Discussion
Public health literacy is an essential concept in modern society that determines the health behavior of individual’s and community. It affects the level of health services utilization and improves the intended outcome of health care services (14). The complex nature of chronic disease needs better health literacy from the public and individual patient. With better health literacy, it is possible to reduce the incidence of chronic disease and improve management of their complication efficiently. Knowledge toward the disease is of great importance in health literacy (15-16). This study is the first in Ethiopia to assess public knowledge of chronic disease. CKD is a significant health concern in Ethiopia even though the inadequacy in data of national figure hospital-based assessment revealed a higher magnitude of CKD (17). For combating this health problem, improving the health literacy of the society would be of great benefit. Therefore understanding the knowledge gap and determining the appropriate intervention is a prior issue.
Consequently, findings generated from this study would be a significant input for policymaker and program manager to look into appropriate intervention. In our study, we explored the public knowledge towards CKD using the tool adopted from previous 154 study (5). The tool was pretested and discussed with experts on its strength to capture the necessary details.
The computed mean (S.D.) knowledge score was found to be 11.2 (± 4.21), which is a substantial level of knowledge. It is comparable with the findings reported from Australia and Tanzania, which was 10.34 (± 5.0) and 3.85 (± 4.66), respectively (5, 13). This high score of knowledge is mainly associated with participant characteristics. We recruited the participant from the capital city of the country, unlike the previous study (13) and more than half of them had a college diploma and above. It was found from the current study established that educational level had a significant effect on knowledge of CKD with P-value of 0.015. Therefore the higher score of the knowledge would be associated with a large number of educated participant and the study site we selected. This finding would not be representative of the country; hence the literacy rate of the Ethiopian population is below 50 per cent, and only 20.4 per cent of the population is the urban population (18). The study included a significant number of rural household participants claimed lower knowledge score in comparison to our study (13).
Regarding general knowledge of study participants on chronic kidney disease, 83.7 % of the study participants knew that a person could lead a healthy life with one healthy kidney; this was slightly lower in comparison to Hong Cong study, in that study most (84.7%) of the participant were aware of the kidney’s function (11). However, the finding of the current study is also promising since organ shortage is a global crisis and the public knowledge and awareness is a crucial element for promoting the living organ donation practice (19). As a developing country, the level of awareness claimed in this study is substantial. A lower number of a study respondent (22.6 %) believes that herbal supplements can be useful in treating CKD however 2/3rd of the participant from Tanzania study claimed that they were likely to use traditional medicines for the treatment of kidney disease and also around 14 % 177 of use self-treatment with home remedies(13). A study from Nigeria revealed that 47.8 % of respondents have faith in local herbal concoctions and spiritual means to cure CKD (10), this may be associated with the belief in herbal medicine in the urban area.
In the present study, almost half (57.5 %) of the study participants knew that certain medications could help to slow down the worsening of CKD, which was lower in comparison to Hong Cong study (80 %). In previously, mentioned study half of the study group had a risk factor for CKD such as diabetes and hypertension (11) that may increase their awareness towards risk factor for CKD. With current evidence expanding health education to prevent CKD is indispensable. Since there are several treatment options which able to render the progression of CKD by preventing the advance in risk factor (20), most participants knew that the kidney makes urine and kidney clean blood, but around 21 and 34 per cent of the participants identified that the kidney helps to maintain blood pressure and keep bones healthy respectively. Likewise, in Hong Cong study, nearly half of the study participants did not know the role of the kidney in maintaining blood pressure (11). Therefore health education focusing on chronic disease prevention and management is critical. There is an increase in the prevalence of the chronic disease in Ethiopia, particularly in urban setups; therefore, due focus from policymaker and health care strategist is expected (21).
The majority of the study respondents knew that hypertension (51.8 %) and Diabetes (57.8 %) are the risk factors for the development of CKD. This finding is similar to several studies elsewhere (10-12). This finding is promising since the public has a good awareness of the risk factor of the disease; the possibility of prevention would be higher. About signs and symptoms of an advanced stage of CKD, 68.8 % of recognized water retention is one of the advanced stage symptoms, nausea and vomiting (39.5 %), loss of appetite (56.6 %) and increased fatigue (75.7%). This finding depicted participants had good knowledge of alarming signs and symptoms of CKD in comparison to previously reported results (5, 10). This would help implement prevention strategies and management of a communicable disease.
Similar to other studies, public knowledge CKD significantly associated with the level of education. Several other studies depicted that the level of education is significantly associated with knowledge related to CKD (5, 10-11). Since health literacy is highly associated with personal determinants like knowledge and competence, this variation is the expected (14). In addition to health literacy, the general literacy of society is essential for improving the overall wellbeing of society. This study assessed the public knowledge of CKD for the first time in Ethiopian, and it produced useful findings which serve as an input for health education programs at the community level, in health facilities and media sector. Furthermore, the findings serve as an input for in-service and pre-service training of health professionals in Ethiopia. As a limitation, we recruited participants only from the capital city of the country and further studies focusing on the rural base of the country will be needed.