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.

Prevalence and biosocial determinants of hypertension in a rural population in Edo State, Southern Nigeria

Background

Hypertension is a public health threat of global concern with increasing prevalence in many countries, including Nigeria.

Aim

The aim of the study was to determine the prevalence and determinants of hypertension in a rural agrarian community in Edo North, Nigeria.

Setting

The study was carried out in Ayua, a community in Edo North, southern Nigeria.

Methods

This cross-sectional descriptive study involved the use of a structured interviewer-administered questionnaire to obtain relevant data. Body mass index (BMI), blood pressure and glucose were recorded. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20.0.

Results

Two hundred and nineteen participants aged > 15 years completed the study with a mean age of 54.03 ± 16.61 years and females comprising 159 (72.6%) of the total. The prevalence of hypertension was 27.9% (in 61 participants). Twenty-one (9.8%) respondents gave a family history of hypertension. The mean BMI amongst respondents was 27.10 ± 6.61 kg/m². Obesity and pre-obesity were found in 58 (26.5%) and 71(32.4%) respondents, respectively. The determinants of hypertension were age and BMI. Compared with those who were less than 40 years old, those aged 40–65 years and > 65 years had 1.9 and 4.2 times increased odds of developing hypertension, respectively. Similarly, compared with the non-obese, obese participants had 2.3 times increased odd of having hypertension.

Conclusion

Hypertension was highly prevalent in this rural community. Health sensitisation and intervention programmes are recommended in rural communities for early detection and management of hypertension, especially amongst older and obese adults.

Prevalence of hypertension and associated factors in a rural community in Bayelsa State

Background: Hypertension is considered among the most common non-communicable diseases globally with significant morbidity and mortality. Closely related to it is pre-hypertension, a category between hypertension and normotension which is believed to be a forerunner to hypertension and cardiovascular disease. Hypertension has been on the increase in recent times, even in rural communities which were previously less affected. The study was carried during the world health day as a screening exercise to determine the prevalence of hypertension and its associated factors in a rural community.Methods: This cross-sectional study was conducted in Ogboloma village, a small rural community in Bayelsa State, Ngeria Consecutive sampling of all eligible participants who presented for the screening exercise was done. Socio-demographic data, clinical history, anthropometry and blood pressure were taken. Data was stored and analyzed using SPSS version 20.0.Results: One hundred and thirty-one participants completed the study. There were 49(37.4%) males. The prevalence of hypertension was 50.4% while pre-hypertension was found in another 41.2%. Factors associated with hypertension on univariate analysis were age (p <0.001) body mass index (p=0.038) waist hip ratio (p=0.008) hyperglycemia (p=0.030) and smoking (p=0.009) However, only age (p=0.004) and smoking (p=0.037) remained significant on multivariate analysis.Conclusions: Hypertension and Pre-hypertension were highly prevalent in this rural community. Age and smoking were significant predictors of hypertension. Hypertension screening and control programmes should therefore target rural communities and smokers.

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 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.