In 2016, we conducted a baseline survey of the renal services that were being offered in the major hospitals in Malawi. The main purpose of the survey was to conduct an analysis of the renal services that were being offered in the major hospitals in Malawi with the aim of identifying gaps in service provision.
The survey was conducted using a structured questionnaire to collect information relating to human resources, equipment and supplies, financing and patient management in major hospitals in Malawi. The hospitals were stratified according to level of service; Tertiary service level being the last in the referral line, whereas secondary level received referrals from the health centres. Summary statistics were computed and presented as median and inter-quartile range (IQR). Categorical data were analysed as counts and proportions. Fisher's exact test was used to test associations between two categorical variables. Wilcoxon Rank Sum test was used for comparing continuous outcomes between relevant groups. The analysis was restricted to univariate given the small sample size. Data was analyzed using Stata 14.0 (Stata Corp. Texas, USA). Statistical significance was declared at 5% significance level.
Data from a total of 14 major hospitals was available for analysis. None of the hospitals had a local or resident nephrologist with 29% (4/14) of the hospitals indicating that their staff had received kidney related training albeit non specialist. Four of the fourteen facilities conducted routine meetings, to review renal patient services. Only two of the 14 hospitals conducted kidney biopsies and three hospitals have dialysis treatment facilities. All the 14 hospitals have a functional lab that assists in diagnosis of renal impairment. Urine analysis is conducted in all the 14 hospitals whilst 57% (8/14) conduct serum tests, 71% (10/14) provide stool diagnostic and only 29% (4/14) provide saliva tests. Half of the hospitals maintain records specifically of kidney patients with 43% (6/14) of them keeping in hard copy files. Only 21% (3/14) patients had a follow up system for patients in their communities. About 43% (6/14) of the hospitals receive specific funding for equipment and supplies for renal disease whilst the rest depend on general medical supplies.
This study was the first of its kind that revealed that major hospitals in Malawi were inadequately equipped with the requisite facilities or infrastructure to manage renal disease exclusively. Resources were limited in all categories assessed. With the surge of kidney disease that is predicted in the Sub Saharan Africa, the situation calls for urgent intervention if we are to ably manage kidney disease.