Increasing incidence of a chronic kidney disease of unknown aetiology (CKDu) is quickly turning into Sri Lanka’s latest health crisis, with hospitals in the country’s most affected province linking 80 percent of patients’ deaths to renal failure. The disease some refer to as an “unknown plague” has triggered internal migration, particularly among youths living in disease-prone areas.
Scientists have failed to identify a cause, thwarting efforts to prevent the disease which leads to renal failure, and at worst, death.
Based on hospital records, men over 40 seem to be most at-risk, which has pushed many households in the island’s north-central region (the most affected nationwide) to encourage young men to migrate.
Manamendra Padmasena,* 48, a farmer from the capital of North Central Province (NCP), Anuradhapura, has undergone treatment for CKDu for the past six years. He takes 48 tablets a day, in three doses and requires constant hospitalization year-round. His wife has also been diagnosed with the disease.
“We can’t find work because we are unfit. Our two sons do farming work but also work as unskilled labourers to support the family,” Padmasena told IRIN. Sumana, his wife, is worried about her sons’ future and tearfully claimed their marriage prospects were “zero” because of their parents’ ill-health.
“We are a burden to our children. Villagers don’t want to give their daughters in marriage to children like ours, fearing they too will end up with renal failure.”
Their neighbour, Agalawatte Padmasiri’s* three children left the area - an increasingly common phenomenon as people flee the disease, say villagers - when some of their family members were diagnosed with the disease. “If they stayed, there would have been no employment and no marriage,” Padmasiri told IRIN.
Confirming the trend, Dr Asanga Ranasinghe, director of the Provincial Renal Disease Prevention Unit of Anuradhapura General Hospital in NCP (the island’s most affected province), said patients’ families found it difficult to marry their relatives because prospective partners often feared higher susceptibility to renal failure.
“People suffer from a fear psychosis and lack awareness. There is a belief that CKDu is communicable and even genetic. If family members are diagnosed with CKDu, others will have reduced chances in marriage.
This health stigma is driving youth away from homes,” said Hemantha Vithanage, executive director of local NGO Centre for Environmental Justice, which has helped conduct disease research.
20,000 patients in one province
The World Health Organization (WHO) estimates there are approximately 20,000 CKDu patients undergoing care in NCP, with the most densely populated district, Anuradhapura, where the disease was first reported in 2000, recording the highest number of patients.
Ranasinghe said the province’s monthly death rate average as of the end of 2013 due to renal failure was 19, the island’s highest.
Some 2,000 cases were reported countrywide in 2013 with the electoral divisions of Medawachchiya and Anuradhapura (where there were nearly 1,600 reported deaths linked to CKDu from 2002-2010) in NCP reporting the most. According to Ranasinghe, the annual increase in kidney patients in Anuradhapura is approximately 1,450, and 450 in the provincial district of Polonnaruwa.
Health officials banned the import of three pesticides (chlopyrifos, propanil and vabarly) last April after local researchers linked agrochemicals to the disease. Agriculture Minister Mahinda Yapa Abeywardena told IRIN: “These pesticides are extremely harmful to human health. Even if there is no direct link, this is preventive action.”
The Health Ministry spends some US$3 million annually to treat persons diagnosed with CKDu. The government provides kidney patients receiving regular treatment with a monthly stipend of about near $4 and those on dialysis, $11.
Though hospitals maintain registers of CKDu patients, data is still spotty, said Ranasinghe. “Out of 10 hospital deaths in the NCP, eight are linked to renal failure.” He added that many sick patients go undetected in the villages.
Two research reports published in 2012 on CKDu’s causes disagreed over statistics and probable causes. One report by WHO estimated 15 percent of the population in NCP and Uva Province (working out to be some 60,000 people) had CKDu, and that 22,000 had died in the past 20 years in Anuradhapura alone from it. There is evidence, according to WHO research, that the disease is spreading to the Southern, Uva and Eastern Provinces.
Meanwhile, the New Delhi-based Centre for Science and Environment (CSE) in a parallel survey placed the figures at over 15,000 people in NCP, indicating water contamination as a possible source.
This only highlights the need for reliable scientific research, Oliver Illeperuma, head of the chemistry department at Peradeniya University in Sri Lanka’s Central Province, told IRIN: “There are multiple causes identified through different research attempts. It is important to treat this as a growing health crisis and increase preventive programmes.”
*Names changed to protect privacy