Task shifting roles, interventions and outcomes for kidney and cardiovascular health service delivery among African populations: a scoping review.

BACKGROUND: Human resources for health (HRH) shortages are a major limitation to equitable access to healthcare. African countries have the most severe shortage of HRH in the world despite rising communicable and non-communicable disease (NCD) burden. Task shifting provides an opportunity to fill the gaps in HRH shortage in Africa. The aim of this scoping review is to evaluate task shifting roles, interventions and outcomes for addressing kidney and cardiovascular (CV) health problems in African populations. METHODS: We conducted this scoping review to answer the question: "what are the roles, interventions and outcomes of task shifting strategies for CV and kidney health in Africa?" Eligible studies were selected after searching MEDLINE (Ovid), Embase (Ovid), CINAHL, ISI Web of Science, and Africa journal online (AJOL). We analyzed the data descriptively. RESULTS: Thirty-three studies, conducted in 10 African countries (South Africa, Nigeria, Ghana, Kenya, Cameroon, Democratic Republic of Congo, Ethiopia, Malawi, Rwanda, and Uganda) were eligible for inclusion. There were few randomized controlled trials (n = 6; 18.2%), and tasks were mostly shifted for hypertension (n = 27; 81.8%) than for diabetes (n = 16; 48.5%). More tasks were shifted to nurses (n = 19; 57.6%) than pharmacists (n = 6; 18.2%) or community health workers (n = 5; 15.2%). Across all studies, the most common role played by HRH in task shifting was for treatment and adherence (n = 28; 84.9%) followed by screening and detection (n = 24; 72.7%), education and counselling (n = 24; 72.7%), and triage (n = 13; 39.4%). Improved blood pressure levels were reported in 78.6%, 66.7%, and 80.0% for hypertension-related task shifting roles to nurses, pharmacists, and CHWs, respectively. Improved glycaemic indices were reported as 66.7%, 50.0%, and 66.7% for diabetes-related task shifting roles to nurses, pharmacists, and CHWs, respectively. CONCLUSION: Despite the numerus HRH challenges that are present in Africa for CV and kidney health, this study suggests that task shifting initiatives can improve process of care measures (access and efficiency) as well as identification, awareness and treatment of CV and kidney disease in the region. The impact of task shifting on long-term outcomes of kidney and CV diseases and the sustainability of NCD programs based on task shifting remains to be determined.

Public-private partnership in hemodialysis in Nigeria: A comparative analysis of renal centers across three Northwestern states.

Background: Public-private partnership (PPP) in hemodialysis delivery in Nigeria is a new concept. We set out to compare the performance of Specialist Hospital Sokoto's (SHS) renal center operating with this model with four other neighboring government-operated dialysis centers. Materials and Methods: We reviewed the 6-year records (May 2011 to April 2017) of Dialysis Center of SHS, operated under a PPP and compared some performance indicators with four government-operated dialysis centers over the same period. Comparisons were made using Chi-square and corresponding P values were reported accordingly. P < 0.05 was considered significant. Results: A total of 1167 patients' data were studied. Of these, 252 (21.6%) patients with end-stage renal disease were dialyzed at SHS. The SHS dialysis center experienced 5 months of interruption in dialysis service. Only 38 (15.1%) patients sustained dialysis beyond 90 days and 105 (41.7%) patients had more than three sessions of hemodialysis. Only one patient was referred for kidney transplant from the dialysis center during the review period. SHS performed better than Federal Medical Center and Sir Yahaya Hospitals in terms of service availability, duration on hemodialysis, and greater number of hemodialysis sessions (χ2 = 29.06, df = 3, P < 0.001). Conclusion: PPP has improved the availability of dialysis service, mean duration on dialysis, and mean number of dialysis sessions but did not improve the kidney transplant referral rate at SHS. There is a need to encourage the current arrangement in the Hospital as well as other centers offering similar partnerships.

