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Saudi Journal of Kidney Diseases and Transplantation
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RENAL DATA FROM ASIA-AFRICA  
Year : 2019  |  Volume : 30  |  Issue : 1  |  Page : 202-207
Awareness about kidney and its related function/dysfunction in school going children: A survey from the Central India


1 Department of Nephrology, Jawaharlal Nehru Medical College, Sawangi, Wardha, Maharashtra, India
2 Department of Nephrology, Government Medical College and Super Speciality Hospital, Nagpur, Maharashtra, India
3 Department of Nephrology, Shravan Kidney Hospital, Nagpur, Maharashtra, India

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Date of Submission07-Nov-2017
Date of Decision15-Feb-2018
Date of Acceptance17-Feb-2018
Date of Web Publication26-Feb-2019
 

   Abstract 


In the absence of a national registry, the exact incidence and burden of chronic kidney disease in children in India is not known. The most common diagnosis for which children are likely to see a pediatric nephrologist is nephrotic syndrome constituting almost 40% of cases. Considering all the renal manifestations in the pediatric age group, we designed simply survey to find out the awareness among school going children about the kidney's function and dysfunction in our Indian scenario. More than 95% of children knew that normally humans have two kidneys. Around 50% of school children on an average were not aware of normal location of their kidneys. About 60%–75% of school going children was unaware of all the functions of a normal kidney. More than half of school children had no idea that even one normal kidney was sufficient to lead a normal life. Again more than half of the participant children were unaware of the basic symptoms of the kidney failure. Around 8%–9% of students reported a positive family history of kidney disease in their family. Pediatric population, especially the school going students should be educated from their early years about the basics of any vital organ like the kidney. Here, in the present study, we found that there is the scope of improvement in making children aware of normal functions of a kidney and the abnormalities that occur when the kidneys are malfunctioning. Early diagnosis will lead to reduced kidney-related morbidity and mortality.

How to cite this article:
Balwani MR, Bawankule CP, Khetan P, Pasari A. Awareness about kidney and its related function/dysfunction in school going children: A survey from the Central India. Saudi J Kidney Dis Transpl 2019;30:202-7

How to cite this URL:
Balwani MR, Bawankule CP, Khetan P, Pasari A. Awareness about kidney and its related function/dysfunction in school going children: A survey from the Central India. Saudi J Kidney Dis Transpl [serial online] 2019 [cited 2019 Jul 19];30:202-7. Available from: http://www.sjkdt.org/text.asp?2019/30/1/202/252911



   Introduction Top


In a country like India, socioeconomic and geographic factors greatly influence the prevalence and outcome of renal diseases in children.

In the absence of a national registry, the exact incidence and burden of chronic kidney disease (CKD) in children in India is not known. Children with initial CKD stages[1],[2] usually does not receive medical attention in the absence of any screening guidelines. A study of adult patients with vesicoureteric reflux from India showed that 80% of patients had CKD at presentation, including 38% with end-stage renal disease (ESRD). Reflux was diagnosed during routine pretransplant evaluation in 5.5% of all adult ESRD patients.[1] In other study also, 58% of children with kidney dysfunction had ESRD at presentation.[2] Thus, pediatric CKD population develops renal insufficiency early in life but does not receive medical attention at the onset of disease. In a series of 305 children with an average age of eight years, the cause of renal failure in 75% of cases was obstructive nephropathy, reflux nephropathy, or chronic glomerulonephritis.[3] In other study, in chil-dren's presenting at an older age, chronic glomerulonephritis was more common.[2] A similar trend has been reported from other developing countries.[4] However, the data from developed countries show that besides obstructive uropathy, congenital aplasia/hypoplasia/dysplasia is also an important cause for CKD in children.[5]

Considering all these renal manifestations in the pediatric age group, we designed this simply survey to find out the awareness among school going children in our Indian scenario, about various aspects of kidney such as its appearance, location, functions, and symptoms of renal diseases.


   Aim Top


The study aimed to evaluate the awareness about kidney and its related function/dysfunction in school going children.


   Methods Top


The study population consisted of school going children ranging from class 5 (n = 341), class 6 (n = 574), class 7 (n =741), class 8 (n = 761), class 9 (n = 1093), and class 10 (n = 427). Nine schools participated in the cross-sectional study. A questionnaire consisting of 18 multiple choice questions (MCQs) was distributed in the school across all the children from different classes in a hard copy format [Table 1]. After distribution, immediately they were asked to tick over the correct options as per their knowledge and awareness in the class only. After all questions were attempted the questionnaire forms were collected back and the data were analyzed. Analyses were performed separately for students of each class. The results were tabulated by evaluating the total number of students opting for each option under each of the 18 questions and the final score in % was calculated for each option of every question.
Table 1: Questionnaire.

