Knowledge and practices of young general practitioners with regard to knee and epidural infiltrations in Cameroon

Nkeck et al. BMC Primary Care (2025) 26:358 https://doi.org/10.1186/s12875-025-03079-3 BMC Primary Care Open Access RESEARCH Knowledge and practices of young general practitioners with regard to knee and epidural infiltrations in Cameroon Jan René Nkeck1,2,3*, Baudelaire Fojo1,2,3, Aïcha Minerve Nanseu1,2,3, Brice Kollo Nzima2, Adeline Pelda1,2,3, Grâce Nwos1,2,3, Saquinatou Hamadjoda1,2,3, Samira Mougnutou1,2,3, Wilson Tamko1,2,3, Atamariam Haman1,2,3, Laure Isabelle Ineza1,2, Arnaud Dado Djoko2 and Madeleine Ngandeu-Singwé1,2,3 Abstract Background Due to the shortage of rheumatologists in Cameroon, general practitioners (GPs) play a crucial role in providing knee and epidural infiltrations. This study aimed to assess their knowledge and practices related to these procedures. Methods A cross-sectional quantitative study was conducted between January and February 2025 among Cameroonian GPs who had graduated within the past five years and had been in clinical practice for at least 12 months. Knowledge and practice were assessed through an online questionnaire and graded as good, average or poor. Factors associated with poor results are presented with the odds ratio (OR) and its 95% confidence interval. Results Of the 202 respondents (51% men), 94.1% were trained in Cameroon, and had an average of three years’ experience. Most of the respondents had an average level of knowledge regarding knee infiltration (67.3%), epidural infiltration (49.2%), and practice (67.3%). Factors associated with poor knowledge were: female gender (OR: 3.46 [1.62; 7.41]) and less than four weeks of undergraduate rheumatology internship (OR: 3.12 [1.05; 9.22]) for knee infiltration; female gender (OR: 3.65 [1.65; 8.09]), less than four weeks of undergraduate rheumatology internship (OR 5.38 [1.71; 16.89]) and shorter than three years of medical practice (OR: 2.52 [1.2; 5.26]) for epidural infiltration. Not having attended a course/workshop on infiltration was associated with a poor level of practice (OR: 4.47 [1.09; 18.36]). Conclusion The level of knowledge and practice among GPs is rated as average overall. There is a need to improve their undergraduate and postgraduate training. Keywords General practitioners, Infiltrations, Knee, Epidural space, Cameroon *Correspondence: Jan René Nkeck 1 Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, the University of Yaoundé I, Yaoundé, Cameroon 2 Yaoundé Rheumatology Research Team (ERRY), Yaoundé, Cameroon 3 Rheumatology Unit, Yaoundé Central Hospital, Yaoundé, Cameroon © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creati vecommons.org/licenses/by-nc-nd/4.0/. Nkeck et al. BMC Primary Care (2025) 26:358 Background Musculoskeletal disorders are common in primary care. The most prevalent of them are degenerative spinal disorders, which lead to low back pain and can account for between 6.4% and 56% of consultations, depending on the population considered [1, 2]. They are followed by degenerative and inflammatory knee disorders, which are characterized primarily by pain and are present in between 5% and 25% of general practice (GP) consultations [3, 4]. There are several treatments and interventions that can be used to help these patients, such as infiltration. This medical procedure involves injecting a pharmacological compound into the knee or the epidural space for spinal disorders to alleviate pain. Knee and epidural infiltration are among the most common procedures performed for rheumatic diseases [5, 6]. They are usually carried out for therapeutic purposes and involve a variety of substances, the most widely used of which are corticosteroid derivatives [7]. These medical procedures must be performed by an experienced practitioner who has received training in order to anticipate and limit the potential complications, some of which can have serious consequences for the patient, such as infection. Practical training is therefore necessary to learn the indications and contraindications, as well as the procedures for these techniques. This treatment can therefore be performed in many countries by rheumatologists, orthopaedists, radiologists, sports medicine practitioners, and GPs [7, 8]. Having received basic training in rheumatic diseases and completed an internship in rheumatology as part of their undergraduate studies, GPs are legally authorized to perform these infiltrations to relieve patients’ symptoms in clinical practice. In sub-Saharan Africa in general, and Cameroon in particular, there is a real shortage of rheumatologists [9]. In 2023, there were approximately 35 rheumatologists for every 25 million people, with an uneven distribution across Cameroon [5]. Consequently, the vast majority of patients with rheumatic disorders are treated by GPs. This situation raises issues on several levels. Firstly, the ratio of GPs to inhabitants in Cameroon is low (0.14 per 1000 inhabitants), and rheumatology theory courses have only recently been incorporated into general medical training programs in Cameroon [10]. Secondly, their practical training is mainly based on internships which are not always effective in rheumatology and which sometimes involve relatively little hands-on experience. In this context, the ability of young GPs to perform rheumatology procedures in Cameroon may legitimately questioned. It was therefore important to first assess their knowledge and practices in order to define the current situation and identify the elements to be taken into account when making recommendations on behalf of the Cameroon College of Rheumatology. Page 2 of 9 Methods Study design and setting This was a cross-sectional quantitative study conducted via an online survey between January 1 and February 28, 2025 among general practitioners (GPs) based in Cameroon. Initial medical training in Cameroon includes seven years of compulsory general medicine studies. The Faculty of Medicine and Biomedical Sciences at the University of Yaoundé I is the oldest and largest medical (...truncated)