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ORIGINAL ARTICLE
Year : 2018  |  Volume : 21  |  Issue : 2  |  Page : 93-98

Kidney disease and children: Experience from the World Kidney Day 2016 campaign in Benin City, Nigeria


Department of Child Health, University of Benin Teaching Hospital, Benin City, Nigeria

Date of Web Publication6-Jul-2018

Correspondence Address:
Dr. Moses Temidayo Abiodun
Department of Child Health, University of Benin Teaching Hospital, Benin City
Nigeria
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DOI: 10.4103/smj.smj_62_16

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  Abstract 


Background: There is a rising burden of chronic kidney disease (CKD) in all regions of the world. Hence, there is a need to enlighten the public on renal protective lifestyle. We evaluated the impact of the World Kidney Day (WKD) 2016 awareness campaign in four schools in Benin City. Materials and Methods: This was a prospective quasi-experimental study using a pre- and post-test design. The intervention comprised health education based on the WKD 2016 school toolkits. A structured questionnaire comprising four-point Likert scales and visual analog scale (VAS) was administered thrice to assess participants' perception of CKD risk factors. F-test was used to detect significant difference among weighted mean scores. Multiple logistic regression identified predictors of improved knowledge. Results: A total of 561 persons took part in the study. Nearly half (42.5%) of them had adequate baseline perception of kidney functions and dysfunction. Knowledge levels improved at posttests 1 and 2-55.5% and 52.5%, respectively. There was an upward trend in their mean scores over the period (F = 12.771, P = 0.000). Furthermore, their mean VAS scores increased significantly (50.4 ± 35.4 vs. 58.1 ± 32.2 vs. 61.2 ± 27.8; F = 4.064, P = 0.018). Their gender (odds ratio [OR] = 3.20, confidence interval [CI]: 1.43–7.18; P = 0.005), class (OR = 0.83, CI: 0.08–0.97; P = 0.04), and type of institution (OR = 5.56, CI: 1.05–29.41; P = 0.04) influenced their knowledge of kidney disease prevention on VAS postintervention. Conclusion: The WKD 2016 campaign led to a sustained increase in the awareness of kidney disease preventive measures among the participants. Relevant school health instructions would sustain the gain.

Keywords: Children, health education, kidney disease, prevention, risk factors


How to cite this article:
Abiodun MT, Iduoriyekemwen NJ. Kidney disease and children: Experience from the World Kidney Day 2016 campaign in Benin City, Nigeria. Sahel Med J 2018;21:93-8

How to cite this URL:
Abiodun MT, Iduoriyekemwen NJ. Kidney disease and children: Experience from the World Kidney Day 2016 campaign in Benin City, Nigeria. Sahel Med J [serial online] 2018 [cited 2018 Jul 20];21:93-8. Available from: http://www.smjonline.org/text.asp?2018/21/2/93/236069




  Introduction Top


There is a rising burden of chronic kidney disease (CKD) in all regions of the world affecting persons of all age groups.[1],[2] CKD will progress to end-stage renal disease (ESRD) requiring renal replacement therapy if not detected and managed promptly. The most comprehensive, population-based CKD registry in children (Italikid project) reported the incidence and prevalence of CKD as 12.1 and 74.7 cases per million children, respectively.[2] The prevalence of CKD in Nigerian children has been estimated in several zones of the country. Asinobi et al.[3] reported that the mean annual incidence of ESRD for children aged 5–14 years was 6.0 per million age-related population in Ibadan, Southwest Nigeria, while Odetunde et al.[4] reported the incidence of CKD as 3.0 new cases per million-child population per year and the prevalence of CKD as 14.9 per million-child population in Enugu, South-East, Nigeria. The actual burden of CKD in the community might have been underestimated in these hospital-based studies since early stages of the disease are often asymptomatic and routine health check is seldom practiced by most families in developing countries.[5],[6] Hence, there is a need for public enlightenment on the causes and prevention of CKD in children.[7]

The risk factors for CKD occur throughout life cycle, initiating and/or promoting the progression of the disease. These include maternal malnutrition, preterm births, low birth weights, intrauterine growth restriction, congenital anomalies of the genitourinary tract, childhood obesity and systemic diseases such as hypertension, diabetes mellitus, and infections such as hepatitis B and C virus infection and Group A streptococcal skin or throat infections.[8],[9] Furthermore, environmental and behavioral risk factors such as poor hygiene, indiscriminate use of analgesics, exposure to cigarette smoke, and native medications can predispose to CKD. Omoloja et al.[10] found that cigarette smoking and second-hand smoking were common among adolescents with CKD. Likewise, obesity-related renal injury has been well proven.[9] Hence, early life risk factors synergize with environmental risk factors to predispose to CKD consistent with the Brenner and Barker's two-hit hypothesis.[11]

Nevertheless, some CKD risk factors are avoidable or potentially modifiable, but there is a low awareness level in the community.[7] It is necessary to educate the public on relevant preventive measures. Hence, the World Kidney Day (WKD) 2016's theme on prevention of kidney disease in children is apt.[7] This paper reports the impact of the campaign in four schools in Benin City. We also evaluate factors predicting sustained knowledge of kidney disease prevention and recommend interventions suitable for resource-limited settings.


  Materials and Methods Top


Study setting and participants

The study was carried out in four selected private and public schools in the University of Benin environs, based on proximity: University Staff School, University Demonstration Secondary School, and University of Benin Teaching Hospital (UBTH) Staff School are private while Eweka Grammar School is public. This was done as a part of the series of activities marking the WKD 2016 in Benin City. A simple random technique was adopted in selecting the participants. They were school children aged 6–16 years and their teachers who attended the WKD campaign in the schools. These schools are located within Egor and Ovia local government areas, Ugbowo, Benin City, Edo state. It is a cosmopolitan city, situated in the rainforest belt 122 meters above sea level with an estimated population of 1,147,188.[12]

Study design

This was a prospective quasi-experimental study using a pre- and post-test design as depicted below [Figure 1].
Figure 1: Schematic presentation of the study design

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Intervention

It comprised health education based on the WKD 2016 school toolkits.[13] The participants were taught kidney functions, its dysfunction and factors predisposing to kidney disease, emphasizing prevalent risk factors in the setting. The researchers and clinical staff of renal unit of UBTH carried out the health education on school assemblies and designated school halls during breaktime using appropriate visual aids. The health education lasted 30–45 min followed by a variable question and answer session. Fliers highlighting the key messages of WKD 2016 on renal protective lifestyles were distributed to the participants.

Sample size was calculated by assuming a prevalence of 18% for adequate knowledge of prevention of kidney disorder in the setting, based on the proportion of in-school teenagers who had adequate knowledge of urine infection and sought appropriate treatment in a recent Jos study.[14] Using a 95% confidence interval and a sample error of 5%, a minimum sample size of 226 was obtained.[15]

Data collection

A self-administered structured questionnaire (comprising a 10-items kidney function-dysfunction scale, a 5-item kidney disease prevention scale, and a 100 mm un-calibrated visual analog scale [VAS]) was administered thrice to participants (pretest, posttest 1, and posttest 2) in March and April 2016. The variables on the questionnaires were obtained from the WKD 2016 health education toolkit on the prevention of kidney disease in children.[13] Participants' perception of each item was accessed on a four-point Likert scale ranging from “strongly agree” to “strongly disagree.” Furthermore, they were asked to indicate on VAS their overall level of knowledge of kidney disease prevention at each of the three stages of the study.

Data analysis

The data were analyzed using SPSS version 20.0 statistical software for Windows (IBM, Armonk, NY, United States). Fisher's exact test or Chi-square test was used to compare categorized data such as gender and type of institution. Weighted mean score was computed for variables on each subscale; reverse scoring applied where appropriate. Adequate perception was defined with a cutoff point of 2.5. F-test (or Student's t-test where appropriate) was used to detect significant difference among weighted mean scores while Scheffé post hoc test identified significantly different weighted means on F-test. Multiple binary logistic regression analysis was done to evaluate possible predictors of improved knowledge postintervention. The level of significance of each test was set at P < 0.05.

Ethical consideration

Approval to carry out the WKD 2016 activities in-schools was obtained from the Edo State Ministry of Education. Permissions were granted by the heads of institution. Ethical clearance exemption was sought from the Research and Ethical Committee of the College of Medicine, University of Benin 1st March 2017. Verbal informed consent was obtained from the respondents, having explained the purpose of the study, and emphasized that participation was voluntary.


  Results Top


A total of 561 students and teachers took part in the study: 242 participated in pretest, 242 in posttest 1, and 77 in posttest 2. [Table 1] shows the characteristics of the participants. Gender distribution was similar throughout the study period with a majority being females (61.2% vs. 56.6% vs. 70.1%; P = 0.102). Furthermore, the pre- and post-test 2 participants were similar in their status and types of schools (P > 0.05), but relatively more senior secondary students participated in the posttest 1 (43.0% vs. 61.6% vs. 50.6%; P = 0.001). Only those who took part in the intervention participated in the 1st and 6th week evaluations.
Table 1: Characteristics of study participants pre- and post-intervention

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Participants' perception of kidney functions and dysfunction

Nearly half (42.5%) of our participants had adequate perception of all the ten items on kidney function and dysfunction assessed in this survey before intervention. About two-thirds (68.5%) knew that there are two kidneys in every child, 65.5% agreed that the kidneys purify blood, and 55.5% perceived that the kidneys control blood pressure (BP) in children. Only 10.5% knew that early kidney disease may be asymptomatic. The baseline weighted mean score on the kidney function-dysfunction scale is 2.60 ± 0.29.

Participants' knowledge improved postintervention with 55.5% and 52.5% becoming aware of all the tested items on weeks 1 and 6, respectively. Their mean scores on the excretory function of the kidney and “BP control” as well as “survival on one kidney” significantly increased posttest (P < 0.05). Altogether, there was an upward trend of mean scores over the period [F = 3.278, P = 0.038; [Table 2].
Table 2: Participants' perception of kidney functions and dysfunction in children

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Perception of kidney disease prevention

A majority (83.4%) of the participants had baseline knowledge of kidney disease prevention. This gradually improved to 89.3% by the 6th week postintervention. Initially, only 25.5% of them were aware that skin infection could cause kidney disease, but 55.5% and 52.5% were aware at posttest 1 and 2, respectively. Likewise, there is a significant improvement in participants' mean scores on items assessing perceived protective effects of physical exercises and native concoctions on the kidneys, P < 0.05. The grand mean scores of all the items increased significantly postintervention [F = 12.771, P = 0.000; [Table 3].
Table 3: Participants' perception of kidney disease prevention in children

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Impact of health education on visual analog scale

The WKD campaign led to a significant increase in participants' awareness of prevention of kidney disease in children assessed on VAS. Only 47.5% of them indicated adequate awareness at baseline, but 54.8% and 66.2% did at 1st and 6th week posttests, respectively (P = 0.027). Furthermore, their mean VAS scores significantly improved over the period (50.4 ± 35.4 vs. 58.1 ± 32.2 vs. 61.2 ± 27.8; F = 4.064, P = 0.018).

At baseline, no factor significantly predicts the knowledge of kidney disease prevention among the participants (P > 0.05). However, gender (odds ratio [OR] =3.20, confidence interval [CI]: 1.43–7.18; P = 0.005) and type of institution (OR = 5.56, CI: 1.05–29.41; P = 0.04) influence participants' knowledge on VAS immediate postintervention while participants' class was significant at 6 weeks (OR = 0.83, CI: 0.08–0.97; P = 0.04).


  Discussion Top


WKD is a global awareness campaign that holds on second Thursday in March every year. It is a joint initiative of the International Society of Nephrology and the International Federation of Kidney Foundations. WKD has a pediatric theme (kidney disease and children; act early to prevent it) for the first time in 2016 since its inception a decade ago.[7] WKD provides a timely opportunity to create awareness of healthy lifestyles that prevent kidney diseases. This is pertinent in developing countries where there is preferential resource allocation to infections and other noncommunicable disorders at the expense of kidney diseases.[1] Therefore, WKD 2016 events aimed to enlighten children, caregivers, parents, and policy makers as well as the general public on the need to maintain healthy kidneys early to avoid CKD and its treatment burden in later life.[7],[13] Furthermore, CKD patients and affected families would receive helpful information and supports.[7]

Nearly half of our participants in this campaign had adequate knowledge of kidney functions at pretest, apparently due to the baseline health information, they have acquired from relevant aspects of school curriculums, compensating for the poor practice of School Health Program in the setting.[16],[17] They were fairly aware of the excretory and regulatory roles of the kidneys in our body. Nonetheless, it is appropriate to implement the WKD campaign in a school setting; this will improve the participants' knowledge and serve as an indirect method of educating various households in the community. After a participatory health education intervention, Ayi et al.[18] in Ghana found that school children function effectively as health messengers in their communities, enhancing uptake of malaria preventive measures. Likewise, Nonaka et al.[19] confirmed that school-based campaigns had a sustained impact on host communities. Thus, to strengthen the impact of our school-based intervention at community level, we distributed take-home flyers highlighting the key messages of the WKD 2016. This further ensures the accuracy of the information transmitted by the participants to their households.

