Salisu Hauwa, a 33-year-old woman in Gashau, a Local Government Area (LGA) in northern Yobe State, Nigeria was diagnosed with chronic kidney disease (CKD) at the Yobe State University Teaching Hospital (YSUTH) in Damaturu. This diagnosis came weeks after she had been experiencing headaches and continuous vomiting. According to her husband, Abubakar Mohammed, Hauwa's condition worsened, as she was constantly screaming, biting, and attempting to run away from the hospital leading some to believe that she was mentally ill. Before long, her condition became so severe that she could no longer recognise her husband and children.
Hauwa endured excruciating pain, causing her body to swell and her skin to peel. Throughout her stay in the hospital, she had 20 blood infusions and 35 dialysis sessions in a desperate attempt to save her life. Unfortunately, she passed away before the kidney transplant, leaving her family in enormous debt.
This year's World Kidney Day theme "Kidney Health for All- Advancing equitable access to Care and optimal medication practice" emphasises the need to break the barriers that prevent access to kidney care including lack of awareness, shortages of kidney specialists, and cost of treatment.
Kidney disease and its prevalence
Chronic kidney disease (CKD) is the 10th leading cause of all deaths globally and it affects approximately 10% of the global population, with more than 850 million people being affected. Gashua, a Local Government Area (LGA) in northern Yobe State, Nigeria is included in these figures.
CKD also known as kidney failure, is a progressive condition impairing kidney function. The non-communicable disease has five stages, from mild damage to total kidney failure. Individuals with CKD will require regular monitoring, diet changes and medication. The most common treatment of CKD is dialysis -- a medical treatment where a machine filters and cleans patient's blood outside their body and then takes it back into the body. In advanced stages, however, experts say only kidney transplants offer hope.
In Nigeria, the true prevalence of CKD remains uncertain due to an absence of available data for the disease. Available studies, many of which are hospital based, suggest a high incidence in the country, especially in northeast Nigeria. According to Dr. Baba Waru Goni, the Chief Medical Director (CMD) of YSUTH, "Yobe State, along with neighbouring states of Borno and Jigawa, carries a significant burden of chronic kidney disease." He said statistics from numerous studies and of patients seeking treatment at the YSUTH indicated that communities residing along the Yobe river valley have the highest incidence of renal failure, and the exact cause in this axis is still unknown. Often, cases appear at the end stage, when the renal organs have suffered irreversible damage, leading to death.
Collaborating to uncover root causes of CKD in Yobe State
Inadequate knowledge of risk factors, as well as the lack of preventative programmes, are contributing factors to the burden of CKD in Nigeria. According to Dr Gana, in 2018, the Yobe State Teaching Hospital, in collaboration with experts from the University of Maiduguri Teaching Hospital and University College London conducted preliminary research, gathering baseline data on the social demographics and characteristics of patients in areas considered a 'hotspot' of CKD. "The data will be instrumental to uncover the underlying cause of the disease in the area and to seek grants and address the global concern of chronic kidney disease of unknown cause (CKDu),"stated Dr Gana.
In 2018, a committee was also set up by the Yobe State government, in collaboration with the Federal Ministry of Health (FMoH), the World Health Organization (WHO) and other partners, to investigate the underlying causes of this condition. In 2019, the Yobe State committee on CKD visited UNC Mansoura Nephrology Centre in Egypt to explore opportunities to introduce kidney transplants in the northeast region. The Urology and Nephrology Centre (UNC) Mansoura is well-known for performing the first kidney transplant in the Middle East and Africa in 1973 and is recognised by the WHO for its expertise in training other professionals. Following this visit, a Memorandum of Understanding (MoU) was signed between the committee and the Urology and Nephrology Centre for collaboration and knowledge sharing. "Our partnership with UNC Mansoura aims to bring advanced treatment to our region, by training doctors and nurses in kidney transplant procedures," Dr Gana added.
Patients with CKD in Nigeria find it extremely difficult to afford dialysis due to widespread poverty in the country. According to Dr Gana, the cost of a single dialysis session varies from 30,000 to 50,000 Naira, and those with end-stage renal disease, often need two to three sessions per week, resulting in a weekly expenditure of about 100,000 Naira or more.
Kidney Health for All
Despite the fact that the Yobe State CKD committee did not achieve its goal of establishing the first kidney transplant facility in the region, there has been significant progress in ensuring equitable access to care for people with CKD. With the backing of the state government, the Yobe State Teaching Hospital in Damaturu initiated the provision of free dialysis services in 2017. This accomplishment has enabled people in Yobe State, who suffer from kidney disease to get dialysis treatment without any financial constraints.
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Efforts to identify the causes of CKD and provide financial support for dialysis are crucial steps in addressing the condition in Yobe State. However, it is essential to develop clear health awareness programmes, especially in communities with high incidence of CKD and limited understanding of CKD risk factors, as well as strengthening primary healthcare centres (PHCs) to include more awareness sessions on the disease. These actions will encourage behavioural adjustments, regarding risk factors as well as the pursuit of suitable therapy to delay the progression and reduce complications.
The Yobe State government should build on existing collaboration with partners, including the federal government of Nigeria to speed up efforts to create a kidney transplantation centre in the state and ensure increased access to kidney care for all.
