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Global heating ‘may lead to epidemic of kidney disease’

kidney disease

Global heating ‘may lead to epidemic of kidney disease’

Chronic kidney disease linked to heat stress could become a major health epidemic for millions of workers around the world as global temperatures increase over the coming decades, doctors have warned.

More research into the links between heat and CKDu – chronic kidney disease of uncertain cause – is urgently needed to assess the potential scale of the problem, they have said.

Unlike the conventional form of chronic kidney disease (CKD), which is a progressive loss of kidney function largely seen among elderly people and those afflicted with other conditions such as diabetes and hypertension, epidemics of CKDu have already emerged primarily in hot, rural regions of countries such as El Salvador and Nicaragua, where abnormally high numbers of agricultural workers have begun dying from irreversible kidney failure.

CKDu has also started to be recorded as affecting large numbers of people doing heavy manual labour in hot temperatures in other parts of Central America as well as North America, South America, the Middle East, Africa and India.

Kidneys are responsible for fluid balance in the body, which makes them particularly sensitive to extreme temperatures. There is an emerging consensus that CKDu should be recognised as a heat stress-related injury, where workers are developing subtle damage to their kidneys each day while they are in the field. This in turn can develop into severe kidney disease or complete renal failure over time.

This repetitive low-grade assault on the kidneys does not necessarily come with symptoms, so workers may not even know they are getting sick over time until things get so bad that they end up with end-stage kidney disease, said Dr Cecilia Sorensen, director of the global consortium on climate and health education at Columbia University.

“I think we just have no idea what the scope of the problem is because we’re not doing surveillance for it,” she said. “There are some regions that are clearly hotspots but in terms of its prevalence and how serious a problem it is, I don’t even think we’ve begun to wrap our brains around it.”

The documented epidemics, however, have similar characteristics. Those affected tend to be people who work in hot conditions outdoors and come from disproportionately vulnerable backgrounds – socially and economically – with limited access to medical care or insurance, or live in areas with modest healthcare infrastructure.

Sorensen said that, according to current data, it appears that the severity of the kidney damage gets worse the more vulnerable and desperate the worker is. She says that those who have no control over their working conditions or are incentivised to work for longer hours with no breaks, such as workers paid for how many berries they pick or how much sugar cane they cut, are likely to be those worst affected.

“They’re getting sick from the work that they’re doing, but they have no other options, and there’s very little regulatory oversight in the work environment that prevents this from happening. It’s a huge blind spot and a human rights issue,” she said.

Dr Ramón García Trabanino, a clinical nephrologist and medical director at El Salvador’s Centre of Hemodialysis, first noticed an unusual number of CKD patients saturating his hospital as a medical student more than two decades ago.

“They were young men,” he said, “and they were dying because we didn’t have the budget or the capacity to give them dialysis treatment. We did the best we could, but they kept dying and more kept coming.”

Since then he has started researching similar epidemics in Mexico, Nicaragua, Costa Rica and Panama.

“If you take a look at the maximum temperature maps in the region in Central America, you will notice that they match the regions where we are describing the disease, the hotspots,” he said. “El Salvador and Nicaragua – every year we have a fight for the first place for the country with the highest mortality due to CKD. Our mortality rates are about 10 times higher than what we should expect. The number of new patients is overwhelming.”

Although the consensus view is that CKDu is related to heat exposure and dehydration, some scientists believe exposure to agrochemicals and infectious agents, as well as genetic makeup and risk factors related to poverty, malnutrition, and other social determinants of health, are also likely to play a role.

Prof Richard Johnson, of the University of Colorado’s school of medicine, said: “What is less clear is the fact that recurrent heat stress is not just a problem in the sugar cane fields of Nicaragua. Even in our own societies, the possibility that heat stress and dehydration can be playing a role in kidney disease is not as appreciated.”

Prof Tord Kjellstrom, of the Australian National University’s national centre for epidemiology and population health, said that heat stress is not getting the attention it needs in debates around how to mitigate the worst effects of the climate emergency.

