Dire Dawa University

College of Medicine and Health Sciences School of Postgraduate

Department of Public Health

RESEARCH PROPOSAL ON MAGNITUDE AND ASSOCIATED FACTORS OF

CHRONIC KIDNEY DISEASE AMONG PATIENTS ATTENDING IN PUBLIC
HOSPITAL IN DIRE DAWA IN THE YEAR 2016 E.C.

BY: Rediet Tilahun (General Public Health Student)

Advisor: Mr Negesse A.
Department of Public Health

Dire Dawa University

Meskerem 2016 E.C

Dire Dawa, Ethiopia
 Acknowledgements

I would like to express my sincere gratitude to Dire Dawa University College of Health and Medical
Sciences and School of Public Health for providing me with the opportunity and support to develop this
research proposal. I am also grateful to the staff of the Dilchora and Sabiyan Hospital Chronic Diseases
OPD Clinic and Medical Ward for their assistance.
I would especially like to thank my advisor, Dr. Negese (MD), for his invaluable guidance, support, and
constructive feedback throughout the research proposal process. I am also grateful to the librarians for
providing me with access to important reference materials.
Finally, I would like to thank my family and friends for their encouragement and support.
 Table of contents

Acknowledgment……………………………………………………………………...i
Table of contents……………………………………………………………………...ii
List of tables ……………………………………………………………………….... iv
List of figures …………………………………………………………………….…. iv
List of abbreviations and acronyms…………………………………………………...v
Summary……………………………………………………………………………...vi
1. Introduction………………………………………………………………………...1
1.1. Background………………………………………………………………………. 1
1.2. Statement of the problem………………………………………………………...2
1.3. The significance of the study……………………………………………………. 4
2. Literature review…………………………………………………………………...4
2.1. Magnitude of Chronic Kidney Disease…………………………………………. 4
2.2. Associated factors for chronic kidney disease……………………………………5
2.3. Conceptual framework…………………………………………………………...7
3. Objectives…………………………………………………………………………. 7
3.1. General objective………………………………………………………………... 7
3.2. Specific objectives………………………………………………………………. 8
4. Methods and Materials……………………………………………………………. 8
4.1. Study Area and Period…………………………………………………………. 8
4.2. Study design……………………………………………………………………...8
4.3. Population………………………………………………………………………...9
4.3.1 Source Population……………………………………………………………… 9
4.3.2. Study population………………………………………………………………. 9
4.4. Inclusion and exclusion criteria…………………………………………………10
4.4.1. Inclusion Criteria……………………………………………………………...10
4.4.2. Exclusion Criteria……………………………………………………………..10
4.5. Sample Size Determination and Sampling procedures…………………………..10
4.5.1. Sample Size Determination…………………………………………………….10
4.5.2. Sample procedure ……………………………………………………….….…10
4.6. Data Collection…………………………………………………………………. 10
4.6.1 Data Collection tool……………………………………………………………. 10
4.6.2. Data Collectors………………………………………………………………... 11
4.6.3. Data Collection procedure……………………………………………………. 11
4.7. Study Variables…………………………………………………………………. 11
4.7.1. Dependent variable……………………………………………………………. 11
4.7.2. Independent Variables………………………………………………………….11
4.8. Operational Definition of Variables……………………………………………... 12
4.9. Data Quality Control……………………………………………………………. 12
4.10. Data Analysis…………………………………………………………………... 12
4.11. Ethical Considerations…………………………………………………………. 13
4.12. Expected outcomes……………………………………………………………. 13
4.13. Dissemination of the study results………………………………………………13
5. Work plan………………………………………………………………………….14
6. Budget……………………………………………………………………………...15
REFERENCES………………………………………………………………………. 16
ANNEXES 21
Annex I: Information Sheet and Informed Voluntary Consent Form for facility head.21
Annex II: Information Sheet and Informed Voluntary Consent Form for participants.23
Annex III: Questionnaire ………………………………………...….….……….……25
List of Tables

Table 1 Project plane for the assessment of magnitude and associated factors of CKD among patients
attending in public hospital in Dire Dawa in 2016 E.C. 11
Table 2 Personnel Budget Notification 12
Table 3 Materials Budget Notification 12
List of abbreviations and acronyms

ACR Albumin creatinine ratio

BMI Body mass index
C-G Cock croft – Gault equation
CKD Chronic kidney diseases
CKD-EPI Chronic Kidney Disease Epidemiology Collaboration
CVD Cardiovascular disease
DM Diabetes Mellitus
DN Diabetic nephropathy
eGFR Estimated glomerular filtration rate.
ESRD End-stage renal disease
FBG Fasting blood glucose.
GBD Global burden of disease
GFR Glomerular filtration rate
IDF International diabetic federation
KDIGO kidney disease improving global outcome
MDRD Modification of Diet in Renal Disease
mGFR Measured glomerular filtration rate
PLOS Public Library of Science
NCDs Non-communicable diseases
WC Waist circumference
WHO World health organization
Summary

