Poor Nigerians between ages 12 and 60, grappling with kidney function damage will again mark World Kidney Day 2023 with high out-of-pocket expenses, no treatment coverage within the national health insurance net, and limited access to care facilities.
At least, more than one percent of Nigeria’s population faces chronic kidney disease (CKD), with the greater spread among nearly 90 million poor people classified under the vulnerable group.
The Nigerian social media spaces are still littered with pitiful cases of patients who resort to public pleas to crowd-fund overwhelming treatment costs, often for consistent dialysis or transplant overseas.
This has left medical experts sounding the alarm that prevention could be the most viable option to reduce the burden of the disease, particularly for those yet to be struck.
Although access to diagnosis and early detection of kidney damage has improved with some urine tests going as low as N500 and blood tests at N5,000, experts are concerned that the unaffordability of treatment could keep the mortality rate growing.
“Nigerians should avoid anything injurious to their kidneys’ health, especially hypertension and diabetes. These are the two common causes of kidney diseases. To prevent hypertension, people should watch their diet, limit their salt intake, exercise, and regularly run tests to monitor their figures. Same for diabetes” Prof. Adetokunbo Fabamwo, chief medical director, Lagos State University Teaching Hospital (LASUTH) told BusinessDay.
According to the World Kidney Day Joint Steering Committee, this year’s commemoration is themed “Kidney Health for All – Preparing for the unexpected, supporting the vulnerable!”
It is focused on raising awareness about disastrous events, natural or man-made, international or local, and their impact on people living with kidney disease whose access to appropriate diagnostic services, treatment, and care is hindered.
In Nigeria, poverty is a key hindrance to care. For instance, a 2020 study of the cost implication of in-patient care of chronic kidney disease at the Department of Internal Medicine, University of Medical Sciences Teaching Hospital, Ondo shows that the cost is out of reach of most Nigerians.
The study which captured the financial records of the ward, laboratory, dialysis, pharmacy, and dietary services shows that a Nigerian depending on the minimum monthly wage of N30, 000 cannot foot the bill of an unexpected kidney failure.
Neither can those living below the poverty line of $1.25 or N875.
The total direct cost of inpatient care for CKD was N150,770 ($431) and the cost of care was higher in those with stage 5 CKD and diabetic nephropathy.
106 or 86.2 precent of patients observed had stage 5 CKD, 105 (85.4%) had emergency hemodialysis (HD) at presentation and all patients paid out of pocket. The average number of HD sessions and days spent on admission was 4 and 14 days, and the major contributors to the cost of care were total dialysis, ward, and pharmacy expenses.
“Healthcare access in Nigeria is not equitable. At present, the NHIS does not cover all aspects of renal care in Nigeria: only six sessions are covered yearly. This is grossly inadequate in sustaining the life of CKD patients,” the report stated.
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“However, if the persistent efforts and advocacy of the Nigerian Association of Nephrology yield the intended result, the NHIS will cover the cost 36 of sessions of HD yearly for ESRD patients and immunosuppressant therapy for kidney transplant patients; although, this is yet to be implemented,” the report stated.
Actions
Olugbenga, Awobusuyi, president-elect, the Nigerian Association of Nephrology (NAN) said the group is pushing for the establishment of a Nigeria Kidney Institute at the national assembly. At the local level, it will provide screening to people screen people across the country, give feedback to patients and organize referrals for those with very severe damage.
He noted that the Lagos state government has some support for the elderly above 60 and children below 12.
However, he has urged for increased caution around actions that build up to kidney damage.
As highlighted by professor Fabamwo, reduction of salt consumption is a proactive measure that the majority of Nigerians can adopt, just as avoiding toxic herbal concoctions.
The World Health Organization (WHO) Global report on sodium intake reduction shows that the world is off-track to achieve its global target of reducing sodium intake by 30 percent by 2025.
The global average salt intake is estimated to be 10.8 grams per day, more than double the WHO recommendation of fewer than 5 grams of salt per day (one teaspoon).
Eating too much salt makes it the top risk factor for diet and nutrition-related deaths. The global health body says more evidence is emerging documenting links between high sodium intake and increased risk of other health conditions such as gastric cancer, obesity, osteoporosis and kidney disease.
only 3% of the world’s population is protected by mandatory sodium reduction policies and 73% of WHO Member States lack full range of implementation of such policies.
It has called for implementing cost-effective sodium reduction policies that could save an estimated 7 million lives globally by 2030.
Nigeria is excluded from a list of nine countries (Brazil, Chile, Czech Republic, Lithuania, Malaysia, Mexico, Saudi Arabia, Spain, and Uruguay) that have a comprehensive package of recommended policies to reduce sodium intake.
WHO expects the reformulation of foods to contain less salt, and set targets for the amount of sodium in foods. It wants the public food procurement policies to limit salt or sodium-rich foods in public institutions such as hospitals, schools, workplaces, and nursing homes.
It has also called for visible labelling that helps consumers select products lower in sodium.
In preparation for unexpected events, the World Kidney Day Joint Steering Committee has asked policymakers to adopt integrated health strategies that prioritise prevention, early detection, and management of NCDs, including kidney disease.
It is seeking equitable and proper access to care for chronic patients in times of emergency and demanding that governments should include emergency preparedness plans in the management and detection of NCDs and favour the prevention of these conditions.
It urged patients to plan for emergencies by preparing an emergency kit that includes food, water, medical supplies, and medical records.
