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СпутникиРНSpaceXРоскосмосNASABackground Diabetes is the leading cause of chronic kidney disease (CKD) globally. In Tanzania, many diabetic patients are diagnosed at advanced stages, leading to poor outcomes. Understanding CKD knowledge and preventive practices is crucial for early intervention. Aim This study assessed CKD knowledge and preventive practices among adult diabetic patients at Muhimbili National Hospital (MNH)-Mloganzila and examined their association. Methods An analytical cross-sectional study was conducted from March 2023 to February 2024 among 284 randomly selected adult diabetic patients attending the MNH-Mloganzila diabetes clinic. CKD knowledge was assessed using an interview-administered questionnaire (maximum score = 10; ≥7 indicating adequate knowledge). Preventive practices related to lifestyle and risk factor modification were assessed. Associations between CKD knowledge and preventive practices were analyzed using Chi-square tests and multivariable logistic regression. Results The median age was 62 years (IQR: 46–78), with 57.7% females. Adequate CKD knowledge was observed in 37.3% of participants. Most participants reported not smoking (93.7%), avoided herbal medications (94.4%), and avoided alcohol (78.5%), though only 19% engaged in regular physical exercise and 20.1% limited salt intake. Having secondary education (AOR = 4.12, 95% CI: 1.43–11.89) and higher education (AOR = 16.99, 95% CI: 5.13–56.22), as well as diabetes duration of 5–10 years (AOR = 3.05, 95% CI: 1.41–6.58), were independently associated with adequate CKD knowledge. Conclusion CKD knowledge and preventive practices are suboptimal among diabetic patients. Integrating CKD education into routine diabetic follow-up is essential for early detection and prevention of CKD among this population.
Research Article
[version 1; peer review: awaiting peer review]
https://orcid.org/0009-0003-5218-1077
1, Vanessa Rutabanahttps://orcid.org/0009-0003-5218-1077
1, Ramadhani M. Sebeahttps://orcid.org/0009-0000-9519-8723
1, [...] Rashad Mustapha1, Theresia A. Ottaru1, Alfred Jubilatehttps://orcid.org/0000-0003-2381-3226
1, Hery C. Sylivester1https://orcid.org/0009-0003-5218-1077
1, Vanessa Rutabanahttps://orcid.org/0009-0003-5218-1077
1, [...] Ramadhani M. Sebeahttps://orcid.org/0009-0000-9519-8723
1, Rashad Mustapha1, Theresia A. Ottaru1, Alfred Jubilatehttps://orcid.org/0000-0003-2381-3226
1, Hery C. Sylivester11 Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences School of Public Health and Social Sciences, Dar es Salaam, Dar es Salaam, Tanzania
Satrumin A. Shirima
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Resources, Supervision, Validation
Vanessa Rutabana
Roles: Data Curation, Writing – Original Draft Preparation, Writing – Review & Editing
Ramadhani M. Sebea
Roles: Data Curation, Formal Analysis, Writing – Review & Editing
Rashad Mustapha
Roles: Data Curation, Formal Analysis, Writing – Review & Editing
Theresia A. Ottaru
Roles: Methodology, Supervision, Writing – Review & Editing
Alfred Jubilate
Roles: Formal Analysis, Methodology, Writing – Review & Editing
Hery C. Sylivester
Roles: Formal Analysis, Writing – Review & Editing
OPEN PEER REVIEW
REVIEWER STATUS AWAITING PEER REVIEW
Corresponding author: Satrumin A. Shirima Competing interests: No competing interests were disclosed.
