- Experts battle to unravel causes
Kidney failure has continued to ravage communities in Yobe and Jigawa States, even as doctors battle to unravel causes. Daily Trust gathered that despite its prevalence, the potential causes of the disease are still unknown.
Our correspondents who went round some hospitals noted that the ailment has continued to claim lives owing to lack of adequate facilities, health personnel with knowledge in the area and high cost of treatment.
At the Yobe State University Teaching Hospital, Khaltum lies on a bed as plastic tubes protrude through her arms, connected to a dialysis machine next to her.
She looked pale and unconscious, when she was brought into the dialysis unit, but as she began to receive treatment, gradually, her condition stabilized.
Outside the room was her worried aged mother, father and other family members who struggled to raise funds to offset Khaltum’s medical bill and keep her alive.
Her brother, Abubakar, said her condition was between life and death when they brought her to the hospital, sometime in October 2018.
“For 12 months now, Khaltum has been bed-ridden in the hospital, receiving two dialysis sessions weekly,” he sobbed.
Head of the hospital’s Dialysis Unit, Idriss Usman, said the case of Khaltum is not different from the over 200 patients that are on regular dialysis in the centre.
He decried that if not for the recent support by government, 90 percent of patients with renal failure attending the hospital could not afford their sessions, despite that, many of them died.
“High prevalence of the disease compelled the state government to declare free dialysis for Yobe indigenes because many people died and are still dying from the ailment,” he said.
He observed that what the government did relieved many patients of the burden of dialysis, but that there is still a problem as the root cause of the disease is yet to be uncovered to halt the prevalence.
According to experts, the disease escalated to communities not only in Yobe, but Jigawa State, due to lack of understanding of the potential causes of the disease.
The experts believe that unless state and federal governments take measures to uncover the cause of the disease, the helpless patients will continue to die because not many people can afford the cost of dialysis and, in worst case, kidney transplant.
Records at the Yobe State Teaching Hospital, Damaturu, made available to Daily Trust, revealed that there is high prevalence of the renal disease in Bade (Gashua), Jakusko, Nguru, Yusufari, Bursari, Gaidam, as well as in neighbouring Hadeija and Kafin Hausa in Jigawa State.
Dr Suleiman Mohammed Maina, a Consultant Nephrologist, with the University of Maiduguri Teaching Hospital, said a baseline survey conducted on the disease by his team, two years ago, revealed that majority of kidney patients visiting the hospitals are from Gashua town.
He said the survey, which was conducted at the Federal Medical Centre, Nguru, indicated that Gashua had 50 per cent of the total number of patients; Gaidam 10 to 15 per cent, Bursari 10 to15 per cent while the other parts of the state shared the remaining.
“Dialysis record in Maiduguri, also showed that minority of the patients are from the farming/fishing communities along the shores of Hadeija-Kamadugu/Yobe river, where Gashua emirate sits,” he said.
According to the doctor, alarmed by high prevalence of the disease in recent time, a group of young men from Bade (Gashua) emirate, contacted him for collaboration and advice on ways to uncover the cause and overcome the trend.
“We had several meetings with them on ways to identify the causes of the disease. We formed different committees and I happened to be part of the scientific committee. Veterinary Doctors and NAFDAC officials were also involved and they have taken samples of meat and water for analysis,” he explained.
On early scientific approach taken to unravel the causality of the disease, Maina said they were making efforts to generate prevalence data from various sources, but that it is capital intensive.
“In generating the data, we will identify the patient’s location, occupation and lifestyle. This will help us to know the hazard and predisposition factors that may likely cause the disease in their respective communities. If they are farmers in regular contact with chemicals or consume traditional medicine, we will have a clue on how and where to start.
“Also blood of goats, in the area, and water samples have been collected to evaluate whether cadmium will be traced in the goats blood or heavy metals from water sources. But, the whole research depends on funding, which is our major challenge for now.” he said.
He regretted that despite the prevalence of the disease the two states and the entire northeast region have very few doctors who specialise in Nephrology.
“We only have one specialist in Yobe, one in Borno, two in Bauchi, one in Adamawa while Gombe and Taraba have none. Also, we have few nurses in the field. Government must sit up to address the impending epidemic,” he said.
When contacted, Dr Mamman Mohammed, of the Department of Veterinary, Public Health and Preventive Medicine, University of Maiduguri, said a research carried out on different food substances and environmental media had revealed “violative concentrations of Cadmium (Cd), Lead (Pb)’’.
Daily Trust gathered that the researchers prioritized Cadmium (Cd) as focus due to the role it plays in the development of chronic kidney diseases even at low level environmental exposure.
Mohammed said he and three other colleagues from the University of Maiduguri and Ahmadu Bello University, Zaria, have started a study into the prevalence of the disease in the areas. They used hospital records which indicated that most cases were among people between the ages of 20 to 40 years, particularly in the last 15 to 20 years.
