|Year : 2021 | Volume
| Issue : 1 | Page : 137-145
|Socio-academic Factors Influencing Knowledge About Organ Donation among Medical Students in Paraguay, 2018
TR Aveiro-Robalo1, X Paredes-González2, C Recalde-Hellman3, E Barboza-Molinas3, P Cardozo3, B Ojeda3, E Ortega4, Christian R Mejia5
1 School of Medicine, Universidad del Pacifico; Scientific Society of Medical Students of the Universidad del Pacífico (SOCEM UP), Asunción; Latin American Federation of Scientific Societies of Medical Students (FELSOCEM), Itaugua, Paraguay
2 School of Medicine, Universidad del Pacifico; Scientific Society of Medical Students of the Universidad del Pacífico (SOCEM UP), Asunción, Paraguay
3 School of Medicine, Universidad del Pacifico, Asunción, Paraguay
4 School of Medicine, Universidad del Pacifico, Asunción; Hospital Nacional Itaugua, Itaugua, Paraguay
5 School of Human Medicine, Universidad Continental, Huancayo, Peru
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|Date of Web Publication||16-Jun-2021|
| Abstract|| |
Organ donation currently is an extremely important issue in public health. Proper information about the details of this topic is extremely important, but is not yet widespread among the public. This study was carried out with the aim to determine the level of knowledge about organ donation among medical students in Paraguay and associated socio-academic factors influencing their level of knowledge. This was an analytical cross-sectional study, based on a multicenter survey among university medical students. About 68.7% (235) of the respondents were preclinical students doing basic sciences. Two aspects were evaluated, the knowledge regarding the donation of the organs and the socio-academic factors, then both the aspects were evaluated through bivariate and multivariate analyses. There were 342 respondents with a median age of 22 years (interquartile range: 20–23 years) of which 263 (77%) were women. One hundred and eighty-eight (55%) reported not knowing the law that protects and regulates the activities of organ and tissue donation in Paraguay. In the multivariate analysis, the highest frequency of a good level of knowledge of organ donation occurred in those who were older [RPA: 1.07, 95% confidence interval (CI): 1.02–1.12, P = 0.007] and in two of the universities evaluated (both with values P <0.012). On the contrary, those who were preclinical students, in general, had a lower level of knowledge of organ donation (RPa: 0.61, 95% CI: 0.46–0.79; value P <0.001). Our findings denote relatively a poor knowledge of organ donation in some socio-academic subsets. Therefore, it is important to develop strategies to increase the knowledge about the subject, by creating opportunities by way of discussions and debates among the students at all academic levels and also by conducting academic conferences on the subject.
|How to cite this article:|
Aveiro-Robalo T R, Paredes-González X, Recalde-Hellman C, Barboza-Molinas E, Cardozo P, Ojeda B, Ortega E, Mejia CR. Socio-academic Factors Influencing Knowledge About Organ Donation among Medical Students in Paraguay, 2018. Saudi J Kidney Dis Transpl 2021;32:137-45
|How to cite this URL:|
Aveiro-Robalo T R, Paredes-González X, Recalde-Hellman C, Barboza-Molinas E, Cardozo P, Ojeda B, Ortega E, Mejia CR. Socio-academic Factors Influencing Knowledge About Organ Donation among Medical Students in Paraguay, 2018. Saudi J Kidney Dis Transpl [serial online] 2021 [cited 2021 Nov 30];32:137-45. Available from: https://www.sjkdt.org/text.asp?2021/32/1/137/318515
| Introduction|| |
Organ donation at present is an extremely important issue in public health. According to the World Health Organization (WHO), organ donation and transplantation have become a very important measure to improve both quality and duration of life. In the last 50 years, from 1991 when the guiding principles for organ donation were first elaborated, this has benefited hundreds and thousands of patients. In 2005, they were updated and, through resolution WHA 63.22, their member states are urged to promote “effective national supervision of the recruitment, processing and transplantation of human cells, tissues and organs,” as well as, to regularly document data with constant upgrades of statistics.
According to data from the WHO global observatory, the 10 countries with the highest rate of organ donation in 2011 were: United States of America (n = 6020), India (n = 5482), Turkey (n = 3044), Mexico (n = 1894), Egypt (n = 1867), Japan (n = 1850), Brazil (n = 1748), Republic of Korea (n = 1620), Islamic Republic of Iran (n = 1545) and the United Kingdom (n = 1063). In Europe, in 2017, 30024 organs were transplanted, of which were kidneys first (21102), followed by livers (7984), hearts (2169), lungs (2013), and pancreas (719); taking into account living donors and cadaveric donors. Among the Latin American countries, the highest activity of organ donation recorded is led by Uruguay, followed by Brazil and Argentina.
