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.

INTRODUCTION: L'intérêt pour la formation postuniversitaire en néphrologie a diminué au fil des ans. Cette tendance pourrait aggraver la pénurie de néphrologues et l'incapacité de répondre aux besoins de santé des patients atteints de maladies rénales si l'on n'y remédie pas de toute urgence. OBJECTIF: Déterminer l'intérêt et les déterminants du choix de carrière en néphrologie chez les jeunes résidents en médecine interne au Nigeria. MÉTHODOLOGIE: Il s'agit d'une étude transversale à laquelle ont participé 273 résidents juniors en médecine interne au Nigeria. Un questionnaire auto-administré, adapté de deux études précédentes, a été utilisé pour la collecte des données. RÉSULTATS: L'âge moyen des répondants était de 33,6±4,4 ans avec un ratio homme/femme de 1,8:1. Cette étude a montré que 16,8 % et 21,6 % des résidents juniors en médecine interne considéraient la néphrologie comme leur premier et deuxième choix de spécialisation, respectivement. Les facteurs les plus déterminants dans la décision de se spécialiser en néphrologie étaient l'intérêt personnel (94,3 %), la possibilité de pratiquer des interventions rénales (93,3 %) et l'exposition à la formation en néphrologie (85,7 %). Les facteurs qui découragent le choix de la néphrologie selon les répondants sont la mortalité élevée (67,3 %), les résultats médiocres (70,2 %), l'incapacité de financer le traitement (66,1 %), l'équilibre vie-travail insatisfaisant (60,7 %) et la présentation tardive des patients rénaux (59,0 %). D'autres facteurs sont la charge de travail élevée par rapport aux médecins disponibles (59,0 %) et la faible satisfaction au travail (55,4 %). Les facteurs qui pourraient susciter un plus grand intérêt pour la néphrologie, selon les répondants, sont la création d'un meilleur environnement de travail avec des équipements adéquats pour la formation (96,3%), la mise en place d'une assurance maladie avec une couverture adéquate pour les patients atteints de maladies rénales (97,4%), et un soutien accru dugouvernement pour les services de soins rénaux (99,3%). CONCLUSION: Il est nécessaire de promouvoir et de soutenir l'intérêt des résidents pour la néphrologie en assurant une meilleure survie des patients grâce à un meilleur accès aux soins rénaux, en assurant une main-d'œuvre adéquate et bien motivée, en fournissant des installations adéquates et des services d'assurance maladie. Mots clés: Néphrologie, Carrière, Intérêt, Résidents, Médecine interne.

Self-perceived Burden on Caregivers, Anxiety and Depression among Chronic Kidney Disease Patients in Southern Nigeria.

Introduction: Psychosocial problems are common in chronic kidney disease (CKD) patients and are associated with poor overall outcomes; however, their evaluation has not received the deserved attention. This study assessed self-perceived burden on caregivers, psychosocial wellbeing, anxiety and depression among CKD patients, and the impact on their quality of life (QoL) in two hospitals in Nigeria. Methods: This was a cross-sectional study. Self-perceived burden on caregivers, QoL, anxiety, and depression of the patients, were assessed using the Cousineau questionnaire, modified SF-12 questionnaire, Hospital Anxiety and Depression Scale, respectively. Results: There were 141 participants in the study comprising 50 haemodialysis (HD) patients, 41 pre-dialysis CKD patients and 50 controls. The male: female ratio for CKD patients and controls were 1.1 and 1.4 respectively. Prevalence of depressive and anxiety symptoms in the CKD patients were 46.2% and 33.0% respectively. The QoL score was significantly higher in the control group compared to the CKD patients (p= <0.001) and significantly lower in the HD patients compared to the pre-dialysis CKD patients (p= <0.001). Self-perceived burden score was significantly higher in the HD group compared to the pre-dialysis CKD group (p = < 0.001) There was a negative correlation between QoL score and self-perceived burden, hospital anxiety score and hospital depression score (p =<0.001). Conclusion: Psychological disorders and self-perceived burdens are highly prevalent among CKD patients. They have negative impact on their QoL, hence regular evaluation and management of these disorders should be incorporated into the care of CKD patients.

