A nephrological program in Benin and Togo (West Africa)

Abstract

Nephrological programs are scarce in Benin and Togo, which are two small developing countries located in West Africa. This article describes a voluntary-based nephrological program that has recently been established in one hospital in north Benin and in another in south Togo. The program included: (1) care of patients with a renal disease; (2) improvement of urinalysis; (3) introduction of serum Na+ and K+ measurements; and (4) screening of renal diseases. This was carried from the records of patients with serum creatinine >/=2.0 mg/dL and of patients with a >/=+++ albuminuria, and the distribution to doctors of a questionnaire. (1) Renal patients were seen on each visit at both hospitals; most had advanced renal failure or nephrotic syndrome. However, due to the lack of major diagnostic and therapeutic facilities, the management of such patients was often difficult. (2) Urinalysis was improved through the introduction of dipsticks for the evaluation of the 10 parameters, the introduction of phase contrast microscopy, and the permanent education of two laboratory technicians. (3) The introduction of flame photometry for the measurement of serum Na+ and K+ was unsuccessful probably due to the poor quality of water and/or gas. (4) In a year, patients in the Benin hospital who had serum creatinine values >/=2.0 mg/dL represented about 3.3% and patients with >/=+++ albuminuria represented 1.0% of all admissions. The questionnaire was answered by seven physicians working in three different institutions in Benin and in one in Togo. It revealed that basic diagnostic and therapeutic facilities, such as electrolyte measurement, urine culture, renal biopsy, and dialysis are either lacking or are available only for the few patients who can afford to pay. Severe renal diseases are found frequently in patients of Benin and Togo. However, due to the lack of money and basic diagnostic and therapeutic facilities, these patients cannot be properly managed.