Introduction
Methods
Results
Participant characteristics
Respondent demographics/experience | Number of responses (% of responses) |
---|---|
Gender | |
Male | 31 (77.5) |
Female | 8 (20) |
Not stated | 1 (2.5) |
Age | |
25–35 years | 7 (17.5) |
35–45 years | 14 (35) |
46–55 years | 9 (22.5) |
> 55 years | 8 (20) |
Not stated | 1 (2.5) |
Location of undergraduate training (number of countries) | |
Africa | 14 (82.4) |
Europe | 1 (5.9) |
North America (including Cuba) | 1 (5.9) |
Not stated | 1 (5.9) |
Location of postgraduate training (number of countries) | |
Africa | 9 (52.9) |
Europe (including Norway) | 4 (23.5) |
North America, Cuba | 2 (11.8) |
Asia | 1 (5.9) |
Not stated | 1 (5.9) |
Years since medical school graduation | |
< 5 years | 1 (2.5) |
5–10 years | 9 (22.5) |
11–20 years | 16 (40) |
> 20 years | 12 (30) |
Not stated | 2 (5) |
Years in Nephrology | |
< 5 years | 15 (37.5) |
5–10 years | 12 (30) |
11–20 years | 7 (17.5) |
> 20 years | 5 (12.5) |
Not stated | 1 (2.5) |
Current clinical role (> 1 role possible) | |
Trainee | 2 (5) [nephrology fellow] |
Specialist | 36 (90) [2 Internists, 4 pediatric nephrologists, 30 nephrologists] |
Other | 3 (7.5) [teaching, research health management] |
Not stated | 1 (2.5) |
Location of nephrology practice (> 1 location possible) | |
Government institution | 18 (45) |
Teaching institution | 23 (57.5) |
Private for profit institution | 13 (32.5) |
Private section within a government facility | 3 (7.5) |
Private non profit institution | 2 (5) |
Own private institution | 6 (15) |
Other | 1 (2.5) |
Not stated | 1 (2.5) |
Position in academic medicine | |
Not in academics | 8 (20) |
Junior faculty | 12 (30) |
Assistant or Associate Professor | 7 (17.5) |
Senior faculty/ Full Professor | 8 (20) |
Not stated | 5 (12.5) |
Volume of patients seen with kidney disease
Access to dialysis
Factors affecting access to dialysis or not
Nephrologists’ experiences of challenges in access to dialysis
Patient constraints • “what do we do with children with AKI who have no financial means, because we could save them?” (R4) • “start dialysis for patients who are not able to continue chronic dialysis because of poverty”(R15) • “…a child had been on PD for 6 weeks with no improvement. The decision as to stop PD and palliate” (R17) • “patient’s family or relatives requesting you to do haemodialysis in terminal cases, cancer etc.” (R24) Institutional constraints • “no resources available” (R1) • “I had to stop dialysis despite no recovery because we have no place in chronic dialysis”(R13) • “there is no public dialysis in my country. Diagnosis is made very late. I struggle to fight for prevention”(R8) • “the dialysis budget is badly used, Corruption ++”(R7) • “Often politicians will interfere with our guidelines on provision of dialysis” (R29) Physician constraints/strategies • “when a patient is being managed in another health facility comes to me I find it difficult to decide where my loyalty lies. To the patient to divulge all the info or to the doctor and I hide things under the carpet?” (R2) • “the patient has dementia, family finds resources for dialysis with difficulty. What do I do?”(R13) • “Our own renal unit have established committee to decide which patients would be offered the RRT. We have entry and even exit criteria for our haemodialysis programme”(R27) • “We have regular meetings with decision makers and stakeholders”(R29) • “It is a huge challenge to work as a nephrologist in Africa but with international support from organisations like AFRAN etc. lobbying for a lot of services to be implemented in possible” (R13) • “I think transplantation is the good therapy to take care end stage of CKD in our countries - then promote that therapy. Develop a program of screen and prevent CKD which can be proposed in Africa” (R11)a |