Prevalence of chronic kidney disease in a Nigerian family practice population

Background: Chronic kidney disease (CKD) is a global public health problem, with a greater burden and prohibitive cost of care particularly in developing countries. This study determined the prevalence of chronic kidney disease and identified its associated risk factors in patients attending the Family Practice Clinic, Wesley Guild Hospital, Ilesa, Nigeria. Method: Consecutive newly-registered patients who attended the Family Practice Clinic of Wesley Guild Hospital, Ilesa from August 2005 to January 2006 were recruited and studied. Relevant data were collected by using an interviewer-administered questionnaire, and determining the spot urinary ACR (albumin-creatinine ratio) of the subjects by using Microalbustix™ reagent strips and using their serum creatinine concentration. The glomerular filtration rate (GFR) of each subject was estimated using the Modification of Diet in Renal Disease (MDRD) formula. A repeat urine test was done three months after the initial screening to identify subjects with persistent microalbuminuria. Results: The age of the study subjects ranged from 20 to 74 years, with a mean age of 50.52 + 13.03 years. There were 68 males and 182 females in the sample population, showing a male to female ratio of 1:2.7. One hundred and thirteen of the 250 subjects (45.2%) were found to have pathologic albuminuria at the initial screening, while 31 (12.4%) had persistent albuminuria three months later. Also, 51 subjects (20.4%) had estimated low GFR at the initial screening and 26 (10.4%) had persistent low GFR three months later. Significant risk factors for CKD in the study subjects were increasing age, elevated blood pressure, history of diabetes mellitus (DM), habitual intake of analgesics and herbs, and an abnormal waist to hip ratio(p < 0.05). The association between persistent abnormal ACR and low GFR did not reach statistical significance (p = 0.053). Habitual analgesic intake (p = 0.002) and age group (p = 0.0027) were true predictors of CKD among the study subjects. Conclusions: The prevalence of CKD in the study population was high and its association with modifiable risk factors was demonstrated. Family physicians have a unique opportunity to identify and address these factors in their patients. Routine screening for CKD in family practice clinics is indicated to reduce the burden of renal disease in the population

Physicians and AIDS Care: Does Knowledge Influence their Attitude and Comfort in Rendering Care?

Adequate knowledge; positive attitude; and feeling of comfort are important factors in providing compassionate care to patients. The purpose of this study was to assess physicians' knowledge; attitude and global comfort in caring for patients with AIDS (PWA); to determine the sociodemographic variables that could influence physicians' attitude and global comfort; and to identify any relationship between their knowledge; attitude and comfort. Consultants and residents (N=211) in two Nigerian teaching hospitals were surveyed using a two-part questionnaire. Part I elicited sociodemographic and previous AIDS encounter information; and Part II assessed knowledge; attitude and global comfort with AIDS patients care. Nigerian physicians showed satisfactory knowledge; but they harbored negative attitude and low level of comfort in caring for PWA. Previous AIDS care experience; age and being a consultant or a senior resident influenced attitude; while male gender and knowing someone with AIDS influenced global comfort. Knowledge is weakly but positively associated with attitude; while attitude is modestly associated with comfort. The study reinforced the need for an ongoing education focused on experiential learning; and professional socialization in order to influence physicians' attitude and enhance their feeling of comfort when caring for PWA