Background information: - chronic kidney disease is a global public health important disease
that is associated with life threatening outcomes including renal failure and premature mortality unless
diagnosed and treated promptly. Diabetes Mellitus and hypertension are the two major causes of
chronic kidney disease worldwide. This study is aimed to determine prevalence and associated factors
of chronic kidney disease among patients attending in public hospital in Dire Dawa in 2015 E.C

Objective: - To assess and identify the magnitude of chronic kidney disease and its associated factors
among patients at public hospitals in Dire Dawa in 2015 E.C Ethiopia.

Methodology: - The study will be conducted in Dilchora referral and Sabiyan general hospital. Dire
Dawa city administration, 466 km east of Addis Ababa. Institutional based A cross sectional study will
be conducted from Tikimt 1 to Tir 30, 2016 E.C. among People who visit medical OPD in both\. A
total of 415 medical OPD visitors in DRH will be selected using systematic random sampling
technique. Data will be collected using pretested, structured questionnaire. Prior to data collection
consent will be obtained after thorough explanation of the purpose and benefits of the study to the
participants. Data will be cleaned, edited, and entered into a computer and analyzed using SPSS version
29. The statistical significance test will be applied to see the association between the magnitude and
associated risk factor towards chronic kidney disease in relation to different socio demographic
characteristics of the respondents.

Budget: - The study will need a total budget of 35,322.00 Ethiopian Birr.
1. Introduction

1.1. Background
The kidneys are two bean-shaped organs located in the abdomen, one on either side of the spine. They
are responsible for filtering waste products from the blood and excreting them in the urine. The kidneys
also help to regulate blood pressure, produce red blood cells, and maintain a healthy balance of fluids
and electrolytes in the body. The kidneys are essential organs that play a vital role in maintaining the
body's internal environment. They filter waste products from the blood, regulate blood pressure, and
produce hormones that help to control other important bodily functions. [1].
Chronic kidney disease (CKD) is defined as a reduction in glomerular filtration rate (GFR) below 60
ml/min per 1.73 m2 and the presence of albuminuria over a period or an indication of abnormalities in
the kidney structure or function in those who had known CKD. In patients with CKD, excess fluid and
waste materials from the blood remain in the body and are not excreted from the body, leading to severe
health problems. Kidney disease is a silent killer[1,2].
Kidney failure is also called end- stage renal disease (ESRD) or Stage 5 chronic kidney disease. When
people have ESRD they need dialysis or a kidney transplant to survive [2]. Chronic Kidney Disease
(CKD) is a worldwide public health problem [3].
Chronic Kidney Disease has been simplified over the last 5 years. Chronic Kidney Disease (CKD) is
defined as kidney damage or glomerular filtration rate (GFR) <60 ml/min/1.73 m2 for more than 3
months with implications for health. The prevalence rates of CKD worldwide are high and have
increased in the last few years to about 13-15%, with an increased prevalence of diabetes and
hypertension which shows it is becoming one of the public health problems [4].
The endemic occurrence of chronic kidney disease of unknown etiology (CKDu) (sometimes referred
to as chronic renal failure [CRF]) was first observed in the 1990s and over the past 15years the
prevalence of the disease within certain geographical locations has increased dramatically [5].
Lack of national registries and community-based studies in Africa makes it a challenge to know its
prevalence in the continent. Studies from Egypt and East Africa have suggested that CKD is at least
three or four times more frequent in developing countries [6]. Currently Chronic Kidney Disease
became a major public health problem worldwide. It has taken on the status of public health concern in
recent years, due to its increased prevalence among the world’s population and its impact on morbidity
and mortality in affected patients. CKD is the 12th highest cause of death and 17th highest cause of
disability worldwide [7].
Of the approximately 1 million people in the world with severe chronic kidney disease who are being
treated with some form of renal replacement therapy, 90 percent live in developed countries. In most
developing countries, however, only 5 to 10 percent of patients who require renal replacement therapy
can obtain it. However, the rapid rush in diabetes and hypertension, both of which predicted to drive
epidemic in CKD, was dramatically escalating this burden [8].
Renal disease deaths in Ethiopia reached 12,038 or 1.47% of total deaths. Very low level of awareness
about renal diseases, their risk factors, lack of data on renal diseases for management and the threat
these tricks to health professionals, policy makers and the public [9].
Given the limited financial and human resources available in our country, a valid estimate of CKD
magnitude is needed to inform resource allocation and prevention programs. Moreover, the scarcity and
high cost of dialysis and kidney transplantation oblige for early the identification and management of
associated factors [10].

