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Lasanthika C, Janlöv AC, Amarasekara T, Larsson H. Caring burden and coping with haemodialysis: a qualitative study with family caregivers in Sri Lanka. BMJ Open 2024; 14:e080775. [PMID: 38580374 PMCID: PMC11002432 DOI: 10.1136/bmjopen-2023-080775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/25/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVE The number of patients with end-stage kidney disease (ESKD) requiring renal replacement therapy in Sri Lanka is significantly rising. Most of these patients depend on haemodialysis, carrying a significant burden on their family caregivers. To develop care and support for both the patient and their family caregiver, it is crucial to understand how caregivers experience their caregiving situation. Therefore, this study aimed to explore family caregivers' experiences of burden and coping when caring for a family member receiving haemodialysis in the Sri Lankan context. DESIGN Qualitative study with an exploratory design. SETTING Family caregivers were recruited at a haemodialysis unit of a main government sector hospital in Sri Lanka between October and November 2021. PARTICIPANTS A purposive sampling of 11 family caregivers who cared for a family member receiving haemodialysis in a main government teaching hospital in Sri Lanka for at least 3 consecutive months. Data were collected through individual semistructured telephone interviews and analysed using qualitative content analysis. RESULTS The results showed an overarching theme, 'striving to hold on and not let go', with four categories: (1) feeling exhausted by the care burden, (2) feeling burdened as failing the care responsibility, (3) striving to cope and find meaning in caregiving, and (4) coping with caregiving through others' support. CONCLUSION The results show that the family caregivers have a multifaceted burden. They continued caring for their family member receiving haemodialysis while making adjustments to the burdensome caregiving situation despite many constraints and suffering. Psychosocial support and financial assistance, including family counselling, are needed by family caregivers, through a community support system, to ensure endurance during their family members' illness trajectory. Advance care planning is vital to alleviate care uncertainty and to meet the care needs of patients with ESKD, particularly in resource-constrained settings.
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Affiliation(s)
- Chalani Lasanthika
- Department of Nursing and Midwifery, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Ann-Christin Janlöv
- Department of Nursing and Integrated Health Sciences, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
| | - Thamara Amarasekara
- Department of Nursing and Midwifery, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Helena Larsson
- Department of Nursing and Integrated Health Sciences, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
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Agada-Amade YA, Ogbuabor DC, Eboreime E, Onwujekwe OE. Cost analysis of the management of end-stage renal disease patients in Abuja, Nigeria. Cost Eff Resour Alloc 2023; 21:94. [PMID: 38066603 PMCID: PMC10704650 DOI: 10.1186/s12962-023-00502-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 11/21/2023] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Although the treatment for end-stage renal disease (ESRD) under Nigeria's National Health Insurance Authority is haemodialysis (HD), the cost of managing ESRD is understudied in Nigeria. Therefore, this study estimated the provider and patient direct costs of haemodialysis and managing ESRD in Abuja, Nigeria. METHOD The study was a cross-sectional survey from both healthcare provider and consumer perspectives. We collected data from public and private tertiary hospitals (n = 6) and ESRD patients (n = 230) receiving haemodialysis in the selected hospitals. We estimated the direct providers' costs using fixed and variable costs. Patients' direct costs included drugs, laboratory services, transportation, feeding, and comorbidities. Additionally, data on the sociodemographic and clinical characteristics of patients were collected. The costs were summarized in descriptive statistics using means and percentages. A generalized linear model (gamma with log link) was used to predict the patient characteristics associated with patients' cost of haemodialysis. RESULTS The mean direct cost of haemodialysis was $152.20 per session (providers: $123.69; and patients: $28.51) and $23,742.96 annually (providers: $19,295.64; and patients: $4,447.32). Additionally, patients spent an average of $2,968.23 managing comorbidities. The drivers of providers' haemodialysis costs were personnel and supplies. Residing in other towns (HD:β = 0.55, ρ = 0.001; ESRD:β = 0.59, ρ = 0.004), lacking health insurance (HD:β = 0.24, ρ = 0.038), attending private health facility (HD:β = 0.46, ρ < 0.001; ESRD: β = 0.75, ρ < 0.001), and greater than six haemodialysis sessions per month (HD:β = 0.79, ρ < 0.001; ESRD: β = 0.99, ρ < 0.001) significantly increased the patient's out-of-pocket spending on haemodialysis and ESRD. CONCLUSION The costs of haemodialysis and managing ESRD patients are high. Providing public subsidies for dialysis and expanding social health insurance coverage for ESRD patients might reduce the costs.
