{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T05:08:33Z","timestamp":1772168913695,"version":"3.50.1"},"update-to":[{"DOI":"10.12688\/f1000research.145904.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T00:00:00Z","timestamp":1736467200000}},{"DOI":"10.12688\/f1000research.145904.2","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T00:00:00Z","timestamp":1736467200000}}],"reference-count":22,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T00:00:00Z","timestamp":1736467200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001292","name":"Edinburgh Napier University","doi-asserted-by":"publisher","award":["PartialfundingfromPublicEngagementFund."],"award-info":[{"award-number":["PartialfundingfromPublicEngagementFund."]}],"id":[{"id":"10.13039\/501100001292","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns4:p>\n                    Chronic kidney disease (CKD) is a persistent, devastating, yet neglected, non-communicable disease, particularly in developing and emerging countries. The traditional risk factors for CKD, such as hypertension and diabetes have received relatively ample attention but do not sufficiently explain the high burden of CKD. Ambient air pollution is an emerging environmental risk factor for CKD; however, epidemiological data and evidence are lacking for susceptible populations in developing countries. The Niger Delta region of Nigeria is a petrochemical hub known for environmental degradation, including air pollution, and thus, serves as a good case study for investigating the association between air pollution and CKD. This brief is based on an exploratory mixed-methods study conducted in four communities situated near an oil and gas refinery in Warri, Nigeria, to explore perceived and actual air pollution risks and determine whether long-term exposure to ambient air pollution is associated with CKD. Air pollutant concentrations measured in partnership with citizen scientists using portable air sensors, showed that all except one air pollutant (ozone) exceeded the WHO acceptable limits in all four communities. PM2.5 ranged from 22.8 to 28.0 \u03bcg\/m\n                    <ns4:sup>3<\/ns4:sup>\n                    , PM10, 40.6 to 55.5 \u03bcg\/m\n                    <ns4:sup>3<\/ns4:sup>\n                    , and CO2, 584-652 ppm. The overall prevalence of CKD was 12.3% but even higher (18%) in a socially deprived semi-urban community closest to the oil refinery. Hypertension, diabetes, other behavioral risk factors, and exposures associated with CKD were prevalent in the four communities and environmental health information was lacking. A multifaceted approach is required to mitigate air pollution and the associated NCD risks in the region. The government needs to invest in air monitoring services, cleaner technologies, and environmental risk communication through various media channels. We strongly recommend public inclusion in planning, designing, and implementing educational interventions. Lastly, environmental risk factors such as air pollution should feature prominently in strategic plans for NCD prevention.\n                  <\/ns4:p>","DOI":"10.12688\/f1000research.145904.3","type":"journal-article","created":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T11:05:07Z","timestamp":1736507107000},"page":"265","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Ambient Air Pollution and Chronic kidney disease risk in Deltan communities: A Policy Brief, 2023"],"prefix":"10.12688","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4993-0474","authenticated-orcid":false,"given":"Ogochukwu","family":"Okoye","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elaine","family":"Carnegie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luca","family":"Mora","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2025,1,10]]},"reference":[{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-015069","article-title":"Prevalence and burden of chronic kidney disease among the general population and high-risk groups in Africa: a systematic review.","volume":"8","author":"S Abd ElHafeez","year":"2018","journal-title":"BMJ Open."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"311-319","DOI":"10.2215\/CJN.08350719","article-title":"Particulate Matter and Albuminuria, Glomerular Filtration Rate, and Incident CKD.","volume":"15","author":"M Blum","year":"2020","journal-title":"Clin. 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Res."}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/13-265\/v3\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/13-265\/v3\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/13-265\/v3\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T11:05:10Z","timestamp":1736507110000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/13-265\/v3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,10]]},"references-count":22,"URL":"https:\/\/doi.org\/10.12688\/f1000research.145904.3","relation":{"has-version":[{"id-type":"doi","id":"10.12688\/f1000research.145904.2","asserted-by":"subject"},{"id-type":"doi","id":"10.12688\/f1000research.145904.1","asserted-by":"subject"}],"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.176702.r358176","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,10]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/13-265\/v3#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.159925.r268338, Chao Yang, Peking University, Beijing, Beijing, 08 May 2024, version 1, 1 approved, 1 approved with reservations, 1 not approved","URL":"https:\/\/f1000research.com\/articles\/13-265\/v1#referee-response-268338","order":0,"name":"referee-response-268338","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Ogochukwu Okoye<\/b>; \n<i>Posted: 17 Jun 2024<\/i>; Thank you for your kind critique of the manuscript.&nbsp; All your comments are valid and appreciated. Being a policy brief, the manuscript was intentionally shortened to provide the basic information in a simple way for the intended audience, which includes policy makers.&nbsp;  More detailed Original manuscripts for a scientific audience &nbsp;have been written and are currently undergoing peer review. However, the link to the Study Thesis was provided with this submission.&nbsp;  Thank you.","URL":"https:\/\/f1000research.com\/articles\/13-265\/v3#referee-comment-11795","order":1,"name":"referee-comment-11795","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Ogochukwu Okoye<\/b>; \n<i>Posted: 30 Sep 2024<\/i>; \n<b>REVIEWER 1<\/b>  We are grateful for your detailed and constructive critique which has helped to significantly improve the merit and quality of our manuscript   1) \n<b>The authors should provide a more detailed description of the mixed-methods approach used in the study. Clarify the specific quantitative and qualitative methods employed, sample sizes, and data collection techniques.<\/b> Thank you for your observations. &nbsp;Extensive methodological and statistical details were deliberately omitted as the manuscript was targeted at policymakers. However, we have provided additional details in the text. The underlying study was \n<b>an exploratory mixed methods study with an embedded citizen science inquiry<\/b>. Details of the first strand which was a focus group has been published and we have provided a reference to the article. In the current brief, we focus on findings from the other strands of the study.&nbsp;&nbsp; (Pages 2,3,5)  2) \n<b>The paper mentions that air pollutant concentrations were measured and compared to WHO limits. However, the analysis of these data and their statistical significance is lacking. The authors should include a more thorough analysis of the air pollution data.<\/b> For the reasons mentioned above, we omitted these details. However, some additional data have been provided in the text and as supplementary files. (Page 5, suppl 1, Figure 1)  3) \n<b>The paper discusses the association between ambient air pollution and CKD risk, but does not claim causality. The authors should clarify this distinction and discuss potential confounders or alternative explanations for the observed association.<\/b> We agree with your observations. We have provided details of confounding factors considered and a supplementary file containing updated results from a binary mixed effects logistic model conducted to account for clustering effects.  We report that long-term exposure to ambient air pollution is associated with CKD risk, but does not independently increase its risk, after adjusting for clustering effects and confounders (age, gender, hypertension, level of education and diabetes). (Page 6, suppl 2)  4) \n<b>The paper should acknowledge other limitations of the study, such as sample size, data availability, or methodological constraints. Additionally, the authors should discuss potential directions for future research to build upon the current findings.<\/b>  The section on limitation of the study has been improved and \n<b>suggestions for future research as follows<\/b>:  \u201cMore research is required from under-served areas to explore:&nbsp; this exposure-effect relationship, the mechanism of air pollution associated CKD and potential interventions to reverse it; and to develop educational interventions that would effectively improve public awareness of environmental health risks\u201d.&nbsp; (Page 11)  5) \n<b>The authors should discuss the generalizability of their findings to other communities and regions with similar industrial activities.<\/b>  This has been included. \u201c\u2026. our findings are generalisable to similar vulnerable populations across the globe who reside near point emission sources\u201d (Page 7)","URL":"https:\/\/f1000research.com\/articles\/13-265\/v3#referee-comment-12543","order":2,"name":"referee-comment-12543","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.159925.r292274, Nikola M Pavlovi\u0107, University of Ni\u0161, Ni\u0161, 11 Sep 2024, version 1, 1 approved, 1 approved with reservations, 1 not approved","URL":"https:\/\/f1000research.com\/articles\/13-265\/v1#referee-response-292274","order":3,"name":"referee-response-292274","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Ogochukwu Okoye<\/b>; \n<i>Posted: 30 Sep 2024<\/i>; We are grateful for your detailed and constructive critique which has helped to improve the merit and quality of our manuscript.&nbsp;&nbsp; &nbsp;  ABSTRACT \n<b>Reviewer comment: <\/b>Objective Clarification: Include a brief statement that clearly outlines the study's objective.&nbsp;&nbsp; &nbsp; \n<b>Author response: <\/b>The objective has been clarified as follows: \u201cThis brief is based on a mixed-methods study conducted in four communities situated near an oil and gas refinery in Warri, Nigeria to explore perceived and actual air pollution risk and determine whether long-term exposure to AAP increases NCD risk\u201d (Page 2)  \n<b>Reviewer comment:&nbsp; <\/b>Methodology Mention: Explicitly mention that a mixed-methods approach was used.&nbsp;&nbsp; &nbsp; \n<b>Author response: <\/b>Done as stated above&nbsp;&nbsp;  \n<b>Reviewer comment: <\/b>Specific Findings: Highlight specific data points, such as the exact levels of pollutants that exceed WHO limits.&nbsp;&nbsp; &nbsp; \n<b>Author response: <\/b>Included as follows: \u201cMeasured PM\n<sub>2.5<\/sub> ranged from 22.8 \u2013 28.0 \u03bcg\/m3, PM\n<sub>10<\/sub>, 40.6 - 55.5 \u03bcg\/m3, and CO\n<sub>2<\/sub>, 584-652ppm\u201d.&nbsp;&nbsp; &nbsp;2  \n<b>Reviewer comment: <\/b>Policy Recommendations: Summarise one or two key policy recommendations for a clear takeaway.\n<b>&nbsp;<\/b>&nbsp; &nbsp; \n<b>Author response: <\/b>Included as follows:&nbsp; \u201cThe government needs to urgently invest in air monitoring services and data, cleaner technologies and environmental risk communication through various media channels. We strongly recommend public inclusion in planning, designing and implementing future environmental interventions. Lastly, environmental risk factors such as air pollution should feature prominently in strategic plans for NCD prevention\u201d. (Page 2)  \n<b>Introduction<\/b>&nbsp; &nbsp; \n<b>Reviewer comment: <\/b>Streamlining: Consider consolidating the discussion on traditional CKD risk factors to avoid redundancy.&nbsp;&nbsp; Focused Transition: Ensure a smooth transition from discussing CKD globally to the specific context of the Niger Delta.&nbsp; &nbsp; &nbsp; &nbsp;&nbsp; Identification of Gap: Introduce the research gap on the link between air pollution and CKD in the Niger Delta earlier in the section.&nbsp;&nbsp; \n<b>Author response: <\/b>Thank you for your suggestions. We have reviewed this section accordingly. (Page 3)  \n<b>Reviewer comment: <\/b>Policy Outcomes and Implications \n<b>Author response: <\/b>This section has been improved accordingly &nbsp;&nbsp; &nbsp;  \n<b>Reviewer comment: <\/b>Direct Link: Explicitly connect the absence of CKD in national health policy to the study\u2019s findings on air pollution and CKD prevalence.&nbsp;&nbsp; &nbsp; \n<b>Author response: <\/b>This has been revised as follows: \u201cThis lack of recognition of CKD and the environmental risk factors important in the disease epidemiology, may explain why CKD and related NCDs are persistent.\u201d (Page 4)  \n<b>Reviewer comment: <\/b>Broader Implications: Discuss the broader public health implications if this policy gap continues, including potential long-term consequences.\n<b>&nbsp;<\/b>&nbsp;&nbsp; \n<b>Author response: <\/b>\u201cThe long-term consequences of continually neglecting CKD in health policies include the persistence of hypertension and CKD with associated considerable morbidity and mortality; high health care expenditure which further impoverishes the affected members of society and their families\u201d.&nbsp; &nbsp;(Page 4)  \n<b>Reviewer comment: <\/b>Evidence of High Ambient Air Pollutant Levels in Warri&nbsp;&nbsp; &nbsp;&nbsp;&nbsp; &nbsp; Narrative Flow: Integrate the table with the narrative by referencing key figures directly in the text.&nbsp;&nbsp; &nbsp; \n<b>Author response: <\/b>This section has been improved accordingly and highlighted in the text&nbsp; &nbsp; &nbsp; &nbsp; ( Page&nbsp; &nbsp;4-5)  \n<b>Reviewer comment: <\/b>Benchmark Against Global Standards: Briefly compare the findings with global or regional averages for context.&nbsp;&nbsp; &nbsp; \n<b>Author response: <\/b>This section has been improved as follows:&nbsp; \u201cThe PM2.5 concentrations for three of the communities are higher than Nigeria\u2019s 2023 average of 23.9 \u03bcg\/m3 (IQAIR) and five times higher than the WHO acceptable limit. Furthermore, these levels are much higher than 7.8\u03bcg\/m3 achieved in Angola, the least polluted African country which ranked 114th out of 134 countries, while Nigeria was ranked the 35th most polluted\u201d.( Page&nbsp; 4-5)  \n<b>Reviewer comment: <\/b>Graphical Representation: Consider using a graph to visualize the levels of pollutants across communities for greater impact.&nbsp;&nbsp; &nbsp; \n<b>Author response: <\/b>A bar chart showing air pollutant levels in the 4 communities have been included. (Figure 1)&nbsp; &nbsp;&nbsp;  \n<b>Reviewer comment: <\/b>High Prevalence of CKD and the Risk Factors&nbsp;&nbsp; &nbsp;&nbsp;&nbsp; &nbsp; Risk Factor Hierarchy: Present the risk factors in order of their strength of association with CKD.&nbsp;&nbsp; &nbsp; \n<b>Author response: <\/b>Included as follows:&nbsp; \u201cThe independent risk factors for CKD were proximity to the refinery [OR=2.00 (1.43 \u2013 2.81], increasing age [OR=1.02(1.005-1.04)], hypertension [OR=1.61(1.12-2.31)], and level of education [OR=0.63(0.44-0.91)]. In a further logistic mixed model, which accounted for clustering effects at household level, only increasing age was an independent risk factor for CKD [OR=1.16 (1.07-1.25)]\u201d, (Page 6) &nbsp; \n<b>Reviewer comment: <\/b>Visual Aids: While the current figure is useful, additional visual aids, such as bar charts or scatter plots, could further clarify the distribution of CKD stages across communities.&nbsp;&nbsp; \n<b>Author response: <\/b>&nbsp;A new figure showing the information requested has been included. (Figure 3) &nbsp;&nbsp; &nbsp; \n<b>Reviewer comment: <\/b>Contextualization: Briefly contextualize the CKD prevalence data with national or regional statistics to highlight the severity.&nbsp;&nbsp; &nbsp; \n<b>Author response: <\/b>Revised as follows: The prevalence of CKD reported across Nigeria and Sub-Saharan Africa varies greatly depending on the population studied, CKD definition and methodology; from as low as 2% to &gt;20% (Abd ElHafeez et al., 2018; Chukwuonye et al., 2018). However, our findings demonstrate a higher CKD prevalence in the nearest\/semiurban community A, compared with a pooled prevalence of 10% and 13.7% reported for Africa and Nigeria, respectively (Abd ElHafeez et al., 2018; Raji et al., 2024). (Page 5)  \n<b>Social Determinants of CKD Risk&nbsp; &nbsp; &nbsp; &nbsp;&nbsp; Reviewer comment: <\/b>Condensation: Consider condensing the list of behavioral factors by grouping similar items, such as unhealthy dietary habits.&nbsp;&nbsp;\n<b> <\/b>&nbsp; \n<b>Author response: <\/b>Revised as follows:&nbsp; \u2018Behavioural factors included unhealthy dietary habits (70-90%), low physical activity (47.2%), habitual exposure to potential nephrotoxins (37-44%)\u2019. (Page 6)  \n<b>Reviewer comment: <\/b>Clearer Connections: Draw clearer connections between these social determinants and the higher CKD prevalence, emphasizing the compounding effect of multiple risk factors.&nbsp;&nbsp; &nbsp; \n<b>Author response: <\/b>Revised as follows: \u201cThe concentration of multiple social and environmental risk factors in the studied population may explain the high prevalence of CKD and other NCDs. These findings support the multicasuation theory, drawing attention to the need for a multi-faceted approach to CKD prevention.\u201d (Page 6) &nbsp; &nbsp;&nbsp; \n<b>Reviewer comment: <\/b>Implications: Discuss the potential public health implications of these social determinants in more depth. \n<b>Author response: <\/b>Done as above. These points were further discussed in the section on implications for policy. (Pages&nbsp; 6,7)  \n<b>Reviewer comment: <\/b>Low Air Pollution Health Risk Literacy in Warri&nbsp;&nbsp; &nbsp;&nbsp;&nbsp; &nbsp; Direct Linkage: Explicitly link low literacy levels to poor health outcomes, particularly in the context of CKD and air pollution.&nbsp;&nbsp; &nbsp; \n<b>Author response: <\/b>Revised as follows:&nbsp; \u201cThis low literacy level suggests that the necessary preventive measures such as individual behavioral changes, are lacking and this may contribute to the high burden of air pollution associated NCDs in the community\u201d. (Page 7)  \n<b>Reviewer comment: <\/b>Awareness Campaigns: Suggest potential public health campaigns or educational interventions to improve awareness based on the findings. &nbsp;&nbsp; &nbsp; \n<b>Author response: <\/b>These have been suggested. \u201cThe high prevalence of CKD risk factors and low awareness of CKD and NCD status among the study participants suggests low health literacy and poor health-seeking behavior which necessitates more persuasive and inclusive public health educational interventions.\u201d&nbsp; (Page&nbsp; 7)  \n<b>Implications for Policy Reviewer comment: <\/b>Structured Recommendations: Present the policy implications in a more structured format, possibly using bullet points or numbered lists for clarity.&nbsp;&nbsp; &nbsp; \n<b>Author response: <\/b>This section has been reviewed accordingly. (Page 7,8)  \n<b>Reviewer comment: <\/b>Evidence Integration: Integrate specific study findings more directly into the policy recommendations to strengthen the argument for immediate action.&nbsp;&nbsp; &nbsp; &nbsp; Prioritization: Consider categorizing the recommendations into short-term, medium-term, and long-term actions.&nbsp;&nbsp; \n<b>Author response: <\/b>We appreciate your comments. This section has been improved as is shown in Table 1. (Page&nbsp; 8-11)  \n<b>Reviewer comment: <\/b>Stakeholder Engagement: Emphasize the role of specific stakeholders (e.g., government, NGOs, the public) in implementing these recommendations.&nbsp;&nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp; &nbsp; Feasibility: Briefly discuss the feasibility of these recommendations, particularly in the context of existing infrastructure and resources.&nbsp;&nbsp; &nbsp;&nbsp;&nbsp; &nbsp; \n<b>Author response: <\/b>These points have all been considered in the revised table of recommendations. (Page 8-11)  \n<b>Limitations of the Study Reviewer comment: <\/b>Strengths Emphasis: Counterbalance the limitations with a brief discussion of the study\u2019s strengths, particularly its novel approach and the involvement of citizen scientists.&nbsp;\n<b>&nbsp;<\/b> &nbsp; \n<b>Author response:&nbsp;<\/b>This has been included as follows:&nbsp; \u201cDespite the limitations, the strength of the underlying study lies in the relatively large sample size, the extensive consideration and adjustment for confounding factors, the innovative combination of multiple research methods and involving citizen scientists in addressing a public health problem\u201d. (Page 11)  \n<b>Reviewer comment: <\/b>Future Directions: Suggest specific areas for future research that could address these limitations, enhancing the study's impact. \n<b>Author response: <\/b>This has been included as follows:&nbsp; \u201cMore research is required from under-served areas to explore: &nbsp;this exposure-effect relationship, the mechanism of air pollution associated CKD and potential interventions to reverse it; and to develop educational interventions that would effectively improve public awareness of environmental health risks\u201d. (Page 110)  \n<b>Conclusion&nbsp; &nbsp; Reviewer comment: <\/b>Stronger Call to Action: End with a more forceful call to action directed at policymakers, highlighting the urgency of addressing CKD in the Niger Delta.