PATIENT KNOWLEDGE ON CHRONIC KIDNEY DISEASE AND SELF-CARE MANAGEMENT AMONG CHRONIC KIDNEY DISEASE PATIENTS AT THE BUEA REGIONAL HOSPITAL

Abstract
Background; chronic kidney disease (CKD) is a global public health problem of great concern even to Sub Saharan Africa. The prevalence of chronic kidney disease has rapidly increased over the years worldwide with the majority of cases being stage 3.
Patient knowledge on chronic kidney disease has been said to have a lot of important benefits in the management of chronic kidney disease, from its importance in early diagnoses, delaying progression of the disease to kidney failure to patient self-care.
Met Aim; The main aim of the study was to assess patient’s knowledge of chronic kidney disease and their knowledge of self-care management strategies.

odds; A descriptive cross-sectional hospital-based study design was adopted for this study with a sample size of 70 patients, the study was conducted from the 25 of March to 20 of June 2021.
A purposive sampling method was used to select the hospital and participants.

Ethical considerations and authorization was gotten from the delegation of Public Health, Faculty of the Health Sciences University of Buea, and the director of the Regional Hospital Buea.
A structured pretested questionnaire was modified from the chronic kidney disease self-care scale and was used for the study, determinants of chronic kidney disease knowledge and patient self-care management were established by chi-square test, cross-tabulations, frequencies p≥0.005 using SPSS version 20.
RESULTS; The study included 70 participants.

The majority 44(62.9%) of the participants were male, most participants 26(37.1%) were among the age range of 40-59 years, more than half 66(94.3%) of the participants were Christians and 25(35.75) of the participants only had primary education.

The results showed that 54(77.1%) of patients at the Regional Hospital Buea have good general knowledge of chronic kidney disease.

And generally, patients had average knowledge on chronic kidney disease self-care management strategies with 37(52.9%) of the patient having average knowledge, 3(4.3%) with good knowledge and 30(42.9%) with poor knowledge.
CONCLUSION; Chronic kidney disease patients at Buea Regional Hospital have good general knowledge on chronic kidney disease but have average knowledge on chronic kidney disease self-care management strategies. So education should be re-enforced to meet up with the level of management they need.
CHAPTER ONE
INTRODUCTION
1.1 Background
Chronic kidney disease (CKD) is a global public health problem of great concern to Sub Saharan Africa [1].

It is progressive in nature and the last stage is called End-stage Renal Disease (ESRD).

It frequently co-exists with other diseases such as hypertension, diabetes, cardiovascular diseases with a high mortality rate per year.
The prevalence of CKD has rapidly increased over the years with about 1.2 million people (10- 13%) worldwide suffering from it with the majority of cases being stage 3 [2].

CKD is more prevalent in males than females. CKD was ranked 10th in the list of causes of a total number of global death in 2013, with the rising incidence of ESRD worldwide at the rate of 5-7% per year [3].
In Sub Saharan Africa, the prevalence of CKD is 13.9%.

Though statistics on the prevalence of CKD in most developing countries is unknown [9] research has shown that the prevalence of CKD in Senegal is 6.1%, Tanzania is 7.0%, Congo is 13.2% and Nigeria is 7.8% [4].
The total prevalence of CKD in Cameroon is unknown; however, the prevalence among people in the Western region of Cameroon is estimated to be about 13.2%.

The prevalence of reduced glomerular filtration rate (GFR) is high at 7.4% among the population of Bamenda.
This high prevalence is associated with risk factors such as advanced age, hypertension, diabetes and obesity.

CKD in children is rare but it has a high mortality rate in CKD hospitalized children in Cameroon [5].

CKD has an increasing burden on public health in Cameroon as it requires specialist and costly management.
A decrease in GFR indicates increasing kidney impairment which may be caused by either primary renal disease such as diabetic kidney disease, recurrent kidney stone disease or secondary renal disease such as hypertension.
CKD is usually asymptomatic in the early stages but signs and symptoms such as muscle weakness, peripheral edema, fatigue, nausea and vomiting, dry skin and ecchymosis are present in the late stage.

As the GFR continues to decline there is the occurrence of complications such as chronic anemia, brain dysfunction, congestive heart failure, bone disease, malnutrition, and electrolyte imbalance.

Depending on the underlying cause, some kidney diseases can be treated but CKD often has no cure.
The management of CKD consist of measures to help control signs and symptoms, reduce complications and slow progression of the disease or other renal replacement therapies (RRT) such as kidney transplantation, hemodialysis and peritoneal dialysis.

Hemodialysis alongside a strict regimen of medication, diets and fluid intake are the remedies commonly used in Cameroon [6].
The goal of management of CKD is based on early diagnoses, delay of progression to end-stage renal failure and promotion of self-management.

Patient knowledge of chronic kidney disease is a very important factor in the management of chronic kidney disease because it promotes self-management in the early stages of CKD which helps to delay progression to more advanced stages and improving outcomes.
Slowing the progression of CKD requires the performance of key self-management behaviors including adherence to medications known to slow disease progression (angiotensin receptor blockers), avoidance of non-steroidal anti-inflammatory drugs, blood pressure control, glycemic control, regular exercise, diet, and tobacco avoidance.
Self-management is associated with adherence to a healthy lifestyle, better glomerular filtration rate, blood pressure control, improve medication adherence and fewer hospitalization.

Although CKD self–management programs often demonstrate improved outcomes, enhancing CKD knowledge remains a big challenge [7].
Such knowledge includes general knowledge about CKD, such as causes, the risk for development and factors associated with disease progression, treatment options, remedies and prognoses.
According to the national health and nutritional examination survey (center for disease control and prevention CDC 2012), only about 50% of CKD patients of all age groups were aware they had the disease and fewer than 15% of people with stages 3 and 4 were aware of their kidney disease which brings the need for the continues assessment of the knowledge of the patients concerning the disease and how it affects their prognoses in Cameroon.
Also, the health practitioner’s knowledge helps a great deal in the management and patient education duties.

When patients are encouraged to self-manage their long term chronic illness, they have greater control, feeling of wellbeing, ability to cope more effectively, reduced number of complications and unnecessary hospital admissions [8]
1.1.1 Problem Statement
The prevalence of CKD is rising in Cameroon with very few facilities in place to manage CKD patients. To the best of our knowledge, little or no research had been done on the knowledge of chronic kidney disease and self-care management among chronic kidney disease patients and how it is related to the prognoses in Cameroon.
Thus, this study sought to assess patient’s knowledge on chronic kidney disease and self-care management at the Regional Hospital Buea.
1.2 Research Questions.
Do patients with CKD at the Regional Hospital Buea have good knowledge of chronic kidney disease?
Are patients with chronic kidney disease at Buea Regional Hospital knowledgeable about self-care management strategies?
1.3 Objectives
1.3.1 General objective
The main aim of this study was to assess the knowledge of patients on chronic kidney disease and self-care management strategies at the Regional Hospital Buea
1.3.2 Specific objectives.

The specific objectives of this study are as follows:
To assess CKD patient knowledge on causes, predisposing factors, prevention, disease management and possible treatment options of chronic kidney disease
To assess CKD patient knowledge of self-care management strategies in chronic kidney disease.