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ORIGINAL ARTICLE
Year : 2023 | Volume
: 22
| Issue : 1 | Page : 18-32
Prevalence and knowledge of kidney disease risk factors among Nigerians resident in Lagos State Metropolitan District, South West Nigeria
Monica Ewomazino Akokuwebe, Erhabor Sunday Idemudia
Department of Psychology, Faculty of Humanity, North-West University, Mafikeng Campus, South Africa
Correspondence Address:
Monica Ewomazino Akokuwebe
North-West University Faculty of Humanities, North West University, Mafikeng
South Africa
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/aam.aam_223_21
Abstract
Objective: The objective is to determine the prevalence of kidney disease (KD) risk factors and their knowledge among Nigerians aged 15–64 living in the Mainland and Island metropolitan districts of Lagos State, South West Nigeria. Materials and Methods: A total of 1171 respondents between 15 and 64 years of age were recruited for the measurements of prevalence and knowledge of KD risk factors using a structured questionnaire. Descriptive, bivariate, and logistic regression statistical analyses were employed. Results: The respondents' mean age was 33.83 ± 11.54, with a male-to-female ratio of 0.54:0.46. Respondents without KD have lower knowledge of KD risk factors (38.26; 37.27‒39.25) than those with KD (45.00; 38.84‒50.16) with an overall knowledge score of 38.39 (37.41‒39.36). The prevalent risk factors include indiscriminate use of analgesics and frequent use of traditional remedies (P < 0.05). Knowledge predictors of KD risk factors among respondents were older age (≥30 years) (with KD–Adjusted Odds Ratio (AOR) 1.06: 95% confidence interval [CI]: 0.82‒1.98; without KD–AOR 2.10: 95% CI: 1.52‒2.25) and chronic ailments (with KD–AOR 1.51: 95% CI: 0.28‒2.93; without KD–AOR 3.03: 95% CI: 0.04‒7.49). Conclusion: The study revealed a lower knowledge of KD risk factors exists in respondents without KD, but the prevalence of risk factors was higher among both cohorts of respondents. Therefore, concerted efforts should be made to sensitize strategic public health programs to expand accurate and adequate awareness and understanding of KD risk factors and their implications for well-being, and to possibly avoid the risk of the disease later in life.
Abstract in French Résumé
Objectif: L'objectif est de déterminer la prévalence des facteurs de risque de maladie rénale (KD) et leur connaissance chez les Nigérians âgés de 15 à 64 ans vivant dans les districts métropolitains continentaux et insulaires de l'État de Lagos, dans le sud-ouest du Nigéria. Matériaux et methods: Un total de 1171 répondants âgés de 15 à 64 ans ont été recrutés pour les mesures de prévalence et de connaissance des facteurs de risque de MK à l'aide d'un questionnaire structuré. Des analyses statistiques descriptives, bivariées et de régression logistique ont été utilisées. Résultats: L'âge moyen des répondants était de 33,83 ± 11,54, avec un ratio hommes/femmes de 0,54: 0,46. Les répondants sans MK ont une connaissance plus faible des facteurs de risque de MK (38,26 ; 37,27‒39,25) que ceux avec MK (45,00 ; 38,84‒50,16) avec un score global de connaissance de 38,39 (37,41‒39,36). Les facteurs de risque prévalents comprennent l'utilisation aveugle d'analgésiques et l'utilisation fréquente de remèdes traditionnels (ρ < 0,05). Les prédicteurs de connaissance des facteurs de risque de MK parmi les répondants étaient un âge plus avancé (≥ 30 ans) (avec rapport de cotes ajusté KD (AOR) 1,06 : intervalle de confiance [IC] à 95 % : 0,82‒1,98 ; sans KD–AOR 2,10 : IC à 95 % : 1,52‒2,25) et les affections chroniques (avec KD–AOR 1,51 : IC à 95 % : 0,28‒2,93 ; sans KD–AOR 3,03 : IC à 95 % : 0,04‒7,49). Conclusion: L'étude a révélé une moindre connaissance des facteurs de risque de MK chez les répondants sans MK, mais la prévalence des facteurs de risque était plus élevée parmi les deux cohortes de répondants. Par conséquent, des efforts concertés doivent être déployés pour sensibiliser les programmes stratégiques de santé publique afin d'élargir la prise de conscience et la compréhension précises et adéquates des facteurs de risque de MK et de leurs implications pour le bien-être, et éventuellement d'éviter le risque de la maladie plus tard dans la vie.
