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A COMMUNITY STUDY OF THE PREVALENCE, RISK FACTORS AND PATTERN OF CHRONIC KIDNEY DISEASE IN ILIE, OSUN STATE, SOUTH-WEST NIGERIA.

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Supervisor: PROFESSOR A. AKINSOLA, DR O.E AYODELE
Faculty: INTERNAL MEDICINE
Month: 11
Year: 2010

Abstract

BACKGROUND: Chronic kidney disease is a global public health problem. It is usually asymptomatic in the early stage and may remain so until late in the course when therapeutic interventions are inaccessible, unaffordable or ineffective. The prevalence in developed, economically emerging and developing countries has been on the rise and in fact more than the rate at which population growth rises. Chronic kidney disease, from some hospital-based studies in Sub-Saharan Africa (SSA), has epidemiological characteristics that are strikingly different from those observed in other regions. Despite the menace of chronic kidney disease in SSA and especially in Nigeria, the most populated country in Africa, there is paucity of data on community studies. This study is therefore set out to determine the prevalence of chronic kidney disease in Ilie community. AIMS: The aim of this study was to determine the prevalence of chronic kidney disease and its associated risk factors in Ilie community in Osun State, South Western Nigeria. The study set out to determine the awareness and level of knowledge of the people in the community. METHODS: A total of 454 participants were randomly recruited for the study using multi-stage sampling technique. Structured questionnaires were used to extract information on sociodemographic characteristics and information on their knowledge of kidney disease. Biophysical measurements of the participants were also done. Participants were screened for the presence of macroalbuminuria. Microalbuminuria:Creatinine ratio and serum creatinine were assessed. Glomerular filtration rate was estimated using Modification of Diet in Renal Disease equation. Prevalence of the risk factors for chronic kidney disease was determined and the association (s) between the risk factors and chronic kidney disease was assessed. Participants’ level of knowledge was also determined. RESULTS: Four hundred and fifty four participants were recruited for this study. Three hundred and forty seven (76.4 %) completed the study. The mean age ± SD of the participants was 45.8 ± 19.0 years. Female participants had higher mean age (47.5 vs. 43.6, p=0.034). Male participants had higher level of education (P < 0.001). Predominantly, female participants were traders while male participants were farmers. Among the participants, 20.4% gave history of hypertension but the prevalence of hypertension (140/90mmHg) was 26.7 %. Of the participants 0.6 % gave history of diabetes but 3.7 % were diagnosed to have diabetes. The mean BMI was 21.6 ± 3.6 kg/m2 and mean waist hip ratio (WHR) was 0.98 ± 0.1, female participants had WHR of 0.96 ± 0.05 while mean for male was 1.0 ± 0.04. Mean waist circumference was 79.1 ± 9.6 cm and 78.0 ± 7.8 cm in female and male participants respectively. Prevalence of obesity using BMI was 2.7 %. Only 7 % had history of cigarette smoking, 3.1% had haematuria, though only 1.1 % had ova of Schistosoma haematobium. The prevalence of albuminuria in the entire studied population was 17.8 % with higher prevalence of macroalbuminuria among females. Prevalence of GFR < 60ml/min/1.73m2 was 12.3 %. The overall prevalence of CKD was 18.8 %. With logistic regression, increasing age ((OR = 0.919, 95% CI = 0.878 - 0.961), female gender (OR = 4.87, 95% CI = 1.336-17.736), systolic blood pressure (OR = 1.038, 95% CI = 1.006-1.071), diabetes mellitus (OR = 15.764, 95 % CI = 1.247 – 199.238) were predictive of chronic kidney disease. Only 35.5 % had heard of chronic kidney disease before the time of the study. Less than 30 % had good knowledge of chronic kidney disease. CONCLUSION: Chronic kidney disease is prevalent in Ilie community. The risk factors were also prevalent and effort should be made toward introducing policies and strategies to reduce the burden of chronic kidney disease and its associated risk factors in the community.

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