Factors affecting access to dialysis for patients with end-stage kidney disease in Sub-Saharan Africa: A scoping review.
Milipaak Japiong, Christine Kurtz Landy, Mary T Fox and 2 others
PMID 37596727WHAT IT FOUND
Dialysis access barriers for people with end-stage kidney disease in Sub-Saharan Africa were cost, distance, machine and staff shortages, weak infrastructure, late diagnosis and family obligations.
Key findings
01The review identified health system, healthcare provider and patient factors as the main themes affecting access to dialysis.
02High treatment cost was reported as the major challenge in 86.7% of the included papers, and patients reduced sessions or other treatments because of financial limits.
03System and provider barriers included inadequate infrastructure, machine and consumable shortages, distance, health insurance, staff shortages, workload and lack of knowledge.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a scoping review, not a trial or intervention evaluation, so it does not show that any strategy improves dialysis access. The authors did not assess study quality, and the included studies used different designs. Only English-language papers and grey literature from 2011 to 2022 were included, so relevant local-language research may be missing. Most included studies were done in facilities that already had dialysis units, so people who never reached dialysis care are under-represented. The review included papers from 12 countries, while Sub-Saharan Africa has about 47 countries, so it may not reflect the whole region.
Declared interests
The authors reported no financial support for the work and no conflict of interest.
The easy way to misread this
Do not read this review as evidence that a specific intervention improves dialysis access. It describes barriers reported by included studies, does not test solutions, and mostly includes patients who already reached dialysis units, so it says little about people who never accessed care.