Eradicating diseases of uncertain etiology
Harnessing and sharing knowledge, application of best practices, preventing occurrence & guaranteeing treatment and ensuring welfare of the affected through a process of coordination
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Fresh effort to solve the 'unknown' aspect of CKDu
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Proposals for three national programs will be presented to first cabinet meeting – President
President Maithripala Sirisena says he would present the proposals related to national programs to be implemented for local food production, environment preservation and drug eradication, to the first cabinet meeting.
He made these remarks at a meeting with the members of the Task Forces of above programs, held today (Aug. 20) at the Presidential Secretariat.
The directors and Ministry Secretaries who are heading these Task Forces presented the progress of their programs to the President.
The local food production program which makes the country self-sufficient will be implemented in several phases. The programs will be put into practice under the units such as agricultural research, qualitative applications and efficient sales system.
The President pointed out the importance of encouraging farmers to cultivate all uncultivated farmlands. He recalled agrarian services act also states the importance of educating farmers on this regard.
The environment preservation program will be implemented under sub programs on environmental issues, soil erosion, elephant-human conflict and coast conservation.
President Sirisena pointing out that the programs he initiated during his time as the Minister of Environment to minimize the use of polythene which is severely affected the environment, rigorously have been deactivated by now. He directed the officials to seek into them and empower them again.
Attention was also paid on the progress of the program for chronicle kidney disease which has been a huge social tragedy.
The plans for drug prevention which will be implemented island-wide in the future were also presented at this occasion.
The President pointed out that all these responsibilities cannot be solved by any ministry or institution alone. He emphasized this programs should achieve their objectives with the participation of everybody for the future of this country
The keen interest of H.E the president, in eradication and prevention of chronic kidney disease spreading specially in 10 districts led the establishment of the Presidential Task force on Prevention of Kidney Disease of uncertain etiology. Primary Objective of the task force is to manage the chronic kidney disease of unknown etiology (CKDu) and prevent further spreading with the coordination of respective authorities and ensure, awareness, preventive and welfare measures are in place to the benefit of the effected community
Background to Chronic Kidney Disease
Chronic Kidney Disease (CKD) is a widespread disease caused by wide range of precipitating factors. According to available health statistics there are approximately 20,000 admissions/ re-admissions of patients with renal failure to government hospitals with approximately 2,000 deaths annually.
Chronic kidney disease of uncertain origin (CKDu) was first detected in the early 90s from North Central Province, which is a toxic nephropathy causing tubular necrosis. It differs from the pathophysiology of CKD caused by Hypertension and Diabetes. CKDu affected areas adjacent to North Central Province were also detected which include Ampara, Badulla, Kurunegala, Matale, Mullative, Trincomalee and Vavuniya Districts.
CKDu is the existence of chronic kidney disease without diabetes, hypertension, ureteric calculi, glomerulonephritis, pyelonephritis or snake bite. In Sri Lanka, the etiology of CKDu is uncertain. However the disease is attributed to several causative factors including high use of agrochemicals, hard water which include high levels of Calcium and Fluoride, dehydration due to inadequate drinking of water and heat, and presence or absence of certain chemical compounds (eg. high levels of Arsenic and Cadmium, low levels of Selenium).
There are approximately 70,000 estimated CKD/CKDu patients in known high risk areas of which majority are from North Central Province. Madawachchiya, Padaviya, Kabathigollawa, Rambawa, Madirigiriya, Wilgamuwa, Girandurukotte, Padavi Sripura, Gomerankadawala, Dehiattakandiya, Polpithigama and Welioya Medical Officer of Health (MOH)/Divisional Secretariat (DS) areas have high prevalence of CKD/CKDu (Annexure 01) (Fig 1).
Community screening for CKD/CKDu started in 2008 and so far 38,000 patients with CKD/CKDu were identified during screening. Anuradhapura and Polonnaruwa Districts reporting approximately 1,000 and 500 CKD/CKDu patients annually during the past four years.
***(Ministry of Health 2015)
Causes of Chronic Kidney Diseases of Uncertain Aetiology (CKDu) Prevalent in certain parts of the dry zone
- High level of Arsenic, Cadmium in humans in these areas
- Low levels of Selenium in humans (Malnutrition)
- High levels of Calcium and fluoride in the water
- Presence of Agrochemicals residues in humans
- Dehydration due to inadequate drinking of water & heat
- Alcohol and tobacco consumption
- Excessive and indiscriminate use of agrochemicals
Action undertaken against prevention of Chronic Kidney Disease
- Screening for early detection of the disease through selected communities
- Strengthening of the 04 curative sectors for management of the CKD patients
- Primary Health Care Units
- Nephrologists Visiting Centers
- Hospitals with Dialysis Facilities
- Nephrology Visiting Centers
- Introduction of CKD/CKDU surveillance and patient registries in high-risk areas
- Providing Financial Assistance to CKD/CKDU patients.