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The epidemiology of chronic kidney disease in Northern Tanzania: a population-based survey.

Stanifer JW, Maro V, Egger J, Karia F, Thielman N, Turner EL, Shimbi D, Kilaweh H, Matemu O, Patel UD - PLoS ONE (2015)

Bottom Line: Half of the cases of CKD (49.1%) were not associated with any of the measured risk factors of hypertension, diabetes, or HIV.We observed a high burden of CKD in Northern Tanzania that was associated with low awareness.Although demographic, lifestyle practices including traditional medicine use, socioeconomic factors, and NCDs accounted for some of the excess CKD risk observed with urban residence, much of the increased urban prevalence remained unexplained and will further study as demographic shifts reshape sub-Saharan Africa.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Duke University, Durham, North Carolina, United States of America; Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.

ABSTRACT

Background: In sub-Saharan Africa, kidney failure has a high morbidity and mortality. Despite this, population-based estimates of prevalence, potential etiologies, and awareness are not available.

Methods: Between January and June 2014, we conducted a household survey of randomly-selected adults in Northern Tanzania. To estimate prevalence we screened for CKD, which was defined as an estimated glomerular filtration rate ≤ 60 ml/min/1.73m2 and/or persistent albuminuria. We also screened for human immunodeficiency virus (HIV), diabetes, hypertension, obesity, and lifestyle practices including alcohol, tobacco, and traditional medicine use. Awareness was defined as a self-reported disease history and subsequently testing positive. We used population-based age- and gender-weights in estimating prevalence, and we used generalized linear models to explore potential risk factors associated with CKD, including living in an urban environment.

Results: We enrolled 481 adults from 346 households with a median age of 45 years. The community-based prevalence of CKD was 7.0% (95% CI 3.8-12.3), and awareness was low at 10.5% (4.7-22.0). The urban prevalence of CKD was 15.2% (9.6-23.3) while the rural prevalence was 2.0% (0.5-6.9). Half of the cases of CKD (49.1%) were not associated with any of the measured risk factors of hypertension, diabetes, or HIV. Living in an urban environment had the strongest crude (5.40; 95% CI 2.05-14.2) and adjusted prevalence risk ratio (4.80; 1.70-13.6) for CKD, and the majority (79%) of this increased risk was not explained by demographics, traditional medicine use, socioeconomic status, or co-morbid non-communicable diseases (NCDs).

Conclusions: We observed a high burden of CKD in Northern Tanzania that was associated with low awareness. Although demographic, lifestyle practices including traditional medicine use, socioeconomic factors, and NCDs accounted for some of the excess CKD risk observed with urban residence, much of the increased urban prevalence remained unexplained and will further study as demographic shifts reshape sub-Saharan Africa.

No MeSH data available.


Related in: MedlinePlus

Study Setting.Map showing the sampling area of Moshi Urban and Moshi Rural in the Kilimanjaro Region of Northern Tanzania.
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pone.0124506.g001: Study Setting.Map showing the sampling area of Moshi Urban and Moshi Rural in the Kilimanjaro Region of Northern Tanzania.

Mentions: We conducted a stratified, cluster-designed cross-sectional survey between January and June 2014 in the Kilimanjaro Region of Tanzania. The adult regional population is more than 900,000 people, and it has a female majority (58%). Almost 35% of the adult population lives in an urban setting, which is comparable to national estimates, and the HIV prevalence is 3–5% which is slightly lower than the national prevalence of 5–6%. The unemployment rate is 19%, and most people have only a primary education (77%); however, the region is slightly more educated with literacy rates of 80% compared to the national average of 72%. The median age, average household size, and occupation distribution are no different from national estimates. The largest ethnic group is the Chagga tribe followed by the Pare, Sambaa, and Maasai tribes, and Swahili is the major language. The region comprises seven districts; our study was conducted in the Moshi Urban and Moshi Rural districts (Fig 1) [5, 16, 17].