In Paraguay, currently, there are no scientific publications with statistical data, which can give us information regarding the current situation of organ donation. Recently, however, a bill was approved, known as “Ley Anita” (the Anita law), which establishes modifications to the existing law on organ donation and transplantation, where the most significant change was that any Paraguayan citizen when he/she attains the age of 18 years, that person automatically becomes a donor. A proper knowledge about the details of this topic is extremely important especially among medical students both clinical and preclinical, who will be the future health professionals responsible for the promotion and dissemination of this information. Therefore, we conducted this study with the objective to determine knowledge about organ donation among medical students, both clinical and preclinical, in Paraguay and relate this to their level of education and other socio-academic factors.
| Subjects and Methods|| |
The design of the study was observational and analytical cross-sectional. This was done through a survey among the students of the medicine, both clinical and preclinical, in the universities of the Republic of Paraguay, during the month of November 2018.
The Paraguayan medical students who were enrolled in the academic semester 2018-II were included in the study. No participants were excluded since all agreed to participate in the study. There were no surveys to be filled. Instead, a nonrandom sampling was carried out, where the snowball method was used, making the first contact with the leaders of student unions, who, then contacted their members, and they, in turn, contacted students in general, i.e., who did not belong to their groups. This process was continued until it reached the minimum required sample size of 339 respondents (calculated on the basis of a previous analysis that found a minimum difference of 46% and 54% of a poor and good knowledge according to the academic stage, respectively; 84%, a confidence level of 95% and for a single sample).
The data collected were in two parts, a first section that collected the socio-demographic data of the participating students (gender, age, university where they studied, and the academic stage in which they were), the second section was used to evaluate knowledge about the theme, donation and organ transplants, in 14 general questions. These questions were validated and adapted from a previous investigation carried out by Paredes-Zapata. The dependent variables were taken according to the level of knowledge that each respondent had of organ donation and transplants. A point was given to each of the 15 questions they responded correctly, generating individual scores for each respondent. To classify the students according to a good or poor level of knowledge, the students who were in the upper tercile and the two lower terciles, respectively, were considered. This data was used for bivariate and multivariate statistics.
The collected data were tabulated using the Google forms which were used for the ease of entering data samples, the possibility of sending easily through social networks, to respect the anonymity of the respondents and to avoid using paper. This was then exported to a database designed for this purpose in Microsoft Office Excel 2013. After verifying the database, the information was transferred to the statistical package Stata © v.14.0 (StataCorp. 2015. Stata Statistical Software: Release 14. College Station, TX: StataCorp LP) where a first descriptive analysis was carried out. The frequencies/percentages were used for the categorical variables and for the quantitative variables the interquartile ranges/medians were used (according to the evaluation of normality with the Shapiro Wilk test). Then, we proceeded to bivariate and multivariate analysis, to obtain the prevalence ratios, 95% confidence intervals, and P values; all through the use of generalized linear models (Poisson family and log link function). For the comparison of the groups, the P values that were <0.05 were considered statistically significant.
The project was presented and approved by the preprofessional degree program of the “Universidad del Pacífico (University of the Pacific)”. In addition, autonomy was respected and the anonymity of the participants was preserved. The data was stored through codes, respecting the confidentiality of the study.
| Results|| |
There were 342 respondents with a median age of 22 years and 76.9% (263) were women (interquartile range: 20–23 years). The Universidad del Pacífico (University of the Pacific) had the majority of respondents (44.4%), followed by the Universidad Nacional de Itapúa (National University of Itapúa) (15.5%) and the Universidad National del Este (National University of the East) (13.7%); 68.7% (235) of the respondents were preclinical students [Table 1].
|Table 1: Characteristics of university students surveyed about knowledge of organ donation, Paraguay.|
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[Table 2] shows the answers to each of the questions that measured knowledge for organ donation, among which 188 (54.97%) reported not knowing the law that protects and regulates organ donation and tissue activities in Paraguay. Three hundred and nine (90.35%) considered that organ and tissue donation is not a lucrative activity and 254 (74.26%) correctly answered the question about when organ harvesting can be performed of a cadaverous donor when the encephalic death (brain death) of a person occurs.
|Table 2: Questions about the knowledge of organ donation in university students, Paraguay.|
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[Figure 1] shows us the scores obtained during the evaluation of knowledge about organ donation. The possible range of scores was 0–14 points, the median was of 11 points (interquartile range: 10–12 points). For reasons of statistical analysis, it was considered that those that scored 12 points or higher had the best level of knowledge (highest tercile of scores).