“As the number and intensity of hot days increases, more and more working people will face even greater challenges to avoid heat stress, particularly the two-thirds of the global population who live in tropical and sub-tropical areas. Heat exhaustion threatens the livelihoods of millions and undermines efforts to reduce poverty,” said Kjellstrom, who is also a former member of the Intergovernmental Panel on Climate Change.

“Global heating is a serious threat both to workers’ lives and the livelihoods of millions of people. Emerging policies on climate must take this into account if we are to have any chance of getting to grips with what is ahead.”

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Health

Lagos to convert General Hospital to eye centre

The Lagos State Commissioner for Health, Prof. Akin Abayomi, says the state government will designate one of its general hospitals as a centre for ophthalmic specialty to improve care for patients with eye conditions.

Abayomi said this during the 4th Annual General Meeting and Scientific Conference of the Africa Retina Society on Thursday in Lagos.

The News Agency of Nigeria (NAN) reports that the event was themed, “Upscaling Retinal Services in a Resource-Constrained Economy.”

Abayomi said the centre would provide a world-class diagnostic, medical, surgical and ophthalmic services in Lagos and Nigeria.

He stressed that the state would prioritise eye health, noting that the state was working on developing screening capacity of all its primary healthcare facilities to detect eye diseases early.

“The conditions that affect the eyes very much reflect the conditions of the community in which you live. HIV, for example, was a major problem in South Africa, and I certainly experienced the impact of HIV on our day-to-day medicine and practice.

“Here in Nigeria, we have other things. We have hypertension, diabetes, sickle cell, and lots of trauma. These are the kinds of things that we see in our clinics here in Lagos and in Nigeria.

“We need to be able to understand how these prevailing conditions really affect us,” he said.

The commissioner further said that efforts are ongoing to promote eye screening, especially in schools, starting with the training of teachers to detect students exhibiting challenges with their vision.

He added that the state would leverage the social health insurance to screen, detect and treat eye diseases as patients presents at health facilities.

The commissioner further said the state would strengthen public awareness and understanding on eye health, especially glaucoma and visual acuity.

Abayomi disclosed that the state through its Ministry of Health had forged a partnership with the Chagoury Group
to develop a specialist eye hospital in Lagos to boost access to eye services.

He acknowledged that ophthalmology was equipment-intensive, stressing that government would pay attention to that and human resources to enable practitioners make appropriate diagnosis, and treatment to reverse medical tourism.

Earlier, Prof. Linda Visser, Head, Division of Ophthalmology Stellenbosch University, South Africa, called on policy makers to formulate policies that would integrate eye screening into diabetes care from the primary healthcare level, noting that cases of diabetic retinopathy was on the increase among Africans.

Diabetic retinopathy (DR) is a chronic progressive disease of the retinal capillaries (small blood vessels) associated with prolonged raised blood glucose levels in people with diabetes.

Visser cited data from International Diabetes Foundation that showed that 537 million adults aged 20 to 79 years are living with diabetes globally, a number that was predicted to reach 1.3 billion in 50 years.

“The high prevalence of type 2 diabetes continues to rise worldwide and is particularly rapid in low- and middle income countries.

“Most of these countries have limited availability and affordability of healthcare services for screening and treating diabetes-related complications, such as retinopathy, to prevent vision loss,”

According to her, all persons with diabetes are at risk of developing DR, however, those with poor blood glucose and blood pressure management and hyperlipidaemia are most at risk.

Visser, Past President, Vitreoretinal Society of South Africa, emphasised that early detection would lead to timely treatment of DR, which could prevent 95 per cent of vision impairment and blindness.

Also, Dr Asiwome Seneadza, Chairman, Africa Retina Society, said that the theme was timely and critical as efforts are made to navigate the complexities and challenges in delivering advanced retinal care across the continent.

Seneadza said, “That’s why we are advocating for improved diabetes care and regular retinal screening made available and accessible for every individual living with diabetes,” he said.

Similarly, Prof. Bassey Fiebai, Chairman, Vitreo Retinal Society of Nigeria, said the meeting was critical to proffering solutions to the challenge of offering standard retina care, improving outcomes and reducing visual loss from retina related disorders among low to medium income countries.

Fiebai said that the government plays a critical role in providing funding, training of personnel, provision of equipment to improve screening, detection and treatment of retinopathy disease.

