Knowledge, Attitudes, and Practices Associated with Chronic Kidney Disease in Northern Tanzania: A Community-Based Study.
BACKGROUND
Non-communicable diseases (NCDs) are a leading cause of death among adults in sub-Saharan Africa, and chronic kidney disease (CKD) is a growing public health threat. Understanding knowledge, attitudes, and practices associated with NCDs is vital to informing optimal policy and public health responses in the region, but few community-based assessments have been performed for CKD. To address this gap, we conducted a cross-sectional survey of adults in northern Tanzania using a validated instrument.


METHODS
Between January and June 2014, we administered a structured survey to a random sample of adults from urban and rural communities. The validated instrument consisted of 25 items designed to measure knowledge, attitudes, and practices associated with kidney disease. Participants were also screened for CKD, diabetes, hypertension, and human immunodeficiency virus.


RESULTS
We enrolled 606 participants from 431 urban and rural households. Knowledge of the etiologies, symptoms, and treatments for kidney disease was low (mean score 3.28 out of 10; 95% CI 2.94, 3.63). There were no significant differences by CKD status. Living in an urban setting and level of education had the strongest independent associations with knowledge score. Attitudes were characterized by frequent concern about the health (27.3%; 20.2, 36.0%), economic (73.1%; 68.2, 77.5%), and social impact (25.4%; 18.6, 33.6%) of kidney disease. Practices included the use of traditional healers (15.2%; 9.1, 24.5%) and traditional medicines (33.8%; 25.0, 43.9%) for treatment of kidney disease as well as a willingness to engage with mobile-phone technology in CKD care (94.3%; 90.1, 96.8%).


CONCLUSIONS
Community-based adults in northern Tanzania have limited knowledge of kidney disease. However, there is a modest knowledge base upon which to build public health programs to expand awareness and understanding of CKD, but these programs must also consider the variety of means by which adults in this population meet their healthcare needs. Finally, our assessment of local attitudes suggested that such public health efforts would be well-received.
Department of Medicine, Duke University, DUMC Box 3182, Durham, NC, 27710, United States of America.|Duke Global Health Institute, Duke University, Durham, NC, 27710, United States of America.|Duke Clinical Research Institute, Duke University, DUMC Box 3646, Durham, NC, 27710, United States of America.
John W
JW
Stanifer
Duke Global Health Institute, Duke University, Durham, NC, 27710, United States of America.|Department of Biostatistics and Bioinformatics, Duke University, DUMC Box 2721, Durham, NC, 27710, United States of America.
Elizabeth L
EL
Turner
Duke Global Health Institute, Duke University, Durham, NC, 27710, United States of America.
Joseph R
JR
Egger
Department of Medicine, Duke University, DUMC Box 3182, Durham, NC, 27710, United States of America.|Duke Global Health Institute, Duke University, Durham, NC, 27710, United States of America.
Nathan
N
Thielman
Kilimanjaro Christian Medical College, Sokoine Road, Moshi, Tanzania.
Francis
F
Karia
Kilimanjaro Christian Medical College, Sokoine Road, Moshi, Tanzania.
Venance
V
Maro
Kilimanjaro Christian Medical College, Sokoine Road, Moshi, Tanzania.
Kajiru
K
Kilonzo
Department of Medicine, Duke University, DUMC Box 3182, Durham, NC, 27710, United States of America.|Duke Global Health Institute, Duke University, Durham, NC, 27710, United States of America.|Duke Clinical Research Institute, Duke University, DUMC Box 3646, Durham, NC, 27710, United States of America.
Uptal D
UD
Patel
Department of Medicine, Queen's University, 76 Stuart Street, Kingston, Ontario, Canada K7L 2VL.
Karen
K
Yeates
D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008519:Medicine, Traditional; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000517:prevention & control*; D012424:Rural Population / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013636:Tanzania / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult