Awareness And Self-care Practice Regarding Prevention Of Chronic Kidney Disease

ali.ma@wecistanche.com

Pierre Marie Theos Mbabazi, et al

Abstract:

Introduction: There is a strong relationship between Hypertension and Chronic Kidney Disease. To minimize and prevent the occurrence of Chronic Kidney Disease, hypertensive patients have to be aware of their condition and adhere to recommended self-care practices.

Aim of the study: To assess the awareness and self-care practice regarding the prevention of Chronic Kidney Disease among patients living with hypertension at the University Teaching Hospital of Butare.

Methodology: The study design was descriptive cross-sectional. A sample size of 140 was selected using a purposive sampling strategy. Data was collected using a closed-ended questionnaire. Descriptive and inferential statistics were used to analyze data.

Results: Nearly 49% had a low level of awareness, and moderate self-care practice was observed in 56.5% of study participants. Educational level was discovered to be associated with awareness (p = .026). Factors associated with self-care practice were age (p = .000), marital status (p = .003), educational level (p.020), occupation (p =.021) and residence (p = .026). A significant weak positive relationship between awareness and self-care practice of participants (r = 0.254, p = 0.02) was established.

Conclusion: Altered levels of awareness and self-care practice regarding Chronic Kidney Disease prevention were revealed. Health care professionals including nurses need to intensify health education to improve awareness and provide adequate information to hypertensive patients on the importance of good self-management. Further research is called for to identify further factors contributing to moderate self-care practice of preventing CKD since awareness only explained 6.4% variance.

Click to cistanche powder health benefits for kidney disease

1. Introduction

Chronic Kidney Disease (CKD) and hypertension (HTN) are two diseases with strong cause-and-effect interrelationships. Hypertension is a typically recognized principal risk factor of CKD while in reciprocal, a decrease in renal function leads to HTN which in turn accelerates the progression to renal failure (Judd & Calhoun, 2015). While the global prevalence of HTN is around 1.13 billion among the adult population (American College of Cardiology, 2016), estimations for CKD show figures between 8% and 16% (Zhang et al, 2016). In Africa including Rwanda, HTN affects 24.7% of the overall adult population, but only less than 3% of the people needing renal replacement therapy (RRT) are able to receive it (Kumela Goro et al, 2019).

By 2025, the projections on the global number of the hypertensive population are expected to be around 1.56 billion thus corresponding to 29% of the overall world adult population. This increasing number is significantly associated with various factors such as family background, diet, lifestyle, and the environment (Bakhsh et al, 2017). Though the prevalence of HTN remains elevated, hypertensive patients continue to exhibit a low level of awareness thus increasing the risk of acquiring CKD complications (Mohamed et al, 2018). To prevent these related complications, hypertensive patients need to be aware of their condition and adhere to self-care practices such as medical prescriptions and lifestyle changes. However, in their daily life, many patients fail to regularly implement these recommendations, hence a high risk of developing CKD complications (Ademe et al, 2019).

Despite the recognized importance of increased awareness and self-care practice in the prevention of Chronic Kidney Disease among hypertensive patients; studies continue to reveal a low level of awareness among these patients. This is evident especially in the low- and middle-income countries where less than 10% of patients living with HTN are aware of the interconnected relationship to CKD (Sherwood & McCullough, 2016). Additionally, evidence of poor self-care practice has been observed where only 36.1% were found to be adhering to HTN medication, 24.5% to regular physical activity, 39.2% to the program of weight reduction, and 12.3% to low salt intake (Motlagh et al, 2016). However, little is still known about the awareness and self-care practice of preventing CKD in Africa and this includes Rwanda. Therefore, the current study assessed the awareness and self-care practice regarding the prevention of CKD among patients living with hypertension at the University Teaching Hospital of Butare in Rwanda.

2. Methodology

2.1. Research design and setting

The study employed a descriptive cross-sectional design. The period of data collection was from 11 May to 11 June 2019. The setting was the University Teaching hospital of Butare, located in the Huye District of the Southern Province of Rwanda. It is one of Rwanda’s national referral hospitals which serves the population of the Southern and Western Province.

2.2. Population and sampling

The study population constituted adult HTN patients attending the outpatient department (OPD) of the study site. The accessible population included HTN patients available during the period of data collection. A sample size of 140 was calculated using the Slovin formula (Sugiyono, 2013), where n = N/(1 + Ne2 ), with a confidence interval of 95%, a margin of error equivalent to 0.05, and N is the number of hypertensive patients attending the study site per month. A purposive sampling strategy was used to select the study participants.

2.3. Data collection instrument

The instrument used for this study was adapted with permission from Khalil and Abdalrahim (2014). The adapted tool for the current study consisted of 3 categories: socio-demographic characteristics; awareness and self-care practice regarding the prevention of CKD among patients living with HTN. The participants responded by choosing one answer between Yes and No and then ticking the appropriate box. Each correct answer was merited with 1 point. The scores for awareness were calculated out of 17 with classification into 3 categories: low (0–8 points) equivalent to 0–49%, moderate (9–11 points) equivalent to 50–69%, and high (12–17) equivalent to 70–100%. With regards to self-care practice, the total score was calculated out of 28. The classified categories of the obtained score were: low (0− − 13) equivalent to 0–49%, moderate (14–19) equivalent to 50–69%, and high (20–28) equivalent to 70–100%.

The validity and reliability of the tool used in the current study were ensured (Heale & Twycross, 2015). The tool was modified and some aspects of the depth literature review were added to fit the context of Rwanda. Experts in the clinical and academic areas were utilized to evaluate the content of the questionnaire. With regards to reliability, the original English version was translated to Kinyarwanda and back-translated to English thus ensuring consistency in both languages. Pretesting of the tool was conducted on a small sample of 15 hypertensive patients and no changes were made to the tool as the participants were able to understand and comprehend the information. The internal consistency of the tool, determined by Cronbach alpha was 0.7, meaning the instrument was an acceptable measure (Gliem & Gliem, 2003) of awareness and self-care practice.

2.4. Data collection procedure

After obtaining ethical approval from the Institutional Review Board of the University of Rwanda, College of Medicine and Health Sciences (Ref: CMHS IRB 076/2019) and study site (Ref: CHUB/DG/ SA050777/2019), the collection of data began. The researcher visited the outpatient department to meet the eligible participants with help from the nurse in charge. The nurse in charge provided the register with all the hypertensive patients coming to the outpatient department for their medical reviews. The eligible participants were informed about the study and granted the liberty to withdraw at any period during the data collection.

All those who agreed to participate in the study signed an informed consent after receiving full information about the study. A written information sheet in either local or English language was distributed to the participants to absorb the information. Furthermore, they were given opportunities to bring forth any related inquiries with the researcher advising accordingly. Thereafter, the researcher gave the questionnaires to participants to fill in while they waited for their opportunity to be interviewed. Participants requiring assistance such as the illiterate were provided with the proper guidance to complete their questionnaires. One hundred and forty questionnaires were answered during the period of data collection.

2.5. Data analysis

The determined significance level was 0.05 and all statistical analyses have been performed using SPSS version 21. Descriptive statistics were used to describe the demographic data, level of awareness, and self-care practice among hypertensive patients regarding the prevention of CKD. Inferential statistics of Chi-square were used to establish an association between demographic characteristics, awareness, and self-care practice of hypertensive patients regarding the prevention of CKD. The correlational coefficient (r) was used to identify the direction and the strength of the relationship between awareness and self-care practice.

3. Results

3.1. Demographic data of study participants

A significant number of the participants were aged over 51 years (55%) with the majority being females (66.4%). Half of the participants were married (50%), and the majority had at least attended primary school (83.6%). There were 50.7% self-employed and 51.4% living in the urban areas. The family antecedents of hypertension were found in 35.7% of participants and 44.3% were living with hypertension for a period of 5 years and over (Table 1).

3.2. Awareness of hypertensive patients regarding the prevention of CKD

While the majority (82.9%) were aware that HTN was a serious threat to their life, less than half (42.1%) were aware that CKD can be a complication of HTN. Regarding the awareness of the risk factors for CKD, 44.3%, 42.1%, 55%, 56.4%, and 53.6% of the participants were aware that obesity, elevated blood lipids, irregular physical activity, smoking, high intake of alcohol, and high intake of salt can lead hypertensive patients to get CKD respectively (Table 2).

4. Self-care practice of hypertensive patients regarding the prevention of CKD

The most practiced dietary self-care were respecting low salt [129 (92.1%)] and eating a healthy diet [111 (79.3%)]. Whilst walking [119 (85%)], non-smoking [114(81.4)] and non-alcohol [118(84.3%)] were most adopted lifestyle changes, running [105(75%)] was not. The majority [113 (80.7%)] always forget to take their antihypertensive medication and 134 (95.7%) had at least stopped antihypertensive drugs without medical advice. However, 109 (77.9 %) were not obliged to adhere to their treatment plans. More than 90% of the participants were able to practice positive health-seeking behaviors of regular medical reviews [126(90%)], regular blood pressure checkups [131 (93.6%)], and not consulting traditional healers [134(95.7%)] (Table 3).

4.1. Level of awareness and self-care practice regarding the prevention of CKD

With respect to awareness, the lowest and highest observed score was 0 and 17 respectively out of the total score of 17. Sixty-eight (48.6%) scored low, 14 (10%) moderate, and 58 (41.4%) high level of awareness of the prevention of CKD (Table 4). With respect to self-care practice, the minimum score was 8 while the maximum was 26 out of a possible score of 28. The majority [79 (56.5%)] exhibited moderate levels, 52 (37.1%) high levels, and only 9 (6.4%) with low levels of self-care practice (Table 4).

4.2. Factors associated with awareness and self-care practice regarding the prevention of CKD

The only factor found to be associated with awareness was the educational level (p = .026). Factors associated with the self-care practice were age (p = .000); marital status (p = .003); educational level (p = .020), occupation (p = .021); residence (p = .026). A significant weak positive relationship between awareness and self-care practice of participants (r = 0.254, p = 0.02) was established. The contribution of awareness to self-care practice was only explained by a 6.4% variance (Table 5).

5. Discussion

5.1. Awareness of hypertensive patients regarding the prevention of CKD

The majority of the participants were females, married with primary school education, and unemployed thus confirming the findings by Sa’adeh et al (2018) and Ikasaya et al (2018). A low level of awareness regarding the prevention of CKD among patients with hypertension was found in the current study. This is similar to a study conducted by Pirasath et al (2017) who indicated unawareness of hypertension in 40.5% of the population. However, 82.9% were aware that HTN is a threat to their life, agreeing with the results of Bakhsh et al (2017). Nevertheless, the unawareness of causality relationship existing between HTN and CKD were noted thus agreeing with the findings of Pirasath et al (2017). On a positive note, Bakhsh et al (2017) indicated an overall level of awareness of 72%.

5.2. Self-care practice on prevention of CKD

Regarding the level of self-care practice, more than half exhibited a moderate level thus similar to the findings of Ikasaya et al (2018). These findings are also supported by Khalil and Abdalrahim (2014) and Ademe et al (2019). The dietary practice of a low salt diet, a healthy diet, and drinking recommended fluids per day were found to be good while Khalil and Abdalrahim (2014) found a contrasting result of only 29.6% respecting the low salt regimen and 18.6% constantly abiding by a balanced meal. The problem of salt restrictions is also observed by Ikasaya et al (2018) who revealed moderate salt intake in only 37.8% of the population.

Self-care practices of regular physical activity, not smoking nor drinking as well as desisting in the use of herbal medicines were evident in the current study, confirming the findings of Khalil and Abdalrahim (2014) and Ikasaya et al (2018). However, with adherence to antihypertensive medication, a number of participants seemed to forget to take their anti-hypertension drugs. Those findings were partially supported by Khalil and Abdalrahim (2014) who highlighted an approximately 37% do not always take antihypertension drugs, 2.3% does not follow their medication regimen, and 35% taking drugs on an irregular routine. The study by Pirasath et al (2017) indicated 99% are aware of the importance of antihypertension medications, but in practice, 84.5% were poorly adhering to medication due to forgetfulness (23.1%) and interruptions of the daily routine (17.5%).

5.3. Factors associated with awareness and self-care practice regarding prevention of CKD

Educational level was the only factor associated with awareness of hypertensive patients thus supporting the findings of Mouhtadi et al (2018), Additionally, Liew et al (2019) specifically highlighted primary (p = 0.03) and secondary education (p = 0.01) to be significant. However, factors associated with self-care practice were age; marital status; educational level, occupation; and residence. This contrasts with the findings of Sa’adeh et al(2018) and Neminqani et al (2013) that revealed only educational level to be significantly associated. Specifically, in the study of Neminqani (2013), participants with university education had a high level of self-management practice compared to those without education. Nevertheless, Sadeq and Lafta (2017) found no demographic characteristics associated with self-care practice in the prevention of CKD. In another study by Ademe et al (2019), a significant association between divorced and self-care compared to singles was revealed. A significant weak correlation between awareness and self-care practice was indicated and this is similar to the findings of Bakhsh et al (2017). Contrary, the majority of studies were not highlighting any relationship between awareness and self-care practice.

5.4. Limitations of the study

The study was carried out in only one referral hospital in Rwanda which only serves the Southern and Western provinces, hence the results cannot be generalized to other regions in Rwanda. There was the possibility of information bias as the respondents might have given more or less information on both awareness and self-care practice. Recall bias was quite possible as the participants were asked to recall what they remember about hypertension and CKD as well as their practice behaviors.

6. Conclusion

The findings revealed low awareness in nearly 49% and moderate self-care practice was observed in more than half (56.5%) of the population under study. While only education was found to be associated with awareness, self-care practice was associated with age, marital status, educational level, occupation, and residence. A significant weak positive relationship between awareness and self-care practice was established. These results indicate a significant number of hypertensive patients at an elevated risk of developing CKD which is irreversible and costly to treat. Health care professionals including nurses need to intensify health education to improve awareness and provide adequate information to hypertensive patients on the importance of good self-management. Further research is called for to identify further factors contributing to moderate self-care practice of preventing CKD since awareness only explained 6.4% variance.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgments

We would express our gratitude to Amani Khalil and Maysoon Abdalrahim for authorizing the use and adaptation of their research tool, the study setting, and all participants. We would express thank the study setting and all participants.

