Thesis:

Influence of knowledge, attitude and on management practices of testicular torsion among clinical officers in tier three hospitals in Kiambu county, Kenya

Testicular torsion refers to a surgical emergency that occurs due to the twisting of the spermatic cord and its contents, and affects 1 in every 4000 young men per year globally. The condition is due to inadequate fixation of the testes within the scrotum, which allows excessive movement of the testes within the scrotum. The young boys who present in casualty emergency departments with testicular torsion in Kiambu County, tier three (Level 4 and 5) hospitals are usually seen and examined by Clinical Officers at first contact. At this first contact with the patient, if there is misdiagnosis, it will delay specific treatment and end up with necrosis of the testis whose only option is to remove the testis (orchiectomy). The specific management of testicular torsion is surgical exploratory detorsion if the diagnosis is made within 6 hours. Orchiectomy is done if there is a delay in diagnosis. There has not been any research done to find out the cause of the delayed diagnosis in Kiambu County. The study sought to determine the knowledge, attitudes, and management practices among Clinical Officers in Kiambu County, Kenya. It specifically sought to determine the level of knowledge of testicular torsion among clinical officers working in tier three hospitals in Kiambu County, establish the attitudes of Clinical Officers towards testicular torsion in tier three hospitals in Kiambu County and to determine the management practices of testicular torsion offered by Clinical Officers in tier three hospitals, Kiambu County. The study participants/respondents were Clinical Officers working in both Level 4 and Level 5 hospitals. A cross-sectional descriptive study design was used and collected using questionnaires. The questionnaires were sorted, coded and keyed in SPSS version 22 for the quantitative data analysis. The knowledge level of the clinical officers was assessed on different aspects as far as management of testicular torsion is concerned. Majority of the clinical officers expressed low knowledge on diagnosis of high riding and horizontal lie in acutely painful scrotum. 59% of clinical officers said the scrotum to be elevated and 20% recommended broad- spectrum antibiotics. In the study, the clinicians expressed a lack of understanding of the relationship between Prehn's sign and testicular torsion. Only a few (15.4%) who indicated that understanding. Testicular torsion to a bigger percentage of COs TT was not a new concept. 85.5% of the respondents indicated they had covered testicular torsion in their basic training. However, the concept of Testicular torsion was new to14.7% of the Clinical Officers. On attitude, 42.3% n=55 of the Clinical Officers somewhat disagreed manual detorsion being professional and ethical and 19.2% of the respondents disagreed in totality that manual detorsion of the testis is professional and ethical in young male child suspected to have testicular torsion. Therefore, Continuous Medical Education in all aspects of testicular torsion conditions is recommended.