INEQUITIES IN CHRONIC KIDNEY DISEASE IN A LOW-INCOME SETTING: AN EXAMPLE FOR RENAL HEALTH INTERVENTIONS

Introduction:

Chronic kidney disease (CKD) is increasing globally and is a current major public health problem, with the greatest impact in low-income countries (LICs) such as Mozambique. A review of the published literature on the approaches to address CKD in this African country revealed: scarcity of scientific CKD-related publications; lack of related preventive investment; growing trends for hypertension and diabetes; low access to renal replacement therapy (RRT) in the public sector. 

Our main aim was to undertake a situational analysis on CKD in one of the most vulnerable LICs. As secondary objectives, we set out to 1) contribute to increase scientific literature on CKD in Mozambique, 2)  design an intervention that reduces inequities related to CKD, and 3) identify key components for replication of strategies for reduction of inequalities in CKD around African LICs.

Methods:

In September 2023, an exploratory, descriptive study was conducted using non-opinion surveys/interviews. The observation and surveys work was carried out in Maputo city and the 14 interviews were undertaken in the three nephrology departments and nine haemodialysis (HD) units nationwide. Government health representatives, people in charge of the departments and health professionals working with CKD patients were surveyed. We conducted different face-to-face and on-line surveys: One for the nephrology and HD professionals, and other, for the two government representatives. Data on the approach to CKD and on perceived inequities in relation to disease prevention, diagnosis, renal health promotion and RRT were analysed, as well as data on the material and human resources available in the country. The typology of service users, the most frequent causes of the disease and the quality of care, especially in HD departments, were also reviewed. The research was approved by the Institutional Bioethics Committee of the Faculty of Medicine/Maputo Central Hospital (Nr: CIBS FM&HCM/083/2023).

Results:

Our data show that the majority of people providing services to people with CKD in Mozambique are nationals, mostly female nurses (predominantly 30-35 years old) with at least two years of experience and up to five years in their jobs. Most health providers belong to the public health system, although a significant representation from the private sector was unveiled. The inequalities found in CKD care are mostly related to: 1) The government's inability to fully address CKD, particularly the lack of a national programme to prevent the disease and promote renal health, and 2) The low availability and poor quality of care, revealed by deficits of HD treatment and shortages of RRTs, including the absence of renal transplantation.

Conclusions:

There is shortage and inadequacy of resources to prevent and manage CKD in the national health system in Mozambique, particularly interventions to avoid the need for RRT and low accessibility to this intervention, when they are needed. As RRTs are associated with high health costs and we are studying solutions for a low-income context, research should be directed towards the prevention of the disease and the promotion of renal health, addressing the social determinants of health and equity issues.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.