We found a significant rise in participants' knowledge of kidney functions and prevention of kidney diseases postintervention, consistent with earlier reports.[20],[21] The WKD campaign clearly improved the participants' perception of the roles of the kidneys in blood purification and maintenance of normal BP in children. Subsequently, they were more favorably disposed to a kidney-friendly lifestyle as evidenced in their increased posttest scores. Daboer et al.[20] reported the effectiveness of health education in reducing secondary school students' health risk behavior in Jos, Nigeria. Likewise, Midzi et al.[21] in Zimbabwe and Vardanjani et al.[22] in Iran confirmed that school-based health education improved knowledge and practice of children about disease control measures and healthy dietary lifestyles in their settings, respectively. The proportion to the participants was aware that environmental factors such as recurrent skin infections can predispose to kidney diseases doubled postintervention in our study, highlighting the impact of the campaign on participants' perception of possible risk factors of kidney disease. Furthermore, this campaign dissuaded the participants against indiscriminate use of over the counter drugs and potentially nephrotoxic native concoctions rampant in the setting.[23],[24] Hopefully, this will translate into improved personal hygiene practices and health-seeking behavior of the participants and their households in the near future.[22] Interestingly, there was no change in the participants perception of the health risk of passive smoking in this study, perhaps due to their high baseline awareness of its danger.

Moreover, participants' knowledge of the possibility of a person surviving well on one kidney improves significantly. This may influence their attitude toward kidney donation and enhance their willingness to donate in future. This will alleviate the challenge of organ availability which is a rate limiting step to kidney transplantation (KT) globally.[25],[26] Hence, the knowledge impacted to the participants in this campaign may translate to an increase in the number of living donors who are the main source of organs in our setting where cadaveric organ donation has not been well legislated.[25] Considering that KT is the definitive treatment of ESRD, reorientation of the society is pertinent in our region since cultural beliefs and ignorance sometimes deter potential living-related donors.[26],[27]

Furthermore, the sustained increase in participants' knowledge score on kidney disease prevention at the 6th week posttest confirms the lasting impact of the campaign. Their enhanced perception of preventive measures remains throughout the study period except for their view of passive smoking that remains at the baseline level. Nonetheless, there is a need for an increased focus on early detection and management of kidney disease in childhood by health authorities, reinforcing the gains of WKD campaigns.[1] Both genders benefited from the WKD campaign, but females were thrice more likely to have an improved knowledge on VAS immediate postintervention in this study, consistent with earlier reports of gender differences in the effects of school-based educational interventions.[28],[29] Although young children can be influenced by school-based health education programs,[30] our participants in senior classes had higher posttest scores on prevention of CKD risk factors than their junior counterparts in this campaign. This may be related to the higher capacity for abstract thoughts and concern for future among senior students in later stages of adolescence.[31]

Although WKD has been celebrated for many years in Nigeria, this is the first report of the impact of WKD health education campaign in our setting. Furthermore, the strength of this study includes its multisite nature and experimental design. Since WKD is a universally implemented program, the pre- and post-test design adopted in this study is the only feasible impact evaluation design averting the deprivation of a control group of the benefits of the awareness campaign.[32] Hence, no students in the participating schools were intentionally excluded from the campaign.


  Conclusion Top


There is moderate baseline awareness of kidney function, dysfunction, and risk factors of kidney disease in our setting. The WKD 2016 campaign led to a sustained increase in our participants' awareness of the roles of the kidneys and renal protective lifestyle. To reinforce the gains achieved in this campaign in our setting and elsewhere, it is desirable to include information on kidney disease prevention in-school health instructions and relevant health programs on mass media at regular intervals.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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