RésuméContexte: Le partenariat public-privé (PPP) dans la prestation d'hémodialyse au Nigéria est un nouveau concept. Nous avons entrepris de comparer les performances du centre rénal de l'hôpital spécialisé de Sokoto fonctionnant avec ce modèle avec quatre autres centres de dialyse gérés par le gouvernement voisin. Méthodes: Nous avons examiné les dossiers de six ans (mai 2011 à avril 2017) du centre de dialyse de l'hôpital spécialisé de Sokoto, exploité dans le cadre d'un partenariat public-privé et comparé certains indicateurs de performance avec quatre centres de dialyse gérés par le gouvernement au cours de la même période. Des comparaisons ont été faites en utilisant le chi carré et les valeurs p correspondantes ont été rapportées en conséquence. Une valeur p <0.05 était considérée comme significative. Résultats: Un total de 1167 données de patients a été étudié. Parmi ceux-ci, 252 (21.6%) patients atteints d'insuffisance rénale terminale ont été dialysés à l'hôpital spécialisé de Sokoto (SHS). Le centre de dialyse SHS a connu cinq mois d'interruption de service de dialyse. Seuls 38 (15.1%) patients ont subi une dialyse au-delà de 90 jours et 105 (41.7%) patients ont eu plus de trois séances d'hémodialyse. Un seul patient a été référé pour une transplantation rénale depuis le centre de dialyse pendant la période d'examen. L'hôpital spécialisé de Sokoto a obtenu de meilleurs résultats que le centre médical fédéral et les hôpitaux Sir Yahaya en termes de disponibilité des services, de durée d'hémodialyse et de plus grand nombre de séances d'hémodialyse (χ2 = 29.06, df = 3, p <0.001). Conclusion: PPP a amélioré la disponibilité du service de dialyse, la durée moyenne de la dialyse, le nombre moyen de séances de dialyse mais n'a pas amélioré le taux de référence pour une greffe de rein à l'hôpital spécialisé de Sokoto. Il est nécessaire d'encourager l'arrangement actuel à l'hôpital ainsi que dans d'autres centres offrant des partenariats similaires.

International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in Africa.

Despite positive economic forecasts, stable democracies, and reduced regional conflicts since the turn of the century, Africa continues to be afflicted by poverty, poor infrastructure, and a massive burden of communicable diseases such as HIV, malaria, tuberculosis, and diarrheal illnesses. With the rising prevalence of chronic kidney disease and kidney failure worldwide, these factors continue to hinder the ability to provide kidney care for millions of people on the continent. The International Society of Nephrology Global Kidney Health Atlas project was established to assess the global burden of kidney disease and measure global capacity for kidney replacement therapy (dialysis and kidney transplantation). The aim of this second iteration of the International Society of Nephrology Global Kidney Health Atlas was to evaluate the availability, accessibility, affordability, and quality of kidney care worldwide. We identified several gaps regarding kidney care in Africa, chief of which are (i) severe workforce limitations, especially in terms of the number of nephrologists; (ii) low government funding for kidney care; (iii) limited availability, accessibility, reporting, and quality of provided kidney replacement therapy; and (iv) weak national strategies and advocacy for kidney disease. We also identified that within Africa, the availability and accessibility to kidney replacement therapy vary significantly, with North African countries faring far better than sub-Sahara African countries. The evidence suggests an urgent need to increase the workforce and government funding for kidney care, collect adequate information on the burden of kidney disease from African countries, and develop and implement strategies to enhance disease prevention and control across the continent.

Usefulness of renal length and volume by ultrasound in determining severity of chronic kidney disease.

To determine the correlation of renal ultrasonic parameters and degree of kidney function among chronic kidney disease patients seen at the Nephrology unit of the University of Ilorin Teaching Hospital (UITH) Ilorin, we studied 322 patients. The results were analyzed with specific reference to socio-demography and correlating renal length and volume with estimated glomerular filtration rate. The male to female ratio was 2:1, with an age range from 20 to 80 years and mean age of 45.06 (±13.0) years. The serum creatinine levels ranged from 201 to 1205 µmol/L, with a mean of 388 ± 168 µmol/L, while the estimated glomerular filtration rate (eGFR) ranged from 3.77 to 44.32 mL/min, with a mean of 18.2 ± 7.19 mL/min. The right and left renal lengths ranged from 6.9 to 13.0 cm, with a mean of 9.11 ± 1.06, and 6.5-13.4 cm, with a mean of 9.23 ± 1.07 cm, respectively. The mean volumes of the right and left kidneys were 98.6 ± 41.9 cm 3 and 105 ± 46.2 cm 3 , respectively. The Pearson correlation of the right and left kidneys length to eGFR were -0.197 and -0.137 respectively, while that of the right and left kidney volume to eGFR were -0.122 and -0.043, respectively. Our study showed that there is a positive correlation between ultrasonic renal measurements and degree of kidney function.