Mots-clés: Insuffisance rénale, connaissances, État de Lagos, prévalence, facteurs de risque
Keywords: Kidney disease, knowledge, Lagos State, prevalence, risk factors
Introduction 
Kidney disease (KD), which is divided into two types: acute KD (AKD) and chronic KD (CKD), is a prevalent and rising health condition that necessitates proper knowledge on the part of health-care providers and patients to slow the disease's progression. Several debates and campaigns on KD have made the disease burden a global epidemic health problem with rising prevalence and large financial costs for KD victims and health-care systems.[1],[2],[3] Yet, as a result of fast urbanization and a growing number of populations exposed to multiple environmental toxins, high infectious disease burdens, and rising rates of non-communicable illnesses (NCDs), the majority of the global burden of KD occurs in emerging nations.[4],[5],[6] For KD, this depicts a high prevalence of KD owing to various etiologies, as it presents distinctive problems. A better understanding of the epidemiology of KD in developing countries is extremely crucial, but this must be accompanied by strong public advocacy and wide, collaborative public health initiatives that target environmental, communicable, and noncommunicable risk factors. Thus, as a direct consequence, the global increase in KD necessitates a well-organized preventive strategy that focuses on detecting risk factors,[4],[6],[7] and while CKD has contributed significantly to the global burden of the disease, yet its priority is low in the public health response to the growing NCD burden in underdeveloped nations, particularly in sub-Saharan Africa.[1],[2] Thus, the epidemiological data remain poorly identified for KD in most developing nations owing to the dearth of community-based studies conducted and inconsistent assessments of KD function as well as nonstandardized or noncalibrated methods.
KD is a major but poorly understood and under-recognized health burden, according to several studies conducted in Asian and Sub-Saharan African regions. Despite these trends, knowledge of CKD epidemiology is still lacking in many Asian and sub-Saharan African regions attributed to lack of studies, poor reporting quality, and inconsistent methods for assessing and defining kidney dysfunction, which can lead to false conclusions when making important comparisons. Similarly, many populations in underdeveloped nations lack access to validated creatinine-based equations for calculating glomerular filtration rate or standardized, quality-controlled measurements of serum creatinine or urine protein.[8],[9] A comprehensive approach to KD prevention, on the other hand, starts with the identification of risk factors' prevalence, incidence, and susceptibility to KD risk factors, followed by the development of mitigation strategies. At-risk populations or individuals must be screened and treated early to prevent onset and delay progression; and reducing KD risk is also heavily dependent on addressing the fact that it is both a direct consequence of and a contributor to socioeconomic inequality.[10],[11],[12],[13] The prevalence of KD is becoming more widely acknowledged as a key metric for estimating the disease's morbidity and mortality. Importantly, a significant proportion of hospital cases mentioned is frequently in the terminal stages of CKD, which may increasingly progress to end-stage renal disease (ESRD) as the early stages of KD can be asymptomatic and early disease diagnosis is difficult to establish.
Despite the fact that robust knowledge of CKD epidemiological studies remains inadequate, the reported prevalence of CKD in Asia, which accounts for more than half of the global population (60%), is among the highest in the world. In addition, population-based surveys conducted in Thailand, Malaysia, and China in regions of East Asia are well documented.[12],[13],[14],[15],[16],[17] The Thai Screening and Early Evaluation of Kidney Disease (SEEK) study found an 18% prevalence of KD, which was higher than previous estimates of 14%.[14],[15] In Malaysia, the prevalence has been reported to be approximately 10%,[16] although, in China, estimates vary from 10% to 19% in the Tibetan regions.[17] In addition, one of the largest population-based prevalence studies to date included 47,204 individuals from various regions of China, and it reported a prevalence of 11%, equating to nearly 120 million people living with CKD in China.[18] In Southeast Asia, numerous studies from Bangladesh, India, and Pakistan have reported CKD prevalence estimates near or exceeding 20% in some communities, and the prevalence appears to be between 10% and 20% in Nepal and Sri Lanka.[19],[20],[21],[22] The global age-standardized CKD prevalence is 10.4% in men and 10% in women, hence, developing nations having a higher prevalence than developed countries.[23],[24] Recent systematic reviews reported a prevalence of 13.9%[23] and 10.1%[25] in sub-Saharan Africa (SSA). West Africa had the highest pooled prevalence of CKD on the continent, at 16%.[26]
