Introduction:
Emerging reports on regional prevalence of chronic kidney disease (CKD) in Ethiopia indicate substantial burden of the disease. However, national primary data are lacking in Ethiopia to estimate the prevalence of CKD. The objective of this study was to explore the utility of a national administrative health data source in Ethiopia to estimate the prevalence of CKD across the country.
Methods:
We conducted a retrospective, cross-sectional study (study period: 2019–2022) based on aggregated health data from District Health Information System 2 (DHIS2). DHIS2 is a health management information system used in 74% of health facilities in Ethiopia and includes information on reported cases of health conditions and health service delivery across the regions. We identified cases of CKD in DHIS2 based on the presence of Ethiopian National Classification of Diseases (NCoD) codes relevant to CKD (N17-1086) and kidney failure (N17-1087). To allow the estimation of the prevalence of CKD across the study period, we obtained estimated population distributions (“denominator”) across regions of Ethiopia from WorldPop (world population distribution), as the denominator is not recorded in DHIS2. The numerator was the number of CKD cases recorded in each year (kidney failure assessed separately). We estimated prevalence for each calendar year, stratified by age group (<15, 15-29, 30-64, and ≥65 years), region, and sex.
Results:
Overall, recorded CKD cases increased continuously between 2019 and 2022, rising from 7,643 cases in 2019 (7.25 per 100,000 population) to 14,992 cases in 2022 (13.27 per 100,000 population). A similar trend was observed in kidney failure, but with some variation in the cases reported over the study period (2019, 2020, 2021, and 2022: 4,076 cases [3.87 per 100,000 population], 5,458 cases [5.06 per 100,000 population], 4,221 cases [3.82 per 100,000 population],and 5,816 cases [5.14 per 100,000 population], respectively. In 2022, there was considerable variability in reported CKD cases across different regions in Ethiopia, ranging from 0.36 cases per 100,000 population in Gambella to 98.89 cases per 100,000 population in Addis Ababa. There was inconsistent reporting of CKD cases in some regions like Gambella, Benishangul Gumuz, and Tigray from 2019-2022: combined total cases were 601, 589, 123, and 149 total cases in 2019, 2020, 2021, and 2022, respectively (regions that experienced limited implementation of DHIS2 and significant disruptions to health services due to the internal armed conflict in Ethiopia). Across categories of age and sex, prevalence was highest in those ≥65 years (<15, 15-29, 30-64, and ≥65 years: 1.50, 11.18, 24.08, 73.49 per 100,000 population, respectively) and in males (male and female: 14.89 and 11.66 per 100,000 population, respectively).
Conclusions:
Findings from this study based on administrative data suggest an increasing prevalence of CKD in Ethiopia. There was significant variation in the reporting of CKD cases across the study period and regions, which may be attributed to incomplete data, variable uptake of DHIS2, and the impact of the internal armed conflict on the health system. Our study demonstrates the utility of DHIS2 as a valuable resource for monitoring CKD epidemiology at a national level and the need for quality data to inform health policy and health service planning.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.