Discrepancies between diagnostic testing and continuity of care in CKDu surveillance: insights from a community-based study in Wilgamuwa, Sri Lanka

Chronic kidney disease of unknown etiology (CKDu) remains a significant public health concern in the dry zone of Sri Lanka, where its causes are still unclear. Although serum creatinine testing (SCT) is common, there is limited research on how these communities manage and retain medical records, which are crucial for continuity of care. This study aimed to investigate local awareness, health behaviors, and testing practices related to CKDu by focusing on SCT and report retention in the Wilgamuwa divisional secretariat of the Matale district. A cross-sectional, community-based screening was conducted across five grama niladhari divisions: Naminigama, Perakanaththa, Sonuththa, Wanarawa, and Dewagiriya. Trained fieldworkers administered structured questionnaires during household visits, gathering demographic data and medical histories, including physician-referred SCT and whether participants retained their test reports. Responses were self-reported and verified, when possible, through direct observation. Among the total screened population (n=4,988), 15.2% (n=757) had undergone SCT; however, only 22.8% (n=173) of those participants retained their test reports. Dewagiriya had the highest number of tests conducted (n=278), yet the retention rate of test reports was only 22.7%. In contrast, Naminigama exhibited the highest retention rate at 91.1%, while Sonuththa had the lowest retention rate at 7.4%. Notably, Wanarawa demonstrated a 100% retention rate, although fewer tests were conducted in this division. These findings highlight critical gaps in health record retention and follow-up care. While physician-referred testing indicates healthcare engagement, poor documentation and limited clinic follow-up hinder disease monitoring and management. Although health literacy was not formally measured, field observations suggested inconsistent understanding of CKDu and its monitoring needs. The study emphasizes the urgent need for improved community awareness and strengthened health record systems which are essential for ensuring early detection, timely interventions, and long-term management of the disease.