The professor noted that retina specialists are few in Nigeria, placing the figure at about 100, stressing that it was inadequate to cater to the teeming population who require eye care.

“Right now in the country, we have just a little over 100 retina specialists. And we know that the population of Nigeria is about 230 million.

“So we’re looking at a situation in which one retina specialist is supposed to cater for 2.3 million people. How does anyone cope?” she queried.

NAN reports that the Annual General Meeting and Scientific Conference of the Africa Retina Society which began on June 26 to June 28, had participants from various African countries brainstorm on enhancing retinal care.

(NAN)

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Cholera outbreak: Tinubu sets up presidential committee to oversee emergency operation centre

President Bola Tinubu has directed the setting up of a presidential committee to oversee the Cholera Emergency Operation Centre, operated by the National Centre For Disease Control.

The Minister of Health, Ali Pate, made this known on Tuesday after the Federal Executive Council meeting chaired by President Tinubu at the State House, Abuja.

He added that the committee’s effort is in addition to state government support to ensure Nigeria makes progress in reducing open defecation.

“The Council then approved a cabinet committee comprising the federal ministries of Health, Finance,Water Resources, Environment, Youth, Aviation, Education because some of our children will be returning to school . In addition to this, the state government, we will co-opt, so that Nigeria makes progress in reducing open defecation because cholera is a developmental issue that requires a multi-sectoral approach.

“The President directed that a cabinet committee be set up to oversee what the emergency operation centre led by NCDC is doing and for the resources to be provided complemented by the state government,” he said.

Pate further disclosed: “At the moment about 31 states have recorded 1528 cases and 53 deaths in Nigeria. That is what we are working through the Emergency Operation Centre that was activated by NCDC on Monday.

“Now we have a cholera outbreak and we discussed extensively in the Council in addition to a new emergence of Yellow Fever specifically in Bayelsa State.

“On cholera we are in the middle of the 7th pandemic globally which is decades in the making. In 2022, the world had almost 500,000 cases of cholera so it is not only peculiar to Nigeria. In 2023 almost 700,000 cases of cholera were reported by the World Health Organization.

“This year more than 200,000 cases have occurred in five regions of the World.”

He emphasised that a multi sectoral approach is required to tackle the outbreak .

“Resources were deployed to 21 states to help them respond to cholera. We are improving awareness of population, handwashing, hygiene sanitation, in addition to treatment with drugs, and intravenous fluids,” he added.

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Health

NCDC reports 1,598 cases of cholera across the country

The Nigeria Centre for Disease Control and Prevention, NCDC, has reported 1,598 suspected cases of cholera across 107 local government areas.

The cholera outbreak is characterised by a case fatality rate of 3.5 per cent, significantly higher than the national expected average of one per cent, underscoring the severity of the situation.

The Director-General of NCDC, Dr Jide Idris, disclosed this on Monday in Abuja while providing an update on the cholera epidemiological situation in Nigeria and ongoing prevention and response efforts at the national and sub-national levels.

Cholera is a severe diarrheal illness caused by the bacterium Vibrio cholerae. The disease remains a significant health challenge, especially in regions with inadequate sanitation and clean water access.

Understanding the transmission mechanism of cholera is crucial to curbing its spread and implementing effective prevention measures.

Idris said: “Government is deeply concerned about the rapid spread and higher-than-expected mortality rate, indicating a more lethal outbreak.”

He emphasised that the fatalities represented significant personal losses, including those of family members, spouses, parents and healthcare workers.

“This situation can be compounded as the rainy season intensifies,” he added.

He disclosed that Lagos State accounted for the highest number of deaths with 29, followed by Rivers with eight, Abia and Delta with four each, Katsina with three, Bayelsa with two and Kano, Nasarawa and Cross River with one each.

He added: “This alarming trend highlights the urgent need for coordinated response to prevent further escalation of the crisis. Sixteen states accounted for 90 per cent of the confirmed cases, with Lagos being the epicentre of the outbreak. Lagos State, having the highest number of cases, has received significant focus, with ongoing support and resources directed to manage the outbreak effectively.”

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