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   Results Top


Section A

With respect to awareness of one's own weight, 97.35% (332/341) students of class 5, 93.21% (535/574) of class 6, 96.36% (714/741) of class 7, 95.93% (730/761) of class 8, 98.63% (1078/1093) of class 9, and 94.84% (405/427) of class 10 had an idea of their own weight. We can infer that the maximum number of students unaware of their weight belonged to class 10 as compared to all their junior counterparts [Figure 1].
Figure 1: Percentage of students who ticked the correct answer have been displayed against each question (Section B).

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The next question was to find out as to how many of them had ever heard the word “kidney.” About 94.13% (321/341) of class 5, 96.17% (552/574) of class 6, 98.25% (728/ 741) of class 7, 98.29% (748/761) of class 8, 97.35% (1064/1093) of class 9, and 98.13% (419/427) of class 10 claimed to have heard the word before.

Section B

Next question was to find out the knowledge of the school children regarding the number of kidneys in a human body. About 97.94% of class 5, 98.26% of class 6, 97.57% of class 7, 95.4% of class 8, 98.9 % of class 9, and 98.59% of class 10 gave the right answer.

Location of the kidneys was the next question, from class 5 to class 10 in an order, the following number of students got the right answer: 49.56%, 49.13%, 56.55%, 51.91%, 45.93%, and 48.48% respectively. This data show that close to 50% of school children on an average are not aware of the location of their kidneys.

67.44% of class 5, 66.9% of class 6, 74.51% of class 7, 74.51% of class 8, 80.33% of class 9, and 86.89% of class 10 were aware of the correct kidney size.

Regarding the functions of the kidney, the following percentage of students from each class got it right: 28.15 from class 5, 42.16 from class 6, 40.35 from class 7, 35.48 from class 8, 26.44 from class 9, and 22.25 from class 10. This data points toward the fact that about 60%–75% of school going children may be unaware of all the functions of a normal kidney.

Next question was about the number of normal kidneys needed to lead a normal life: 43.4% of class 5, 36.76% of class 6, 35.22% of class 7, 43.76% of class 8, 50.69% of class 9, and 56.21% of class 10 rightly felt that one kidney is adequate to lead a normal life. On an average, more than half of the school children may be unaware of the fact that even one kidney is sufficient to lead a normal life.

On the question pertaining to awareness regarding symptoms of kidney failure, the following percentages of students got the right answer: 37.54%, 47%, 48.72%, 43.63%, 31.2%, and 24.59% from class 5, 6, 7, 8, 9, and 10, respectively. Once again this pattern shows that more than half of the school children are unaware of the basic symptoms of kidney failure.

The next question was about the best treatment for permanent kidney failure, and the following percentages of students from class 5–10 got the right answer: 76.25%, 77%, 78.27%, 82.52%, 86.37%, and 84.54% respectively. Hence, at least three-fourth of school students were aware of kidney transplant being the permanent solution for kidney failure.

Students were also enquired to find out if they had ever seen a patient with kidney disease, the percentages of students who said “yes” were: 52.79%, 41.81%, 55.2%, 51.64%, 58.65%, and 59.72% from class 5 to 10 in ascending order, respectively.

The students were also asked about the ways to keep kidneys healthy. The percentage of students who were aware of these basics were: 34%, 50.7%, 50.2%, 49.93%, 46.57%, and 36.77% for class 5 to 10 in order, respectively.

The next question was to find out if students were aware of alcohol harm to kidney: 49.27% from class 5, 55.92% from class 6, 65.18% from class 7, 86.33% from class 8, 91.03% from class 9, and 88.29% from class 10 said “yes” for the same.

The students were asked if according to them CKD can be spread through contact with an already diseased person, the following percentage of students rightly disagreed: 84.16, 87.11, 93.52, 92.25, 93.67, and 96.6 from class 5 to 10 in order.

Next question was the amount of urine that a normal human passes per day, and the following percentage of students rightly ticked on the option of 1.5 to 3.0 L: 44.57, 38.85, 47.23, 47.04, 36.32, and 38.88 from class 5 to 10 in order.

The following percentage of students agreed upon the fact that both high-BP and diabetes could be the common causes of kidney diseases: 42.52%, 46.86%, 44.94%, 50.99%, 39.62%, and 50.82% from class 5, 6, 7, 8, 9, and 10, respectively. From this pattern, we can infer that more than half of these school students felt that either high-BP or diabetes were the exclusive cause to disease the kidney.

The next question was about the color of urine when a person is dehydrated. The percentages of students who got the correct answer (dark yellow color) were as follows: 66.28%, 75.09%, 71.66%, 82.92%, 86.28%, and 86.65% from class 5, 6, 7, 8, 9, and 10, respectively. Here, we see an increase in the proportion of students aware of this fact, with increase in class hierarchy.

