ORIGINAL

Niger J Paed 2014; 41 (1):48 –53

Okpere AN

Anochie IC

Knowledge and Attitude of

Healthcare Workers towards

Kidney Transplantation in Nigeria

DOI:http://dx.doi.org/10.4314/njp.v41i1,9

Accepted: 13th September 2013

Abstract

Background: The

Majority (45.2%) of the respon-

dents were aged 35 – 44 years;

59.0% had been in practice for

more than 10 years and 83.9%

were Christians. On the average,

the healthcare workers responded

correctly to 63.9% of the questions

testing on knowledge and 50.7%

were willing to donate kidneys.

There was significant relationship

between willingness to donate and

profession (p = 0.001) but not with

age, gender, tribe, religion or dura-

tion of practice.

knowledge and attitude of health-

care workers towards kidney

transplantation are fundamental in

the development and sustainabil-

ity of transplant programs.

Healthcare workers caninfluence

the willingness to donate kidneys.

Objectives: To evaluate the

knowledge and attitude of Nige-

rian healthcare workers regarding

kidney transplantation.

Okpere AN (

Anochie IC

)

Department of Pediatrics,

University of Port Harcourt Teaching

Hospital,

PMB 6173,Port-Harcourt,

Rivers State,

Nigeria.

Email: anokpere@yahoo.com

Tel: +234-8059150818

Methods: A prospective study of

doctors and nurses at the 43 Pae-

rd

diatric Association of Nigeria

Conference in Ile-Ife, in January

Conclusion: Nigerian healthcare

workers have good knowledge and

favourable attitude towards kidney

transplantation. We recommend

training of health workers to fur-

ther improve their knowledge on

renal transplantation.

2

012 was carried out. Self-

administered questionnaires on

the knowledge and attitude of

healthcare workers towards kid-

ney transplantation were given to

participants practising in Nigeria

to complete.

Key words: Kidney Transplanta-

Results: The questionnaire com-

pletion rate was 93.6% (n = 217).

tion, Healthcare workers, Nigeria

Introduction

pansion of renal transplantation services in Nigeria with

the inclusion of children, the need for cadaveric kidneys

will eventually become inevitable.

Renal transplantation is the standard and preferred treat-

ment option for patients with end stage renal disease

(

ESRD) with potential for improved quality of life and

Healthcare workers (HCW) play an important role in

influencing potential kidney donors and their relatives;

HCW are the most critical linkin the organ procurement

1

increased life expectancy. However, renal

transplantation is still hampered by shortage of kidneys

in both developed and developing countries due to

discrepancy between the demand and supply of donor

organs. In the United States of America (USA),more

than 82,000 patients are on the renal transplant waiting

7

process. The knowledge and attitude of HCW regarding

renal transplantation is thus very crucial in the develop-

ment, improvement and sustenance of transplant pro-

grammes.

2

,3

2

list. The shortage of organs for transplantation is largely

8

attributed to unwillingness of the public to donate or-

gans including the kidney. Previous studies had noted

that culture, socio-demographic characteristics such as

age, gender, education and economic status; supersti-

tion; religion and uncertainty about the safety of the

donationprocess were the major barriers to kidney do-

nation. These barriers are more glaring in developing

nations where most of the transplants are performed

with live donor kidneys. In Nigeria, renal transplanta-

Evanisko et al in a previous study in the USA reported

that twothirds of critical-care staff members lack the

necessaryknowledge and training in organ donation and

9

transplantation.In Nigeria, Aghanwa et al in a previous

study noted that over 90% of health workers in Ile-Ife

had correct knowledge of renal transplantation while

4

,5

10

Anochie et al reported that less than half of the medical

students in Port Harcourt were willing to be living kid-

ney donors. This present study was therefore conducted

to evaluate the knowledge and attitude of Paediatric

HCW in Nigeria towards kidney transplantation.

6

tion is the only form of organ transplantation that is been

carried out with living relatives as donors. With the ex-

4

9

Materials and Methods

Table 1: Characteristics of the Study Population

This was a prospective cross-sectional study conducted

during the 43 Paediatric Association of Nigeria Confer-

Parameter

Gender

Number Percentage

rd

ence (PANCONF) in Ile-Ife, Osun State, Nigeria on

January 25 , 2012 among paediatric doctors and nurses

practising in Nigeria who were attending the conference.

