Kidney disease affects many Batswana
But most are not diagnosed until it is too late
Kidney transplant is a form of treatment for kidney failure, but unfortunately transplants are not readily and abundantly accessible in most African countries.
This therefore makes all forms of kidney dialysis the primary option for life sustaining treatments for patients with late- stage kidney failure.
It is not surprising that kidney- related diseases are among the leading causes of indispositions and death in sub- Saharan Africa. There is also a clear rise in the occurrence of high blood pressure ( hypertension) and type- 2 diabetes. This increase is expected to have a negative impact on the incidence of kidney failure in Africa. Economically, this is also costing the continent a lot in health care services and otherwise.
However, it is not easy to properly quantify this as the number of studies on the economics and the impact of the kidney failure and its treatments such as dialysis is limited. Literature demonstrates that life maintenance treatments such as dialysis are expensive and not affordable in many parts of Africa. Most countries have an over- proportional burden to finance life- sustaining dialysis treatments.
Other factors that contribute to the increase in kidney failure and its cost implication in developing countries potentially include high levels of alcohol consumption and infections such as HIV and malaria. Some people suffering with severe cases of COVID- 19 are said to be showing signs of kidney damage, even those who had no previous kidney problems prior to infection. Already, scientific reports are showing that up to 30 percent of patients hospitalised with COVID- 19 in some countries developed moderate or severe kidney failure as a result of contacting COVID- 19 virus. More patients with kidney failure will require the use of kidney replacement devices and treatments to remain alive. Kidney failure will continue to overwhelm medical, social and economic budgets for patients, carers and family members as well as costs to the individual countries’ health care systems. More studies need to be undertaken in these countries to fully understand the implications and the direct costs of kidney failure and its treatment. The question of distributional equity is of paramount importance when dealing with expensive treatments in any case. Financial limitations seem to be the biggest contributory factor to the challenges of obtaining adequate dialysis treatments.
For those that can afford to start dialysis treatments in some of these developing countries, most of them will eventually stop the treatment because of the depletion of funds. Therefore, death and sickness will be higher in late stage kidney diseases in Sub- Saharan Africa compared to the developed countries.
Nephrologists ( doctors specialising in kidney diseases) in Botswana, say there is no precise and accurate data collection on the incidence and prevalence of late stage kidney diseases.
But the occurrence is estimated to be around 150/ million per year; translating to roughly 300 new patients falling into this category per year. This is a staggering number, given that Botswana’s population is relatively small. This group of patients are normally given a life sustaining treatment of either haemodialysis or peritoneal dialysis. The majority of these patients are treated from government funding, whereas about 15 percent are paid for by Medical Aid schemes. When funds run out with medical aid, the government takes over. Botswana’s approach illustrates a much better outcome compared to most African countries where patients with late stage kidney diseases will simply die because of lack of kidney replacement treatments or infrastructure. But compared to most developed countries where kidney replacement treatments are very much in advanced stages, the kidney dialysis rates across Africa are said to be less than 20 per million population as compared to a global prevalence of 223 per million. I strongly believe that scientifically sophisticated medical care can be well established in most developing countries. The approach requires intense effort and understanding of cost- effective exploration of modern medical equipment.
Initial work must embrace resolving ethical dilemmas, acquiring adequate funding, establishing expert- based supply lines, and cultivating skill based focused support. The decisions regarding how much to extend kidney dialysis in Africa need to be made in the context of overall benefit package- design, and alongside consideration of other components, such as preventative interventions or palliative care. Such considerations are particularly important in Africa where preventive efforts— tackling infections or hypertension and type- 2 diabetes— could reduce the incidence of late stage kidney disease. African countries should start to prepare and plan for the long- term burden that the Covid- 19 pandemic will cause. It is becoming clear that increase in kidney disease will inevitably be one them.