Philip Mwachaka

Medical and nursing students' intentions to work abroad or in rural areas: a cross-sectional survey in Asia and Africa

Abstract Objective To assess medical and nursing students’ intentions to migrate abroad or practice in rural areas. Methods We surveyed 3199 first- and final-year medical and nursing students at 16 premier government institutions in Bangladesh, Ethiopia, India, Kenya, Malawi, Nepal, the United Republic of Tanzania and Zambia. The survey contained questions to identify factors that could predict students’ intentions to migrate. Primary outcomes were the likelihoods of migrating to work abroad or working in rural areas in the country of training within five years post-training. We assessed predictors of migration intentions using multivariable proportional odds models. Findings Among respondents, 28% (870/3156) expected to migrate abroad, while only 18% (575/3158) anticipated a rural career. More nursing than medical students desired professions abroad (odds ratio, OR: 1.76; 95% confidence interval, CI: 1.25–2.48). Career desires before matriculation correlated with current intentions for international (OR: 4.49; 95% CI: 3.21–6.29) and rural (OR: 4.84; 95% CI: 3.52–6.66) careers. Time spent in rural areas before matriculation predicted the preference for a rural career (20 versus 0 years: OR: 1.53, 95% CI: 1.19–1.98) and against work abroad (20 versus 0 years: OR: 0.69, 95% CI: 0.50–0.96). Conclusion A significant proportion of students surveyed still intend to work abroad or in cities after training. These intentions could be identified even before matriculation. Admissions standards that account for years spent in rural areas could promote greater graduate retention in the country of training and in rural areas.

Ventriculoperitoneal shunt complications: a three-year retrospective study in a Kenyan national teaching and referral hospital

Background/Aims: Ventriculoperitoneal shunt complications have scarcely been reported in sub-Saharan Africa. This study aimed at determining the frequency of these complications and their associated risk factors in a Kenyan National Teaching and Referral Hospital. Methods: This cross-sectional study retrospectively covered 117 patients admitted to the Kenyatta National Hospital neurosurgical ward between January 2005 and December 2007 with ventriculoperitoneal shunt complications. The data obtained were analysed using the Statistical Package for the Social Sciences. Results: The most common complication was obstruction in 63 patients (53.8%), followed by migration in 25 (21.4%) and infection in 23 (19.7%) of the patients. Up to 49.6% of the complications occurred in patients younger than 6 months. Multiple complications were seen in 23.9% of the cases. The mean shunt duration was 18.05 months. Positive correlations existed between the presence of a shunt complication and patient age, shunt duration and the number of complications developed. These correlations were, however, neither strong nor statistically significant. Conclusion: This study reports the highest frequencies of shunt obstruction and migration ever recorded in the literature. The high rate of development of multiple shunt failures coupled with a short shunt duration calls for a closer monitoring of patients with ventriculoperitoneal shunts.

Variations in the position and length of the vermiform appendix in a black kenyan population.

Background. Topography of the appendix influences its mobility, degree of mobilization of the cecum, and need for additional muscle splitting during appendectomy. Although appendectomy is a common surgical procedure, there is a paucity of data on its topography in black Africans. Methods. The position and length of the appendix and relation of the appendicular base with spinoumbilical line were determined in 48 cadavers obtained from the Department of Human Anatomy, University of Nairobi, Kenya. Results. The commonest appendicular types in males were retrocecal 10 (27%) while in females was subileal 4 (36.4%). The average length of the appendix was 76.5 ± 23.6 mm. The base of the appendix was located along, below, and above the spinoumbilical line in 25 (52.1%), 9 (18.8%), and 14 (29.2%) cases, respectively. Conclusion. The topography of appendix in Kenyans shows variations from other populations. Knowledge of these variations is important during appendicectomy.

Repeated exposure to dissection does not influence students' attitudes towards human body donation for anatomy teaching.

