Chronic Kidney Disease of unknown Etiology (CKDu) has been reported from 10 districts in the country. The cases are mostly in the North Central, Uva, North Western and Central Provinces. According to the Health Ministry, the number of CKDu patients in 2010 was 29,336. By 2014, this number increased to around 40,000. The current data is not available but according to press reports, nearly 60,000 people have been affected by CKDu. President Maithripala Sirisena appointed a presidential task force (PTF) in 2014 due to the gravity of the problem. The primary objective of the task force was to take prompt, appropriate action to prevent the spread of this fatal disease in co-ordination with the respective government and non-governmental organizations. Ironically, the number of patients suffering from CKDu has continually and significantly increased. The website of PTF does not indicate the number of CKDu affected people. The disease has now spread to a number of areas such as Mahiyanganaya and Girandurukotte, which hitherto were relatively free from CKDu, indicating the inadequate action taken by the Task Force.
An International Expert Consultation on CKDu was held in 2016 from 27-29 April in Colombo. This was organized jointly by the World Health Organization (WHO) Country Office for Sri Lanka and the Presidential Task Force on CKDu (PTF). At the conclusion of this meeting, 27 recommendations were made. One of the recommendations of this consultation was to establish community-based disease surveillance to understand the burden, geographical distribution and time trends of CKDu in Sri Lanka. Almost one year has passed since this consultation was held and the PTF appear to not have taken any action to implement this recommendation.
"The cases are in North Central, Uva, North Western and Central Provinces."
In order to ensure and facilitate implementation of this National Action Plan, a framework for monitoring, implementation and accountability was presented. The PTF is to be the focal point for the proposed inter-sectoral coordinating mechanism, but the PTF appears not to have taken realistic action connected with the proposed three-pronged framework.
CKDu is considered to be of multi-factorial origin. A recent review by the International Water Management Institute (IWMI) (ref. IWMI Working Paper 158) indicates that no specific substance/compound has been proven to cause CKDu. Research studies carried out to-date indicate that drinking contaminated water is the main cause of this disease. Therefore, it is important to provide clean water to all inhabitants of CKDu affected and surrounding villages. Hence, the PTF needs to have an effective programme to supply good-quality water to those in the CKDu affected areas. But there appears to be no effective plan to supply good quality water to the affected areas. To achieve this objective, it is necessary to know the number of affected people in the different DS divisions. This information is not available.
"The President appointed a presidential task force (PTF) in 2014 to look into the problem."
During the last few years, hundreds of research studies related to CKDu have been conducted. Contributions on CKDu by professionals are given in the website maintained by the Coordinating Secretariat for Science, Technology and Innovation (COSTI). However, there is no definite conclusion on what causes CKDu. One of the recommendations of the International Expert Consultation was to establish a consortium of national/international researchers to conduct long-term interdisciplinary research on this issue. PTF appears to have taken no action in this regard.
The 2017 budget allocated Rs.100 million to the National Science Foundation to conduct studies related to CKDu. However no action appears to have been taken by PTF to initiate this study. As the main authority on CKDu in Sri Lanka, it is crucial that the PTF takes relevant action immediately to prevent/control CKDu which is creating hardships for thousands of people.