COVID-19 worsened inequities in kidney care in low- and lower- middle income countries
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Following the COVID-19 pandemic, inequities regarding kidney disease treatment have worsened in low- and lower-middle income countries, according to data published in Seminar Nephrology.
However, the pandemic has led to some improvement among health care systems in these countries.
“Although we can talk about challenges, at least there are a few things that COVID-19 has taught us,” Elliot Koranteng Tannor, Bsc, MBChB, FWACP, FISN, MPhil Nephrology, MBA, a senior lecturer from the department of medicine at Kwame Nkrumah University of Science and Technology and a consultant nephrologist at the Renal Unit of the Komfo Anokye Teaching Hospital in Kumasi, Ghana, told Healio.
Tannor and colleagues reviewed the progress made in kidney care among patients with COVID-19 and kidney disease in low- and lower-middle income countries (LLMICs) compared with patients in high-income countries.
Prior to the pandemic, inequities in LLMICs existed but the review revealed that COVID-19 significantly widened these gaps with regards to testing, management and availability of vaccines. Diagnosis and management of kidney disease during the pandemic proved to be more challenging for providers in LLMICs compared with those in high-income countries due to the inability to conduct rapid polymerase chain reaction testing. At the peak of the pandemic, 68% of lower-middle income countries (LMICs) had limited testing resources compared with only 20% of high-income countries.
Not only did LLMICs have limited resources, but staffing was also low with the few staff stretched thin without adequate personal protective equipment associated with psychological stress. “Optimal management of AKI in the light of COVID-19 is impossible without an adequate nephrology workforce,” Tannor and colleagues wrote. “The nephrologists per million population (pmp) in high income countries is 28.5 pmp as compared to 2.4 pmp in LMIC and 0.31 pmp in LICs.” There was slow turnaround time for test results and consequently, a delayed diagnosis and management of COVID-19 in patients with chronic kidney disease especially in LLMICS.
Tannor said generally LLMICs in Africa had low infection and mortality rates. For example, Africa accounted for 5% of COVID-19 cases in the world during August 2020. However, researchers noted that poverty, low health workforce and low infrastructure led to poor outcomes in patients with severe cases in Africa.
“The impact of COVID-19 has become what it is in LLMCs, not because of the numbers, but because of our weak health systems," Tannor said.
Although the vaccine rollout was generally slower in LMICs than in higher-income countries (13% of citizens in Nigeria vs. 99% of United Arab Emirates were vaccinated by May 11, 2022) vaccine uptake was also especially low in LLMICs, researchers said. Myths about COVID-19 vaccinations were common in all countries, but mistrust in allopathic medicine and fears of being used as test subjects increased vaccine hesitancy, according to the researchers.
Moving forward, Tannor said the importance of disease prevention to reduce disparities between LLMICs and higher-income countries. For COVID-19, Tannor said the cheapest option entails adherence to safety protocols, such as social distancing, hand washing and wearing face mask. For kidney diseases, nephrologists should focus on keeping patients healthy before the disease progresses to kidney failure because dialysis is not readily available, and patients often pay out of pocket for dialysis services in some countries, Tannor said.
“There were serious challenges from the start, but during the course of the pandemic, health systems improved after the initial shock with COVID-19. They were able to come up with some ways to try and mitigate the impact of COVID-19 on patients with kidney disease, on dialysis, and even those undergoing transplantation,” Tannor said. “Though we work under dire circumstances, you will find that nephrologists, physicians, nurses and [other staff], doing their best to be able to get the best of care for their patients.”
Editor's Note: On April 4, edits were made for clarification.The editors regret the error.
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