareness campaign, targeting the people of urban slums for reducing misconceptions and promotion of home based service is needed to encourage health seeking practice in the future.