Knowledge, attitudes and practice of venous thromboembolism risk assessment among surgical doctors in Tanzania

Date of Award

2021

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Dr. Masawa Nyamuryekung’e

Second Supervisor/Advisor

Dr. Athar Ali

Third Supervisor/Advisor

Dr. Natasha Housseine

Department

Medical College (East Africa)

Abstract

Introduction: Surgical patients are at increased risk of venous thromboembolism due to the nature of their conditions and treatments. The incidence ranges from 61.3% to 64.9% in developed countries, compared to 43% in Africa. Although venous thromboembolism is fatal, it is potentially preventable. Physician-implemented risk assessment models reduce events by 70%. No country in sub-Sahara Africa has implemented a national venous thromboembolism risk assessment guideline. The subsequent burden is probably a reflection of low awareness and knowledge, negative attitudes, and substandard practice among physicians towards risk assessment.

Justification: In the current study, we assessed Tanzanian surgical doctors' knowledge, attitudes, and practices of venous thromboembolism risk assessment and further determined whether surgical physicians' age, gender, years of practice since graduation of bachelor of medicine (experience), and academic level were associated with their knowledge, attitudes, and practice on venous thromboembolism assessment. Findings of this study would allow conception of evidence-based recommendations and possible interventions targeted at reducing the incidence of hospital-acquired venous thromboembolism and its associated morbidity and mortality in Tanzania.

Methods: A prospective survey among surgical doctors was conducted at two, public national refferal level hospitals in Dar es salaam, Tanzania. A researcher-administered questionnaire was used. The questions on knowledge were adopted from PROMOTE study, and the questions on attitudes and practice domains were developed by the investigators. The knowledge and practice domains were assessed according to the 10th ACCP guidelines.

Results: The overall mean venous thromboembolism knowledge score among surgical doctors was 55.2%. Although 66% of respondents felt hospitalization increased venous thromboembolism risk, 58% felt some surgical patients do not require venous thromboembolism risk assessment. About 45% felt venous thromboembolism prophylaxis increased treatment costs, 33% felt it increased hospital mortality and 47.7% felt some thromboprophylaxis interventions were ineffective. thromboembolism risk, only --- felt surgical patient required risk assessment. More than 8 out of 10 have had an experience of patient developing venous thromboembolism, a similar proportion doctors reported that they would prescribe thrombo-phylaxis in a patient with significant risk, however some setbacks like inadequate knowledge (53.8%) was reported to limit practice.

Conclusion and Recommendations: The venous thromboembolism knowledge is not ideal among surgical doctors in Tanzanian refferal level hospitals, this adversely impacts attitudes and practice and is a patient safety risk. There is a need to develop and adopt a comprehensive hospital-wide policy on VTE and ensure implementation of its guidelines and protocols in all clinical settings. Knowledge gaps need to be addressed, and sustainable program for regular and frequent regular re-training of surgical doctors in Tanzania tertiary level hospitals on VTE, its risk assessment, prevention and management needs to be set up.

This document is available in the relevant AKU library

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