Male

Female

Age group (years)

80

36.9

63.1

th

137

˂

25

3

1.4

2

3

4

˃

Religion

Christians

Muslims

Tribe

Ibo

Yoruba

Hausa

Others

Profession

Doctors

Nurses

Place of Practice

Tertiary/Teaching

Hospital

General Hospital

Private Hospital

PHC Centre

5 – 34

5 – 44

5 – 54

51

98

50

15

23.5

45.2

23

Verbal consent was obtained from the participants. Self-

administered questionnaires on knowledge and attitude

towards renal transplantation were given to the partici-

pants to complete and collected immediately. Data col-

lected were analysed using SPSS version 17 (SPSS Inc.,

Chicago, Illinois, USA). The differences among groups

were assessed using Pearson Chi-square tests and the

Fisher’s exact test where appropriate. P values of less

than 0.05 were considered statistically significant.

Logistic regression was performed to explore the asso-

ciation between the respondent’s willingness to donate a

kidney and co-variants (age, gender, tribe, religion, pro-

fession and duration of practice). Respondents who an-

swered ‘undecided’ regarding their willingness to donate

were excluded from the logistic regression analysis.

55

6.9

182

35

83.9

16.1

56

92

20

49

25.8

42.4

9.2

22.6

161

56

74.2

25.8

186

15

12

4

85.7

6.9

5.5

1.8

Results

Duration of Practice (years)

Response rate and Demographic Characteristics of the

Study Population

˂ 5

33

56

128

15.2

25.8

59

5

– 10

˃10

Of the 250 questionnaires distributed, 234 (93.6%) were

returned; 16 (6.8%) had missing information and were

discarded. The remaining 217 (92.7%) questionnaires

met the study criteria and were analysed. They com-

prised of80 (36.9%) males and 137 (63.1%) females

with a Male: Female ratio of 1:1.7. Table 1 shows the

characteristics of the study population. Majority (70.1%)

of the respondents were less than 45 years and 182

Key: PHC = Primary Health Care

Table 2: Correct Knowledge of Health Workers Regarding

Renal Transplantation

Parameter

Number Percentage

185

Definition of renal transplantation

Awareness of renal transplantation

centres in Nigeria

Indication for renal transplantation

Awareness of renaltranplant in

children in Nigeria

85.3

(

83.9%) were Christians. Over 70% of the respondents

were doctors of which 64 (39.8%) were consultants and

7 (60.2%) were residents. The respondents were prac-

ticing in 32 (of the 36) States in Nigeria; majority

85.7%) in the Tertiary/Teaching hospitals.

154

172

71

93.7

9

43

19.8

49.3

Age at which children should be

transplanted

(

107

Knowledge regarding kidney transplantation

Attitude towards renal transplantation

A total of 185 (85.3%) respondents knew the definition

of kidney transplantation. Table 2 shows the respondents

knowledge regarding renal transplantation. A total of

A total of 201 (93.1%) respondents agreed that patients

should receive donated organs to prolong life. However,

only 160 (73.7%) respondents will approach relatives of

potential donors to discuss the possibility of kidney

donation. Table 3 shows the attitude of doctors towards

renal transplantation compared to that of the nurses. The

doctors were more willing to approach relatives of po-

tential donors, donate a kidney, receive a kidney trans-

plant, support cadaveric kidney transplant and sign an

organ donation card compared to nurses; the differences

1

54 (71.0%) respondents were aware of renal transplant

centres in Nigeria; those in the Tertiary/Teaching hospi-

tal were more aware than those in the Private clinics and

Primary Health Care (PHC) centres but the difference

was not statistically significant (p = 0.453). However,

1

9.8% respondents were aware of renal transplantation

being done in children in Nigeria and less than half of

the respondents knew the correct age at which children

should be transplanted. Overall, doctors were more

knowledgeable than nurses and the differences were

statistically significant (p = 0.000 in all cases). On the

average, the healthcare workers responded correctly to

were

statistically significant in all cases (p ˂

0.05).Participants practicing in the teaching/tertiary

institutions and those that have practiced for less than

five years were more willing to approach the relatives of

a potential donor, although, the differences were not

6

3.9% of the five questions on knowledge of renal

5

0

statistically significant (p = 0.666 and 0.445 respec-

tively). Reasons given for not approaching relatives of

potential donors included high cost of renal transplanta-

tion (66.7%); religious beliefs (17.5%); fear (12.3%);

feelings for the relatives and lack of legislation for renal

transplantation in Nigeria (1.8% each respectively).

