Ntokozo Dlamini

Congratulations to Ntokozo Dlamini, recipient of the 2015 Wesley Watkins International Grant

The biggest challenges facing the Nephrology Profession in the country

Swaziland is a developing country with a small economy. It’s GDP per capita of $7,917 means it is classified as a country with a lower-middle income. The Swazi population faces major health issues: HIV/AIDS and, to a lesser extent, tuberculosis are serious challenges. As of 2013, Swaziland had an estimated life expectancy of 50 years. The population of Swaziland is fairly young with a median age of 20.5 years and people aged 14 years or younger constituting 37.4% of the country’s total population. The present population growth rate is 1.195%.

The biggest health care challenges facing the nephrology profession locally, are many in number, broad in scope and fundamental in nature. Apart from the high cost of kidney care and the prevailing low socio economic state, the management of kidney diseases especially end stage kidney in the country is froth with diverse challenges listed as follows:

  1. Medical staff
    • Shortage of Nephrologists
    • Scarcity of Renal medical staff
    • Insufficient Nephrology nurses
    • Need for dietician
    • In-house psychologist
  2. Prevention or early detection
    • Primary care early detection program
    • Need to strengthen management of communicable + non communicable diseases known to cause kidney failure ( diabetes, HIV, Hypertension and glomerulonephritis )
    • Need for continuous education for all nephrology personnel
  3. Need for secondary level nephrology clinics
    • Human resource
  4. The rapid increase in end stage renal disease(ESRD) patient numbers
    • Need for kidney transplant as an exit for dialysis
  5. Costs of renal replacement therapy
    • Possibility of charging patients on medical aid to assist the government via their medical aid schemes.
  6. Many risks for Acute Kidney Injury
    • Late presentation to health facilities with already damaged kidneys which could have been prevented with education/sensitization
    • Herbal + over the counter medicines
  7. Non availability of Vascular Surgeon locally
    • Extra expense for government to refer to South Africa for insertion
  8. A fully functional laboratory and imaging department
  9. Clean and reliable water delivery system

Lack of adequate and appropriate health facilities, dialysis units including health care personnel poses a great challenge to care of patients with kidney related ailments.

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