Knowledge, attitude, and practice of clinicians practising at the Kenyatta National Hospital, on ionizing radiation

Abstract

The World Health Organization (WHO) Global initiative report on Radiation Safety in the Health Care Setting of March 2010 states that low dose ionizing radiation used in diagnostic imaging has the potential to cause detrimental health effects1. Statement of the problem The level of awareness of radiation risk among the clinicians in Kenya has not been documented. Aim of the study The aim of this study wasto evaluate and document the knowledge, attitude and practice of the teaching hospital clinicians towards the use of ionizing radiation (IR). Study setting Kenyatta National Hospital Study design A descriptive cross-sectional study Methodology The study participants were a total of 170 who were distributed as follows:25 Consultants, 66 Residents, 21Medical Officers and 58 Clinical Officers. Sampling was by using simple random method. The data was collected using well-structuredself-administeredquestionnaires and analyzed using SPSS 17 Study duration The study duration was 10 months from August 2013 to May 2014 Results More consultants, residents and medical officers correctly classified the imaging modalities that use ionizing radiation compared to the clinical officers (CO) p=< 0.004. Health workers with no ionizing radiation (IR) training were less likely to correctly identify all the imaging modalities that use IR compared to those with IR training (50.9% versus 27.5%; OR = 0.37, 95% CI 0.180.72). Significantly more consultants, residents and medical officers were able to classify MRI and US as not using IR compared to the CO p=< 0.001.When it came to identifying that an abdominal CT has the highest radiation dose, those with formal training (69.8%) fared significantly better than those with no formal training (37.1%) p= < 0.001.Length of professional experience, field of clinical training, and formal training in IR of the clinicians had no influence on their knowledge of IR doses.With respect to organ sensitivity only 72 clinicians rated bone marrow as a very sensitive organ. More clinicians rated gonads, thyroid, skin and brain as more sensitive than bone marrow. Of the 170 health workers, 148 (87.1%) reported that IR use in diagnostic imaging could cause harmful health effects.In their practice only 7(4.2%) considered ionizing radiation dose an important factor when referring patients for imaging. Of the 170 clinicians,97 (57.1%) referred patients for ionizing radiation investigations where the results would not alter the diagnosis or treatment plan. All the cadres of clinicians responded that they rarely informed their patients on the inherent risks of IR and there was no significant difference in their responses p= < 0.05. Of the 170 clinicians, only 1 (0.6%) had attended a CME on IR protection. Conclusion The results from this study show that health workers lack the basic knowledge on ionizing radiation doses and its harmful effects, which impacts negatively on their attitude and practice. The implications here are serious for the patient as they are possibly being exposed to unnecessary radiation, which could increase their risk of carcinogenesis. Recommendations The only way to bridge this gap is by increasing clinician awareness about ionizing radiation through continuous medical education, development of imaging referral guidelines and incorporating a module on medical radiation and its risks during their training pro