Grant information: This study was supported by the MUHAS–Tanzania Diabetes Association (TDA) Non-Communicable Diseases (NCD) Research Grant, 2023. No grant number was assigned.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Copyright: © 2026 Shirima SA et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Shirima SA, Rutabana V, Sebea RM et al. Knowledge and preventive practices for chronic kidney disease among adult diabetic patients at Muhimbili National Hospital-Mloganzila diabetes Clinic in Tanzania: cross-sectional study. [version 1; peer review: awaiting peer review]. F1000Research 2026, 15:1368 (https://doi.org/10.12688/f1000research.186569.1) First published: 13 Aug 2026, 15:1368 (https://doi.org/10.12688/f1000research.186569.1) Latest published: 13 Aug 2026, 15:1368 (https://doi.org/10.12688/f1000research.186569.1)
Chronic kidney disease (CKD) is a debilitating condition characterized by progressive loss of kidney function, which can lead to fluid overload, electrolyte imbalances, and accumulation of nitrogenous wastes in the body. According to Kidney Disease: Improving Global Outcomes (KDIGO), CKD is defined as abnormalities of kidney structure or function persisting for more than three months, with health implications. This includes a glomerular filtration rate (GFR) <60 ml/min/1.73 m2 or markers of kidney damage, such as albuminuria, for over three months.1
Diabetes mellitus and hypertension are the leading contributors to CKD, with diabetes alone accounting for approximately half of CKD cases globally, and hypertension contributing about 23%.2 The International Diabetes Federation estimated that in 2021, 537 million adults worldwide were living with diabetes, representing a 16% increase since 2019. In Tanzania, the prevalence of diabetes among adults was reported at 12.3% in 2021.3,4 Studies in Tanzanian tertiary hospitals indicated a high burden of CKD among diabetic patients; for example, at Bugando Medical Centre, 83.7% of diabetic patients were found to have CKD, yet none were aware of their condition, and only 1.3% had a recorded diagnosis.5
Patient education, self-care, and empowerment are vital components in managing diabetes and chronic kidney disease (CKD). The American Diabetes Association (ADA) and KDIGO guidelines emphasize the importance of patients actively participating in their care in collaboration with healthcare professionals to develop personalized treatment plan.6,7 Empowered patients who are knowledgeable about their condition-including aspects such as diet, physical activity, medication adherence, and monitoring-are more likely to engage in preventive behaviors6 Additionally, regular physical activity (≥150 minutes per week) and smoking cessation are strongly encouraged.6,7 By focusing on these elements, the goal is to enhance early detection of CKD and to minimize complications among patients with diabetes.
Despite the availability of relatively simple screening tools, effective implementation of diabetes-associated CKD screening in low- and middle-income countries remains limited, and the cost-effectiveness of such screening has not been well explored. This highlights a critical gap in early detection and preventive care among diabetic patients in resource-limited settings,8 thus patient knowledge and awareness as well as preventive practices remains crucial for the prevention of CKD in this population. Evidence suggests that individuals with adequate knowledge of CKD are more likely to adopt preventive behaviors, seek routine screening, and receive timely diagnosis.9,10 Despite this, there is limited evidence in Tanzania on diabetic patients’ knowledge of CKD and whether this influences preventive practices. A recent multi-region study among 5,121 Tanzanian adults reported that lifestyle practices often remain incongruent with knowledge of non-communicable disease risk factors.11 Understanding CKD knowledge and prevention practices among diabetic patients is therefore crucial to inform interventions that can reduce CKD burden and improve early detection in resource-limited settings.
Given the high burden of CKD among diabetic patients in Tanzania and the potential role of patients’ knowledge in improving preventive behaviors, this study was conducted to assess CKD knowledge and preventive practices among diabetic patients attending a tertiary hospital in Tanzania, by determining the level of knowledge regarding CKD among diabetic patients, describing the preventive practices adopted to reduce CKD risk and examining the association between CKD knowledge and preventive practices among diabetic patients.
This is an analytical cross-sectional study conducted at the Diabetes Clinic of Muhimbili National Hospital (MNH)–Mloganzila, Dar es Salaam, between March 2023 and February 2024. This clinic provides specialized outpatient care for patients with diabetes mellitus, receiving referrals from primary health facilities, regional hospitals, and other departments within MNH. On average, 60–80 patients attend the clinic daily. The study aimed to assess knowledge of CKD and preventive practices among adult patients with diabetes receiving care at the MNH clinic.
Eligible participants for the study included adults (≥18 years) with a confirmed diagnosis of diabetes mellitus who attended the clinic at MNH and provided written informed consent. Newly diagnosed patients (<3 months), pregnant women, severely ill patients, and those with mental illness were excluded from this study.
The sample size was calculated using the single population proportion formula, a prevalence of 23% for good CKD knowledge among diabetic patients from a previous similar study in Malaysia12 with a 5% margin of error and a 95% confidence interval. This yielded a sample size of 272 participants. After adjusting for a 10% non-response rate, the final sample required was 300 participants. A total of 284 participants were finally enrolled in this study.