He regretted that the actual cause of the disease is not known yet and its epidemiology remains poorly understood, most probably, due to poor health facilities and lack of qualitative health records.
“Cadmium is a heavy metal with high toxic potentials, even at very low exposure levels, resulting in acute and chronic effects on health and environment. It is relatively a rare element and its most common natural sources in the environment are volcanoes and weathering. Man-made activities play vital roles in the emissions and spread of Cadmium,” he explained. He said a study was carried out to evaluate levels of Cadmium and blood samples of 356 semi-intensively managed goats were collected from five randomly selected wards in the study area, and the concentration of blood cadmium was analysed.
“A total of 55 goats were sampled from Dagona; 72 from Katuzu; 78 from each of Lawan Musa and Sabon Gari; and 73 from Usur/Dawayo wards,” he said.
Mohammed further observed that all the affected areas are significantly agrarian population that depends heavily on River Hadejia-Kamadugu/Yobe as source of livelihood.
“Fishery, livestock, irrigation and rain-fed farming practices are their major occupations throughout the year. They live along the river bank,” he said.
He also said that previously there were reports expressing concern over deteriorating quality of the basin’s environment, especially due to dumping of industrial and municipal wastes at the upstream Kano river and from the large scale irrigation project at the Hadejia valley.
“So, the wastes from human activities from the upstream are the major sources of toxic heavy metals in the environment. Nephrotoxic metals such as Cadmium (Cd), Lead (Pb), Arsenic (As) and Mercury (Hg) are some of the metals associated with anthropogenic (poisonous to kidney) activities”.
“The National Agency for Food, Drugs Administration and Control.(NAFDAC) has reported concentrations of Cadmium (Cd) and lead (Pb) in samples of drinking water from the area ranging from 0.01 to 0.10 ppm and Not Detected to 0.30 ppm for Cd and Pb respectively,” he added.
According to him, a recent study carried out reported high concentrations of As, Cd, Pb, Nickel (Ni) and Chromium (Cr) from the water sources used for irrigation in Jawa, a village located in the study area, while Waziri and Lawan villages, have also reported high concentrations of Cd and Pb in vegetables raised in the area. Another research reported elevated levels of Cd and Pb in freshwater catfish from River Yobe.
“These findings could be good indicators of heavy metals pollution status of the environment and, possibly, its associated risks. But, the focus of the current research is on single metal due to financial constraints,” he said.
A visit to some of the affected areas by Daily Trust, revealed that the statistics received from the hospital underestimated the public health crisis of the disease.
Umar Abubakar Ahmad, is the Chief Imam of Gashua Central Mosque. He said the kidney disease is aggravating by the day.
“Many people have died and are still dying from this disease. I pity the patients each time they come to mosques, seeking assistance and in most cases they die from the disease.
“The dialysis is just temporary and, in most cases, the patient dies because it is too expensive. That is why some people have now resorted to prayers and traditional medicine,” he said.
On the causes of the disease, the Chief Imam said, religiously, there was no tentative cause unless scientifically proven.
“We call on government and philanthropists to come to our rescue because thousands of people are dying from this epidemic. Not only in Gashua, Jakusko and other parts of Yobe, but in Hadejia and Kafin Hausa in Jigawa State,” he said.
When contacted, the Permanent Secretary, Yobe State Ministry of Health, Hamidu Alhaji, said a stakeholders technical meeting that involved academics, health professionals and government officials was held last year.
“Government supported us to host the consultative meeting with the experts and came up with a proposal. All the key processes to develop the proposal were supported by government,” he said.
He explained that the proposal is an institutional research of about N400 million and is currently under government’s consideration.
“Before then, government came up with the issue of free dialysis for indigenes to take over the burden of treatment cost, which in most cases patients cannot afford’’, he said.
He said at the meeting, risk factors and possible areas to research on the prevalence and causality were discussed extensively.
“We wrote to PCNI, before they rounded off to support the research. We also presented the high prevalence of the kidney disease at the 59th National Council Meeting on Health, appealing for more push on federal government to release funds for the research,” he added.
Chairman of Hadejia Ina Mafita Association, a Civil Society Organisation (CSO), Alhaji Hussaini Shehu, said the prevalence of kidney failure in Hadejia axis is far more than that of Gashua emirate.
He said, according to findings and statistical record by the Kidney Center of the Bayero University, Kano, in collaboration with the National Institute of Health, USA, and Nigerian Institute for Medical research (NIFMR) in 2018, Hadejia zone recorded the highest prevalence of kidney disease at 35 per cent, Zone C of Yobe, 25 per cent and Borno, 20 per cent.
He said three different researches were conducted, simultaneously, to know the actual cause of the disease, but none of it gave convincing clue to the cause of the epidemic.
“The first and second researches were carried out by the National Research Institute for Chemical Technology (NARICT), Zaria. However, according to the research, the suspected chemicals found in the sampled water, blood, urine and food analyses were insignificant to cause high prevalence of the disease unless they accumulated in people’s body over time.