1.2. Statement of the problem

Chronic diseases became a major challenge to 21st century as world health policy. In developing
countries, the growing prevalence of chronic diseases such as chronic kidney disease has severe
implications on health and economic output. The rapid rise of common risk factors such as diabetes,
hypertension, and obesity, especially among the poor, results in even greater and more profound
burdens that developing nations are not equipped to handle [11].
Chronic Kidney Disease (CKD), a non-communicable disorder included in the plan, is ranked 18th
among the global causes of death it was ranked 27th in 2011 and the number of deaths from CKD has
risen by 82% during that time. It is the third among the top 25 causes of death, next to HIV/AIDS and
diabetes [12].
In sub-Saharan Africa, hypertension and diabetes mellitus are among the leading causes of end-stage
renal disease. By 2020, the burden of diabetes and cardiovascular disease had increased by 130% in
Africa alone, with concomitant increases in the prevalence of CKD and end-stage renal disease [9].
In the context of the epidemiological transition in Ethiopia, a double burden of disease is already
emerging with the mix of persistent infectious diseases and increasing non communicable diseases [13].
According to WHO, comprehensive and integrated action is the means to prevent and control chronic
disease. In low-income countries, such as Ethiopia, chronic disease is a growing problem. Like many
other chronic diseases, the incidence of chronic kidney disease (CKD) in Ethiopia is rising because of
increased risk factors such as high blood pressure and diabetes mellitus [14].
There are virtually not sufficient published reports on the incidence, magnitude, or survival of patients
with renal disease in Ethiopia. So it makes difficult to plan substantial public health programs that can
help to the development and implementation of more effective intervention programs. Dilchora hospital
is pioneer for health service specially related to kidney problem and Sabiyan hospital has the first
dialysis center which will be beneficial from the outcome of our research. Generally, this research
primarily intended to provide additional timely and objective information about current situation of
CKD and its risk factors among patients [15].
1.3. The significance of the study
Chronic Kidney Disease is not only an individual issue but also a family and community problem.
Therefore, identifying the magnitude and risk factors helps to tackle the problem. The disease
especially if the patient reaches end stage of renal disease, family face challenge due to dialysis fee.
Therefore, the result of this study will provide an insight for health institutions, educational centers, and
policy makers and for the government to see the level of the problem and to develop intervention tools
[16].
Measuring the magnitude of CKD is important for determining appropriate service improvement
actions and identifying the determinants of rapid disease progression. This study may provide insights
into the high incidence of CKD, assess associated risk factors, and suggest improvement measures. It
will also serve as a baseline for future studies and interventions.