Table 4: Willingness to donate Kidneys according to

Demographic Characteristics

Paramet

er

Undecid

ed (%)

All (%)

Yes (%)

No (%)

6 (7.5)

P value

Gender

Male

80(36.9)

44 (55.0)

66 (48.2)

30 (37.5) 0.097

Female

137(63.1)

25 (18.2) 46 (33.6)

Age group (years)

Of the 165 (76.0%) respondents that are willing to

receive kidney transplant, 140 (84.9%) will prefer living

donor kidneys, 2 (1.2%) will prefer cadaveric kidneys

while 23 (14.0) will accept either a living donor or

cadaveric kidney.

˂

25

3 (1.4)

0 (0.0)

3 (100.0) 0.272

17 (33.3)

2

3

4

5 – 34

5 – 44

5 – 54

51 (23.5)

98 (45.2)

50 (23.0)

15 (6.9)

27 (52.9)

55 (56.1)

21 (42.0)

7 (46.7)

7 (13.7)

10 (10.2) 33 (33.7)

11 (22.0) 18 (36.0)

˃

55

3 (20.0)

5 (33.3)

Religion

Christia

ns

Table 3: Attitude of Health workers towards Kidney Trans-

plantation

182 (83.9) 91 (50.0)

29 (15 9) 62 (34.1) 0.278

Attitude

Total

Doctors

Nurses

p value

Muslims 35 (16.1)

19 (54.3)

2 (5.7)

14(40.0)

N = 217

(N = 161)

(N = 56)

Tribe

Approach relatives of

potential donor

Ibo

56 (25.8)

92(42.4)

20 (9.2)

49 (22.6)

33(58.9)

40 (43.5)

12 (60.0)

25 (51.0)

3 (5.4)

20 (35.7) 0.155

No (%)

Yoruba

Hausa

19 (20.7) 33 (35.9)

Yes

No

Willingness to donate a kidney

Yes

No

Undecided

Willingness to receive Kidney Transplant

Yes

No

Support cadaveric Kidneys for Transplant

Yes

No

Willingness to sign an organ donation card

Yes

No

160 (73.7) 126 (78.3) 34 (60.7) 0.01

35 (21.7)

1 (5.0)

7 (35.0)

57 (26.3)

22 (39.3)

Others

Profession

Doctors

8 (16.3)

16 (32.7)

110 (50.7) 91 (56.5)

15 (9.3)

55 (34.2)

19 (33.9) 0.001

16 (28.6)

21 (37.5)

161 (74.2) 91 (56.5)

56 (25.8) 19 (33.9)

15 (9.3)

55 (34.2) 0.001

31 (14.3)

76 (35.0)

Nurses

Duration of Practice (years)

16 (28.6) 21 (37.5)

1

2

165 (76.0) 129 (80.1) 36 (64.3) 0.015

52 (24.0) 32 (19.9) 20 (37.5)

˂

5

33 (15.2)

56 (25.8)

128 (59)

18 (54.5)

31 (55.4)

61 (47.7)

3 (9.1)

4 (7.1)

936.5)

0.288

5

– 10

21 (37.5)

154 (71.0) 127 (78.9) 27 (48.2)

34 (21.1)

0

˃10

24 (18.8) 43 (33.6)

63 (29.0)

29 (51.8)

Table 5: Logistic Regression Modelling for Willingness to

Donate a Kidney

93 (42.9)

57 (26.3)

67 (30.9)

79 (49.1)

32 (19.9)

50 (31.1)

14 (25.0)

25 (44.6)

17 (30.4)

Undecided

Crude OR

(95% CI)

p

value

Adjusted OR

(95% CI)

Variable

pvalue

Willingness to donate kidneys

0.842

(0.2666 -

2.658)

0.835 (0.135

- 5.166)

0.295(0.058-

1.500)

1.561 (0.585

- 4.165)

5.831 (1.769

- 19.219)

1.742 (0.441

- 6.887)

0

.360 (0.137

- 0.949)

.818 (0.176

Sex (male)

Age

0.39

0.798

0.152

0.106

0

0.769

0.846

0.141

0.374

0.004

0.428

A total of 110 (50.7%) of the respondents were willing

to donate a kidney; 98% of which would prefer to do-

nate to their children and spouse, whereas only 42.9%

were willing to sign an organ donation card.