&nbsp;&nbsp; &nbsp; \n<b>Author response: <\/b>Thank you for your suggestions. The section has been improved. (Page&nbsp; 11,12)  \n<b>Reviewer comment: <\/b>Summary of Key Points: Briefly summarize the most critical findings and recommendations to leave a lasting impression.&nbsp;&nbsp; &nbsp; \n<b>Author response: <\/b>Thank you for your suggestions. The section has been improved. (Page 11, 12)  \n<b>Overall&nbsp;&nbsp; &nbsp;&nbsp;&nbsp; &nbsp; Reviewer comment: <\/b>Consistency: Ensure consistency in the use of terms (e.g., CKD vs. chronic kidney disease) throughout the document.&nbsp;&nbsp; &nbsp; \n<b>Author response: <\/b>CKD is now used consistently throughout the text, except for where it was first mentioned. &nbsp;&nbsp; &nbsp; \n<b>Reviewer comment: <\/b>Clarity: While the document is generally clear, some sections, particularly those with dense data, could benefit from simpler language and clearer transitions.&nbsp;&nbsp; &nbsp; \n<b>Author response: <\/b>Thank you. The authors have made significant efforts to improve the clarity and readability of the document using a proof reader. &nbsp;&nbsp; &nbsp;  \n<b>Reviewer comment: <\/b>Visual Aids: Consider the strategic use of additional visual aids to break up text-heavy sections and improve reader engagement.&nbsp;&nbsp; &nbsp; \n<b>Author response: <\/b>Additional visual aids have been introduced. e.g., more figures and the recommendations have been tabulated. &nbsp;&nbsp;","URL":"https:\/\/f1000research.com\/articles\/13-265\/v3#referee-comment-12544","order":4,"name":"referee-comment-12544","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.159925.r279715, Nicholas Osborne, The University of Queensland, Saint Lucia, Queensland, 14 Sep 2024, version 1, 1 approved, 1 approved with reservations, 1 not approved","URL":"https:\/\/f1000research.com\/articles\/13-265\/v1#referee-response-279715","order":5,"name":"referee-response-279715","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Ogochukwu Okoye<\/b>; \n<i>Posted: 30 Sep 2024<\/i>; We are grateful for your detailed and constructive critique which has helped to significantly improve the merit and quality of our manuscript.&nbsp;  \n<b>Comment:<\/b> This study proposes to discover association between air pollution and CKD.&nbsp; Unfortunately, an accurate measure of air pollution was not available.&nbsp; Consequently, attempts to examine the relationship do not have data of sufficient quality to make the linkage. \n<b>Response:<\/b> Extensive methodological and statistical details were deliberately omitted as this document was targeted at policymakers. However, we have provided additional information in the text&nbsp; to describe how air pollution was measured and other details are available in the link to the underlying study.&nbsp; Page 4  \n<b>Comment: <\/b>Similarly, an accurate measure of the health outcome, kidney function was not available. Diagnosis of CKD requires two measures of kidney function (usually by eGRF) at least 3 months apart. \n<b>Response:<\/b> We agree with your observation. The authors initially set out to obtain at least two measurements from participants who have abnormalities but encountered challenges with participant retention. This limitation has been highlighted in more detail.&nbsp; However, all biological samples were handled and processed by a reputable independent laboratory with documented standard operating procedures to ensure accuracy and reliability.&nbsp; Page 11  \n<b>Comment: <\/b>The paper was not conducted as a policy brief.&nbsp; Large amounts of extant literature were missing from the evidence base presented\n<b>.<\/b> \n<b>Response:&nbsp;<\/b>Thank you for your valid observation. We structured the paper according to the journal's template for a policy brief. Our intention was to provide a brief summary of the underlying study before delving into the policy implications and recommendations. We deliberately excluded excessive statistical information to enhance readability for the non-academic audience. However, we have now included more data in the text figures and supplementary files.