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STOP CKDu gets underway in the Uddhanam region of Andhra Pradesh

In  order to curb the rising incidence of chronic kidney disease in the Uddanam region of Andhra Pradesh by getting to and analysing the root causes, the Stop CKDu study kicked off in January 2018 with a team comprising members from The George Institute for Global Health and The Energy and Resources Institute (TERI) undertaking field visits in Srikakulam District.

The team met with Dr.Tripathy Rao, District Medical and Health Officer  (DMHO) along with the nodal officers responsible for public health delivery in Srikakulam district. The objective of the meeting was to gain an understanding and perspective on community based screening approaches and identify the key areas with reported high prevalence of CKD in Srikakulam district so as to inform the selection of the villages for the study area. The DMHO office provided the study team with details of the CKD screening data and district level map delineating the health delivery facilities.

The study team along with DMHO met with Mr  Dhanunjaya Reddy IAS, District Collector of Srikakulam and sought his support for the implementation of the STOP CKDu activities.

The team visited Sainoor  and Amalapadu villages in the Vajarapu Kothuru mandal  of the Uddhanam region served by the Govindapuram PHC.  There was a detailed interaction with the frontline healthcare workers and the PHC medical officer to gather information on population size of the villages and health systems capacity in the area. The team also interviewed patients and reviewed their available medical reports and current treatment status.

The field trip included   a walkthrough of the residential areas, visit to families and the farming areas comprising  cashew and paddy fields, ascertaining the sources of irrigation and  understanding the farming practices. The villages seemed similar in socio- economic status, education, occupations. Drinking water sources included both household and community water tap, RO based systems were being installed in the villages.  Nearly all households seemed engaged in cashew and paddy cultivation. Seasonal migration was not evident. Women engagement in community activities and access to resources such as school system, temple and health care.

Observations and discussions of diet, drinking water sources, cultural habits relating to within family marriages, intake of recreational drugs/ alcohol, cooking fuel used, utensils for preparing and serving food formed the primary component of the assessment.

Community members voiced concerns about the water source and locally prepared alcohol as possible sources of health problems. Other issues which were expressed by care providers included inadequate fluid intake, use of over-the- counter drugs, especially pain-killers and pesticide exposures.

Dialysis patients appeared to be satisfied with the treatment being provided through the PPP dialysis centres which was easily accessible to those needing dialysis services. Awareness about kidney disease among the communities was high.

The team gathered valuable insights into the geographic terrain, accessibility, community perceptions and also assessed the population distribution and workforce capacity in order to undertake the STOP CKDu Study in Srikakulam district.

The team also met Dr B Ashok Kumar, elected Member of Legislative Assembly from the region. He  pointed out that there are significant gaps in provision of treatment and mobilizing kidney disease patients to Govt health care facilities. He urged the team to come up with an awareness campaign with a specific focus to address the stigma associated with CKD, and abnormal serum creatine values. He also suggested that doctors and other medical practitioners in the Uddhanam area need to be educated in diagnosis and management of kidney disease patients.

The Study team in coordination with the Srikakulam district administration conducted an interactive training session at Srikakulam, where Prof. Vivekanand Jha, executive director of the George Institute for Global Health, India provided in-depth training to the medical officers on the early detection of kidney disease and management for preventing progression of those with early Chronic Disease. An evidence based guideline of management of CKD at the Primary Healthcare centres and when to refer to higher centre for management has also been developed by the study team and made available to Govt of Andhra Pradesh for implementation.

The study team visited 18 Primary Health Centres (PHC’s) and 2 Community Health Centres (CHC’s) of Uddanam area. Team conducted village level awareness session in the community. The objective of these sessions was to gain perspective from the community. Team interacted with the members of the villages about chronic kidney disease risk factors, management, importance of regular check-ups and use of medicines. In all the Uddhanam Mandals, village level awareness sessions are being conducted.

As per guidance from Shri. Dhananjaya Reddy, District collector of Srikakulam, the formation of village level committees for concerted response to CKD and general health conditions. These committee consists of one ANM, ASHA, Aganwadi teacher, village revenue officer, Govt. School teacher and a sadhikara mitra (SHG leader). The study team has conducted qualitative interviews to understand the community members perceptions related to the burden and existing pattern of care for of kidney disease.

Team conducted Indepth Interviews (IDI) and Focus Group Discussions (FGD) with agriculture, horticulture, industrial and water supplies department staff and IDI with Physicians, ANM’s, patient groups. A total of 12 In depth Interviews and 9 Focus Group Discussions were conducted.  Based on the feedback from the community members relevant health education and IEC materials for use by the people about caring for the kidneys have been developed.

As several research initiatives in the past years in the Uddhanam region have conducted surveys and collected samples for investigations with very little feedback to the communities, the communities confidence is being built through the process of participation of the community members in the planning of the field survey activities and implementation of the evaluation of the root cause analysis through detailed clinical and laboratory evaluations including environmental and other exposure factors.