A sampling frame was obtained from the clinic appointment registry of all diabetic patients scheduled for that day. Participants were selected using simple random sampling through computer-generated random numbers using their hospital registration numbers. On each clinic day, selected patients were approached consecutively and screened for eligibility. Eligible patients were invited to participate in the study. Participants were not allowed to participate more than once during different visits.
Data were collected using an interviewer-administered structured questionnaire adopted from a validated questionnaire modified to suit our local context.13 It was also translated into Swahili to make it easier for the participants to understand. This questionnaire consisted of a section for sociodemographic and clinical characteristics of participants, such as age, sex, level of education, and duration of diabetes. A total of 7 questions were used to assess knowledge of CKD (S1 Appendix-Section B). Questions were B1, B2, B3, B4, B5, B6, B7, B8, and B9, which focused on whether the participant could correctly identify the functions of the kidney, the population at risk of CKD, and the signs and symptoms of CKD. Questions B1, B3, B4, and B5 each had a score of 1 for correct responses and 0 for incorrect or “don’t know” responses. Questions B2, B6, and B7 each had a score of 2 for participants who mentioned two options as required; for those who mentioned only one available option, they scored 1, and 0 for incorrect or “don’t know” responses. The overall score on CKD knowledge was calculated by summing the correct responses, with a maximum possible score of 10.
The overall score was then categorized using Bloom’s cutoff criteria into two groups: adequate knowledge (overall score ≥ 7) and inadequate knowledge (overall score < 7). Participants were also asked about practices toward the prevention of CKD. Five prevention practices were assessed, including avoiding cigarette smoking, avoiding alcohol drinking, avoiding unprescribed herbal medication use, avoiding adding excess salt to the diet beyond the recommended amount, and performing regular physical exercise (S1 Appendix-section B).
The questionnaire was pretested among 5% of the sample at the clinic, and internal consistency was acceptable (Cronbach’s alpha = 0.672 for knowledge questions, 0.665 for preventive practices). This was not included in the final analysis.
Data was entered and analyzed using SPSS version 25. Continuous variables were summarized using the mean and standard deviation (or median and interquartile range for skewed data), while categorical variables were summarized using frequencies and percentages. Bivariate analysis was conducted using Chi-square tests, and variables with p < 0.2 were included in multivariable logistic regression to control for potential confounders, including age, sex, education, and duration of diabetes. Statistical significance was set at p < 0.05.
Ethical approval was obtained from the Institutional Review Board of Muhimbili University of Health and Allied Sciences (REF NO DA 282/298/01 L/116), with additional permission from the Directorate of Research at MNH–Mloganzila and the Head of the Diabetes Clinic. Written informed consent was obtained from all participants, and confidentiality was maintained throughout the study.
Among 284 participants, 164 (57.7%) were female. The median age of participants was 62 (IQR: 46–78) years, and the majority were between the ages of 61 and 70 years. Of all participants, 219 (77.1%) were married, 129 (45.4%) had primary school education as their highest level of education, 128 (45.1%) were self-employed, and 175 (61.6%) had a daily income of more than 1.9 USD. Of all study participants, 245 (86.3%) had type II diabetes, 217 (76.4%) were on oral hypoglycemics, and 102 (35.9%) had been diagnosed with diabetes for more than 10 years. Table 1 below summarizes the socio-demographic and clinical characteristics of the participants.
Out of the 284 participants included in the study, only 106 (37.3%) participants had adequate knowledge of CKD (Scored at least 70% in the CKD knowledge questionnaire). The mean knowledge score was 5.8 ± 2.29, which falls under the inadequate knowledge category. The most reported sources of information on CKD were health professionals (58.9%), friends (38.4%), and television (19%). A substantial percentage of the participants (53, 18.7%) reported never having heard of CKD at all. Table 2 below summarizes the responses to the CKD questions.
