Equity of Maintenance Hemodialysis in Myanmar: Cross-Sectional Descriptive Study

Abstract

Background: Maintenance hemodialysis has been the commonest Renal Replacement Therapy (RRT) in Myanmar. The equity is questionable in Myanmar, a developing country, as developed countries reported inequities of dialysis in various aspects. Methods: A cross-sectional descriptive study was conducted in selected Hemodialysis Centers (HDC) which are under the care of government of Myanmar in August 2022. Data were collected by using standardized forms and analysis was done. Results: A total of 168 cases from 5 HDC situated in Yangon (lower part of Myanmar), Nay Pyi Taw (central part of Myanmar), Aung Ban (Eastern part of Myanmar), Lashio (North eastern part of Myanmar) and Kyaing Ton (near Golden Triangle) were included. The age range was 21-79 years; old age was not excluded for maintenance hemodialysis. Male to female ratio was 1:1.2 revealing accessibility of both sex to maintenance hemodialysis. The proportion of ethnic groups was Burmese (139/168), Rakhine (8/168), Karen (7/168), Shan (6/168), Danu (2/168), Paoh (1/168), Chin (1/168), Kachin (1/168), inlay (1/168), Lesue (1/168) and Larhu (1/168); it was in accordance with normal ethnic distribution in Myanmar. Regarding religion, the majority were Buddhist (158/168); Nine patients were Christian. One patient was Islam. It was proportionate with percentage of population by religion in 2014 Census. Only 38 patients were graduates and four patients were illiterate; therefore, illiterates were accessible to maintenance hemodialysis. Ninety-eight percent of patients had comorbidities; and, 5% had 5 comorbid diseases revealing patients with multiple comorbid status were not left behind. Half of the patients were unemployed pointing that the jobless were not excluded for hemodialysis. Median travel time to HD center was 45 minutes (IQR 26-120 minutes). The maximum was 3 hours (180 minutes) in 3 patients. Half of the patients required 60 minutes travel time to HDC. Fifty percent of patients had booster vaccination to COVID-19. Most of the patients, over 90%, were doing their daily routine activity without assistance. Ninety-eight percent of patients were satisfied with treatments in their corresponding HDC. Conclusion: There was no difference in age, sex, race, religion, comorbidity, employment status, underlying etiology and education in terms of accessibility to maintenance hemodialysis. Although they were dealing with long travel time of more than one hour in 50% of cases, their attitude was positive. As half of the patients had travel time of more than an hour, we need new HDC in Aung Ban. Resource allocation to renal replacement therapy should be encouraged at ministry level.