Importantly, CKD is characterized in Africa by the young age of patients, with significant morbidity and premature deaths; and approximately 90% of CKD patients die within 90 days of procuring dialysis. CKD prevalence in sub-Saharan Africa may be comparable to or exceed that of many high-income countries in several countries.[25],[26] Regardless of the fact that data are limited and imperative, several community-based surveys from the Democratic Republic of the Congo, Tanzania, Ghana, and Senegal have since reported prevalence estimates ranging from 5% to 17%, as well as very low awareness.[27],[28],[29],[30] Despite Nigeria's large population (over 200 million people),[31] however, little is known about the epidemiological data of CKD in the general population. Yet, the peak prevalence of CKD has been observed to be between the third and fifth decades of life, contributing to a labor shortage and economic waste,[10],[11],[12],[13] and the incidence of CKD in Nigeria has been found to range between 1.6% and 12.4%,[32],[33],[34] respectively. Another study conducted by Ulasi and Ijeoma[35] highlighting the enormity of CKD in Nigeria determined that ESRD cases accounted for 8% of all medical admissions and 42% of renal admissions in a teaching hospital in the southeast of Nigeria. These studies, however, are hospital-based and may have excluded many patients who do not have access to hospital care; and there is no national data on CKD prevalence; and only a few community-based studies have been undertaken in some regions of the country.[30],[31],[32],[33],[34],[35]
A recent systematic review identified seven population-based studies, five from the Southern part of the country and two from the Northern part, and the prevalence of CKD ranged from 2.5% to 26% in this study.[12] Previously, Oluyombo et al.[36] reported 18% of the prevalence of CKD in a rural community in South-Western Nigeria. A similar study conducted in South-East Nigeria found a prevalence of 11.4% in rural dwellers and 11.7% in semi-urban dwellers.[32] Besides, another study from North-West Nigeria in a recent review documented CKD prevalence of 26%,[37] implying an underlying high prevalence of CKD and clearly stating the need for more studies to understand the actual burden of CKD in the Nigerian population. Combining regional population-based studies with sufficient capacity may allow for an evaluation of the true magnitude of CKD burden if the national data are unavailable. These overall national data allow for the adjustment of confounding factors such as ethnicity and important predisposing factors found within the regions.
Several studies in recent decades have reported that KD risk factors are associated with a vast multitude of biological and social factors such as genetic, clinical factors, sociodemographic, and environmental risk factors of KD. In most societies around the world, the prevalence of KD is consistently related to socially defined conditions. This phenomenon is well documented in developed nations, where the disease affects racial/ethnic minorities and persons with poor socioeconomic position. Racial and ethnic minorities (e.g., African Americans in the United States) are disproportionately affected by advanced and progressive KD, as demonstrated by several extensive data.[38],[39] The relationship between socioeconomic status and the likelihood of developing CKD and eventually kidney failure has also been amply studied, with individuals with a lower socioeconomic position bearing the brunt of the burden.[13],[36] CKD outcomes have also been attributed to clinical health problems such as diabetes and hypertension, as well as lifestyle habits such as dietary behaviors.[11],[33]
Furthermore, promoting knowledge of health risk may enhance positive health-related behaviors, drives health determinants, and has a beneficial impact on successful KD treatment and management.[13],[33] Thus, knowledge of KD and its adverse outcomes may therefore help to increase perceived risks, and the availability of diagnostic testing for early diagnosis is very important, especially among vulnerable persons. This allows for early treatment, resulting in lower morbidity, death, and healthcare expenditures. According to studies, a high prevalence of KD is associated with a lack of kidney health services and health insurance coverage for KD patients, particularly in low-resource nations like Nigeria.[32],[33] Although a lot of clinical- and community-based studies have documented general public KD knowledge level and risk-inducing lifestyles in Nigeria[12],[32],[33],[34],[35],[36],[37] and in Lagos State,[10],[13] yet there is a dearth of community-based studies in Lagos State on prevalence and knowledge of KD risk factors, prompting us to undertake this study in the Metropolitan District of Lagos State, located within South-West geopolitical zone of Nigeria. As a result, this study adds to the body of knowledge in the fields of health demography and public health.
Materials and Methods Study design
The study was a community-based descriptive cross-sectional study. It was carried out in Lagos Island and Lagos Mainland of the main metropolitan districts of Lagos State, South-West, Nigeria.