2. Literature review
2.1. Magnitude of Chronic Kidney Disease

Chronic kidney disease (CKD) is a complex and multifaceted disease that affects approximately 13.4%
of the world’s population and is growing rapidly due to an increased aging population and prevalence of
type 2 diabetes mellitus, obesity, hypertension, and cardiovascular disease that contribute to CKD. The
majority, 79%, were at late stages of the disease (stage 3–5); however, the actual proportion of people
with early CKD (stage 1 or 2) is likely to be much higher since early kidney disease is clinically silent
[18].
A 2017 study published in the Lancet Global Health journal estimated that the global prevalence of
CKD was 10.4%. The highest prevalence of CKD was found in Central America (14.8%), followed by
South Asia (13.4%) and the Middle East and North Africa (12.7%). The lowest prevalence of CKD was
found in high-income North America (8.1%) and Western Europe (7.8%) [17].
Currently, more than 2 million people globally receive treatment with dialysis or kidney transplants to
stay alive; of them, 20% are treated in 100 low-income countries, which make up half of the world’s
population [20].
Data on the prevalence of CKD are limited; however, a few studies suggest that renal illness has
emerged as a serious public health issue in Ethiopia. A cross sectional study estimates that 12.2% of
Ethiopians have CKD, and that the number has increased recently along with instances of diabetes and
high blood pressure. Up to 41% of people under the age of 35 years and 62% of men have CKD in
Ethiopia [27].
A review of literature suggests that in low- and middle-income countries, most people with kidney
failure have insufficient access to life-saving dialysis and kidney transplantation. The cost of treating
CKD and its complications is unaffordable to the government and individuals in many part of the
world, including Ethiopia [28].
2.1. Associated factors for chronic kidney disease
A person can lose up to 90% of kidney function before experiencing any signs and symptoms. Most
people have no symptoms until CKD is advanced. Untreated kidney failure is life-threatening, so the
early detection of falling kidney function is crucial because it allows for suitable treatment before the
kidney is damaged [19].
A 2018 study published in the journal PLOS Medicine found that CKD is more common in certain
populations, including people with diabetes, hypertension, obesity, and older adults. The prevalence of
CKD was 26.7% in people with diabetes, 20.5% in people with hypertension, and 19.9% in people with
obesity. The prevalence of CKD also increased with age, from 5.5% in people aged 18-39 years to
34.3% in people aged 70 years and older [18].
Next to cardiovascular complications, CKD is a serious public health issue among people with type 2
diabetes (T2DM). Patients with type 2 diabetes are more likely to require recurrent hospital stays and
are at greater risk of increased mortality [21]. CKD is a well-recognized and serious complication of
diabetes, and diabetes is one of the most common causes of CKD, with up to 44% of patients with CKD
affected by diabetes [22]. The prevalence of CKD among patients with hypertension (HTN) was 21.1%
in Tigray [26], 46.9% in Gahanna [23], and 17.6% in Northwest Ethiopia referral hospitals [24].
Geographically, the prevalence of CKD linked to human immunodeficiency virus (HIV) varies, ranging
between 2% and 38% due to genetic variation, the start of anti-retroviral therapy (ART), and the various
definitions of CKD in each region [25].
The global prevalence of chronic kidney disease among persons living with HIV (PLHIV) is 6.4%. This
prevalence varies by continent: 7.9% in Africa, 7.1% in North America, 5.7% in Asia, and 3.7% in
Europe [25].
A retrospective, descriptive hospital cohort study carried out during the period 2001-2002, indicated
that the number of persons with health issues seeking treatment at nephrology clinics in
Anuradhapura and Kandy were increasing, and the majority was CKDu patients [5].
Clinically, CKD is characterized by tubular proteinuria, usually ß2-microglobulinuria, and the absence
of hypertension and edema [29]. The histological appearance of the disease reveals a tubule interstitial
pathology that can commonly be observed in toxic nephropathies [29]. To date, there is no unequivocal
evidence to recognize the possible environmental causative factors that could lead to nephron toxin
being responsible for the disease [30].
Recent personal communications from scientists are pointing to episodic dehydration as a cause that
could be contributing factor for CKDu (farmers undergo episodic dehydration events due to their field
activities) and the strong association with lifestyle habits that included smoking and the
consumption of illicit liquor and micro albuminuria that is documented [29].
In this respect, the predominant causal factor(s) that have been suggested in the literature that may
contribute to the development of the disease, include heavy metals (cadmium [Cd], arsenic [As] and
3various nucleotides, including uranium [U]), elevated levels of fluoride (F) in groundwater, the
specific composition of groundwater, aluminum (Al) and exotoxins [31]. It is worth noting that this
issue of chronic kidney disease (CKD) is not confined to Sri Lanka and that there are reports in the
literature that describe similar clinical etiologies from India (Rao and Pereira 2007), Nicaragua
[9], Costa Rica [10] and other Central American states [31].
The reports from Central America cite an increased risk of the disease among agricultural workers,
in general and sugarcane workers in particular[32]. They have also noted that kidney disease
decreases at higher altitudes [32]. Heavy workloads in hot climatic conditions often lead to chronic
dehydration, which has emerged as a possible hypothesis in Central America [33].

2.3. Conceptual framework

3. OBJECTIVES

3.1 General Objective

 To assess the magnitude of chronic kidney disease and its associated factors among patients at
public hospitals from Tikimt 1 to Tir 30, 2016 E.C.
3.2 Specific Objectives

 To determine the magnitude of chronic kidney disease among patients at public hospitals in Dire
Dawa from Tikimt 1 to Tir 30, 2016 E.C.
 To identify associated factors for chronic kidney disease among patients at public hospitals in
from Tikimt 1 to Tir 30, 2016 E.C.

4. 4. Methods and Materials

4.1 Study area and period

This study will be conducted in Dilchora and sabiyan hospital, both is found in Dire Dawa town city
administration, Ethiopia. Dire Dawa is one of the most popular historical towns in the Eastern part of
Ethiopia, surrounded by the State of Oromia, Harari, and Djibouti. There is total of 38 numbers of
kebeles 9 in the town and 29 is rural while the rural part of the State has 17 farmers associations. The
State's size is estimated at 1,213 km².
Dire Dawa town city administration is populated by 493,000 inhabitants. Dire Dawa is located 466km
from the capital Addis Ababa. It has two government Hospitals, Dilchora Referral Hospital, Sabiyan
general Hospital, 5 private Hospitals, 15 Health Centres and many private clinics serving the people of
the city.
Dilchora Hospital is one of the two government Hospitals; It is founded in 1952E.C by Emperor
Hileslase as Hilaeslase hospital. During Derg regimen in 1965E.C it was named as Abiyotawi Dilchora
hospital. It serves around 1.5 to 2 million population annually. It has four main departments:
Gynaecology and obstetrics, Internal Medicine, Surgery, and Pediatric. Chronic disease OPD and
medical wards is well equipped with senior physicians & other supporting staffs.
Sabiyan general hospital ……

4.1.2 Study period

 The data collection for the study will be from Tikimt 1 to Tir 30, 2016 E.C.

