A roadmap for kidney care in Africa: An analysis of International Society of Nephrology–Global Kidney Health Atlas Africa data describing current gaps and opportunities

Delivery of kidney care in Africa is significantly constrained by various factors. In this review, we used International Society of Nephrology–Global Kidney Health Atlas (ISN–GKHA) data for Africa to address sub-regional differences in care delivery in the continent with focus on infrastructure, workforce, and the economic aspects of kidney care. Forty two African countries participated in the survey conducted in 2018. North Africa had the highest proportions of nephrologists [12.53 per million population (pmp)], nephrology trainees (2.19 pmp) and haemodialysis (HD) centres (8.58 pmp); whereas southern Africa had the highest proportions of peritoneal dialysis (PD) centres (0.89 pmp) and kidney transplant (KT) centres (0.29 pmp); West Africa had the greatest nephrology workforce shortages. The annual median costs of HD (US$22,731 [interquartile range (IQR): US$1,560–43,902]) and PD (US$34,165 [US$34,165–34,165]) were highest in Central Africa and only Algeria, Egypt and South Africa reported zero co-payment for all modalities of kidney replacement therapy in the public sector. Policies on chronic kidney disease and non-communicable diseases were scarcely available across all African sub-regions. The ISN–GKHA African data highlight a stark difference in kidney care measures between North and sub-Saharan Africa and also suggest the need for a more cohesive approach to policy formulations that support and protect patients with kidney disease in the continent, especially from the excessive costs associated with care. Using the World Health Organization (WHO) Global Action Plan for noncommunicable diseases, this paper proposes an African roadmap for optimal kidney care

Water Erosion Risk Assessment in the Kenya Great Rift Valley Region

The Kenya Great Rift Valley (KGRV) region unique landscape comprises of mountainous terrain, large valley-floor lakes, and agricultural lands bordered by extensive Arid and Semi-Arid Lands (ASALs). The East Africa (EA) region has received high amounts of rainfall in the recent past as evidenced by the rising lake levels in the GRV lakes. In Kenya, few studies have quantified soil loss at national scales and erosion rates information on these GRV lakes’ regional basins within the ASALs is lacking. This study used the Revised Universal Soil Loss Equation (RUSLE) model to estimate soil erosion rates between 1990 and 2015 in the Great Rift Valley region of Kenya which is approximately 84.5% ASAL. The mean erosion rates for both periods was estimated to be tolerable (6.26 t ha−1 yr−1 and 7.14 t ha−1 yr−1 in 1990 and 2015 respectively) resulting in total soil loss of 116 Mt yr−1 and 132 Mt yr−1 in 1990 and 2015 respectively. Approximately 83% and 81% of the erosive lands in KGRV fell under the low risk category (<10 t ha−1 yr−1) in 1990 and 2015 respectively while about 10% were classified under the top three conservation priority levels in 2015. Lake Nakuru basin had the highest erosion rate net change (4.19 t ha−1 yr−1) among the GRV lake basins with Lake Bogoria-Baringo recording annual soil loss rates >10 t ha−1 yr−1 in both years. The mountainous central parts of the KGRV with Andosol/Nitisols soils and high rainfall experienced a large change of land uses to croplands thus had highest soil loss net change (4.34 t ha−1 yr−1). In both years, forests recorded the lowest annual soil loss rates (<3.0 t ha−1 yr−1) while most of the ASAL districts presented erosion rates (<8 t ha−1 yr−1). Only 34% of all the protected areas were found to have erosion rates <10 t ha−1 yr−1 highlighting the need for effective anti-erosive measures

Water Erosion Risk Assessment in the Kenya Great Rift Valley Region

The Kenya Great Rift Valley (KGRV) region unique landscape comprises of mountainous terrain, large valley-floor lakes, and agricultural lands bordered by extensive Arid and Semi-Arid Lands (ASALs). The East Africa (EA) region has received high amounts of rainfall in the recent past as evidenced by the rising lake levels in the GRV lakes. In Kenya, few studies have quantified soil loss at national scales and erosion rates information on these GRV lakes’ regional basins within the ASALs is lacking. This study used the Revised Universal Soil Loss Equation (RUSLE) model to estimate soil erosion rates between 1990 and 2015 in the Great Rift Valley region of Kenya which is approximately 84.5% ASAL. The mean erosion rates for both periods was estimated to be tolerable (6.26 t ha−1 yr−1 and 7.14 t ha−1 yr−1 in 1990 and 2015 respectively) resulting in total soil loss of 116 Mt yr−1 and 132 Mt yr−1 in 1990 and 2015 respectively. Approximately 83% and 81% of the erosive lands in KGRV fell under the low risk category (−1 yr−1) in 1990 and 2015 respectively while about 10% were classified under the top three conservation priority levels in 2015. Lake Nakuru basin had the highest erosion rate net change (4.19 t ha−1 yr−1) among the GRV lake basins with Lake Bogoria-Baringo recording annual soil loss rates >10 t ha−1 yr−1 in both years. The mountainous central parts of the KGRV with Andosol/Nitisols soils and high rainfall experienced a large change of land uses to croplands thus had highest soil loss net change (4.34 t ha−1 yr−1). In both years, forests recorded the lowest annual soil loss rates (−1 yr−1) while most of the ASAL districts presented erosion rates (−1 yr−1). Only 34% of all the protected areas were found to have erosion rates −1 yr−1 highlighting the need for effective anti-erosive measures