Study setting
The study was conducted in the main districts of Lagos metropolitan local government areas (LGAs) in Lagos State, South West Nigeria. The main metropolitan districts are the Mainland, Greater Lagos, and the Islands.[40] The rapid urbanization of Lagos State and its expansion to the Lagoon areas have led to the classification of Lagos State into metropolitan districts.[41],[42] The Mainland consists mainly of densely populated suburbs, with a large proportion of inhabitants and industries, while Greater Lagos includes residential districts located on the outskirts of the metropolitan LGAs, reflecting a suburban population. The Islands are adjacent to the Lagoon and are separated from the Mainland, comprising two major urban islands called Lagos and Victoria Islands. Lagos Island and Mainland were randomly selected for this study using the random number method.[43],[44] The demographics of the two selected metropolitan districts have an estimated population of 527,645, of whom 60% live in the Mainland,[40],[43] with an unemployment rate of 21.1%, having higher education or less (24.6%), with an 85% literacy rate.[40] The largest and dominant ethnic group is the Yoruba tribe, followed by the Igbo and the Hausa.[45] In this study, other minority ethnic groups were excluded, as their populations were small in numbers compared to the dominant ethnic groups (Yoruba, Igbo, and Hausa) in Lagos Mainland and Lagos Island. Hence, Lagos Mainland and Lagos Island were selected for this study, as they featured prominently as two of the kidney-disease-prone districts in 2015.[34]
Sample size determination
The minimum sample size was determined using the Lemeshow et al.'s[46] formula, where the total sample size for the survey will be derived from a sample size estimate for a population survey with a 95% confidence interval (CI) and a minimum sample size of 384 as the baseline.[46] Using Lemeshow et al.'s formula, the minimum sample size was determined as follows: n = (Z2 [ρ (1- ρ)])/d2= (1.962 [0.5 (1- 0.5)]) ÷ 0.052 = 0.9604 ÷ 0.0025 = 384.16 ~ 384; n = 384. Where “n” is the minimum sample size, “ρ” is the disease's estimated prevalence of the disease and in particular, if the prevalence of the disease is unknown, 50% can be used as a proxy for the prevalence rate as recommended by the World Health Organization on sample size determination in health Studies),[46] “d” is the sampling error (5%), Z-score = 1.96. As a result, the sample size for this study must be at least 384. In order to expand the range of generalization by 50%, 1920 respondents were recruited as target population to increase the level of precision for this study.
Study population and sampling method
The study population aged 15–64 years targeted for this research was recruited from 450 households living in the study area during the study. Thus, a total of 1920 respondents were interviewed and 1171 subjects were valid for this study. A complete list of the 2006 enumeration areas (EAs) of Lagos State was obtained from Lagos Island and Lagos Mainland metropolitan districts of Lagos State. The communities randomly selected from Lagos Island include Eti-Osa, Ikoyi, Amuwo-Odofin and Apapa while Ebute-Meta, Mushin, Yaba, and Iwaya were the randomly selected communities from Lagos Mainland. The sampling technique adopted for this research was a combination of multistage, stratified, and equal sampling techniques. The first stage was to identify the LGAs by metropolitan districts (3) and the main metropolitan districts of Lagos are the Mainland, Greater Lagos, and the Islands. The second stage was engaged to randomly select two areas out of the three districts: Lagos Island and Lagos Mainland as the study setting.
Then, the total numbers of wards (31) within Lagos Island (20) and Lagos Mainland (11) were identified. The third stage was employed to purposively select 20 wards across Lagos Island and Lagos Mainland by applying the 50% prevalence rate when the prevalence of the disease is unknown as recommended by the World Health Organization (WHO). These sampled metropolitan districts have no documentation of KD prevalence rates.[46] The fourth stage was applied to randomly and purposively select eight communities, four communities each from Lagos Island and Lagos Mainland from the selected wards. Notably, the 2006 National Population Census (NPC) figures did not include wards in the LGAs; however, the 1991 NPC contained the number of wards (246) in the twenty LGAs where they are stratified into communities and Local Council Development Area (LCDA).
Furthermore, the estimated number of an average household in Lagos State population figures was 6.5 persons per household while the sampling frame for this study is the estimated number of households in the selected wards. This was obtained by factoring in the 2016 projected population of the selected communities by the average household size of 6.5, using the projection formula 
. Where E = 2006 National Population Census figures; GR = Growth rate of 3.2% at year 2016; n = number of years (1991–2016).[13] This gave a subtotal of 30,602 for Lagos Island and 71,932 for Lagos Mainland giving a total of 102,534. This served as the sampling frame from which the samples were drawn. To avoid bias and ensure that everyone in the population had an equal chance of being chosen to take part in the survey research. EAs in the study sites were purposively selected, and the pre-census list (2016 projected population of the selected communities) was utilized to know the total households and persons in each EAs.[10]
A sample size of 50% was randomly selected across the LGAs to determine the required number of questionnaire to be administered. From the sampling frame of 102,534 households, a total of 1900 residential persons were purposively and equally selected from the sample households. Besides, the purposive sampling technique was adopted from previous studies that have used utilized this technique in selection of respondents to satisfy the research requirements carried out as community-based studies in relation to KD in Nigeria.[10],[13],[33] In addition, 237 copies of the questionnaire were equally distributed across the selected LGAS in the metropolitan districts: Lagos Island (Eti-Osa, Ikoyi, Amuwo-Odofin, and Apapa) and Lagos Mainland (Ebute-Meta, Mushin, Yaba and Iwaya), which gave a total of 1900 copies of the questionnaire that were distributed across the sampled study settings. About 1800 respondents from 420 households were found to have completed the validated survey and gave their consent of participation in the community-based survey. Around 1171 copies of questionnaires were found to be valid for the statistical analysis, in which 1149 respondents have reported not to have KD and 22 of them reported having been diagnosed with KD with proof of clinical diagnosis [Figure 1].