4.1.3 Study design

 The study design will be a descriptive institution-based cross-sectional study.

4.2 Population

4.2.1 Source population

 All medical Patients who will be seen in and out patients in medical chronic disease OPD at
Dilchora referral Hospital and Sabiyan general Hospital.
4.2.2 Study Population
 The study population included all adults aged ≥18 years with chronic kidney disease who had
regular follow-ups at the Dilchora Referral Hospital and Sabiyan general hospital outpatient
clinic during the study period.

4.2.3 Inclusion and Exclusion Criteria

[Link] Inclusion criteria

 Adult Patients who attend the hospital outpatient department at the time of data
collection and who are willing to participate in the study are included.

[Link] Exclusion criteria

  Patients who are unable to participate in the study.
 Patients age less than 18 years will be excluded.

4.2.4 Sample size determination and sampling procedure

[Link] Sample Size

 The sample size will be determined by using the single proportion formula(P) as indicated
below.
The formula: n = (Zα/2)2 P (1-P)
(D) 2
Where n is sample size, P (proportion CKD patient) in the study sites & D is the margin of
error. The following assumptions were used. Since there is no local data available for the value
of P, it was taken to be 50% (P=0.5) to allow maximum sample size. Allowing 5% for expected

margin of error (d) and 95% confidence level

(
Z α =1 .96
2 )
the required sample size n was 384.
With a 10% non-response rate the total sample size was 422.

[Link] Sampling procedure

The study participants were selected using a systematic random sampling technique. The total number
of chronic patients who had regular follow-ups at the HTN, DM, and ART outpatient departments was
1,075. Then k was calculated by dividing 1,075 by the sample size, which was 2. The data were
collected from the study participants via face to-face interviews, a questionnaire, and secondary data
from the patient cards.

4.3 Data Collection

4.3.1 Method of Data Collection

Data will be collected using a structured interview-administered questionnaire and patient chart review.
The questionnaire is prepared in English. One week before the actual data collection period, the
questionnaire will be pre-tested on 5% of the total sample size of patients.

4.4. Data Analysis

The collected data will be coded, cleaned, entered into a computer and analyzed using (statistical
package for social science) SPSS computer software. Associations and strength of the association
between the independent and dependent variables will be tested using Odds Ratio and 95 %
Confidence Interval. Data will be cleaned, edited, compiled and described. Analysis will be done using
29.0 SPSS where applied result will be presented using number, ratio, tables and graphs.

4.5. Data Quality

Before starting the data collection, data collecting questioners will be cross matched with available
information on records; then the study questions will be rearranged if necessary.

The principal investigator will have ongoing supervision to ensure the quality of data by checking filled
questionnaires for their completeness. The data collectors will get informal training in how to extract
information and fill the questioneris from pregnant mother who comes for ANC follow up by the
principal investigator.

After completing necessary materials and obtaining permission to conduct this study, data will be
collected from adult patients who attends chronic disease medical OPD during the data collection
period by hospital workers using structured questionnaire.

4.6. Ethical Consideration

Permission will be obtained from medical director of Dilchora referral and sabiyan general hospital by
letter. The purpose of the study will be explained to each worker to proceed the data collection from
pregnant mothers who are antenatal care attendees during the data collection period. Data collectors
will be strictly oriented towards patient confidentiality and the patients’ name or card number will never
be used by any means throughout the research.

4.7 Operational Definition

• Patients with underlying chronic disease: patients who have HTN, diabetes mellitus
(DM), HIV/AIDS, two of these conditions concurrently, or all the above.
 • Smoking status: Smoking status was assessed by asking, “On how many of the past 7 days
did you smoke a cigarette or cigar, even just one puff?” Respondents who reported 0 days were
considered a non-smoker. All others were categorized as smokers.