The use of unclaimed bodies for anatomical dissection has been the main method of instruction at our institution. There is however a shortage of cadavers for dissection given the increase in the number of medical schools as well as in the number of students enrolling in these schools. This shortage could be mitigated by having voluntary human body donation programs. This study aimed at assessing the attitudes of medical students and surgical residents towards body donation for anatomy learning. We conducted an online survey involving 72 first-year medical students and 41 surgical residents at University of Nairobi who had completed one year of anatomy dissection. For the medical students, this was their first dissection experience while it was the second exposure for the surgery trainees. Most of the surgical trainees (70.7%) and medical students (68.1%) were opposed to self-body donation. This was mainly due to cultural (37%) and religious (20%) barriers. Surprisingly, of those not willing to donate themselves, 67.9% (82.8% surgical trainees, 59.2% medical students) would recommend the practice to other people. Exposure to repeated dissection does not change the perceptions towards body donation. It is noteworthy that culture and religion rank high as clear barriers amongst this “highly informed” group of potential donors.

Branching Pattern of Inferior Mesenteric Artery in a Black African Population: A Dissection Study

Background. Branching pattern of inferior mesenteric artery (IMA) and pattern of vascular supply to the left colon and rectosigmoid areas, though important during colorectal surgery, display interethnic variations. Further, these regions have notable vascular “weak points” reported to be highly susceptible to ischemic colitis. This study aimed at evaluating the branching pattern of IMA in a black African population. Materials and Methods. Fifty-seven formalin-embalmed cadavers (28 Male, 27 Female) were studied. The length, branching pattern, and diameter of IMA at its origin were recorded. Results. IMA mean length and diameter at origin were 30.57 ± 10.0 mm and 4.10 ± 0.9 mm, respectively. IMA most frequently branched into left colic artery and a common sigmoid trunk in 23 cases while the classical branching pattern was observed in only 7 cases. Colic marginal artery was absent at the splenic flexure and sigmoid colon in 7 and 5 cases, respectively. Arc of Riolan was observed in 9 cases. Conclusion. Branching pattern of IMA shows variations from the previously reported cases which might help account for some of the untoward outcomes observed following colon surgery. An angiographic study to further delineate functionality of the arterial anastomoses in this region is recommended.

Factors influencing choice of paediatrics as a career among medical students at the university of Nairobi, Kenya

Objective. We aimed to determine factors influencing choice of a career in paediatrics by medical students in Kenya. Methods. A cross-sectional survey of 450 medical students from the University of Nairobi, Kenya, was undertaken using a questionnaire designed to assess their preferences with regard to future specialisation, and timing of and factors influencing this choice. The data were analysed using the Statistical Package for Social Sciences. Results. The response rate was 385/450 (85.6%). Paediatrics was the second most preferred specialty after surgery, and was chosen by 50 students (13.0%). Female students were five times more likely than males to select paediatrics. Choice of paediatrics as a career was mainly determined by perceived intellectual challenge, presence of a role model, and ease of combining a career with raising a family. Those who had completed a clerkship in the specialty reported that they were encouraged by the teaching and clinical staff ( p =0.006), but found the specialty less prestigious than others ( p =0.030). None of the male students but 12 of the female students (30%) considered gender distribution to be a factor influencing their career choice ( p =0.046). Conclusion. This study indicates that paediatrics is popular among female students and that several factors influence choice of this specialty. Understanding these factors may help medical school administrators and faculty plan future recruitment strategies.

Is cadaveric dissection vital in anatomy education? Perceptions of 1st and 2nd year medical students

Introduction: The use of innovative ways of teaching anatomy as well as shortage of cadavers for dissection have raised questions as to whether dissection should continue to be used in teaching anatomy. This study aimed to assess the views of medical and dental students on the importance of dissection in learning gross anatomy, and whether they would prefer other ways of learning anatomy instead of cadaveric dissection. Materials and Methods: First- and second-year students enrolled at the University of Nairobi (Kenya) were asked to fill an online questionnaire. Data gathered were analyzed using Statistical Package for Social Sciences. Results: Ninety-eight (83 medical and 15 dental) students participated in the study. All students agreed dissection was useful in learning anatomy. Up to 95.2% of medical and 86.7% of dental students favored dissection. Most students strongly agreed or agreed that dissection helped them to develop three-dimensional (3D) awareness of the human body (94.9%), work as a team (89.8%), learn medical terminology (85.7%), and learn how to use basic surgical instruments (80.6%). Dissection was preferred to use of 3D models, prosected specimens, computer-aided learning techniques, or modern imaging techniques by 63.3%, 60.3%, 37.7%, and 34.4% of the students, respectively. Conclusion: Dissection is an important resource for learning anatomy. Other teaching techniques should be used to supplement dissection rather than replace it.