References

Ademe, S., Aga, F., & Gela, D. (2019). Hypertension self-care practice and associated factors among patients in public health facilities of Dessie town. Ethiopia. BMC Health Services Research, 19(1), 1–9.
American College of Cardiology (2016). The Global Burden of High Blood Pressure. Retrieved December 21, 2018.
Bakhsh, L. A., Adas, A. A., Murad, M. A., Nourah, R. M., Hanbazazah, S. A., Aljahdali, A. A., & Alshareef, R. J. (2017). Awareness and knowledge on hypertension and its self-care practices among hypertensive patients in Saudi Arabia. Ann Int Med Den Res, 3(5), 58–62. https://doi.org/10.21276/aimdr.2017.3.5.me13
Gliem, J. A., & Gliem, R. R. (2003). Calculating, interpreting, and reporting Cronbach’s alpha reliability coefficient for Likert-type scales. Midwest Research-to-Practice Conference in Adult, Continuing, and Community. Education.
Heale, R., & Twycross, A. (2015). Validity and reliability in quantitative studies. Evidence-based Nursing, 18(3), 66–67.
Ikasaya, I., Mwanakasale, V., & Kabelenga, E. (2018). Knowledge, attitudes, and practices of hypertension among hypertensive patients at Buchi clinic, Kitwe, Zambia. Int J Curr Innov Adv Res, 1, 78-89.
Judd, E., & Calhoun, D. A. (2015). Management of hypertension in CKD: Beyond the guidelines. Advances in Chronic Kidney Disease, 22(2), 116–122.
Khalil, A., & Abdalrahim, M. (2014). Knowledge, attitudes, and practices towards prevention and early detection of chronic kidney disease. International Nursing Review, 61(2), 237–245.
Kumela Goro, K., Desalegn Wolide, A., Kerga Dibaba, F., Gashe Fufa, F., Wakjira Garedow, A., Edilu Tufa, B., & Mulisa Bobasa, E. (2019). Patient awareness, prevalence, and risk factors of chronic kidney disease among diabetes mellitus and hypertensive patients at Jimma University Medical Center, Ethiopia. BioMed Research International, 2019.
Liew, S. J., Lee, J. T., Tan, C. S., Koh, C. H. G., Van Dam, R., & MüllerRiemenschneider, F. (2019). Sociodemographic factors in relation to hypertension prevalence, awareness, treatment and control in a multi-ethnic Asian population: Across-sectional study. BMJ Open, 9(5), e025869.
Motlagh, S. F. Z., Chaman, R., Sadeghi, E., & Eslami, A. A. (2016). Self-care behaviors and related factors in hypertensive patients. Iranian Red Crescent Medical Journal, 18 (6).
Mouhtadi, B. B., Kanaan, R. M. N., Iskandarani, M., Rahal, M. K., & Halat, D. H. (2018). Prevalence, awareness, treatment, control and risk factors associated with hypertension in Lebanese adults: A cross-sectional study. Global Cardiology Science &
Practice, 2018(1)
Neminqani, D. M., El-Shereef, E. A., & Thubiany, M. M. A. L. (2013). Hypertensive patients: Self-care management practices in Al-Taif. KSA. Int J Sci Res, 12(4), 1705–1714.
Pirasath, S., Kumanan, T., & Guruparan, M. (2017). A study on knowledge, awareness, and medication adherence in patients with hypertension from a tertiary care center in northern Sri Lanka. International Journal of Hypertension, 2017, 1–6.
Sa’adeh, H. H., Darwazeh, R. N., Khalil, A. A., & Zyoud, S. H. (2018). Knowledge, attitudes, and practices of hypertensive patients towards prevention and early detection of chronic kidney disease: A cross-sectional study from Palestine. Clinical
Hypertension, 24(1).
Sadeq, R., & Lafta, R. K. (2017). Knowledge, attitude, and practice about hypertension in hypertensive patients attending hospitals in Baghdad, Iraq. southeast Asia Journal of Public Health, 7(1), 29–34. https://doi.org/10.3329/seajph.v7i1.34676
Sherwood, M., & McCullough, P. A. (2016). Chronic kidney disease from screening, detection, and awareness, to prevention. The Lancet Global Health, 4(5), e288–e289.

Sugiyono. (2013). Educational Research Methods Quantitative Approach, Qualitative, and R&D. Bandung: Alfabeta.

Mohamed, S. F., Mutua, M. K., Wamai, R., Wekesah, F., Haregu, T., Juma, P. & Ogola, E. (2018). Prevalence, awareness, treatment, and control of hypertension and their determinants: results from a national survey in Kenya. BMC Public Health, 18(3), 1-10.
Zhang, Wen, Shi, Wei, Liu, Zhangsuo, Gu, Yong, Chen, Qinkai, Yuan, Weijie, Chen, Nan (2016). A nationwide cross-sectional survey on prevalence, management, and pharmacoepidemiology patterns of hypertension in Chinese patients with
chronic kidney disease. Scientific Reports, 6(1).