• Alcohol use: Alcohol use was determined using the CAGE international screening tool to
discuss a patient’s alcohol use/abuse. Each response to the four CAGE questions is scored in
points: either 0 points for “no” or 1 point for “yes.” If a participant score ≥2, they are an alcohol
user.
• Non-steroidal anti-inflammatory drug (NSAID) use: If a person takes diclofenac,
ibuprofen, indomethacin, or aspirin for at least 2 weeks, they are considered an NSAID user.
• Proteinuria: Participants were considered to have proteinuria if their laboratory results
showed +1 and above for the urine dipstick test.
• Chronic renal failure is defined as either pathological abnormalities or markers of
damage, including abnormalities in blood or urine tests or GFR<60 ml/min/1.73 m2 for>=3
months.
• Adult patients: Patients who attend Medical OPD Dilchora and sabiyan hospital whose
Age ≥ 18.
• Knowledge on kidney function and disease : Patient knows the role of kidney and
understands malfunction signs like flank pain, change in urination.

4.8 Variables
4.8.1 Dependent Variables

 Independent variables
o Age
o Ethnicity
 o Religion
o Marital status
o Educational status of both the mother and father
o Socio-demographic factors
o History of diabetes
o history of hypertension
o Obesity
o Smoking habits
o Alcohol consumption
o Level of physical activity
o Use of traditional medicine
o Family history of DM and hypertension (HTN)

 Dependent variables
o Chronic Kidney Disease

4.9 Plans for Dissemination Research

 After completion of this study the result will be copied and given to regional health bureau, Dire
Dawa University library, Dilchora and Sabiyan hospital library, department of internal medicine
and through publication in different journal and magazines.

5 - WORK PLAN
 Table 1- Project plane for the assessment of magnitude and associated factors of CKD among
patients attending in public hospital from Tikimt 1 to Tir 30, 2016 E.C.

Activities Responsible Mesk Mes Mes Tiki Tiki Yeka Yeka Mega
Bodies erem kere kere mt mt tit tit bit
m m
Research Principal
development Investigator (PI)
1st draft PI
submission
Final proposal PI
submission
Collection of PI
material and
budget
Data Data collector
Collection
Data analysis PI

Preparation PI
for1st draft
submission
Rearrangement PI
of final report
Submission of PI
final report

NB: The dark boxes show activities in relation to the time factor.

6. BUDGET NOTIFICATION
Table 2 Personnel Budget Notification

Personnel qualification No Working Birr Total

days Salary/day
Secretary 1 15 300 4,500.00Birr
Data collector (staff or 2 56 150 16,800.00Bir
students) r
Total 3 21,300.00Bir
r

Table 3 Materials Budget Notification

No Items Unit Quantity Unit Price in Birr Total

1 Paper A4 1 Pack 600.00 600.00
2 Pen Each 3 15.00 45.00
3 CD Each 1 50.00 50.00

4 Ruler Each 1 25.00 25.00

5 Printing Page 70 15.00 1050.00

6 Photocopy Page 2114 5.00 10570.00

7 Total 12,340.00

Summary of budget notification

Personnel =21,300.00 birr

Materials = 12,340.00 Birr
Total without contingency = 33,640.00Birr
Grand total with 5%
Contingency = 35,322.00Birr