1. Frequency, n (%)
The distribution of CKD knowledge scores across selected socio-demographic and clinical characteristics is shown in Table 3. There was no statistically significant difference in CKD knowledge scores between male and female participants (p = 0.629). Median scores were also similar in both groups. However, knowledge scores differed significantly across age groups (p = 0.012). Participants aged less than 50 years had the highest mean score (6.47 ± 1.92), while those aged 70 years and above had the lowest mean score (4.69 ± 2.67). A clear difference in knowledge scores was observed across levels of education (p < 0.001). Participants with higher education had the highest mean knowledge score (7.55 ± 1.82), followed by those with secondary education (6.17 ± 2.08). Participants with no formal education or less than primary education recorded the lowest mean score (4.22 ± 2.49). Knowledge scores also varied by duration of diabetes (p = 0.001). Participants with a diabetes duration of 5–10 years had a higher mean score (6.26 ± 2.24) compared to those with diabetes for less than 5 years (6.05 ± 2.16) and those with a diabetes duration of more than 10 years (5.21 ± 2.33).
The responses of the participants on preventive practices for CKD are shown in Table 4. Most participants reported no current cigarette smoking, with 78.5% having never smoked, while only 3.2% were current smokers. Nearly four in five participants, 227 (79.9%), reported adding excess salt to food above the recommended daily amount. Regarding avoidance of alcohol use, about one-fifth (21.5%) of participants were current drinkers, while almost half (46.5%) reported never drinking alcohol. Use of unprescribed herbal medications was uncommon, with the majority of participants (94.4%) reporting no use, with only a few (1.1%) reporting daily to weekly use. However, majority of the participants had reported not engaging in regular physical exercise as recommended, with only 54(19%) participating in physical exercise more than 3 times in a week.
In bivariate analysis, as shown in Table 5, knowledge of CKD was significantly associated with performing physical exercises (p-value = 0.018). The proportion of those who were not performing physical exercise was significantly higher among those with inadequate knowledge of CKD compared to those with adequate knowledge. There was no significant association between knowledge of CKD and avoidance of cigarette smoking, avoidance of alcohol drinking, avoidance of using unprescribed herbal medications, and limiting salt to the advisable daily amount in the diet.
A multivariable logistic regression analysis including all variables was performed to identify independent predictors of Adequate CKD knowledge and to control for potential confounding, as shown in Table 6. After adjustment, the level of education and duration of diabetes were found to be independently associated with adequate CKD knowledge. Participants with secondary education were about four times more likely to have adequate knowledge compared with those with no formal or less than primary education (AOR = 4.123; 95% CI: 1.43–11.885; p = 0.009). This association was stronger among participants with higher education, who were nearly 17 times more likely to have adequate CKD knowledge (AOR = 16.99; 95% CI: 5.13–56.22; p < 0.001).
Participants with a diabetes duration of 5–10 years had a significantly higher likelihood of adequate CKD knowledge compared with those with a diabetes duration of less than five years (AOR = 3.05; 95% CI: 1.41–6.58; p = 0.005). Sex, age, lifestyle, and behavior-related factors—including cigarette smoking status, alcohol consumption, physical activity, herbal medication use, and salt intake-were not significantly associated with CKD knowledge after adjustment (p > 0.05).
This study assessed knowledge of CKD and preventive practices among diabetic patients attending a tertiary hospital in Tanzania and examined the association between knowledge and preventive behaviors. The findings demonstrate that only 37.3% of participants had adequate knowledge of CKD, indicating substantial gaps in awareness among diabetic patients in this setting. Additionally, while knowledge was significantly associated with physical activity, it was not significantly associated with most other preventive practices.
The proportion of participants with adequate CKD knowledge in this study was low. This finding aligns with studies conducted in other low- and middle-income countries (LMICs), which report generally inadequate knowledge of CKD among diabetic populations.14 A significant proportion of participants in this study, 53 (18.7%), who had never heard of CKD, further underscores the magnitude of the knowledge gap. This is particularly concerning given the previously reported high burden of CKD among diabetic patients in Tanzania5 may contribute to delayed presentation and diagnosis, consistent with evidence from LMICs showing that CKD is often detected at advanced stages.8
Education level was independently associated with adequate CKD knowledge, with participants who had secondary or higher education demonstrating significantly greater knowledge. This finding is consistent with global evidence showing that higher educational attainment improves health literacy and disease-specific knowledge.15 Education likely enhances access to health information, comprehension of medical advice, and engagement with healthcare services.15 Duration of diabetes was also independently associated with knowledge. Patients with longer disease duration may have had more frequent contact with healthcare providers and greater exposure to health education messages, increasing cumulative knowledge over time.
