Abstract: FR-PO872
Using Design Ethnography to Identify Barriers to Dialysis Access in Lagos, Nigeria
Session Information
- Diversity and Equity in Kidney Health - II
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Diversity and Equity in Kidney Health
- 800 Diversity and Equity in Kidney Health
Authors
- Wright, Natasha C., University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
- Warehime, Jacqueline Rose, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
- Szot, Benjamin, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
- Bernemann, Carolyn, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
- Yekinni, Ibrahim O., University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
- Rheault, Michelle N., University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
Background
There is limited access to renal replacement therapy (RRT) for end stage kidney disease patients in low- and middle-income countries (LMICs). An estimated 9.1 million people globally will not be able to access RRT by 2030. This growth is aided by advancing age, diabetes, and hypertension with a greater burden expected in LMICs which are experiencing an epidemiological transition from communicable to non-communicable disease. While LMICs may be the most affected, they are also the least equipped; less than 10% of those who need RRT in LMICs are able to access it. In this study, interview methods were used to identify barriers to dialysis treatment for patients in Nigeria, where only HD is available, and to elucidate insight on PD as an alternative treatment.
Methods
Semi-structured ethnographic design interviews were conducted in Lagos, Nigeria in January 2020. 33 HD patients were interviewed across 3 dialysis centers. Audio recordings were transcribed and analyzed using descriptive and emotion-based coding in NVivo.
Results
Matrix analysis of the descriptive and emotion-based codes revealed three primary themes: (i) The high cost of HD leads to lower treatment frequency compared to optimal prescription. Costs include financial (e.g. treatment cost, lab work) and lost time (e.g. transportation, wages). The descriptive code of cost overlapped with the emotion code of sad (n=14), overwhelmed (n=20), and stressed (n=12). (ii) Family involvement is a critical part of the patient’s experience. With this high level of moral and financial support, patients often felt a sense of guilt. (iii) PD is associated with feelings of independence and comfort. Patients preferred PD (n=24) compared to HD (n=6).
Conclusion
The findings support the hypothesis that patients in Nigeria may be interested in and benefit from PD as a treatment option. Patients performed HD treatment less frequently due to high costs which left them feeling weak between treatments, often resulting in lost wages. Patients were drawn to the perceived independence of PD. The majority of patients indicated strong familial support and comfort with the idea of administering treatment in their home. A service to train patients on treatment administration and local PD fluid production were identified as necessary to increase the feasibility of PD adoption.
Funding
- Other U.S. Government Support