Annex II: - References

1. National Kidney Foundation (2003) K/DOQI clinical practice guidelines for bone metabolism
and disease in chronic kidney disease. Am J Kidney Dis 42: S1-S201.
2. National Chronic Kidney Disease fact sheet (2014).
3. Oluyombo R, Akinsola A, Ayodele O, Onayade A, Arogundade F, et al. (2011) Prevalence,
risk factors and patterns of chronic kidney disease in a rural community in South West Nigeria.
J Epidemiol Community Health 65: P1-271.
4. Ababio GK, Bosomprah S, Olumide A, Aperkor N, Aimakhu C, et al. (2017) Predictors of
quality of life in patients with diabetes mellitus in two tertiary health institutions in Ghana and
Nigeria. Niger Postgrad Med J 24: 48-55.
5. Wanigasuriya KP, Peiris-John RJ, Wickremasinghe R (2011) Chronic kidney disease of
unknown etiology in Sri Lanka: Is cadmium a likely cause? BMC Nephrol 12: 32.
6. Amira O, Taslim B, William R (2014) Chronic kidney disease: a ten-year study of aetiology and
epidemiological trends in Lagos, Nigeria. Brit J Renal Med 19: 19-23.
7. Fiseha T, Kassim M, Yemane T (2014) Prevalence of chronic kidney disease and associated risk
factors among diabetic patients in Southern Ethiopia. Am J Health Res 2: 216-221.
8. Lola N, Kever RT, Uba MN, Sambo BD, Dathini H, et al. (2014) Predisposing factors to
chronic renal failure among clients attending kidney center of University of Maiduguri Teaching
Hospital, NorthEastern, Nigeria. J Res Nurs Midwifery 3: 106-111.
9. Ibrahim A, Ahmed MM, Kedir S, Bekele D (2016) Clinical profile and outcome of patients with
acute kidney injury requiring dialysis: An experience from a haemodialysis unit in a developing
country. BMC Nephrology 17: 1-5.
10. Ladi-Akinyemi TW, Ajayi I (2017) Risk factors for chronic kidney disease among patients at
Olabisi Onabanjo University Teaching Hospital in Sagamu, Nigeria: A retrospective cohort
study. Malawi Med J 29: 166-170.
11. Nugent RA, Fathima SF, Feigl AB, Chyung D (2011) The burden of chronic kidney disease on
developing nations: A 21st century challenge in global health. Nephron Clin Pract 118: 269-
277.
12. Lebov JF, Valladares E, Peña R, Peña EM, Sanoff SL, et al. (2015) A population-based study of
prevalence and risk factors of chronic kidney disease in León, Nicaragua. Can J Kidney Health
Dis 2: 1-14.
13. Levey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, et al. (2005) Definition and
classification of chronic kidney disease: a position statement from kidney disease: Improving
Global Outcomes (KDIGO). Kidney Int 67: 2089-2100.
14. World Health Organization (2003) The world health report 2003: shaping the future.
15. Levin A, Hemmelgarn B, Culleton B, Tobe S, McFarlane P, et al. (2008) Guidelines for the
management of chronic kidney disease. Can Med Assoc J 179: 1154-1162.
16. Meuwesen WP, Du Plessis JM, Burger JR, Lubbe MS, Cockeran M (2016) Investigation of the
coexistence of CKD and non-communicable chronic diseases in a PBM company in South
Africa. S Afr Fam Pract 58: 136-41.
17. GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic
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Lancet. 2020;395(10225):709–33. pmid:32061315.
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Annex I: Information Sheet and Informed Voluntary Consent Form for
facility head

Title of the study: To assess the magnitude of chronic kidney disease and its associated factors among
patients at public hospitals in Dire Dawa in 2016 E.C.

Principal investigator: Rediet Tilahun

Introduction

Chronic kidney disease (CKD) is a progressive condition that damages the kidneys and their ability to
filter waste from the blood. CKD is a major public health problem, affecting millions of people
worldwide. The magnitude of CKD varies from country to country, but it is estimated that
approximately 10% of the global population has CKD.

CKD is increasing in prevalence, particularly in developing countries. This is due to a number of

factors, including increasing rates of obesity, diabetes, and hypertension. CKD is also a major risk
factor for cardiovascular disease, stroke, and end-stage renal disease.

Purpose of the study

The purpose of this study is to assess the magnitude of CKD and its associated factors among patients
at public hospitals in Dire Dawa in 2016 E.C. The findings of this study will help to inform
policymakers and healthcare providers about the burden of CKD in Dire Dawa and will identify priority
areas for prevention and control.

Study procedures
If you agree to participate in this study, you will be asked to complete a questionnaire that will collect
information about your demographics, medical history, and lifestyle. You will also be asked to provide
a blood and urine sample.

The blood and urine samples will be tested for markers of CKD. The questionnaire data will be used to
assess the relationship between CKD and other factors such as age, sex, diabetes, hypertension, and
obesity.

Risks and benefits

There are no known risks associated with participating in this study. The benefits of participating
include the potential to contribute to the advancement of knowledge about CKD and to help improve
the prevention and control of CKD in Dire Dawa.

Confidentiality

All information collected from participants will be kept confidential. Your name will not be used in any
reports or publications from this study.

Rediet Tilahun
+251910346083
rediettilahun9@[Link]

If you have any questions about this study, please contact the principal investigator, Rediet Tilahun, at
+251910346083 or rediettilahun9@[Link].

Annex II: Information Sheet and Informed Voluntary Consent Form for
participants

Informed Voluntary Consent Form

Title of the study: To assess the magnitude of chronic kidney disease and its associated factors among
patients at public hospitals in Dire Dawa in 2016 E.C.

Principal investigator: Rediet Tilahun

I have read and understood the information sheet for the above-mentioned study. I have also had the
opportunity to ask questions about the study and to receive satisfactory answers. I agree to participate in
this study voluntarily.

I understand that I am free to withdraw from the study at any time without penalty. I also understand
that I can change my mind about participating in the study even after I have signed this consent form.

I authorize the principal investigator and other members of the research team to collect and use my data
for the purposes of this study. I also authorize the principal investigator to share my data with other
researchers who are working on CKD-related research.
I understand that my data will be kept confidential. My name will not be used in any reports or
publications from this study.

