COMMUNITY PERCEPTIONS OF CKDU IN AN ENDEMIC AREA OF COSTA RICA: "IT HAS A HUGE IMPACT AND IT IS ALARMING."

Introduction:

Chronic kidney disease of unknown etiology (CKDu) disproportionately affects young male agricultural workers in tropical regions in South Asia and Central America. In Northwest Costa Rica, a region severely impacted by CKDu, the situation is further compounded by seasonal migrant workers from CKDu-endemic areas of Nicaragua, intensifying the public health challenge. Despite the increasing prevalence of CKDu, there is a significant gap in the scientific literature on the perspectives of local communities and its societal and emotional effects. This mixed methods cross-sectional study seeks to describe the lived experiences and perceptions of CKDu among residents of several affected communities.

Methods:

We conducted 16 individual semi-structured interviews, 3 paired semi-structured interviews, and 2 focus groups of 7 to 8 participants in agricultural communities in Northwest Costa Rica. Participants resided in communities in which CKDu is a significant problem as identified by prior researchers. Study participants were recruited by community leaders to represent a variety of demographics and occupations. A survey was completed by all participants and verbal responses were transcribed. Transcripts were coded using Dedoose software with both deductive and inductive approaches with at least 15% of transcripts coded by 2 authors to ensure inter-coder reliability. We performed thematic analysis with results summarized in text and figures. Survey responses were analyzed with descriptive statistics in R software. 

Results:

Of the 37 participants, 57% were male, median age was 56, and the median highest education level was primary school. The most common occupations were homemakers (n=9) and agricultural workers (n=7). The most common causes of CKD reported were insufficient water intake (n=29), arsenic (n=22), and agrochemicals (n=22). In the interviews and focus groups, key themes emerged including an emphasis on the high prevalence of CKD in their community and its profound impact. This impact extends through physical, emotional, relational, and economic psychosocial dimensions and affects individuals, families, and the communities. For example, participants reported the isolation experienced by those with CKDu, the significant burden placed on families when a member is afflicted, and a sense of fear of CKDu that permeates the entire community. Many reported that CKDu is often linked to agricultural and/or strenuous work, and they experience tension between the need to continue working to support their families and the risk of worsening their health. Many described the emotional effect of becoming dependent on others in the setting of developing CKDu.

Conclusions:

CKDu has impacts that far outreach the physical symptoms of the affected patient. The high prevalence of this disease in vulnerable agricultural communities has immense consequences on all aspects of life for the individual, family, community, region, and nation. There is an urgent need for continued research, increased health education, improved socioeconomic conditions, and increased occupational opportunities for people living in vulnerable communities. 

I have potential conflict of interest to disclose.
Project funded by Fogarty International Center, National Institutes of Health, USA

I did not use generative AI and AI-assisted technologies in the writing process.