|Figure 1: Scores obtained in the evaluation of knowledge about organ donation in university students, Paraguay.|
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By making the multivariate analysis, it was found that the higher frequency of a good level of knowledge about organ donation was found in those subjects of higher age [relative risk RR: 1.07; 95% confidence interval (CI): 1.02–1.12; P = 0.007], those who studied in Universidad Nacional de Itapúa (RR: 1.54; 95% CI: 1.16–2.04; P = 0.003) and those who studied in Universidad del Norte (RR: 1.70; 95% CI: 1.13–2.57; P = 0.011). Students who were in the preclinical years had comparatively a lower level of knowledge about organ donation (RR: 0.61; 95% CI: 0.46–0,79; P <0.001), this was adjusted by the gender of the interviewed subjects [Table 3].
|Table 3: Bivariate and multivariate analysis of socio-academic factors associated to the level of knowledge about organ donation in university students, Paraguay.|
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| Discussion|| |
Our study showed that there was a general lack of knowledge about the subject of organ donation among the participants, especially in some particular aspects of it (questions 9 to 13). It is really important to understand these key points to focus on the problems at hand, to generate optimal and efficient teaching strategies. By this, the medical students can have a broader and sufficient knowledge of the subject, considering that this topic is currently one of the most important issues in public health.,
It is important to point at the lack of information among a large group of the population about the legislation regulating organ donation in Paraguay. This is in contrast with a study performed among physicians of Emergency and Primary Medicine departments in Spain, where most of the population studied has sufficient knowledge of the national regulations on organ donation. In our situation, it must be noted that the population we are referring to is the special group being medical students and should have had good knowledge about the topic at hand. This difference of knowledge should be only minimal, since, as future healthcare providers and professionals, they should be well aware of the legal aspects of national and international health policy regarding organ donation. At present this is the only research found in a healthcare-related population studied in the region and by what was seen in this study, we feel that it is imperative that the topic be included in medical curricula nationwide.,
The same is true with other questions which we feel should be widely known, such as the concept of brain death for retrieval of organs for transplants. Studies performed in Costa Rica and Spain –with health science students and medical residents, respectively- showed that, while not all subjects had full knowledge in the matter, a big majority showed sufficient knowledge.,, It is recommended that education institutes must evaluate, in a general way, the knowledge about this matter among their students –not only as part of a sub-subject within a class, but also, make it a part of the list of competences that all medical graduates in the country must acquire.
In our study, we found that the students of some universities had a better level of knowledge than others. However, this result must be interpreted carefully since those in the universities cannot really represent the general population, but this study was performed in order to have a general idea about the medical students in the country. Indeed, these results do show that a difference is existing. As a matter of fact, all universities have a certain level of autonomy to manage the content and the methods used to impart knowledge, both in curricular and extracurricular ways –classes, topics, lectures, forums, debates, seminars.,, Furthermore, other factors could be influencing the results, such as the individual interest of students on the topic, attendance to activities done by Scientific Societies specialized in the matter, access to scientific –and non-scientific-information related to the topic, among many others.
Finally, it was found that the age and the academic year had important influences in the level of knowledge about the topic; having the two variables going hand-in-hand, since, the higher the age and the academic year, the more experience and knowledge will be there about all topics in the field of studies. Some studies have shown that the academic year of the students influences the knowledge in specific topics in a great way, as in a research performed in Brazil, where the perception of students in the clinical years of studies was higher. According to the age of participants, it was found that in general, these topics are rather unknown to preclinical and pregraduate populations,,,, but it’s important to realize that a great majority of them had a positive approach to learn about the said topics. Subjects also showed a high interest in learning more about the topic, in order to be able to provide a more accurate and reliable information to society. This interest must be exploited by each educational institution and their governing bodies, to generate educational programs, both in-person and virtually, about the subject, so this population, and other ones that are interested in it, can have access to relevant and updated information.
Our study had a limitation due to selection bias, considering that a randomized sample was not be performed (there was no interest in extrapolating results to each population studied, but the interest was rather laid on the association of knowledge to certain socio-academic factors). For this reason, the results obtained for each university must be taken as exploratory, with a need of further, more specific research being done in each of them, with adequate sample size and sampling type that can yield specific results.
However, with what was found, we can conclude that, still only a poor level of knowledge exists regarding organ donation among medical students in Paraguay, especially in some specific areas of the matter. The level of knowledge was associated directly with the university they were studying and also the academic year that students were in. Furthermore, it was indirectly associated with the age of the study participants.
Conflict of interest: None declared.
Presentation at a meeting: Final degree project of the school of medicine, “Universidad del Pacífico”, Asunción, Paraguay.
Organization: School of Medicine, “Universidad del Pacífico”.
Place: Asunción, Paraguay.
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T R Aveiro-Robalo
School of Medicine, Universidad del Pacifico, Asunción
[Table 1], [Table 2], [Table 3]
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