Developing nephrology services in low income countries: A case of Tanzania

Background: The burden of kidney diseases is reported to be higher in lower- and middle-income countries as compared to developed countries, and countries in sub-Saharan Africa are reported to be most affected. Health systems in most sub-Sahara African countries have limited capacity in the form of trained and skilled health care providers, diagnostic support, equipment and policies to provide nephrology services. Several initiatives have been implemented to support establishment of these services. Methods: This is a situation analysis to examine the nephrology services in Tanzania. It was conducted by interviewing key personnel in institutions providing nephrology services aiming at describing available services and international collaborators supporting nephrology services. Results: Tanzania is a low-income country in Sub-Saharan Africa with a population of more than 55 million that has seen remarkable improvement in the provision of nephrology services and these include increase in the number of nephrologists to 14 in 2018 from one in 2006, increase in number of dialysis units from one unit (0.03 unit per million) before 2007 to 28 units (0.5 units per million) in 2018 and improved diagnostic services with introduction of nephropathology services. Government of Tanzania has been providing kidney transplantation services by funding referral of donor and recipients abroad and has now introduced local transplantation services in two hospitals. There have been strong international collaborators who have supported nephrology services and establishment of nephrology training in Tanzania. Conclusion: Tanzania has seen remarkable achievement in provision of nephrology services and provides an interesting model to be used in supporting nephrology services in low income countries.publishedVersio

Renal transplantation and quality of life in Tanzania

Background: Renal replacement therapy (RRT), which includes dialysis and kidney transplantation, is the treatment of choice for patients with end stage renal failure (ESRF). Most sub-Saharan African countries have not developed renal transplantation services and are relying on referring patients to overseas countries. This study was carried out to describe renal transplantation experience in Tanzania.Methods: Forty-four renal transplant recipients were recruited in this study. Standardized questionnaire and Swahili version of standard form – 36 (SF-36) were used to collect socio-demographic information, clinical data, laboratory test results and health related quality of life information.Results: Ages of transplant recipient ranged from 21 to 66 years with mean age of 45.9 ± 10.5 years. The leading causes of end stage renal failure among participants was hypertension 58.8% (25/44) followed by glomerulonephritis 15.9% (7/44). Twentyeight (63.6%) of transplantations were paid by the government. Most of the donors (97.7%) were living out of which 26 (59.1%) were siblings and 11 (25%) were second-degree relatives (cousins and nephews). Most common complication noted following transplantation was diabetes mellitus 9 (20.5%) and 3 (6.8%) had chronic rejection. Mental health was the domain with highest mean score (75.6 ± 14.3) and role physical had the least mean score (44 ± 45.6).Conclusions:  Hypertension was the leading cause of ESRF in this study. Most of the donors were siblings and the costs of transplantation were largely covered by the government. There is a need for concerted effort to establish local kidney transplantation services in Tanzania. Keywords: Renal transplantation, quality of life in transplantation, Tanzania

Nutrition knowledge, attitudes and practices among healthcare workers in management of chronic kidney diseases in selected hospitals in Dar es Salaam, Tanzania; a cross-sectional study

BACKGROUND: Chronic kidney disease (CKD) is a global public health problem. All health care professionals need to be knowledgeable and competent in nutrition as it applies to health promotion, prevention and treatment of acute and chronic diseases. Nutrition intervention is an important component in optimizing diet among CKD patients. However, there is limited information on the nutrition knowledge on management of CKD among healthcare workers in Dar es Salaam Tanzania. This study assessed nutrition knowledge, attitudes and current practices of healthcare workers in management of patients with CKD in selected hospitals. METHODS: This cross sectional study was conducted amongst 133 healthcare workers in renal units in selected hospitals from December 2011 to March 2012. Hospitals were purposively selected based on the availability of renal care services in the facility. Nutrition knowledge and practices were assessed using a standardized questionnaire. Knowledge levels were categorised as > 61 % “adequate”41–60 % “moderate” and 1–40 % “low”. Attitudes were measured using a 5 Likert scale. Descriptive statistics were used to summarize data. Chi-square was used to test the relationship between categorical variables. A p -value of < 0.05 was considered statistically significant. RESULTS: The mean nutrition knowledge score among health care workers was 9.8 (SD 3.12). There was a significant difference in the nutrition knowledge among carders (p ≤ 0.001). Medical specialists had a higher mean score (13.75) compared to medical doctors and nurses with mean scores 12.05 and 9.51 respectively. Other cadres had lower mean score of 8.65. Likert scale showed that 94 % had positive attitudes on the role of nutrition in preventing and treating diseases. Most of respondents (92 %) did not use any nutrition guidelines. Nutrition management were discussed occasionally during ward rounds. There were significant relationship between age group (χ 2 = 16.69; p = 0.01), work experience (χ 2 = 18.61; p < 0.01) and nutrition knowledge of participants. CONCLUSION: Nutrition knowledge among study participants was poor; though their attitude was positive they failed to practice due to poor knowledge. Inadequate nutrition training in medical school, lack of resources and motivation were identified as factors that influence nutrition management of CKD in the study area. Recommendations from the study include: review of medical curriculum to incorporate clinical nutrition topics, continuous nutrition education programs for in-services, improving working conditions and hiring clinical nutritionists in each hospital department would improve nutrition management of CKD patients in hospitals

Developing nephrology services in low income countries: A case of Tanzania

Background: The burden of kidney diseases is reported to be higher in lower- and middle-income countries as compared to developed countries, and countries in sub-Saharan Africa are reported to be most affected. Health systems in most sub-Sahara African countries have limited capacity in the form of trained and skilled health care providers, diagnostic support, equipment and policies to provide nephrology services. Several initiatives have been implemented to support establishment of these services. Methods: This is a situation analysis to examine the nephrology services in Tanzania. It was conducted by interviewing key personnel in institutions providing nephrology services aiming at describing available services and international collaborators supporting nephrology services. Results: Tanzania is a low-income country in Sub-Saharan Africa with a population of more than 55 million that has seen remarkable improvement in the provision of nephrology services and these include increase in the number of nephrologists to 14 in 2018 from one in 2006, increase in number of dialysis units from one unit (0.03 unit per million) before 2007 to 28 units (0.5 units per million) in 2018 and improved diagnostic services with introduction of nephropathology services. Government of Tanzania has been providing kidney transplantation services by funding referral of donor and recipients abroad and has now introduced local transplantation services in two hospitals. There have been strong international collaborators who have supported nephrology services and establishment of nephrology training in Tanzania. Conclusion: Tanzania has seen remarkable achievement in provision of nephrology services and provides an interesting model to be used in supporting nephrology services in low income countries