The Epidemiology of Chronic Kidney Disease in Northern Tanzania: A Population-Based Survey

<div><p>Background</p><p>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.</p><p>Methods</p><p>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.</p><p>Results</p><p>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).</p><p>Conclusions</p><p>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.</p></div

The Determinants of Traditional Medicine Use in Northern Tanzania: A Mixed-Methods Study

<div><p>Introduction</p><p>Traditional medicines are an important part of healthcare in sub-Saharan Africa, and building successful disease treatment programs that are sensitive to traditional medicine practices will require an understanding of their current use and roles, including from a biomedical perspective. Therefore, we conducted a mixed-method study in Northern Tanzania in order to characterize the extent of and reasons for the use of traditional medicines among the general population so that we can better inform public health efforts in the region.</p><p>Methods</p><p>Between December 2013 and June 2014 in Kilimanjaro, Tanzania, we conducted 5 focus group discussions and 27 in-depth interviews of key informants. The data from these sessions were analyzed using an inductive framework method with cultural insider-outsider coding. From these results, we developed a structured survey designed to test different aspects of traditional medicine use and administered it to a random sample of 655 adults from the community. The results were triangulated to explore converging and diverging themes.</p><p>Results</p><p>Most structured survey participants (68%) reported knowing someone who frequently used traditional medicines, and the majority (56%) reported using them themselves in the previous year. The most common uses were for symptomatic ailments (42%), chronic diseases (15%), reproductive problems (11%), and malaria/febrile illnesses (11%). We identified five major determinants for traditional medicine use in Northern Tanzania: biomedical healthcare delivery, credibility of traditional practices, strong cultural identities, individual health status, and disease understanding.</p><p>Conclusions</p><p>In order to better formulate effective local disease management programs that are sensitive to TM practices, we described the determinants of TM use. Additionally, we found TM use to be high in Northern Tanzania and that its use is not limited to lower-income areas or rural settings. After symptomatic ailments, chronic diseases were reported as the most common reason for TM use which may be particularly important in Northern Tanzania where non-communicable diseases are a rapidly growing burden.</p></div

Venn diagram.

<p>The proportion of CKD associated with HIV, hypertension, and diabetes.</p

Forest plot.

<p>The crude and fully-adjusted (model 4) prevalence risk ratios for CKD by each variable relative to the reference group for each variable.</p

Characteristics of the Survey Sample.

<p>§ Other tribal ethnicities represented in our groups include Luguru, Kilindi, Kurya, Mziguwa, Mnyisanzu, Rangi, Jita, Nyambo, and Kaguru</p><p># Includes housewives and students</p><p>† Professional includes any salaried position (e.g. nurse, teacher, government employee, etc.) and retired persons</p><p>* Heart Disease includes coronary disease, heart failure, or structural diseases</p><p>Characteristics of the Survey Sample.</p

Study Setting.

<p>Map showing the sampling area of Moshi Urban and Moshi Rural in the Kilimanjaro Region of Northern Tanzania.</p

Most common conditions treated by traditional medicines (a)*, means of accessing healthcare (b), and reasons for using traditional medicines (c) among the adult population of Kilimanjaro, Tanzania.

<div><p>* Chronic Diseases: Hypertension, Heart problems, Diabetes, and Body Swelling</p> <p>Reproductive: Sexual Arousal/Virility, Menstrual Problems, Pregnancy Termination, and Fertility/Impotence</p> <p>Neurologic: Epilepsy, Mental Confusion, and Depression</p> <p>Spiritual/Traditional: Peace of mind/Ward off curses, Protection from ‘evil eyes’, Unexplained Illnesses, and To Improve Luck</p> <p>Symptomatic Ailments: Increase Strength, Constipation, Increase energy, Digestion/Stomach problems, Fatigue, Arthritis/joint pains, Flu/Cold symptoms, Headaches, and Skin problems</p> <p>Urogenital: Kidney problems and Urinary problems</p></div

Baseline characteristics of the focus group discussions (FGDs) and in-depth interviews.

<p>*Other Tribal Ethnicities represented in our groups include Luguru, Kilindi, Kurya, Mziguwa, Mnyisanzu, Rangi, Jita, Nyambo, and Kaguru.</p><p>^# Includes housewives.</p><p>^† Professional includes any salaried position (e.g. nurse, teacher, government employee, etc.) and retired persons.</p><p>Baseline characteristics of the focus group discussions (FGDs) and in-depth interviews.</p

Baseline characteristics of the traditional healers and herbal vendors.

<p>Baseline characteristics of the traditional healers and herbal vendors.</p

Determinants for the use of Traditional Medicines.

<p>The diagram illustrates the five major determinantsand their relationship to each other.</p