ASSESSMENT OF THE KNOWLEDGE AND ATTITUDES OF THE POPULATION OF OUAGADOUGOU REGARDING KIDNEY DONATION

Chronic kidney disease (CKD) is a global public health issue. Its most feared complication is chronic renal failure (CRF). The number of patients with end-stage renal disease (ESRD) is constantly increasing, especially in developing countries [1]. It is estimated that 14.5 million people will require renal replacement therapy by 2030 [2].  In sub-Saharan Africa, and particularly in West Africa, kidney transplantation is still in its infancy [3]. In Burkina Faso, hemodialysis remains the only treatment for end-stage renal failure. The high cost of dialysis and the lack of hemodialysis centers limit access to care.

Kidney transplantation (KT) is the treatment of choice for ESRD in terms of survival, quality of life, and reduction of complications [4] [5]. Hence the need for KT programs currently being developed or implemented in developing countries, particularly in sub-Saharan Africa.

The acceptance of a transplant program requires the support and understanding of the population. We felt it was important to conduct a population survey. This survey will enable us to assess the knowledge and attitudes of the population of Ouagadougou regarding kidney donation in order to prepare for raising awareness among the population about kidney donation.

This was a cross-sectional, analytical study. It was conducted from 3 June to 26 August 2019. The city of Ouagadougou, which served as the study setting, comprises 12 districts and had an estimated population of 2,854,356 in 2018. [6].  Our study took place in districts 2 and 10.  A random draw was conducted to select these districts. The population of these districts was 429,801 inhabitants [7]. The sample size was determined to be 1,600 people using the OPEN EPI version 3 platform. This number was divided equally between the two boroughs. Within each borough, the distribution was made proportionally within the sectors. Within each borough, all sectors were considered. In each sector, starting from a central point (market or well-known crossroads), a direction was selected using the bottle method for selecting households. The bottle method consists of choosing a random direction of travel by spinning a bottle, moving in a straight line in that direction and selecting all households up to the boundary of the chosen street. In each household, we included two individuals chosen at random. Data collection was carried out through face-to-face interviews using a standard, anonymous questionnaire that we administered to participants.

Subjects aged 18 years and older who gave their consent were included. Subjects who did not answer all questions or did not understand the questions were not included.

Data processing and analysis were performed using Epi Info version 7.2.2.2 and Excel 2016 software.

Quantitative variables were expressed as mean ± standard deviation, and qualitative variables as frequency and percentage.

The chi-square test was used to compare qualitative variables. A p-value < 0.05 was considered statistically significant.

Ethical and deontological considerations were taken into account (approval of district mayors, informed consent, anonymity and confidentiality).

RESULTS

A total of 1,604 subjects from districts 2 and 10 of the city of Ouagadougou were included in our study. We recorded 877 men and 727 women. The male-to-female ratio was 1.2. The average age of the subjects in our study was 34.2 ± 12 (range = 18 to 72 years). The most represented age group was 18 to 30 years, with 794 subjects, or 49.5%. Muslims were the most represented, with 703 subjects, or 43.8%. In our study, unemployed subjects were the most numerous, with 395 subjects, or 24.6%. 374 subjects, or 23.3%, worked in the informal sector, and 324 subjects, or 20.2%, were pupils or students. The subjects were divided into four categories according to their level of education. Among the subjects surveyed, secondary education was the most common, with 646 subjects, or 40.3%. Of the subjects surveyed, 1,420 out of 1,604, or 88.5%, had knowledge of chronic kidney disease (CKD). Of the 1,420 subjects with knowledge of CKD, 450 subjects, or 31.7%, knew or had known at least one person with CKD.

Among the 1,420 subjects who were aware of CKD, 928 surveyed subjects, or 65.3%, were aware of kidney transplantation as a treatment for chronic renal failure. Of the 928 surveyed subjects who were aware of kidney transplantation, 819 subjects, or 88.2%, reported the media as their main source of information. In our study, 52 of the 1,604 subjects surveyed, or 3.2%, knew someone who had received a kidney donation, and 33 of the 1,604 subjects surveyed, or 2.5%, knew someone who was a kidney donor. Eight hundred and fifty-one of the 1,604 respondents, or 53%, were not in favour of living kidney donation. Four hundred and nine of the 1,604 respondents, or 25.49%, were not in favour of kidney donation after death. Regarding kidney donation from a family member after death, 545 subjects out of 1,604 surveyed, or 33.9%, were not in favour. In our study, respondents could choose one or more reasons.

The responses were categorised into four reasons: fear, religion, personal belief, or no reason.

Fear was the main reason for a negative response to living kidney donation (75.3%). Religion was the main reason for a negative response to post-mortem kidney donation (35.9%).

Personal conviction was the main reason for kidney donation from a family member (46.9%).

In our study, 753 out of 1,604 subjects, or 46.9%, were in favour of living kidney donation. Regarding kidney donation after death, 1,195 out of 1,604 subjects surveyed, or 74.5%, were in favour of kidney donation after their death, and 1,059 out of 1,604 subjects, or 66%, were in favour of cadaveric kidney donation from a family member.

Our study assessed the knowledge of the population of Ouagadougou on chronic renal failure and kidney transplantation, identified the reasons for an unfavourable response to kidney donation, and detected a pool of potential kidney donors.

It would be beneficial to conduct a larger study that could include rural populations.

An awareness campaign on chronic renal failure and kidney transplantation could facilitate public acceptance of kidney donation and change attitudes by providing accurate information on kidney transplantation.