Introduction: Les problèmes psychosociaux sont commun chez les patients atteints d'insuffisance rénale chronique (MRC) et associés à de mauvais résultats globaux, mais leur évaluation n'a pas reçu l'attention méritée. Cette étude a évalué le fardeau autoperçu par les patients sur les soignants, le bien-être psychosocial des patients atteints d'IRC et l'impact sur leur qualité de vie (QoL) dans deux hôpitaux en Nigéria. Méthodes: Il s'agissait d'une étude transversale qui évaluait lefardeau auto-perçu des patients sur les soignants, la qualité de vie, l'anxiété et la dépression à l'aide du questionnaire Cousineau, du questionnaire SF-12 modifié et de l'échelle d'anxiété et de dépression hospitalière respectivement chez les patients atteints d'IRC et les témoins. Résultats: Il y avait 141 participants à l'étude comprenant 50 patients hémodialysés d'entretien (HD), 41 patients atteints d'IRC en pré-dialyse et 50 témoins. Le rapport homme: femme pour les patients atteints d'IRC et le groupe témoin était respectivement de 1,1 et 1,4. La prévalence des symptômes dépressifs et anxieux chez les patients atteints d'IRC était de 46,2% et 33,0% respectivement. Le score de qualité de vie était significativement plus élevé dans le groupe témoin par rapport aux patients atteints d'IRC (p = <0,001). Le score de qualité de vie était significativement plus faible chez les patients HD par rapport aux patients atteints d'IRC en pré- dialyse (p <0,001). Le score d'autoévaluation du fardeau était significativement plus élevé dans le groupe HD que dans le groupe avant la dialyse CKD (p = <0,001) Il y avait une corrélation négative significative entre la qualité de vie et l'auto-perception du fardeau, le score d'anxiété hospitalière et le score de dépression hospitalière (p = < 0,001). Conclusion: Les maux psychologiques sont très répandus chez les patients atteints d'IRC et ont un impact négatif sur leur qualité de vie. Une évaluation et une prise en charge régulières de ces maux doivent être intégrées dans la prise en charge des patients atteints d'IRC. Mots clés: anxiété, dépression, qualité de vie, fardeau pour les soignants, maladie rénale chroniq.

Awareness and Knowledge of Patients' Bill of Right among Physicians and Patients in a Tertiary Hospital in Southwest Nigeria.

BACKGROUND: Patients' Bill of Right (PBoR) was launched in Nigeria in 2018 with the aim of improving health service delivery to Nigerians. However, knowledge of PBoR among physicians and patients is pivotal to achieving its laudable objective. AIM: This study assessed the awareness and knowledge of PBoR and associated factors among physicians and their patients at the University of Medical Sciences Teaching Hospital in Ondo State, Southwest Nigeria. METHODS: This was a cross-sectional study that assessed awareness and knowledge of PBoR among physicians and patients using questionnaire. Maximum score obtainable was 16 and those with less than 8 were considered as having poor knowledge, 8-12 as good knowledge and 13-16 as excellent knowledge. P value of <0.05 was taken as significant. RESULTS: Four hundred and fifty-three respondents made up 199 physicians and 254 patients participated in the study. There were 227(50.1%) males and 226(49.9%) females. Amongst the participants, 212(46.8%) were aware of existence of PBoR and 108(23.8%) claimed to be aware of its contents. Physicians and patients with good to excellent knowledge were 60.6% and 21.3 % respectively. The physicians had significantly better knowledge of PBoR compared to patients (p= <0.001). Factors associated with good to excellent knowledge of PBoR were male gender (p= 0.004), higher educational level (p= <0.001), being physician (p= <0.001) and younger age (p= <0.001). CONCLUSION: Overall level of knowledge of PBoR was unsatisfactory especially among the patients. There is an urgent need for government to adequately educate and sensitize the public on PBoR in order to ensure qualitative health services delivery.

Pregnancy-related acute kidney injury: Etiologies and short-term outcomes in a tertiary hospital in Southwest Nigeria.

Although the incidence of pregnancy-related acute kidney injury (PRAKI) is declining in developing countries, it still remains a major cause of maternal and fetal morbidity and mortality. The aim of this study was to determine the etiologies, short-term outcomes, and their predictors in patients with PRAKI managed in a tertiary health facility in Southwest Nigeria over a four-year period. This was a four-year retrospective review of clinical records of patients managed for PRAKI in University of Medical Sciences Teaching Hospital, Ondo State, Nigeria. Thirty-two women with a mean age of 31.09 ± 7.50 years had PRAKI during the period reviewed. Twenty-four (75%) patients were multiparous and PRAKI was most common in the postpartum period (56.3%). Twenty-three patients (71.9%) were in RIFLE Stage 3, 24 (75%) received blood transfusion, 5 (15.6%) required intensive care unit (ICU) care, 24 (75%) needed dialysis while 19 (59.4%) had hemodialysis. The common causes of PRAKI were obstetric hemorrhage in 16 (50%), sepsis in seven (21.9%), and eclampsia in six (18.8%). Maternal and fetal mortality were 34.4% and 50% respectively. Seventeen (53.1%) had full renal recovery and only one (3.1%) became dialysis dependent. Significant factors that were associated with maternal mortality were admission to ICU (P = 0.01), hypotension (P = 0.02), and impaired consciousness (P <0.001) PRAKI is still relatively common and significantly contributes to maternal and perinatal mortality in Nigeria. Obstetric hemorrhage which is the most common cause of PRAKI is preventable and treatable. There is a need for physicians to effectively prevent and manage obstetric hemorrhage.