The percentages of students who felt that pain killers are the group of drugs most likely to damage the kidneys were as follows: 64.81% from class 5, 57.84% from class 6, 68.29% from class 7, 66.23% from class 8, 67.52% from class 9, and 63.7% from class 10. Hence, at least one-fourth of students overall were not aware of this fact.

Awareness about the word “cadaver organ donation” was also checked. Nearly 52.2%, 58.36%, 60.99%, 46.12%, 68.25%, and 70.73% of students, respectively, from class 5, 6, 7, 8, 9, and 10 claimed to be aware of it. About 30% to 50% of students in toto were, therefore, unaware of the concept of cadaver organ donation.

Section C

Next enquiry was about any family history of kidney disease among the school students. 8.8%, 8.01%, 9.45%, 6.44%, 8.33%, and 8.43% of students from class 5, 6, 7, 8, 9 and 10 respectively reported a positive family history. One-third of students overall reported that they consume 2–3 L of water per day.


   Discussion Top


More than half the students overall were unaware of the normal location of kidneys. Any symptom of renal calculi like pain in the lower back could be misinterpreted for the same reason. It's a matter of concern that close to three-fourth of the students in this survey were not aware of the normal functions of the kidney. It is a general notion among pediatric age group that urine formation is the only job of our kidneys. They need to be educated and reinforced about other important function of the renal system like erythropoietin production, renin-angiotensin system to balance blood pressure, maintenance of pH, etc. In addition to this, more than half of the students were ignorant about the manifestation of renal disease. Ironically, majority of class 9 and 10 students (70%–80%) got this answer wrong as compared to their junior counterparts (50%–60%). It can be due to selection bias as the study population involved belongs to different schools with different socioeconomic and familial backgrounds. It may also be due to nonseriousness of senior students while answering the questionnaire or it may be representing their actual knowledge. If so, the curriculum of the senior students should contain more information regarding kidney functions and dysfunctions so that they may be kept well aware throughout the curriculum. Most of them felt that blood in urine is the only symptom of renal failure. They were unaware of other symptoms such as pedal edema and anuria/oliguria. More than 50% of students were also not aware that both hypertension and diabetes are common causes of renal disease. On the brighter side of things, most students knew that kidney transplant is the best treatment for permanent kidney failure, they were aware that kidney disease is not a contagious one, to spread from one person to the other, and also agreed that alcohol could be one of the culprits of kidney disease.

Thus, the author recommends the pediatric population should be made well aware of the normal functions of a kidney and the abnormalities that occur when the kidneys are malfunctioning. They should be encouraged to raise any concerns of kidney abnormalities such as pain in the back below the ribs, abnormal color or odor of urine, pedal edema, generalized edema, excessive/easy fatigability, shortness of breath, burning micturition, fever and chills, foamy urine, bloody urine, poor appetite, etc. It henceforth becomes easier to diagnose any renal disease as early possible, to facilitate complete recovery and prevent morbidity/mortality, by early reporting of such signs and symptoms.


   Conclusion Top


The study finds that there is a lack of awareness among school going children regarding the function and dysfunction of the kidney. Pediatric population, especially the school going students should be educated from their early years about the basics of any vital organ like the kidney. School curriculum should be modified to increase the knowledge about healthy behavioral practices to keep the kidneys healthy.

Conflict of interest:

None declared.



 
   References Top

1.
Sakhuja V, Muthukumar T, Sud K, et al. Vesicoureteric reflux and reflux nephropathy as seen at a tertiary care adult nephrology service in India – An analysis of 86 patients. Ren Fail 2003;25:173-81.  Back to cited text no. 1
    
2.
Gulati S, Mittal S, Sharma RK, Gupta A. Etiology and outcome of chronic renal failure in Indian children. Pediatr Nephrol 1999; 13: 594-6.  Back to cited text no. 2
    
3.
Hari P, Singla IK, Mantan M, Kanitkar M, Batra B, Bagga A. Chronic renal failure in children. Indian Pediatr 2003;40:1035-42.  Back to cited text no. 3
    
4.
Jamro S, Channa NA, Shaikh AH, Ramzan A. Chronic renal failure in children. J Pak Med Assoc 2003;53:140-2.  Back to cited text no. 4
    
5.
Chadha V, Warady BA. Epidemiology of pediatric chronic kidney disease. Adv Chronic Kidney Dis 2005;12:343-52.  Back to cited text no. 5
    

Top
Correspondence Address:
Manish R Balwani
Department of Nephrology, Jawaharlal Nehru Medical College, Sawangi, Wardha - 440 003, Maharashtra
India
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DOI: 10.4103/1319-2442.252911

PMID: 30804282

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