From the newsletter
A recent review published in Nature has clearly outlined the direct and indirect ways in which climate change increases the incidence of urological diseases in Africa, as well as the carbon footprint of urological treatments on the environment.
First-order effects include heat-induced dehydration, increasing the risk of kidney stones and renal disease. Second-order effects involve climate-driven exposure to pollutants, contaminated air, and carcinogenic drinking water.
Third-order effects include healthcare access disruptions from climate disasters, infrastructure damage, and medical supply shortages. These factors collectively contribute to the rising incidence of urological diseases and cancers in Africa.
More details
Previous studies have shown that urological diseases account for over 25 million years lost to illness and disability worldwide, with the highest rates occurring in sub-Saharan Africa. Although data on urological surgical rates is limited, surgical volumes tend to be lowest in developing regions.
A major challenge in sub-Saharan Africa is the shortage of trained staff and equipment. Most countries in the region have only a small number of urologists; for example, Nigeria, the most populous country in Africa, has just one urologist for every 3.2 million people. Training programs are scarce, and funding for education and access to care is limited.
Sub-Saharan Africa has approximately 145,000 physicians serving a population of over one billion. Urology is a specialized field that requires specific equipment, which often lacks regular maintenance in resource-limited settings. Common urological conditions needing surgical intervention in African hospitals include benign prostatic hyperplasia (BPH), urinary calculi, and urethral strictures.
In Ethiopia, a study highlighted significant challenges in urology, such as insufficient equipment and qualified personnel. Most urologists are concentrated in urban areas, leaving rural regions underserved. In Tanzania, chronic kidney disease (CKD) affects 7% to 15% of the adult population, with a notably higher prevalence in urban areas (15.2%) compared to rural regions (2.0%), underscoring the urgent need for improved healthcare access and resources.
Financial barriers also pose significant challenges; a study from sub-Saharan Africa found that 47% of surgeries were canceled because the costs were entirely borne by patients. Additionally, public hospitals face a shortage of endourology equipment, and logistical issues hinder many urologists from obtaining advanced technical training in Europe or the USA.
Endourology, a crucial component of modern urological practice, is underdeveloped in Africa. A 2023 survey of 21 referral centers across the continent revealed that open surgery for upper urinary tract stones remains common, with only 23.3% of centers equipped for minimally invasive procedures like rigid and flexible ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL). Similarly, open prostatectomy continues to be the predominant technique for prostatic resection. These challenges highlight the pressing need for affordable equipment and surgical support programs to enable urologists to acquire essential skills.
Our take
Despite the existing obstacles in urological care in Africa, climate change is further deteriorating patient outcomes due to factors such as poor diet, increased exposure to chemical pesticides, rising temperatures, and the expansion of pathogen ranges. For instance, extreme heat events have been linked to higher rates of kidney disease and urinary tract infections, with studies indicating a 13% increase in the incidence of chronic kidney disease (CKD) for every 10 µg/m³ increase in fine particulate air pollution.
The escalating burden of kidney diseases and urological cancers in Africa necessitates urgent attention. Experts recommend the implementation of advanced dialysis technologies to help lower mortality rates. High-volume hemodiafiltration (HDF) is preferred over conventional hemodialysis because it offers better toxin removal and enhances patient well-being. Nonetheless, access to these technologies is restricted by high costs and inadequate infrastructure.
Additionally, there is a pressing need to enhance healthcare infrastructure to meet the rising demand for kidney disease treatments. This includes improving access to dialysis services, ensuring the availability of essential medications, and training healthcare professionals to manage these conditions effectively.