Botswana Guardian

Kidney disease affects many Batswana

But most are not diagnosed until it is too late

- Patrick Jolomba* Patrick Jolomba, Medical science researcher, Scientific Expert and member of the United Kingdom Health Research Authority; Research Ethics Committee

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.

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