Figure 1: Flow diagram showing participants who were enrolled in the studyData collection
Using local researchers in the sampled districts in Lagos Island and Lagos Mainland, we administered the structured KD risk assessment survey instrument using a three-stage cluster probability sampling method stratified by main and central districts of the metropolitan areas sampled (Lagos Mainland and Lagos Island) in Lagos State. Our sampling procedures have previously been described in detail.[1],[14] In brief, we used a random number marker to sample and select four LGAs each from Lagos Mainland and Lagos Island, respectively. Probability proportional size was adopted using the 2006 Nigeria National Census and the 2018 Metropolitan District-level census data from Lagos State Archives.[15],[16],[17] A consultation gathering was held with the community leaders and the local researchers who had been recruited, the purpose of the study and the subject were amply explained. Each respondent gave written consent, and where applicable, verbal consent was given after a thorough understanding of the procedure.
We enrolled 1900 adults from 450 households with a household nonresponse rate of 60% [Figure 1]. As shown in the figure below, 729 of those who participated in the validation study did not complete the survey or give their consent to participate in the study, and the remaining 1171 completed a validated knowledge and risk assessment survey. 1171 adults in the age cohort of 15‒64 years from the metropolitan districts in Lagos Island (Eti-Osa, Ikoyi, Amuwo-Odofin, and Apapa) and Lagos Mainland (Ebute-Meta, Mushin, Yaba and Iwaya), in Lagos State, Nigeria, were gotten from the fieldwork. From these, 22 persons were identified and confirmed with clinical proof of laboratory testing for a kidney-related condition (either acute or chronic KD), while 1149 participants reported that they never had any kidney-related condition or kidney ailments before this survey. Respondents were divided into two groups for the purposes of this study: those who did not have KD and those who did. Furthermore, respondents who were residents of the study districts, whether male or female who are 15 years and older than 15 years, and nonresidents as well as non-Nigerians were excluded from the survey to avoid selection bias.
Variable measurements
A semi-structured questionnaire with both closed- and open-ended questions was used to obtain social and demographic information, KD knowledge (types, causes, symptoms, and prevention), self-reported medical history of KD or other chronic ailments, KD risk factors (lifestyles and medical/biomedical) and determinants of perceived susceptibility to KD risk (increased or decreased odds). The questionnaire was administered verbally in English, Yoruba, or Pidgin English language. Thus, an outcome variable can be observed and measured in three ways: outcome variables can be categorical, ordinal, or continuous. Therefore, the study data were collected as continuous variables so that it can be transformed into outcome variable in continuous and categorical form accordingly. The transformation process will allow the utilization of categorical outcome variable as binary form for logistic regression analysis and continuous outcome variable for mean score to allow the statistical application of linear regression analysis. This transforming method will allow outcome variable in binary form and mean score to accommodate both logistic and linear regression analyses. However, first, for the knowledge domain, separate univariable models were fitted to mean knowledge score in a continuous form. We then obtained the sum of the 15 scored items. Composite scores were reported as mean (95% CI) and were sample-balanced using age- and gender-weights based on the Metropolitan District-level census data from Lagos State archives.[47],[48],[49],[50] Second, for the outcome variable to be in a categorical form, knowledge was calculated as a composite score (range: 0–15). To do so, we first scored each item as “Yes” (1) or “No” (0), with “Do not know” and “Unsure” being treated as inaccurate and recoded as “No.” In addition, for the risk factors, each item of the questions on risk factors was scored as “Yes” (1) or “No” (0); and each item in the KD risk assessment questions was scored as “increased” (1) or decreased (0) odds as against demographic (age and gender) and risk factors (lifestyles and medical/biomedical).
