Strategic Framework for Managing Non Communicable Diseases: Preventing Chronic Kidney Disease of Multifactorial Origin (CKDmfo / CKDu) as an Example

Research Article

Chronic Dis Int. 2015; 2(2): 1018.

Strategic Framework for Managing Non Communicable Diseases: Preventing Chronic Kidney Disease of Multifactorial Origin (CKDmfo / CKDu) as an Example

Sunil J Wimalawansa*

Department of Medicine Endocrinology, Cardio Metabolic Institute, U.S.A

*Corresponding author: Sunil J Wimalawansa, Department of Medicine Endocrinology and Nutrition, Cardio Metabolic Institute, New Jersey, U.S.A

Received: September 11, 2015; Accepted: December 30, 2015; Published: December 31, 2015


The incidence of non-communicable diseases is escalating worldwide, especially in developing countries. Meanwhile, the incidence of communicable diseases such as infectious and diarrheal diseases (except parasitic) has plateaued or decreased. Nevertheless, health departments in most countries do not have proactive, effective strategic plans for combating non-communicable diseases. Departments of health and the public sector organizations are challenged with escalating incidence of chronic diseases. The increasing associated costs are not-matched by the available limited resources. Departments of health and the public sector organizations are challenged with escalating disease incidence and the consequent costs, for which available resources are limited and inadequate. Many health ministries and departments continue to maintain the failing, expensive, compartmentalized structures that are cost-prohibitive in controlling individual diseases. In general, these uncoordinated and fragmented approaches are inefficient, expensive, unproductive, and unsustainable. Further, most of the public health-sector groups, hospitals, heath ministries and departments do not impose targets or implement performance improvement steps at individuals or organizational levels. In addition, because of the lack of accountability reference to expected outcomes and deliverables, none undertakes responsibility for the tasks. These lack of leadership qualities seriously affecting the credibility of the health-related organizations; thus the likelihood that chronic diseases are curbed. This article proposes a simple, seven-phase, step-wise approach for developing a countryspecific strategic framework for the health ministries and departments of health. These can be easily adapt for combating, escalating incidences of any chronic disease. The index health crisis used in the discussion here is chronic kidney disease of multi-factorial origin, a deadly, pandemic disease, killing more than 5,000 farmers annually in Sri Lanka, and more in other equatorial countries.

Keywords: CKDmfo; Obesity; Diabetes; Economics; Environment; Quality of care; Premature deaths


NCD - Noncommunicable Diseases; NCP - North Central Province; CKDmfo - Chronic Kidney Disease of Multi Factorial Origin; CKDua - Chronic Kidney Disease of Uncertain Etiology; GIS - Geographic Information System; WHO - World Health Organization


The incidences of chronic, Noncommunicable Diseases (NCDs) are escalating, particularly in developing countries [1], whereas those of common, infectious-based communicable diseases are decreasing. Noncommunicable diseases are increasing at an alarming rate, especially among economically deprived communities [2]. Yet most can be controlled by taking proactive, cost-effective steps and adopting methods that have been implemented successfully in countries [3].

Health care is a basic human right not a privilege. It should not depend on skin color, ethnic origin, having a credit card, the ability to pay, or where one lives. Each country needs an effective health care system that is capable of providing for the needs of all its inhabitants [4]. In most countries, the health care delivery system is fragmented and needs revitalizing. This can be achieved through administrative changes, including the reallocation of funds from acute hospital medicine to nationwide preventive medicine and changing the way physicians practice medicine.

Worldwide, chronic diseases are responsible for approximately 70% of deaths; in the United Sates, almost 2.0 million people die of chronic disease each year. Death tolls are significantly higher in developing countries. Nations with emerging economies urgently need comparative effectiveness research that leads to solutions for early diagnosis and successful interventions. The next hurdle will be to provide this valuable information in a publicly accessible, and costeffective manner.

Reducing surgical site infections has been achieved with simple measures, such as hand washing, and technology, including redesigning operating theaters to have no-touch lighting, which have improved patient safety and reduced morbidity and costs [5- 8]. All other preventative care steps must be looked at systematically in every medical discipline and incorporated as routine practices. This article outlines a strategic framework that can be adapted for the management of most chronic diseases worldwide. To illustrate this strategy, the author uses chronic kidney disease of multi factorial origin (CKDmfo) [9,10], also known as chronic kidney disease of uncertain etiology (CKDu or CKDuo), as an example.

Chronic kidney disease of multi factorial origin in Sri Lanka

Latest among all NCDs in Sri Lanka is the Chronic Kidney Disease of Multi Factorial Origin (CKDmfo), also known as CKD of uncertain etiology (CKDu); it is the most rapidly escalating diseases in the country [11,12]. This deadly disease predominantly affects middleage male farmers in the main rice-growing region in the country, the North Central Province (NCP) [13]. The incidence of the disease is doubling every 4-5 years [12,14]. As with environmentally induced chronic diseases in other agricultural societies, CKDmfoin Sri Lanka primarily affects people of low socioeconomic status (poverty is common across all affected communities), mostly male farmers who are exposed to this adverse environment, in rural communities with less access to clean water or modern amenities [9,12,15,16]. Figure 1 illustrates the multiple consequences of having CKDmfo.