“The first research was sponsored by a politician, Ubali Shittu, who is now a senator. The second one was financed by the state government. For over three months now, the state governor has been putting pressure on us to invite the researchers for a town hall meeting to present their findings with a way forward,” he said.
He said the governor has promised to do everything possible to end the epidemic.
“The governor, state and federal ministries of health, traditional rulers, religious leaders, Civil Society Organisations (CSOs), our legislatures and eminent sons and daughters of Hadejia emirate would all attend the town hall meeting,’’ he added.
The chairman said that many people are attributing the prevalence of the disease to too much intake of local herbs as well as excessive use of chemicals like herbicides, insecticides and other chemicals in farms.
When contacted, the University of Maiduguri Teaching Hospital (UMTH) said it was aware of the high prevalence of the disease in parts of Yobe State.
“We were aware of the prevalence of kidney disease in some parts of Yobe State long before Dr. Sulaiman Mohammed Maina, conducted his research there,” Dr. Ibrahim Ummate, the Director of the Kidney Centre of the hospital, told Daily Trust on phone.
“I conducted a similar research way back in 2006 there, although it was confined to only Gashua and Nguru local government areas, but my research confirmed the prevalence there.
“I submitted the findings of my research to the Yobe State government then, which also submitted it to the University Teaching Hospital, but since then, I have not seen or heard anything about it.
“The government, at whatever level, philanthropists or any concerned stakeholder in the healthcare should establish a support or research fund on the prevalence of the disease in Yobe State.
“The research should be conducted on the food and water residents of the affected areas take, whether the food and water contain elements causing the disease and whether there are other related causes,” he said.
The Head, Nephrology Unit, Aminu Kano Teaching Hospital, Professor Aliyu Abdu, said they are aware of the preponderance of renal diseases around Hadejia axis of Jigawa State.
He added that research is ongoing to ascertain why the cases are common in that area.
“We are aware of the issue but the National Institute of Medical Research in collaboration with the National Institute of Health Research, United States of America, is currently undertaking a research to find out why the issue is common in the zone,” he said.
He said that through community effort, a dialysis centre has been built in Hadejia, to cater to the needs of patients who cannot afford care at the hospitals.
He said volunteer doctors from AKTH and other hospitals go to the dialysis centre every week to see patients suffering from kidney failure free of charge.
Also speaking on the issue, the Director General/Chief Executive Officer (CEO) of the Institute of Medical Research, Yaba in Lagos, Professor Babatunde Salako, said the institute was currently carrying out a study on high prevalence of the disease in Hadejia, Jigawa State.
This, he said followed a report by Professor Aliyu Abdu, who manages many patients in Kano State and noticed that a large number of those going through dialysis are from the area.
“Professor Aliyu belongs to a Consortium of ours called, The H3 Africa Kidney Disease Network. H3 means Human, Heredity and Health in Africa, this time, on kidney disease. The aim of the H3 Consortium is to follow-up on a previous finding that showed that a particular gene called ‘APOL 1 Risk ALLEL’ predisposes black people to kidney disease.
“So, we put a report together to our senior partners in the United States and we got a small fund from the National Institute of Health (NIH).and from that fund, we tried to do a demography of Hadejia town where we studied about 1,500 people with the aim of finding out the prevalence and possible causes of kidney disease in the area.
“The study is ongoing in Hadejia and we are trying to close out completely in the next few months. The fund we had was small and could only do a preliminary investigation. We’re working with the Jigawa State Ministry of Health,” he said.
He said the thinking now, while study is ongoing in Hadejia, is that the cause of disease might be from the water, which is sourced from Hadejia River, where they also fish.
“We also heard of some practices where people use some kind of chemicals to kill fishes in the river. So, we are looking at the fishes too. We are also looking at the ground water from wells. We have taken all the samples for analysis and we have continued to collect blood, stool, urine and saliva samples from participants. We also had an engagement with leaders from the community,’’ he said.
Apart from the prevalence of renal disease, the DG disclosed that the results of screening carried out during the recent World Hepatitis Day, also revealed a high prevalence of hepatitis in Hadejia, compared to the average prevalence in the country.
“We looked at their blood bank and we saw that the prevalence among blood donors was much higher even though this may be among risk individuals. So, we are beginning to think that perhaps, this may be linked to the high prevalence of chronic kidney disease in Hadejia. We have not analysed, as the study is ongoing and we are beginning to think of closing up to look at the results.
“The idea is if we find out that the prevalence of kidney disease in the region is much higher than the average national prevalence, then we will declare an epidemic of chronic kidney disease in the region and that will call for significant government attention to work with us to unravel what the cause may be,” he added.
The Director, Public Health, Federal Ministry of Health, Dr Evelyn Ngige, did not respond to calls and text messages sent to her to find out if the ministry was aware of the situation and what it was doing to tackle the menace.