The burden of chronic kidney disease (CKD) is rising globally, but disproportionately impacting on low- and middle-income countries (LMIC) including Malawi, which have the fewest resources to manage it. Furthermore, CKD is the leading cause of catastrophic health expenditure worldwide, largely due to the extremely high costs of kidney replacement therapy (KRT) for people with kidney failure. Access to KRT remains limited in many settings, including Malawi, where there is only one nephrologist for a population of over 21 million. It is therefore essential to diagnose and treat CKD in its early stages, to facilitate earlier and more cost-effective treatment to prevent its progression to advanced disease which is associated with increased risks of kidney failure and of cardiovascular morbidity and mortality. CKD is usually asymptomatic in its early stages, so early diagnosis and treatments requires access to key diagnostic tests, in addition to strategies for channelling resources to those at the highest risk.
The causes of CKD are diverse, particularly in LMIC settings where the increasing prevalence of non-communicable diseases intersects with ongoing high burdens of infectious diseases, malnutrition, and many other social and environmental determinants of kidney health. The World Health Organization recommends integrated approaches to improve equity of quality care for people living with long-term conditions, and CKD would be amenable to integrated approaches, however CKD has been neglected from global NCD agendas and there is little data to guide the most effective methods for integrating its care with other long-term conditions (such as hypertension, diabetes and HIV infection), particularly in low-income settings such as Malawi.
The aim of this study is to explore current experiences of care for CKD and related long-term conditions, and to qualitatively evaluate the acceptability and feasibility of different potential approaches to integrating their care, amongst different stakeholders groups in Malawi.
Adults aged ≥ 18 years
Hypertension
Diabetes mellitus
HIV infection
• Under 18 years of age
Acute physical or mental illness, which requires urgent treatment and might impact on ability to participate in and complete interview
Current hospital inpatient
Unable to participate in interview due to severe communication difficulties (e.g. aphasia), confusion or behavioural disturbance
\- We will recruit adults aged 18 years and older from the following stakeholder groups: * Patients * Caregivers * Healthcare workers (HCWs) * Policy makers Patients will be adults with, or at risk of, CKD and at least one other long-term health condition, who receive outpatient care at Queen Elizabeth Central Hospital (QECH) in Blantyre, Chiradzulu District Hospital or primary health centres within Chiradzulu district. * Caregivers of patients from meeting eligibility criteria will also be invited to participate, if they are identified by the patient to be their primary caregiver. * Healthcare workers (HCWs) will be recruited from amongst staff working at any of the named study locations, whose role involves caring for patients with CKD and/or other long-term health conditions. * Policy makers will be individuals with leading roles in planning, managing and implementing services and policies for non-communicable diseases and/or other long-term conditions in Malawi
Other
Other
Receipt of healthcare for long-term conditions
Other interventionThe patient participants are people who are already receiving healthcare for CKD and/or hypertension, diabetes, HIV, heart failure and/or stroke at one of the named study sites, for at least 6 months prior to recruitment into this qualitative study. The caregiver participants are caregivers for patients meeting these criteria.
Provision of healthcare
Other interventionThe healthcare worker participants are all providing care to patients with long-tem conditions, at one of the names study sites
Policy making
Other interventionThe policy makers recruited to this study will be individuals involved in policy making for long-term conditions in Malawi
Codes and themes
The outcomes of this study will be the codes and themes identified through thematic analysis of the interview and focus group discussion transcripts.
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Liverpool School of Tropical Medicine
Lead sponsor
Wellcome Trust (Liverpool Clinical PhD Programme)
Collaborator
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