Health

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.”

Health

Nurses reject NSIWC circular on allowances

Lagos nurses, midwives suspend 3-day warning strike

The National Association of Nigerian Nurses and Midwives, Federal Health Institutions (NANNM-FHI), has rejected a recent circular issued by the National Salaries, Income and Wages Commission (NSIWC).

The association called it unfair and dismissive of the role of nurses in federal health institutions.

The circular, No. SWC/S/04/S.218/III/646, dated June 27 and titled “Review of Allowances for Medical/Dental Officers in the Federal Public Service,” was criticised for excluding nurses from key allowance revisions.

Rising from an emergency National Executive Council (NEC) meeting on Thursday in Abuja, the association said the circular failed to recognise the important contributions of nurses, who account for between 60 and 70 per cent of the healthcare workforce.

NANNM-FHI President, Nurse Morakinyo-Olajide Rilwan, told journalists that the circular was issued without prior consultation with the association, in spite of its impact on a major segment of healthcare professionals.

He said the document did not address critical allowances due to nurses, including shift, uniform, specialist, call duty, and retention allowances.

“Nurses run intensive shifts, spending extended hours with patients and their relatives. Yet, our current shift allowance is just 8.5 per cent of our salary, despite a 2009 circular approving 30 per cent of basic salary,” Rilwan said.

He added that nurses are required to change uniforms multiple times daily due to the nature of their duties, stressing that uniform allowance should reflect this reality.

“Uniforms are essential, not optional. At a minimum, we need three uniforms a week,” he said.

Rilwan said the selective application of the specialist allowance was discriminatory and unfair to nurses with specialist qualifications.

He noted that nursing includes several specialist cadres who deserve equal treatment.

He called on the Federal Government to prioritise the retention of trained nurses, who are increasingly migrating abroad in search of better conditions

“Nigeria has the nurses, but we are losing them due to poor welfare and policy neglect,” he said.

Rilwan also urged the government to reconstitute the Governing Board of the Nursing and Midwifery Council of Nigeria, saying it had remained dormant for years.

He added that nurses must also be included in the boards of Federal Health Institutions, as they represent the largest workforce in the sector.

He expressed concern over the removal of nurse educators, especially those on grade levels 7 and 8, from clinical duties, in spite of their role in training student nurses.

“The same circular states that trainers should be paid. Yet, those training others are being sidelined,” he said.

The NANNM-FHI president further demanded internship placements for university-trained nurses to enable them to participate in the National Youth Service Corps (NYSC), recommending a centralised system to ensure uniformity and quality.

He also called for the creation of a Department of Nursing within the Federal Ministry of Health.

“While we have a Director of Nursing, there is no actual department. There should be directorates for training, statistics, and clinical practice within that framework,” he said.

Rilwan said the association was open to engagement and dialogue with the government and would allow time for an appropriate response.

However, he warned that failure to act could lead to industrial action.

Health

Lagos to begin mandatory health insurance enforcement for residents

The Lagos State Government has vowed to begin the enforcement of compulsory health insurance policy for residents.

A Thursday statement noted that the Permanent Secretary, Lagos State Health Management Agency, Dr Emmanuel Zamba, said the enforcement would begin in earnest in early 2026, in line with the Executive Order signed by Governor Babajide Sanwo-Olu in July 2025.

She made this known at the Ilera Eko Providers Forum held at the Lagos Sheraton Hotel, Ikeja, where key stakeholders across the health insurance value chain, including healthcare providers, health maintenance organisations, and technical partners, gathered to review progress and discuss future implementation strategies.

The order mandates that residents must show evidence of enrolment in a health insurance scheme before accessing public health services, excluding emergencies.

‘We want all residents to be aware and onboard before enforcement begins’, the permanent secretary said, urging residents to embrace the scheme as a financial protection tool.

‘We are finalising our emergency services programme to ensure that no Lagos resident is denied urgent care’.

‘People in emergencies must be treated without first presenting an insurance ID’, Zamba added.

To further strengthen identity management and prevent fraud, Zamba disclosed that LASHMA had partnered with the Lagos State Residents Registration Agency to roll out biometric card readers across health facilities.

‘This will eliminate impersonation and ensure only genuine enrollees benefit from the scheme’, she said.

He also highlighted the agency’s expansion into diagnostics, telemedicine, and virtual care initiatives designed to extend access to remote and underserved populations.

‘Even if there is no facility near you, you can dial a toll-free number or use our app for a live consultation with a doctor, 24/7.

‘We have also installed virtual booths in marketplaces to provide health education and consultation services on the go’ he explained.

The Ilera Eko Providers Forum, according to Zamba, is not just a platform for information dissemination but a critical feedback mechanism.

He announced that LASHMA would now host quarterly provider engagement meetings to receive and act on feedback from partners, with a view to improving the scheme’s responsiveness.

‘This is a partnership, and like all successful partnerships, it must be mutually beneficial. We are here to listen, dialogue, and find lasting solutions together’, he said.

The permanent secretary noted that the state currently has over 865 accredited providers, ranging from primary healthcare facilities to specialists in dental and eye care, as well as community pharmacies.

‘Healthcare providers are now the gatekeepers of our scheme’, Zamba said, adding: ‘We are training them not just to offer care but to enrol clients right at their facilities as part of our broader strategy to drive up enrolment figures’.

Zamba revealed that over 400 providers had so far been trained under the newly established Ilera Eko Academy, a platform aimed at equipping providers with the tools and knowledge to actively support enrollment and implementation efforts.

Health

Lagos state govt move to curb activities of unprofessional skincare producers

The Lagos State Government has announced plans to regulate and curb the activities of unqualified practitioners in aesthetic medicine,skincare.

The state Commissioner for Health, Professor Akin Abayomi, disclosed this while speaking at the 19th Annual General Meeting and Scientific Conference of Nigerian Association of Dermatologists (NAD).Travel packages

“We all know that there is an explosion in aesthetic dermatology around the world and it is not peculiar to Lagos.

“As a government, we are very concerned about this trend of unqualified people masquerading themselves as experts in aesthetic dermatology which focuses on skincare.

“These quacks administer a whole lot of treatment options that can be dangerous.

“And so, the regulatory arm of the ministry, Health Facility Monitoring and Accreditation Agency, is looking into this exploding phenomenal in Lagos.

“We want to work with NAD who are experts to define the limitations of these quacks and ensure they are under close scrutiny by government to ensure residents are not exposed to quackery,” he said