Signature: -
Date: -
 ANNEX III: Questionnaire
Dire Dawa University
College of Medicine and Health Sciences School of Postgraduate
Department of Public Health

RESEARCH ON MAGNITUDE AND ASSOCIATED FACTORS OF CHRONIC

KIDNEY DISEASE AMONG PATIENTS ATTENDING IN PUBLIC HOSPITAL
IN DIRE DAWA FROM TIKIMIT 1 to TIR 30 2016 E.C.

This questionnaire is prepared by a Rediet Tilahun MPH student to the study of magnitude and
associated factors of chronic kidney disease among patients attending in public hospital in Dire Dawa
in 2016 E.C. The output of the research will be used later to improve service provision to chronic
kidney disease patient. You are selected to be part of the study. Your participation will enrich the
document; yet it’s based on your will. If you are interested to be a part of this, we can proceed. Are you
willing to be part of the study? Yes_____________ No___________
Name of the interviewer _____________________________
Date of interview _____________

Part I. Socio-demographic Characteristics Adult Patients Visited chronic disease OPD in

Dilchora referral and Sabiyan general hospital, Dire Dawa, Ethiopia
S. No Questions Response Skip to
101 Age of the patient
102 Sex 1. Male
2. Female
103 Residence 1. Dire Dawa
2. Out of Dire Dawa
104 Educational status 1. No formal education

2. Primary

3. Secondary

4. Tertiary

105 Marital status 1. Single

2. Married
3. Divorced
4. Widowed
106 Occupation 1. Student
2. Employed
3. Self-employed
4. Retired
5. Unemployed
107 Family history of CKD Yes
No
Part II Chronic Kidney Disease and Related Characteristics of Adult Patients Visited chronic
disease OPD in Dilchora referral and Sabiyan general hospital, Dire Dawa, Ethiopia
201 Chronic kidney disease 1. Yes
2. No 206

202 If yes, stage of CKD 1. Stage I

2. Stage II

3. Stage III

203 Followed dialysis session (on dialysis) 1. Yes

2. No
204 If yes, the number of dialysis per week .
205 Referred for kidney transplant 1. Yes
2. No
206 If the answer for 201 is no, Is there other 1. Acute renal failure
type of kidneys disease?
 2. Nephrotic syndrome
3. Glomerular disease
4. Polycystic kidney disease
5. Other
207 If acute renal failure type (categories) of [Link]-renal
Acute renal failure?
[Link]-renal
[Link]-renal
Part III: Causes and Clinical Risk Factors of CKD among Adult Patients Visited chronic disease
OPD in Dilchora referral and Sabiyan general hospital, Dire Dawa, Ethiopia
301 Hypertension? 1. Yes
2. No 303

302 If yes, the duration of HTN (in months or

years)? ……………………..
303 Diabetes mellitus? 1. Yes
2. No 305

304 If yes, the duration of DM (months or

years)? ………………………
305 Type of DM? 1. Type 1
2. Type 2

306 Cardiovascular disease? 1. Yes

2. No
307 Liver disease? 1. Yes
2. No
308 Kidney Cancer or malignancy? 1. Yes
2. No
309 HIV serostatus? 1. Positive
2. Negative
310 Urinary tract infection 1. Yes
312
2. No
311 If yes, type of UTI? 1. Pyelonephritis
2. Urethritis
3. Cystitis
4. Others
312 Urinary tract obstruction or obstructive 1. Yes
314
kidney disease? 2. No
313 If yes type of obstructive kidney disease? 1. BPH
2. Renal Stone
3. Tumor
4. Others
314 Autoimmune disease? 1. Yes
2. No
315 Recurrent kidney infection? 1. Yes
2. No
316 Tonsillitis? 1. Yes
2. No
317 Glomerulonephritis? 1. Yes
2. No

Part IV: Behavioral Factors among Adult Patients Visited chronic disease OPD in Dilchora
referral and Sabiyan general hospital, Dire Dawa, Ethiopia
401 Smoker? 1. Yes
2. No
402 Alcohol drinker? 1. Yes
2. No
403 Frequent users of non-steroidal anti- 1. Yes
2. No
inflammatory drugs?
Part V: Description of Laboratory Findings of Adult Patients Visited chronic disease OPD in
Dilchora referral and Sabiyan general hospital, Dire Dawa, Ethiopia
501 Cholesterol level mg/dl
502 Proteinuria (Albuminuria) Positive
Negative
503 Serum creatinine mg/dl
504 Urea mg/dl
505 Phosphorus mg/dl
506 Serum sodium level mmol/L
507 Serum potassium level mmol/L
508 Serum chloride level mmol/L