Table 4 shows the respondents willingness to donate

kidneys according to demographic characteristics. Medi-

cal doctors were significantly more willing to donate

kidneys compared to nurses (p = 0.001). Also, being a

male, in the age group 35 – 44 years, a Muslim, an

Hausa and in practice for 5 – 10 years were associated

with increased willingness to donate, although, the dif-

ferences was not statistically significant ( p ˃ 0.005 in

all cases).

0

- 3.804)

0.330 (0.073

Religion (Muslims) - 1.504)

5

.700 (0.690

Tribe

- 47.101)

5.109 (2.161

- 12.080)

2

Duration of practice - 8.752)

Profession (doctor)

.361 (0.637

0.199

Key: OR = Odds Ration; CI = Confidence Interval

Reasons for Unwillingness to donate a Kidney

The commonest reason for unwillingness to donate a

kidney for transplantation was religious belief (35%) as

shown in Figure 1. Other reasons included fear (26.7%)

and desire to be buried intact with all body parts (4.9%).

Logistic regression analysis was performed to assess the

association between different variables and willingness

to donate. In both the crude and adjusted models, being

a medical doctor was strongly associated with willing-

ness to donate kidneys (crude odds ratio [OR] = 5.109;

Fig 1: Reasons given by Health workers for Unwillingness to donate a

Kidney

9

0

1

5% confidence interval [CI] = 2.161 – 12.080; p =

.000 and adjusted OR = 5.831; 95% CI = 1.769 –

9.219; p = 0.004); there was no significant relationship

between willingness to donate kidneys and age, gender,

tribe, religion or duration of practice as shown in

Table 5.

5

1

Discussion

sent study may be attributed to the fact that the study

was carried among relatives of patients in need of a kid-

ney transplant in a centre with established solid organ

transplantation programmes.

The present study demonstrated that HCW in Nigeria

have good knowledge of renal transplantation. This find-

ing contrast with prev₁ ious report by Evanisko et al in

8

1

12

the USA, Molzahn in Canada and Alsultan et al in

Saudi Arabia who reported poor knowledge of HCW

regarding organ donation. The findings of the present

stu₁₃dy however is comparable to the report by Akgun et

al who found a good level of knowledge(87.3%) about

kidney transplantation among healthcare professionals

in Turkey. The higher level of knowled₃ ge about kidney

However, despite the reported willingness to donate

kidneys documented in the present study, only 42.9% of

the respondents were willing to sign an organ donation

card. Reasons given for not signing an organ donation

card included fear of death and mistrust on health pro-

fessionals who may harvest viable organs in an uncon-

scious state even before they are certified dead.

1

transplantation reported by Akgunet al compared to the

There was no significant association between age and

willingness to donate organ in the present study. This is

present study may be attributed to the fact that the study

was conducted among HCW practicing in a Country

with established transplant centres and programmes.

The present study also showed that knowledge about

kidney transplantation increased with increasing medical

education as medical doctors were more knowledgeable

than nurses regarding renal transplantation. This finding

9

similar to pre₀vious reports by Aghanwa et al i₁n₄ Nigeria,

2

Bilgel et al in Turkey and Schaeffner et al in Ger-

ma₈ny, but contrast with previous reports by Odusanya et

1

al in Nigeria and in the other parts of the world

2

1,22

where younger age was found to be significantly

associated with willingness to donate organs. The reason

for the disparity in these findings cannot be readily as-

certained. Also, the present study documented no sig-

nificant association between willingness to donate kid-

neys and₈ gender. This is similar to a previous report in

1

4

is similar to previous reports by Schaeffner et al

among medical students and physicians r₃egarding organ

1

donation in Germany and Akgun et al among physi-

cians and nurses in Turkey.