Effect of Monocular Deprivation on Rabbit Neural Retinal Cell Densities

Purpose: To describe the effect of monocular deprivation on densities of neural retinal cells in rabbits. Methods: Thirty rabbits, comprised of 18 subject and 12 control animals, were included and monocular deprivation was achieved through unilateral lid suturing in all subject animals. The rabbits were observed for three weeks. At the end of each week, 6 experimental and 3 control animals were euthanized, their retinas was harvested and processed for light microscopy. Photomicrographs of the retina were taken and imported into FIJI software for analysis. Results: Neural retinal cell densities of deprived eyes were reduced along with increasing period of deprivation. The percentage of reductions were 60.9% (P < 0.001), 41.6% (P = 0.003), and 18.9% (P = 0.326) for ganglion, inner nuclear, and outer nuclear cells, respectively. In non-deprived eyes, cell densities in contrast were increased by 116% (P < 0.001), 52% (P < 0.001) and 59.6% (P < 0.001) in ganglion, inner nuclear, and outer nuclear cells, respectively. Conclusion: In this rabbit model, monocular deprivation resulted in activity-dependent changes in cell densities of the neural retina in favour of the non-deprived eye along with reduced cell densities in the deprived eye.

Effects of monocular deprivation on the dendritic features of retinal ganglion cells

La privacion monocular de la vision resulta en cambios anatomicos en la corteza visual en favor del ojo no privado. Aunque la retina forma parte de la via visual, hay escasez de datos sobre el efecto de la privacion monocular en su estructura. El objetivo de esta investigacion fue describir los efectos de la privacion monocular en las caracteristicas de las dendritas de las celulas ganglionares de la retina. Se diseno un estudio cuasi-experimental. Se examinaron 30 conejos (18 experimentales, 12 controles). La privacion monocular se logro a traves de la sutura unilateral del parpado en los animales de experimentacion. Los conejos fueron observados durante tres semanas. Cada semana, 6 animales experimentales y 3 control fueron eutanasiados, donde se obtuvo la retina y fue procesada para realizar microscopia optica. Las microfotografias de la retina fueron tomadas con una camara digital y luego se utilizo el software FIJI para su analisis. El numero de dendritas primarias, terminales y el area del campo de dendritas en los ojos no privados aumento un 66,7% (p=0,385), 400% (p=0,002), y 88,4% (p=0,523), respectivamente. Los ojos no privados, tenian 114,3% mas dendritas terminales (p=0,002) en comparacion con los controles. Entre los ojos privados, todas las variables medidas tuvieron un aumento gradual en las dos primeras semanas, seguido de descenso con mayor privacion. No se observaron diferencias estadisticamente significativas entre los ojos privados y el grupo control. En conclusion, la privacion monocular produce un aumento de los contactos sinapticos en los ojos no privados, con cambios reciprocos que se manifiestan en los ojos privados de la vision.

Who Wants to be a Surgeon? A Survey of Medical Students at the University of Nairobi, Kenya

Background: In Sub Saharan Africa, surgical conditions account for a significant disease burden. Surgical workforce is however inadequate, and thus strategies such as attracting medical students to surgical specialties could avert the situation. This study determined the proportion of students interested in pursuing surgical career and factors that influence choice of this specialty. Methodology Four hundred and fifty medical students, from first to fifth year of study at the University of Nairobi, were each issued a self administered questionnaire designed to assess their specialty preferences, and factors influencing these choices. Results: The response rate was 385/450(85.6%). Surgery was the most popular specialty with 105(27.3%) students. Majority, 6 (57%), of those who preferred surgery were in the preclinical years. Male students had a two-fold likelihood of selecting a surgical career compared to females. Significant factors that attracted students to surgery instead of non surgical careers were prestige of the specialty (p<0.001), presence of a role model (p=0.002), and intellectual challenge (p=0.005). Main deterring factors were ease of raising a family (p<0.001), length of residency (p<0.001) and lifestyle of practice (p=0.020). Conclusion: Although surgery is the most preferred specialty among medical students at the University of Nairobi, there appears to be a declining interest among the clinical students. In order to attract and maintain student interest in the specialty, there is need for early and active mentoring. The Annals of African Surgery, Volume 6, 2010