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Affiliation(s)
- Yakubu Adole Agada-Amade
- Department of Health Administration and Management, University of Nigeria, Enugu Campus, Nigeria Enugu, Enugu State, Nigeria
- National Health Insurance Authority, Abuja, Nigeria
| | - Daniel Chukwuemeka Ogbuabor
- Department of Health Administration and Management, University of Nigeria, Enugu Campus, Nigeria Enugu, Enugu State, Nigeria.
- Department of Health Systems and Policy, Sustainable Impact Resource Agency, Enugu, Nigeria.
| | - Ejemai Eboreime
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Obinna Emmanuel Onwujekwe
- Department of Health Administration and Management, University of Nigeria, Enugu Campus, Nigeria Enugu, Enugu State, Nigeria
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria
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Berhe T, Tegegne GT, Berha AB. Quality of life and associated factors among chronic kidney disease patients at Zewditu Memorial and Tikur Anbessa Specialised Hospitals, Ethiopia: a cross-sectional study design. BMJ Open 2023; 13:e069712. [PMID: 37263701 DOI: 10.1136/bmjopen-2022-069712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) is associated with significant morbidity, mortality, healthcare cost and reduced health-related quality of life (HRQoL). This study aimed to assess HRQoL and associated factors among patients with CKD at both Zewditu Memorial and Tikur Anbessa Specialised Hospitals, Ethiopia. METHOD A cross-sectional study design was performed. All patients who visited the renal clinics in both hospitals from March to July 2019 were targeted, and data were collected using interviews and medical records. HRQoL was assessed using the Kidney Disease and Quality of Life-36 tool. Normality assessment was done for HRQoL subscales. Descriptive statistics, logistic regression, t-test and one-way analysis of variance were performed. RESULT A total of 300 patients with CKD were included. Around 62% of them were in either stage 3 or 4 CKD. The mean domain scores of physical component summary (PCS), mental component summary (MCS), burden of kidney disease, effect of kidney disease and symptoms and problems of kidney disease (SPKD) subscales were 50.4, 59.5, 63.1, 74.6 and 80.4, respectively. The lowest HRQoL was seen in the PCS scale, while the highest was in SPKD. In addition, the study revealed that a lower level of education, elevated serum creatinine and a history of smoking were significantly associated with poor PCS score. Further, the presence of three or more comorbidities, CKD-related complications and a lower haemoglobin level were significantly associated with poor MCS. CONCLUSION The overall mean scores of PCS and MCS were low, below the standard level. Level of education, serum creatinine and smoking history were significantly associated with PCS, while the presence of comorbidity, complications and haemoglobin level were significantly associated with MCS. Stakeholders working on CKD management should design a relevant strategy targeting patients, patients' care providers and healthcare professionals to improve HRQoL of patients.
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Affiliation(s)
- Teshome Berhe
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gobezie T Tegegne
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemseged Beyene Berha
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Okoro RN. Cushioning the economic burden of chronic kidney disease for patients in LMICs: The heightened need for a government-driven financial support policy. Health Policy and Technology 2021. [DOI: 10.1016/j.hlpt.2021.100507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Dodd R, Palagyi A, Guild L, Jha V, Jan S. The impact of out-of-pocket costs on treatment commencement and adherence in chronic kidney disease: a systematic review. Health Policy Plan 2019; 33:1047-1054. [PMID: 30247548 DOI: 10.1093/heapol/czy081] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2018] [Indexed: 01/31/2023] Open
Abstract
Chronic kidney disease (CKD) is a significant and growing driver of the global non-communicable diseases (NCD) burden, responsible for 1.2 million deaths in 2016. While previous research has estimated the out-of-pocket costs of CKD treatment and resulting levels of catastrophic health expenditures, less is known about the impact of such costs on access to, and maintenance of, care. Our study seeks to fill this gap by synthesizing available evidence on cost as a determinant of CKD treatment discontinuation. We searched for studies which considered the financial burden of treatment and medication for CKD patients and the extent to which this burden was associated with patients forgoing or discontinuing treatment. We identified 14 relevant studies, 5 from high-income countries and 9 from low-middle income countries. All suggest that cost adversely influences adherence to CKD medication and dialysis treatment. In poorer countries, those entering treatment programs were typically diagnosed late, under-dialysed and suffered very high levels of mortality. Identified studies present consistent findings regardless of study context: cost is barrier to treatment and a driver of non-adherence and discontinuation, with poorer households worst affected. This is in line with previous research. Major gaps in the literature remain, however, in relation to differential impact of the cost burden on men and women, the coping strategies of poor households and the effect of insurance coverage.
