Prevalence of Anaemia and its associated factors among patients with chronic kidney disease at Mnazi mmoja and Tasakhtaa hospitals, Zanzibar

Abstract

ABSTRACT Background: Aneamia from chronic kidney disease contributes to greater morbidity, mortality, and quality of life. Chronic kidney disease, a worldwide health burden, has huge economic consequences for healthcare systems and sufferers' families. To the best of my knowledge, no study has been done on the prevalence, clinical characteristics, and associated factors of anaemia among chronic kidney disease patients in Zanzibar. Objective: This study is intended to estimate the prevalence of anaemia and its associated factors among patients with chronic kidney disease at two selected hospitals in Zanzibar. Methods: A descriptive cross-sectional study design was conducted in two hospital settings among non-dialysis CKD patients (18 years of age and older), from stages 1 to 5. Convenience recruitment was conducted among 195 patients with CKD who attended the outpatient renal clinic, including those admitted to the wards at two selected hospitals in Zanzibar. In data collection, a Swahili-translated questionnaire was used to obtain socio-demographic data, and a checklist was used to obtain important past medical records and laboratory parameters. The data were initially recorded in Excel and then imported into SPSS version 26 for analysis. Descriptive analysis summarized baseline characteristics, with continuous variables summarized by mean and standard deviation and categorical variables presented as frequencies, percentages, and charts. Pearson’s chi-square test or Fisher's exact test were used to find the associations between sociodemographic and clinical factors among anaemic and non-anaemic CKD patients. To find the independent factors associated with anaemia in people with chronic renal disease, both univariate and multivariate modified poissons regression analyses were utilized. At a value of p below 0.05, all significance levels were established. Results: A total of 195 participants were included to estimate the prevalence of anaemia among chronic kidney disease patients. The mean age of all participants was 55.8 ± 13.1 years. The prevalence of anaemia was 91.3% [95% CI (86.5-94.5)], and anaemia increased as kidney function declined. After adjusting for other confounders: Mode of payment, whereby patients treated in the hospital free of charge (APR = 1.14, 95% CI: 1.01–1.29, p = 0.033) were 1.14 times more likely to develop anemia compared to those with health insurance coverage. Additionally, in educational level, compared to patients with college or university education, those with primary education or no schooling (APR = 1.29, 95% CI: 1.05–1.57, p = 0.015) were 1.29 times more likely to develop anemia and those with secondary education (APR = 1.23, 95% CI: 1.003–1.51, p = 0.047) were 1.23 times more likely to develop anemia. Keywords: Anaemia, chronic kidney disease, prevalence, Zanzibar. Conclusion: This study discovered that the majority of CKD participants were anaemic, confirming that anaemia is a common comorbidity among CKD patients in our environment. Anaemia was common at all stages of chronic renal disease and exacerbated by a steady reduction in kidney function. Patients who received free hospital care were more likely to acquire anaemia than those who had health insurance. Recommendations: Healthcare institutions should lead improvements in several areas of CKD care, particularly early detection and treatment, and should implement periodic screening and intervention programs to prevent anemia among CKD patients. Policymakers and government support should develop anaemia preventive policies relevant to the country’s context, and measures to increase health insurance coverage should be implemented to improve the quality of care, particularly in hospitals that provide free CKD services.