A survey of facilities and human resource for paediatric nephrology training and practice in Nigeria: Resident doctors’ perspective

Abstract

Abstract: Background: Kidney diseases are emerging as important contributors to non- communicable diseases in children worldwide and they impact negatively on the socioeconomic wellbeing of families and nations. Unlike rich economies of the world there is dearth of facilities and manpower needed for the practice and training in Paediatric Nephrology in resource challenged nations like Nigeria. There are however no data to support this assertion.

Objectives: The study sought to provide information on facilities and manpower available for paediatrics nephrology practice and education in the country. Methods: We deployed an indirect, unobtrusive and introspective method to gather needed data using semi structured self- administered questionnaire on resident doctors who fitted well as key informants. Subjects were attendees at the annual Update Course in Paediatrics organised by the National Postgraduate Medical College of Nigeria in 2019. Results: Of the 154 attendees 93 (31 males and 62 females) participated in the study. Fifty four, 34 and 5 respectively were from Federal Teaching Hospitals, Federal Medical Centres and State Teaching Hospitals. Seventeen (31.5%), 14(25.9%) and 12(22.2%) of the residents working in federal teaching hospitals were from the South-south, Northwest and Southeast zones respectively while majority of the residents employed in state facilities were from the Southwest. Northeast and North-central zones had few residents. Facilities for haemodialysis (X2 = 9.58; p= 0.008), renal biopsy (X2 = 27.98; p= 0.000) and tissue handling (X2 = 9.97; p= 0.007) were significantly more in state and Federal Teaching Hospitals compared to Federal Medical Centres. Haemodialysis is not done in a quarter of the hospitals and in places where it was carried out, facilities are not dedicated to children and are not regularly done. One in 4 and two in 5 respondents came from centres where peritoneal dialysis (PD) is carried out with improvised materials. Among a quarter and half of the respondents, PD is respectively not done or seldom carried out. The views of 55.9% and 60.2% of the respondents on practice of Paediatric Nephrology was “fair” and “basic” respectively. Supplementary local and overseas training respectively could be accessed by only 23.7% and 12.9% of the respondents. Dedicated training in nephrology was available in centres hosting only 29% of the respondents. Where available the training was assessed as fair and good by 37.0% and 55.6% of the residents respectively. In the opinion of about half the respondents factors militating against training and practice were manpower/ infrastructural deficits, and lack of commitment of stakeholders.

Conclusion and Recommendations: Practice and training in Paediatrics Nephrology in Nigeria is at best basic and limited in scope and depth. They are hamstrung by multiplicity of factors. Advancing their cause in the country would require commitment of all stakeholders through improved funding and programs re-orientation.

 Keywords: Paediatrics, nephrology, facilities, training, practice, Nigeria