Definition of concepts
Following the completion of the KD assessment risk tool survey, KD knowledge and its risk factors were self-reported before the survey. KD respondents provided clinical proof of the presence of albuminuria (≥30 mg/dL) in repeated clinical laboratory testing.[51] Young age (15‒29) and old age (≥30) in both sexes were adopted in this study in line with the World Health Organization's working population definition.[52] Indiscriminate use of over-the-counter medicines was self-reported.[53] Misuse of prescription medicines was self-reported.[53] Frequent use of self-prescribed analgesics was self-reported.[54] Daily usage of herbal supplements was self-reported.[55] Frequent consumption of traditional remedies in a water or alcohol mixture was self-reported.[56] Chronic ingestion of alcohol by taking two or more bottles/cups was self-reported.[57] Cigarette smoking more than two sticks of cigarette products was also self-reported.[58] Physical inactivity was self-reported, defined as achieving less than 30 min of moderate-intensity physical activity per week.[59] A sedentary lifestyle was self-reported, defined as involving little or no physical activity.[60] A large quantity of salt in food was self-reported, defined as eating more than 6 g of salt a day (2.4 g sodium).[61] Any noncommunicable disease (such as diabetes and hypertension) was self-reported, with clinical proof or prescribed medications (if any).[62] Infectious disease (such as urinary tract infection) was self-reported, with laboratory testing proof or prescribed medications (if any).[63]
Method of data analysis
Descriptive and inferential statistics were used to analyze the data collected. Continuous variables were summarized by their means and standard deviations, and categorical variables as crude counts and proportions. Categorical differences in unweighted proportions between groups were compared using the Chi-square test for independence of Fisher's exact test, and summary estimates for these variables were also sampled. For the knowledge score, separate variable models were employed to calculate the weighted mean knowledge score for each demographic, social and self-reported medical/biomedical factors. A bivariate model for the independent variables associated with the categorical outcome variable, including demographics, social and self-reported medical/biomedical factors was fitted to the mean knowledge score to determine the relationships between the independent and outcome variables. Furthermore, comparisons were carried out with two categories of respondents: KD-non-diagnosis and KD-diagnosis of respondents, respectively. Crude and adjusted mean differences were estimated using generalized linear models assuming an identity relationship. We accounted for the design effect owing to cluster sampling using the Taylor Series Linearization method[64] implemented using the SPSS commands. This was followed by multivariate analyses, where linear and logistic regression analyses were employed, and the predictor variables were included in the binary logistic regression to determine the knowledge of KD risk factors. All data were performed using the SPSS statistical package (version 21.0) (SPSS Inc, Chicago, Illinois, USA) and the statistical level of significance was set at P < 0.05.
Ethical clearance
The study received ethical clearance from the University of Ibadan Social Sciences and Humanities Research Ethics Committee (UI/SSHEC/14/0003) before it commenced. Respondents who are less than 18 years were given written informed consent forms and their signatures was obtained for them to have participation in the survey.
Results Sociodemographic characteristics of the respondents
Among the 1171 respondents who participated in the survey, the overall mean age was 33.8 ± 11.54 years with a median age of 34.0 years, with male-to-female ratio of 0.54:0.46. The overall mean knowledge of KD risk factors among the respondents was 38.39 (37.41, 39.36) [Table 1]. A majority of the respondents were male (53.5%), and 73.8% were residing in Lagos Mainland. About 59.3% were single and 74.7% were employed with high income (73.0%) and educated (99.1%) [Table 1]. Also, findings relating to the perception of health status before 6 months before the survey showed a majority of the respondents (92.7%) reporting their previous health to be good and their current health status to be better (75.1%) [Table 1]. Most of the respondents (74.2%) indicated the risk of developing any ailments, while 35.4% of them reported visiting orthodox places based on health grounds in the past 6 months before this survey. Other places visited based on health grounds were herbal home (1.4%) and prayer home (26.6%). About 65% of the respondents did not disclose any disease diagnosis, but 26.6% of respondents reported being diagnosed with diabetes or hypertension, and 4.3% of them mentioned being diagnosed with tuberculosis or urinary tract infections; 4.4% of respondents mentioned that they were diagnosed with spiritual problems in the prayer homes they visited before the survey [Table 1].
Table 1: Demographic factors, social characteristics, and perception of health status of the study population stratified by kidney disease risk status (n=1171)The univariate regression analyses between selected characteristics and knowledge of KD risk factors are presented in [Table 2]. Gender was significantly associated with knowledge of KD risk factors, with females having higher odds of knowledge of KD risk factors compared with males (odds ratio [OR] =1.82, CI = 1.87–2.28). Significantly, younger respondents aged 15–24 (OR = 1.28, CI = 1.42–2.48) and respondents in middle age 25–34 (OR = 2.59, CI = 2.42–3.83) had higher odds of knowledge of KD risk factors compared with older respondents (35+) [Table 2]. Residing in Lagos Island was significantly associated with higher odds of having knowledge of KD risk factors than living in Lagos Mainland (OR = 4.85, CI = 4.87–5.63). Similar associations were seen for education level, with respondents with education having higher odds of knowledge of KD risk factors (OR = 4.98, CI = 4.37–5.81) compared to uneducated respondents [Table 2]. By marital status, those married (OR = 3.92, CI = 2.37–4.28) or previously married (OR = 5.60, CI = 2.51–8.47) were found to have higher odds of knowledge of KD risk factors than unmarried respondents [Table 2]. Employed respondents and having a high monthly income had higher odds of having knowledge of KD risk factors than those who were unemployed or of low-income status. Respondents exposed to non-communicable disease, communicable and “others” were found to have higher odds of knowledge of KD risk factors, but this was significantly associated with those diagnosed with any non-communicable disease [Table 2].