The epidemiology of chronic kidney disease in Northern Tanzania: a population-based survey.

Stanifer JW, Maro V, Egger J, Karia F, Thielman N, Turner EL, Shimbi D, Kilaweh H, Matemu O, Patel UD - PLoS ONE (2015)

Study Setting.Map showing the sampling area of Moshi Urban and Moshi Rural in the Kilimanjaro Region of Northern Tanzania.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4401757&req=5

pone.0124506.g001: Study Setting.Map showing the sampling area of Moshi Urban and Moshi Rural in the Kilimanjaro Region of Northern Tanzania.
Mentions: We conducted a stratified, cluster-designed cross-sectional survey between January and June 2014 in the Kilimanjaro Region of Tanzania. The adult regional population is more than 900,000 people, and it has a female majority (58%). Almost 35% of the adult population lives in an urban setting, which is comparable to national estimates, and the HIV prevalence is 3–5% which is slightly lower than the national prevalence of 5–6%. The unemployment rate is 19%, and most people have only a primary education (77%); however, the region is slightly more educated with literacy rates of 80% compared to the national average of 72%. The median age, average household size, and occupation distribution are no different from national estimates. The largest ethnic group is the Chagga tribe followed by the Pare, Sambaa, and Maasai tribes, and Swahili is the major language. The region comprises seven districts; our study was conducted in the Moshi Urban and Moshi Rural districts (Fig 1) [5, 16, 17].

Bottom Line: Half of the cases of CKD (49.1%) were not associated with any of the measured risk factors of hypertension, diabetes, or HIV.We observed a high burden of CKD in Northern Tanzania that was associated with low awareness.Although demographic, lifestyle practices including traditional medicine use, socioeconomic factors, and NCDs accounted for some of the excess CKD risk observed with urban residence, much of the increased urban prevalence remained unexplained and will further study as demographic shifts reshape sub-Saharan Africa.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Duke University, Durham, North Carolina, United States of America; Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.

ABSTRACT

Background: In sub-Saharan Africa, kidney failure has a high morbidity and mortality. Despite this, population-based estimates of prevalence, potential etiologies, and awareness are not available.

Methods: Between January and June 2014, we conducted a household survey of randomly-selected adults in Northern Tanzania. To estimate prevalence we screened for CKD, which was defined as an estimated glomerular filtration rate ≤ 60 ml/min/1.73m2 and/or persistent albuminuria. We also screened for human immunodeficiency virus (HIV), diabetes, hypertension, obesity, and lifestyle practices including alcohol, tobacco, and traditional medicine use. Awareness was defined as a self-reported disease history and subsequently testing positive. We used population-based age- and gender-weights in estimating prevalence, and we used generalized linear models to explore potential risk factors associated with CKD, including living in an urban environment.

Results: We enrolled 481 adults from 346 households with a median age of 45 years. The community-based prevalence of CKD was 7.0% (95% CI 3.8-12.3), and awareness was low at 10.5% (4.7-22.0). The urban prevalence of CKD was 15.2% (9.6-23.3) while the rural prevalence was 2.0% (0.5-6.9). Half of the cases of CKD (49.1%) were not associated with any of the measured risk factors of hypertension, diabetes, or HIV. Living in an urban environment had the strongest crude (5.40; 95% CI 2.05-14.2) and adjusted prevalence risk ratio (4.80; 1.70-13.6) for CKD, and the majority (79%) of this increased risk was not explained by demographics, traditional medicine use, socioeconomic status, or co-morbid non-communicable diseases (NCDs).

Conclusions: We observed a high burden of CKD in Northern Tanzania that was associated with low awareness. Although demographic, lifestyle practices including traditional medicine use, socioeconomic factors, and NCDs accounted for some of the excess CKD risk observed with urban residence, much of the increased urban prevalence remained unexplained and will further study as demographic shifts reshape sub-Saharan Africa.

No MeSH data available.


Related in: MedlinePlus