Although cigarette smoking and herbal medication use were relatively low, the majority of participants reported adding excess salt to food and not engaging in regular physical exercise. These findings reflect suboptimal adherence to recommended preventive behaviors, particularly regarding lifestyle modification. The high proportion of participants not engaging in regular physical activity is concerning, given strong evidence that exercise improves glycemic control and reduces CKD progression risk.6,7 Similarly, excessive salt intake is associated with hypertension and faster CKD progression.7
Knowledge of CKD was significantly associated only with physical exercise, but not with other preventive practices such as smoking, alcohol use, salt intake, or herbal medication use. This suggests that knowledge alone may not be sufficient to drive consistent behavioral change. This finding is supported by behavioral science models such as the Health Belief Model and Theory of Planned Behavior, which demonstrate that knowledge is only one determinant of health behavior. Perceived susceptibility, perceived severity, cultural norms, environmental constraints, economic barriers, and self-efficacy also play critical roles.16,17
Several recent studies have similarly reported a gap between knowledge and practice in non-communicable disease prevention. A large Tanzanian study found that, despite sufficient knowledge of Non-communicable disease (NCD) risk factors, unhealthy lifestyle behaviors remained prevalent.11 Likewise, research in LMICs has shown that structural factors such as poverty, food insecurity, limited access to healthy foods, and lack of safe spaces for exercise hinder translation of knowledge into action16,17 Cultural dietary habits and economic limitations may partly explain the high salt consumption observed in this study. Additionally, physical inactivity may reflect environmental barriers rather than a lack of awareness.18 These findings highlight the need for structured interventions that go beyond patient education to address structural and contextual determinants of health behavior.
The findings suggest that strengthening patient education alone may not be sufficient to reduce CKD risk among diabetic patients. Interventions should incorporate behavioral counseling, culturally appropriate lifestyle programs, and system-level improvements to routine CKD screening in diabetes clinics. Integrating structured CKD education into routine diabetes care may improve early detection and patient empowerment in resource-limited settings.
This study has several limitations. Preventive practices were self-reported, which introduces the possibility of social desirability bias and recall bias. Participants may have over-reported healthy behaviors such as avoiding smoking or alcohol consumption. Also, response bias may have occurred if participants provided answers they believed were expected by healthcare professionals. The cross-sectional design, on the other hand, limits causal inference; the direction of association between knowledge and preventive practices cannot be established. This study was conducted at a single tertiary hospital, which may limit generalizability to other settings in Tanzania. Despite these limitations, the study provides important insights into CKD knowledge gaps and behavioral patterns among diabetic patients in Tanzania.
This study demonstrates inadequate CKD knowledge and suboptimal preventive practices among diabetic patients at high risk of kidney disease. Integrating CKD education and routine screening into standard diabetic follow-up care is essential. Nurse-led CKD education and counseling should be strengthened within diabetic clinics to improve patient awareness and preventive behaviors. Clinicians should also reinforce patient counseling on CKD prevention, while policymakers should support training of diabetic clinic staff and incorporate CKD risk assessment into routine diabetes management protocols to promote early detection and reduce disease progression.
Ethical approval for this study was obtained from the Muhimbili University of Health and Allied Sciences Institutional Review Board (Ref. No. DA 282/298/01 L/116). All participants provided written informed consent before participation.
This study is about Knowledge and Preventive Practices for Chronic Kidney Disease Among Adult Diabetic Patients at Muhimbili National Hospital–Mloganzila Diabetes Clinic in Tanzania: A Cross-Sectional Study.
The dataset underlying this study, together with the data collection questionnaire (provided as S1 Appendix), has been deposited in the Figshare repository and is available under a CC BY 4.0 licence at: https://doi.org/10.6084/m9.figshare.32938763.19
We are grateful for the support of all the participants in this study. We extend our gratitude to Miss.
Basilisa Sebastian Kalanga, a registered nurse at MNH-Mloganzila, for her essential assistance in data collection.
This study was supported by the MUHAS–Tanzania Diabetes Association (TDA) Non-Communicable Diseases (NCD) Research Grant, 2023. No grant number was assigned.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
© 2026 Shirima SA et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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