1

Nigeria but contrast with previous reports in the west-

The finding that HCW in the present study had positive

attitude towards or₅gan donation was similar to previ₁o₆u_,₁s₇

ern worlds where higher proporti₂o₁n_,₂₃of females were

more willing to be potential donors.

1

reports in Nigeria and in other parts of the world.

The proportion of HCW in the present study willing to

approach and discuss with relatives of potential kidney

donors is also very impressive and encouraging as this

may contribute to increase in organ procurement for

transplantation in Nigeria. The findings in the present

study however contr₁₄ast with those reported in

The lack of significant association between religion and

willingness to donate a kidney contrast previous report

which showed that religious beliefs play_,₂₄a role in

5

determining one’sview of organ donation. The find-

ings of the present study is however encouraging and

favourable to the sustenance of renal transplantation

programme in Nigeria considering the fact that religious

beliefs has gre₂a₅tly interfered in some health programmes

in thecountry.

11

Canada and Germany where majority of the HCW

indicated reluctance and felt insufficiently prepared to

approach relatives of potential organ donors.

The fact that high proportion of HCW in the study sup-

ports cadaveric kidney transplantation is very encourag-

ing considering the possible inevitable need for ca-

daveric kidney donation in future in Nigeria. This find-

Being a medical doctor was the only independent pre-

dictor of willingness to donate kidneys in the present

study. This observation has been r₁e₃p_,₁o₄rted in previous

studies in other parts of the world. A study showed

that the educational level of health professionals was

positivel₆y related to their personal willingness to donate

1

7

ing is in con₃sonant with that reported by Rios et al and

1

Akgun et al in Spain and Turkey respectively.

2

In the present study, about half of the HCW reported

willingness to donate their kidneys. This finding is

higher than the 39.3% reported among ₇medical students

organs. A higher medical educational level is associ-

ated with greater knowledge and a more positive attitude

towards organ donation.

1

in a previous study in Port Harcourt and the 30.0%

1

8

reported by Odusanya et al among the general popula-

tion in Lagos, Nigeria. It is however lower than the

The strengths of our survey included the high response

rate of the participants and the fact that the study was

conducted among HCW practicing in different centres in

Nigeria. The findings of this study therefore reflects the

knowledge and attitude of a wider population of HCW

in Nigeria towar_,₁d₅s renal transplantation compared to

12

7.0% reported in Saudi Arabia andmuch lower₅ than

1

5

the 75.6% and 62.5% reported by Agaba et al and

9

Aghanwa et al respectively among HCW in previous

Nigerian studies. The present study was conducted

among diverse HCW from different institutions while

the previous studies were conducted in single centres in

Nigeria and Saudi Arabia with established renal units.

This may explain the lower value of willingness to do-

nate kidneys among H₉ CW in the present study. In a

9

previous studies which were conducted in single cen-

tres in Nigeria. The present study however only deter-

mined willingness of HCW to donate kidneys which is

different from actual rate of donation. Willingness to

donate does not necessarily translate to actual donation

1

27

study by Ndlovu et al in South Africa, 80% of the liv-

rate. Further studies need to be conducted to determine

ing-related potential donors indicated willingness to

donate a kidney. This higher value compared to the pre-

the actual rate of kidney donation by HCW in Nigeria.

5

2

Conclusion

Author’s Contributions

Both authors conceived the study, designed the study

instrument, prepared and approved the final version of

the manuscript.

Conflict of Interest: None

Funding: None

In conclusion, Nigerian HCW have good knowledge and

favourable attitude towards renal transplantation. Major-

ity of the HCW expressed willingness to donate a kid-

ney and being a medical doctor is the strongest inde-

pendent factor associated with willingness to donate

kidneys. We recommend the establishment of nation-

wide education programmes on renal transplantation for

the training of HCW in each centre in Nigeria to further

improve their knowledge on renal transplantation.

Acknowledgement

We are grateful to the 2012 Local organising committee

rd

of the 43 Paediatric Association of Nigeria Conference

(

PANCONF) in Ile-Ife for permitting the conduct of the

survey. We are also very grateful to the healthcare work-

ers who participated in this study.

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