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Affiliation(s)
- Rebecca Dodd
- The George Institute for Global Health, University of New South Wales, Missenden Rd, Sydney, Australia
| | - Anna Palagyi
- The George Institute for Global Health, University of New South Wales, Missenden Rd, Sydney, Australia
| | - Laura Guild
- School of Professional Studies, Northwestern University, Chicago, 339 East Chicago Avenue, Chicago, Illinois, USA
| | - Vivekanand Jha
- The George Institute for Global Health, 311-312, Third Floor, Elegance Tower, Plot No. 8, Jasola District Centre, New Delhi, India
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Missenden Rd, Sydney, Australia
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Abstract
Background Transplant tourism entails movement of recipient, donor or both to a transplant centre outside their country of residence. This has been reported in many countries; and has variously been associated with organ trade. The objective of this study is to determine the frequency and pattern of transplant tourism among transplant patients in Eastern Nigeria. Methods This is a non randomized cross sectional study. All kidney transplant patients who presented at Enugu State University Teaching Hospital Parklane Enugu and Hilton Clinics Port Harcourt in Nigeria were recruited. The clinical parameters including the transplant details of all the patients were documented. The data obtained was analysed using SPSS package. Results A total of one hundred and twenty six patients were studied, 76.2% were males with M:F ratio of 3.2:1 and mean age of 46.9 ± 13.3 years. Fifty four and 58.7% of the patients were managed in a tertiary hospital and by a nephrologist respectively before referral for kidney transplant. Only 15.8% of the patients had their kidney transplant without delay: finance, lack of donor, logistics including delay in obtaining travelling documents were the common causes of the delay. Ninety percent of the patients had their transplant in India with majority of them using commercial donors. India was also the country with cheapest cost ($18,000.00). 69.8% were unrelated donors, 68.2% were commercial donors and 1.6% of the donors were spouse. All the commercial donors received financial incentives and each commercial donor received mean of 7580 ± 1280 dollars. Also 30.2% of the related donors demanded financial incentive. Conclusion Transplant tourism is prevalent in eastern Nigeria.
