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Chronic Disease in El Salvador and Sri Lanka

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For nearly two decades, large areas of El Salvador have been affected by an align epidemic of chronic kidney disease (CKD). The less known disease had hampered the lives of youth who were breadwinners of most of the families. Following its emergence in the 1990s, the disease was widely ignored by authorities even as it devastated impoverished rural communities. Only now, bolstered by a growing body of scientific research, governments have begun to vigorously search for causes and solutions.  Based on medical reports death toll has reached at least 20 000.


The Ministry of Health's El Salvador annual report for 2011 - 2012 stated that chronic renal failure (CRF) was the third cause of hospital death in adults. During the last decade for example it has the highest overall mortality from kidney disease in the world. Epidemiological studies found a high prevalence in agricultural areas, predominantly in men, mainly aged less than 60 years, exposed to agrochemicals in combination with other risk factors.
Hospitalizations for CKD increased by 50 per cent from 2005 to 2012, and it is the leading cause of hospital deaths. There were a total of 1,474 hospitalized cases of CKDNT among the group aged 0-19 years (relative to the total of 39,000 cumulative cases) and the hospitalization rate doubled from 2011 to 2012.
According to data submitted by national coordinators or national donation and transplant committees in the countries, approximately 3,100 patients are in substitution treatment in El Salvador currently.

An increase in CKD incidence has been noticed in poor agricultural communities Sri Lanka. Chronic renal failure was first observed in the 1990s, and over the past 25 years the prevalence of the disease within certain geographical locations has increased dramatically.

Nontraditional risk factors, identified in several studies are toxic, environmental and occupational. There appears to be a complex interaction between poor working conditions, notably inadequate handling of agrochemical mixtures-many of which are banned-used in large amounts and without protection and prolonged, intense physical effort at high temperatures, with insufficient hydration.

Over the past two decades, the occurrence of high levels of arsenic in drinking water has been recognized as a significant public health issue, which is global in extent. The adverse health effects of depend strongly on the dose and duration of exposure.

Specific dermatological effects are characteristic of exposure to Arsenic. Government statistics indicate over 1,500 deaths due to CKD Annually. Treatment for patients affected by the disease is either through a kidney transplant or dialysis, in the case of the latter treatment has to be carried out at least once a week.

It is estimated that the affected area covers approximately 17,000 km2 with a population of approximately 2.5 million, in which, more than 95% live in rural areas.

According to current estimates, CKD appears to be three to four times higher in the North Central Province as against the other provinces, except the Northern Province. As early as 2002, three times the national average of CKD patients were found in the North Central Province. 

The agro-chemicals that are routinely used in rice production systems have been identified as the source of Arsenic and  being associated with agro-chemicals has been suggested as the possible source, it is difficult to reconcile why the disease does not afflict all rice growing areas of Sri Lanka.

Arsenic distribution in the urine of CKDu (n = 125) patients and non-CKDu (n = 180) cohorts.

It is vital that both governments play a major role to protect farmers in both countries from CKD disease and to ban pesticides. Government of Sri Lanka became the first to ban import of Glyphosate recently. Such acts are needed to prevent the spread of CKD Disease in other countries as well to create Eco Friendly Agricultural arena in future. 

Source : Ministry of Health El Salvador, Ministry of Health Sri Lanka, WHO, Daily

Last Updated on Friday, 26 February 2016 07:53  
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