Preliminary assessment of socio-demographic, environmental, and lifestyle factors among healthy adults living in a CKDu-endemic area of Sri Lanka

Abstract

Chronic kidney disease of unknown etiology (CKDu) is a major public health concern in Sri Lanka, particularly in certain agricultural regions such as North Central, North Western, Uva, and more recently, Central Provinces. This preliminary study aimed to identify the sociodemographic, environmental, and lifestyle factors of healthy adults living in a CKDu-endemic area in Sri Lanka. A cross-sectional survey was conducted among 30 healthy adults selected through stratified random sampling from the Perakanaththa, Naminigama, and Wilgamuwa Grama Niladhari Divisions, based on defined inclusion and exclusion criteria. Socio-demographic and environmental data were collected using a pre-tested, interviewer-administered questionnaire. Data were entered and analysed using SPSS version 25. All participants were engaged in agriculture as their primary livelihood, mainly growing maize and rice cultivation, with 40% also involved in the livestock sector. The majority (43.3%) were between 41 and 50 years of age, with an equal male-to-female ratio (1:1). Most households (80%) had incomes below the poverty line, with 63.3% earning less than LKR 10,000 per month. The majority of participants (43.3%) had completed their education up to the Ordinary Level. A large proportion (76.7%) had lived in the area for over 20 years. Regarding environmental exposures, 26.6% reported daily mosquito coil smoke exposure exceeding three hours. Almost all participants (96.7%) used both aluminium and clay cookware, while most stored water in plastic containers. Housing materials commonly included asbestos roofing (73.3%), cement flooring (73.3%), and brick walls (93.3%). Fertilisers were applied by 73.3%, but only 9.1% of these used protective clothing. Handling pesticides was reported by 63.3%, with 10.5% of them using protective clothing. Current drinking water sources included reverse osmosis (RO) water (50%) and well water (33.3%). The RO water consumption started in the last five years. Among males, 60% consumed alcohol, 40% smoked cigarettes or beedi, and 83.3% reported betel chewing. Additionally, 53.3% reported a family history of CKDu, involving one or two family members. These preliminary findings reveal a high prevalence of potential CKDu-related risk factors among healthy adults in the study area, including long-term residence in endemic regions, occupational exposure to agrochemicals without adequate protection, the use of asbestos roofing and aluminium cookware, and widespread betel chewing. Further research will be conducted in non-endemic areas to compare these factors and better understand their association with CKDu.