&nbsp;  \n<b>Comment: <\/b>The paper has a limited data reference list. \n<b>Response:&nbsp;<\/b>The short reference list was to adhere to the limits of a policy brief. More references have been included in specific sections. Pages 3,5,6,7,14  \n<b>Comment: <\/b>Abstract mentions CKDu in passing without mentioning its prevalence in certain LMIC settings.&nbsp; The disease CKDu in Sri Lankan and Mesoamerican settings. \n<b>Response:&nbsp;<\/b>Thank you for your comment. There may have been a mix up. CKDu was not mentioned in the abstract. -","URL":"https:\/\/f1000research.com\/articles\/13-265\/v3#referee-comment-12545","order":6,"name":"referee-comment-12545","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.172808.r348567, Karl  Kilbo Edlund, Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, G\u00f6teborg, 30 Dec 2024, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/13-265\/v2#referee-response-348567","order":7,"name":"referee-response-348567","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Ogochukwu Okoye<\/b>; \n<i>Posted: 30 Dec 2024<\/i>; We appreciate your review and useful critique.&nbsp; We acknowledge your main concerns and wish to respond here. However, we will revise our manuscript where needed.  1) Regarding the inclusion of considerable empirical data and analysis:&nbsp;&nbsp;&nbsp;The original manuscript submitted had minimal empirical data as expected for a policy brief. However, we included more data in response to two of the previous reviewers. We agree that the intended audience may find some aspects of the manuscript too technical and we will make some adjustments to minimise the data and complexity.  Although the empirical data has not been published in any journal, we included a link to the Thesis underlying this study. We agree that our data serves to support the existing literature on PM and kidney disease, although these studies are mostly from the global north.&nbsp; While we note the study limitations, we agree that our findings are a strong validation that air pollution associated health effects noted elsewhere also applies to the Niger Delta.&nbsp;  2) The section on &quot;High prevalence of CKD and risk factors&quot;&nbsp; will be split to improve clarity.&nbsp; 3) Response to concerns about some 'actionable recommendations:&nbsp; a)We agree that whole population screening may be cost-intensive and require cost-benefit analysis. However, screening of high-risk populations is currently recommended in Nigeria and globally. (KDIGO).&nbsp; Treatment options for early CKD mostly entails addressing identified risks to slow progression of the disease. These treatment measures are widely available.&nbsp;  b)We agree that the subsidy re-introduction would need a cost-benefit-analysis, which we consider a great suggestion for further studies.&nbsp; c) Thank you for drawing our attention to the possible Human Rights implication of requiring a medical fitness certificate before issuing international passport. We will explore the feasibility and revise this accordingly.  d) Regarding the calculated Hazard Quotients and Total HQ, we stated that the figures do not necessarily represent&nbsp; a statistical probability of harm occurring. However, we have included a further statement that 'the Total HQs do not represent synergies or magnitude of health effect'.&nbsp;  e) The concentration for VOC was not included in Figure 1, for simplicity of presentation as the values were less than 1. However, the HQs for VOC were included in the calculation of total HQ. Again, for simplicity, we have not included these details in the text. All information is available in the underlying Thesis.&nbsp;  f) The two references highlighted will be sorted. Thank you.&nbsp; g) We will replace 'R studios' with 'R'. Thank you","URL":"https:\/\/f1000research.com\/articles\/13-265\/v3#referee-comment-13043","order":8,"name":"referee-comment-13043","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This project was partially funded by Edinburgh Napier University's Public Engagement Fund. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":9,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}