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Ashuntantang G, Osafo C, Olowu WA, Arogundade F, Niang A, Porter J, Naicker S, Luyckx VA. Outcomes in adults and children with end-stage kidney disease requiring dialysis in sub-Saharan Africa: a systematic review. Lancet Glob Health 2017; 5:e408-e417. [PMID: 28229924 DOI: 10.1016/s2214-109x(17)30057-8] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 12/02/2016] [Accepted: 12/16/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND The burden of end-stage kidney disease (ESKD) in sub-Saharan Africa is unknown but is probably high. Access to dialysis for ESKD is limited by insufficient infrastructure and catastrophic out-of-pocket costs. Most patients remain undiagnosed, untreated, and die. We did a systematic literature review to assess outcomes of patients who reach dialysis and the quality of dialysis received. METHODS We searched PubMed, African Journals Online, WHO Global Health Library, and Web of Science for articles in English or French from sub-Saharan Africa reporting dialysis outcomes in patients with ESKD published between Jan 1, 1990, and Dec 22, 2015. No studies were excluded to best represent the current situation in sub-Saharan Africa. Outcomes of interest included access to dialysis, mortality, duration of dialysis, and markers of dialysis quality in patients with ESKD. Data were analysed descriptively and reported using narrative synthesis. FINDINGS Studies were all of medium to low quality. We identified 4339 studies, 68 of which met inclusion criteria, comprising 24 456 adults and 809 children. In the pooled analysis, 390 (96%) of 406 adults and 133 (95%) of 140 children who could not access dialysis died or were presumed to have died. Among those dialysed, 2747 (88%) of 3122 adults in incident ESKD cohorts, 496 (16%) of 3197 adults in prevalent ESKD cohorts, and 107 (36%) of 294 children with ESKD died or were presumed to have died. 2508 (84%) of 2990 adults in incident ESKD cohorts discontinued dialysis compared with 64 (5%) of 1364 adults in prevalent ESKD cohorts. 41 (1%) of 4483 adults in incident ESKD cohorts, 2280 (19%) of 12 125 adults in prevalent ESKD cohorts, and 71 (19%) of 381 children with ESKD received transplants. 16 studies reported on management of anaemia, 17 on dialysis frequency, eight on dialysis accuracy, and 22 on vascular access for dialysis INTERPRETATION: Most patients with ESKD starting dialysis in sub-Saharan Africa discontinue treatment and die. Further work is needed to develop equitable and sustainable strategies to manage individuals with ESKD in sub-Saharan Africa. FUNDING None.
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Affiliation(s)
- Gloria Ashuntantang
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Charlotte Osafo
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Wasiu A Olowu
- Paediatric Nephrology and Hypertension Unit, Department of Paediatrics, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, State of Osun, Nigeria
| | - Fatiu Arogundade
- Renal Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, State of Osun, Nigeria
| | - Abdou Niang
- Internal Medicine-Nephrology, Cheikh Anta Diop University, Dakar, Senegal
| | - John Porter
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Saraladevi Naicker
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Valerie A Luyckx
- Institute of Biomedical Ethics, University of Zurich, Zurich, Switzerland.
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Okafor UH, Aneke E. Outcome and challenges of kidney transplant in patients with sickle cell disease. J Transplant 2013; 2013:614610. [PMID: 23691273 DOI: 10.1155/2013/614610] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Revised: 02/28/2013] [Accepted: 03/12/2013] [Indexed: 01/11/2023] Open
Abstract
Sickle cell nephropathy is a common presentation in patients with sickle cell disease. End-stage kidney disease is the most severe presentation of sickle cell nephropathy in terms of morbidity and mortality. Sickle cell disease patients with end-stage kidney disease are amenable to renal replacement therapy including kidney transplant. Kidney transplant in these patients has been associated with variable outcome with recent studies reporting short- and long-term outcomes comparable to that of patients with HbAA. Sickle cell disease patients are predisposed to various haematological, cardiorespiratory, and immunological challenges. These challenges have the potential to limit, delay, or prevent kidney transplant in patients with sickle cell disease. There are few reports on the outcome and challenges of kidney transplant in this group of patients. The aim of this review is to highlight the outcome and challenges of kidney transplant in patients with sickle cell disease.
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Okafor UH, Wachukwu C, Emem-Chioma P, Wokoma FS. Kidney transplant in a 26-year-old nigerian patient with sickle cell nephropathy. Case Rep Nephrol 2012; 2012:406406. [PMID: 24555134 DOI: 10.1155/2012/406406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 11/29/2012] [Indexed: 11/29/2022] Open
Abstract
Sickle cell nephropathy (SCN) is a common complication of sickle cell disease (SCD). It has variable presentation, ranging from hyposthenuria to end-stage renal disease (ESRD). Management of ESRD in SCD patients is froth with multiple challenges which has potential to impact negatively the outcome of the patient. Kidney transplant is the preferred renal replacement therapy in these patients.
The objective of this case study is to report kidney transplant in a Nigerian young man with sickle cell nephropathy and to highlight the outcome and the challenges to kidney transplant in this patient.
The index case is a 26-years-old sickle cell disease patient with ESRD complicated with cardiovascular, pulmonary, immunological, and infective challenges. These conditions were controlled, and the patient had a successful live-related kidney transplant. Kidney transplant is a viable option for sickle cell disease patients with ESRD.
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