NIGERIANS AND THE   END-STAGE - RENAL  DISEASES

                       Writing by Olson omorogbe

Hemodialysis problems:

The incidence of end-stage-renal failure is increasing worldwide at an annual rate of 8%. Data for much of the developing world are often unavailable, but given the prevalence of poor socioeconomic factors , the incidence is likely to be far more greater. In Sub- Sahara Africa, economic and manpower factors dictate a conservative approach to therapy in most instances. The majority of those with end – stage renal disease perish because of the lack of funds, as very few can afford regular maintenance dialysis and renal transplantation is often not available. Hemodialysis remains the most common modality of management, with a very few units offering peritoneal dialysis. Limitations to regular maintenance hemodialysis include the paucity of dialysis units, restriction of those units to urban centers, and the absence of government funding or subsidy and health insurance to cover the relatively high cost of dialysis.

The few available units are bedeviled with multiple problems: old machines frequently break down, absence of adequate maintenance technical support and spare parts, and frequent power outages. Staff motivation and remuneration are equally poor with consequent disruption of services due to industrial action and emigration of trained staff to Middle East and Western world. Present avenues for improvements include: focusing on prevention to stem the high prevalence of ESRD, greater government and nor-government agencies to better fund units and thus enhance the quality of service rendered , and the wider availability of transplantation.

Millions of people in Nigeria and other developing countries suffer poor health or death simply because they do not have access to the technology that can save them. In addition, these health problems lead to decreased productivity, lower incomes, and excessive strain on family and government resources. Many institutions around the world strive to bring affordable health care to developing countries like Nigeria , but these effort are generally founded on the charitable donation of medical technology and service s, with no sustainable structure in place to ensure continuity and widespread impact.

In Nigeria and other African low incomes countries, preventable and curable illnesses often result in unnecessary death. For instance, diarrheal and fever are the most common cause of death among Nigerian children. While high blood pressure and hypertension are the leading cause of death among Nigeria adults.

Kidney failure is the end result of many such illnesses in children and adults alike. End stage renal disease, as it is called is increasing worldwide year after year. Most of the Nigerians affected are in their prime productive years with 70 percent of them under 50 years of age. Statistics for Nigerian children under 10 years of age do not exist, but a pediatric nephrologist at the university college hospital estimates that 70 to 90 children a year at his hospital alone suffer from chronic renal failure, and over 1500 have acute renal failure.

For many curable illnesses, countries like Nigeria lack the appropriate technology and technical expertise  and training to treat them effectively. In case of renal failure, in place where the technology is available, patients are treated with hemodialysis,  a basic procedure that filter their blood to remove harmful waste. Similar to many other diseases, while more than 60 percent of renal failure patients in developed countries receive dialysis, only 1 percent in Nigeria and Sub-Sahara Africa are treated children generally respond better to dialysis than adults , but most Nigerian children in need of dialysis are left to die. Just two hours of dialysis treatment can save their lives. A nephrologist once told me he estimate the need for acute dialysis treatment, which involves just one treatment ,at the three hospital in which he is working to be well over 2,000 people per month .The estimate for people needing chronic dialysis treatment three session per week –is 150 children and 400 adults.

Even when medical technology is available, it is generally neither affordable nor accessible to the majority of the population , and it often comes donated from developed countries , lying idle as soon as something breaks down .

Dialysis treatment facilities in Nigeria are sparse and expensive .The country  currently has 80 dialysis machines of which fewer than 25 are functioning, and only one adult renal transplant unit.

There are no pediatric dialysis units. the dialysis machines like other medical technology provided by the West , have frequent breakdown , poor technical support, and no spare parts.

Cost alone, however , is often the most prohibitive factor in health care access, exacerbated by a lack of knowledge transfer regarding lower- cost technologies and new medical advances. For instance, over 70 percent of Nigerians with chronic renal failure cannot afford dialysis

 treatment, only 5 percent of patients who need dialysis are offered peritoneal dialysis, a less – expensive alternative to hemodialysis.

My group will be focusing on the specific problems of renal failure because of  its severity in Nigeria and other developing countries and its simple treatment , but we also recognizes that the problems of affordable healthcare extend much further. Lack of access to life saving technology is an obstacle face by million of Nigerians with variety of curable illnesses.