Table 2: Unadjusted univariate linear regression analysis of knowledge of kidney disease risk factors by demographic factors, social characteristics, and self-reported medical history (n=1171)[Table 3] presents the univariate analysis of risk-inducing factors among respondents without KD or with KD. Respondents without KD were significantly associated with risk-inducing lifestyles by having higher odds of engaging in misuse of over-the-counter medicines (OR = 1.69, CI = 0.57–5.02, P < 0.05) compared with their counterparts who have KD [Table 3]. Respondents without KD were more likely to engage in indiscriminate use of analgesics than those who had KD [Table 3]. Similar findings were seen for regular use of herbal supplements and frequent use of traditional remedies. For cigarette smoking, a positive association of a higher odds was evident among respondents without KD than those who have KD (OR = 1.21, CI = 0.28–5.24, P < 0.05) [Table 3]. Consuming a large quantity of salt in food was statistically significant for risk-inducing lifestyles among respondents without KD compared to those with KD. Similarly, respondents without KD with reported NCDs or communicable diseases were significantly associated with higher odds of risk-inducing lifestyles compared with respondents diagnosed with KD [Table 3].
Table 3: Univariate analysis to determine risk-inducing lifestyles for kidney disease risk among the study respondents (n=1171)[Table 4] shows the prevalence of risk factors for KD among respondents with or without KD. Risk factors such as misuse of over-the-counter medicines (27.2%, P < 0.05), indiscriminate use of analgesics (26.8%, P < 0.05), regular use of herbal supplements (29.1%, P < 0.05), frequent use of traditional remedies (44.0%, P < 0.05), chronic ingestion of alcohol (29.5%, P < 0.05), and a large quantity of salt in food (23.1%, P < 0.05) were found to be significantly prevalent among respondents not diagnosed with KD. Risk factors such as older age (≥30 years) (45.5%, P < 0.05), regular use of herbal supplements (18.2%, P < 0.05), frequent use of traditional remedies (31.8%, P < 0.05), chronic ailments (diabetes and hypertension) (45.5%, P < 0.05), and infectious diseases (TB and urinary tract infections) (40.9%, P < 0.05) were prevalent among respondents diagnosed with KD [Table 4].
Table 4: The prevalence of risk factors associated with respondents with or without kidney disease (n=1171)[Table 5] shows the adjusted multivariate logistic regression results of all the selected variables. The results show that some of the variables were significant knowledge predictors of KD risk-inducing lifestyles among respondents who have been diagnosed with KD (all P < 0.05). The results further show that older age (≥30 years), indiscriminate use of analgesics, regular use of herbal supplements, frequent use of traditional remedies, large quantity of salt in food, chronic ailments (diabetes and hypertension), and infectious diseases (tuberculosis and urinary tract infections) are significant knowledge predictors for being involved in risk-inducing lifestyles among respondents without KD [Table 5]. However, misuse of over-the-counter medicines (no KD: OR 1.82, P > 0.05; with KD: OR 1.21, P > 0.05) and misuse of medicines without prescription (no KD: OR 1.07, P > 0.05; with KD: OR 1.01, P > 0.05) were not significant but have increased odds of knowledge predictors of risk-inducing lifestyles among respondents with or without KD [Table 5].
Table 5: Adjusted logistic regression analysis of predictors of knowledge of risk-inducing lifestyles among respondents with or without kidney diseaseFurthermore, the results in [Table 5] showed that higher odds of knowledge predictors of risk-inducing lifestyles among respondents with or without KD were older age (≥30 years) (no KD: OR 1.06, P < 0.05; with KD: OR 2.10, P < 0.05), indiscriminate use of analgesics (no KD: OR 1.03, P < 0.05; with KD: OR 1.02, P < 0.05), regular use of herbal supplements (no KD: OR 1.16, P < 0.05; with KD: OR 4.12, P < 0.05), frequent use of traditional remedies (no KD: OR 1.55, P < 0.05; with KD: OR 2.13, P < 0.05), large consumption of salt in food (no KD: OR 1.80, P < 0.05; with KD: OR 2.20, P < 0.05), chronic ailments (diabetes and hypertension) (no KD: OR 1.51, P < 0.05; with KD: OR 3.03, P < 0.05), and infectious diseases (tuberculosis and urinary tract infections) (no KD: OR 1.95, P < 0.05; with KD: OR 1.24, P < 0.05), respectively [Table 5]. Furthermore, being involved in risk-inducing lifestyles such as chronic ingestion of alcohol (no KD: OR 0.20, P > 0.05), chronic cigarette smoking (no KD: OR 0.65, P > 0.05; with KD: OR 0.54, P > 0.05), physical inactivity (lack of exercise) (with KD: OR 0.68, P > 0.05) and sedentary living (no KD: OR 0.79, P > 0.05; with KD: OR 0.33, P > 0.05) have lower odds of knowledge predictors but are not significantly associated among respondents either with or without KD [Table 5].
