title: Knowledge of physicians on chronic kidney disease and their attitudes towards referral, in two cities of Cameroon: a cross-sectional study.
abstract: BACKGROUND
  Chronic kidney disease (CKD) is frequently unrecognized by non-nephrology physicians. There is an ongoing governmental program to create hemodialysis centers in the ten regions of Cameroon, where a previous study reported high levels of late referral to nephrologists. We aimed to assess the knowledge of physicians on CKD and their attitudes regarding referral.
  
  
  METHODS
  A questionnaire based on the Kidney Disease Outcome Quality Initiative Guidelines of 2002 was self-administered to general practitioners and non-nephrology specialists working in two Cameroon cities that have hemodialysis centers (Douala and Bamenda).
  
  
  RESULTS
  Of the 174 general practitioners and non-nephrology specialists approached, 114 (65.5%) returned answered questionnaires. Only 58.8% of doctors identified the correct definition of CKD. Most physicians were aware of the major risk factors of CKD (hypertension, 97.4% and diabetes mellitus, 95.6%). Most physicians were also aware of complications such as anemia (93.0%), hypertension (90.4%), uremia (85.1%) and hyperkalemia (85.1%). Only 44% knew that CKD had five stages, with general practitioners 3.4 times more likely to know than specialists (p = 0.004). Even though 61.4% of the physicians knew that the estimated glomerular filtration rate was the appropriate clinical means to diagnose CKD, 12.7% would use serum creatinine alone for diagnosis. Also, up to 21.9% of physicians would refer at late stage.
  
  
  CONCLUSIONS
  General practitioners and non-nephrology specialists lack general knowledge on CKD, especially on the definition and staging; they also have inadequate attitudes with regards to diagnosis and referral to the nephrologists. Educational efforts are warranted to improve on physicians' knowledge and skills on CKD in Cameroon.
authors.affiliation: Department of Internal Medicine and Pediatrics, Faculty of Health Sciences, University of Buea, Buea, Cameroon. schoukem@gmail.com.|Health and Human Development (2HD) Research Group, Douala, Cameroon. schoukem@gmail.com.|Diabetes and Endocrine Unit, Department of Internal Medicine, Douala General Hospital, P.O. Box 4856, Douala, Cameroon. schoukem@gmail.com.
authors.forename: Simeon-Pierre
authors.initials: SP
authors.lastname: Choukem
authors.affiliation: Department of Internal Medicine and Pediatrics, Faculty of Health Sciences, University of Buea, Buea, Cameroon. keafonnchifor@yahoo.com.
authors.forename: Pennghan K
authors.initials: PK
authors.lastname: Nchifor
authors.affiliation: Nephrology and Hemodialysis Unit, Department of Internal Medicine, Douala General Hospital, Douala, Cameroon. patricehalle@yahoo.fr.|Department of Clinical Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon. patricehalle@yahoo.fr.
authors.forename: Marie-Patrice
authors.initials: MP
authors.lastname: Halle
authors.affiliation: Health and Human Development (2HD) Research Group, Douala, Cameroon. dnebongo@yahoo.com.
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Nebongo
authors.affiliation: Health and Human Development (2HD) Research Group, Douala, Cameroon. djieka_yannick@yahoo.fr.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Mboue-Djieka
authors.affiliation: Nephrology and Hemodialysis Unit, Yaoundé University Hospital Center, Yaoundé, Cameroon. f_kaze@yahoo.fr.|Departement of Internal Medicine and Subspecialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon. f_kaze@yahoo.fr.
authors.forename: François F
authors.initials: FF
authors.lastname: Kaze
authors.affiliation: Department of Internal Medicine and Pediatrics, Faculty of Health Sciences, University of Buea, Buea, Cameroon. globalhealth2202@yahoo.fr.
authors.forename: Gotlieb L
authors.initials: GL
authors.lastname: Monekosso
mesh_terms: D002163:Cameroon; D002947:Cities; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D058005:General Practitioners / Q000193:education*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007668:Kidney / Q000473:pathology / Q000503:physiopathology; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D011795:Surveys and Questionnaires; D061665:Time-to-Treatment