Discussion This study documented the prevalence of KD and knowledge of KD risk factors among Nigerians resident in Lagos State metropolitan district, South West Nigeria. Community-based adults in the Island and Mainland metropolis of Lagos State have average knowledge pertaining to KD and its risk factors as well as its risk, although overall knowledge and knowledge specific to KD types, causes, symptoms and risk factors of KD were average. The respondents had a basic understanding of the kidneys' normal function as filtering organs, as well as the role of biomedical care in the diagnosis and prevention of KD. This baseline knowledge could serve as a solid foundation upon which to educate individuals and enhance their knowledge of KD and its risk factors. Improving health outcomes for KD through targeted educational interventions in high-risk populations may be integral for improving NCD outcomes more broadly.[12],[33] In our study population, age, setting (Mainland and Island), education, employment status and self-reported medical history of non-communicable disease had the strongest association with mean knowledge score for KD. In high-income countries, the level of education is directly associated with better health outcomes in individuals with KD, and education can moderate the effectiveness of interventions.[11],[65] One way in which education is linked to health outcomes is through health literacy, which is the ability to receive, process, and comprehend basic health information to make health-care decisions. In high income settings, targeting individuals at high risk of low health literacy has been effective in improving KD care.[33],[66]
Targeting individuals residing in municipal areas who have limited health-care access due to unemployment, as well as persons with low levels of education who are at high risk of low health literacy, may allow for more efficient interventions that better account for these disparities in the Lagos metropolis. We discovered risk variables (lifestyles and medical factors) that were strongly associated to a keen willingness to learn more about KD. The respondents also had frequent concerns about the economic, health, and social impact of being diagnosed with KD. Inadequate knowledge of the health implications of having risk factors contributes to low recognition of the kidney, making it not to be seen as a central organ in the body's metabolism.[13],[67] As such, individuals' thinking of their vulnerability to KD development is not foreseen in their day-to-day activities. Public health efforts aimed at improving awareness of KD and reducing the aforementioned concerns have been effective in other low-resource settings outside sub-Saharan Africa.[10],[11],[12],[13] Our findings suggest that such efforts would also be well-received in Lagos State. In this specific situation, where mobile health (mhealth) technologies have been successfully used in public health activities relating to chronic disease management, maternal-child health, HIV, and tuberculosis, the utilization of technology-based platforms may be useful in implementing such programs.[68] The use of technology-based platforms for improving chronic disease prevention and management care modalities, such as KD, is established in a few African countries, such as South Africa.[69]
This study's assessment of knowledge of KD and healthcare practices in disseminating information on KD risk factors as well as KD preventive modalities suggested that mobile health would be a potentially well-received means of facilitating such KD public health efforts in Nigeria, especially in local urban settings.[10],[11],[12],[13] Thus, health communication and education can be circulated among certain populations through personal emails in Nigeria. Regardless of KD status, the participants were willing to seek healthcare from a variety of sources, including traditional healers. This is in consistent with earlier research studies, which found that traditional treatments are used first to treat chronic illnesses. This behavioural pattern or use of traditional remedies is not limited to rural, low-income, or elderly populations.[70] However, the use of traditional remedies has been documented to perpetuate some practices risky to the kidney, such as use of herbal concoctions for the treatment of illnesses. The damaging effect of herbal concoctions has been widely reported.[70],[71] Given the harmful impact of a combination of inadequate public health awareness, use of traditional remedies, and high patronage of patent medicine vendors (PMVs), it is critical to promote awareness and practices. These practices eventually lead to late detection of any existing chronic ailments such as KD. Patronage of PMVs and over-the-counter medicine for treatment of ailments is a common practice in Nigeria and other African countries.[70],[71],[72] Onyeneho et al.[72] found that more than 50% of their study participants patronized PMVs, similar to the findings in this study. This practice may result from underlying situations, such as poverty, ignorance, and cultural beliefs. When actually faced with certain symptoms, medicine vendors may be unable to look beyond mild ailments including malaria or flu.[5],[54] Physical examinations and laboratory tests are among the hospital services that may assist to discover asymptomatic illness, allowing for early intervention and better outcomes.
To the best of our knowledge, this is the first community-based assessment of knowledge, risk factors, and behavioral risk associated with KD in Lagos. It is also the first study to look at knowledge, risk factors, and KD risk in a Nigerian community-based pool of respondents with and without KD. Our findings will aid in the development of community-based and local-level programs. The African Association of Nephrology (AFRAN) and Nigerian Association of Nephrology (NAN) operate to promote, advance and disseminate knowledge of the kidney and to seek means of prevention as well as treatment of kidney and urino-genital tract disorders. The findings of
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