RENAL DISEASE PREVENTION

PROGRAMME
(RDPP)

 DEPARTMENT OF HEALTH SERVICES

NORTH CENTRAL PROVINCE
SRI LANKA
 
 & Demography
 The North Central Province consists of two districts namely Anuradhapura and

Polonnaruwa and it is located 200 km away from the capital Colombo, towards the
North. It has a land area of 10,258 sq.km and is the largest province in the country,
  with a population of 1.1 million as estimated in 2002. The land area of
Anuradhapura district is about 6861 sq.km and is the largest district in Sri Lanka,
consisting population of 800,000. The Land area of
Polonnaruwa district is 3332 sq.km and consists a population of 310,000.
The North Central Province lies between altitude 8” and 9” in North and longitude
80” and 81” in East. The minimum temperature in the province is generally 20 C 0
in January and February and maximum temperature is around 30 C 0 during the
months of May and August. The mean annual rainfall ranges from 1500 mm in the
East and 2000 mm in the West. Much of it depends on the North East monsoon
rains between November and January.
About 90% of the people of the community live on cultivation and
another 5 – 6% of the community is engaged in permanent jobs in the
province. Out of the community engaged in farming, nearly 40% of them
work as casual laborers to assist agricultural activities. As a result they
were exposed to heavy usage of artificial fertilizer and pesticides. Most of
the people in this province are exposed to severe evaporative conditions
in their open lands due to the nature of work they get involved in dry
climatic condition.
Even though the province has more than 3000 tanks, only a few tanks are
used as sources of safe drinking water. And the coverage of the
provision of the pipe born water is about 35% in the province. The
average intake of safe drinking water is also a serious factor under dry
climatic conditions. Malaria was the leading disease of this province, in
the past few decades and subsequently very potent insecticides such as
DDT & Malathion were used in the control measures.
SITUATION ANALYSIS

The cases of Chronic Renal Failure are progressively increased over last 10 years in Sri
Lanka. Out of the cases of Chronic Renal Failure reported in Sri Lanka, more than 60% of
the patients were from the North Central Province. The burden of managing those patients
were reflected mainly to the Nephrology Unit, General Hospital Kandy and the National
Hospital, Colombo Sri Lanka.

Over last 3 – 4 years the cases reported, due to Renal diseases NCP were ranked second
only to the cases of poisoning. Even though the number one cause of hospital death in NCP
was due to poisoning, the leading disease causing death was, Chronic Renal Failure
(CRF). The Renal Disease being the number one killing disease in NCP. This disease
condition is more crippling the lives of the community than any other Medical condition.
Usually the patients of Renal Disease are detected late in the disease spectrum. As a result
the medical management involved in the Renal Disease has become complicated. At the
terminal stages of the illness the treatment is extremely costly and it is almost unbearable to
the patients.
 
 Diagnosed patients of CRF attending clinic / Hospital in Anuradhapura district

Date of Diagnosed at
Registration (Name of the
No Division Name Hospital to the Clinic Address hospital)
1 NPC P. Santha 24.03.2005 Puwarsankulama GH - Anuradhapura
2 NPC C.R. Karunawathi 16.07.1998 Railway Town , Medawachchiya GH - Anuradhapura
3 NPC Thegis 18.12.2004 Paniyankadawala GH - Anuradhapura
4 NPC P. Seelawathi RH Parasangaswewa26.05.2005 Siyabalagaswewa , ParasangaswewaGH - Anuradhapura
5 NPC A. Senarathna 09.06.2005 Peragoda , Parasangaswewa GH - Anuradhapura
6 NPC E. Siripala 29.01.2004 Paniyankadawala GH - Anuradhapura
7 NPC S. Premawathi 21.04.2005 Siyabalagaswewa , GH - Anuradhapura
8 NPC S.P.Ariyarathne RH Willachchiya 20.05.1999 No.27,Ulukkulama,Pemaduwa GH - Anuradhapura
9 NPC B. Menikhamy 07.09.2000 No.282,Left Bank,Mahawillachchiya GH - Anuradhapura
Cases of CRF in Sri Lanka 1996 – 2003 (Cases/ Deaths)

Year Anuradhapura Polonnaruwa Sri Lanka

1996 745/136 176/31 5475/870

1997 746/119 283/28 4827/992

1998 1102/138 288/51 5526/1042

1999 1267/167 341/47 6194/1095

2000 1354/202 345/39 5841/1035

2001 1405/184 395/41 6113/1075

 jl =
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k ai y u r K
^j d¾; d mdol l r . k su sk a&

Colombo Matale Kurunegala Puttalama Anuradhapura Polonnaruwa

Cases C/D C/D C/D C/D C/D C/D

2002 1069/30 70/4 461/120 112/8 1880/136 780/82

2003 882/274 141/11 305/57 118/12 2212/143 808/98

2004 1203/302 150/12 380/62 124/17 2980/157 860/96

2005 1470/402 153/11 391/64 135/22 3021/183 890/94

2006 1520/507 156/14 412/76 148/31 4820/220 970/110

2007 Not Not Not available 151/30 5430/234 988/112

available available

2008 Not Not Not available 156/34 5836/253 1117/108

available available

2009 Not Not Not available Not available 6432/281 1207/112

available available
 Occupational Distribution
Category Number %
Farmers 174 56.3[71%]
House wife 29 9.4
Labors 15 4.9
Business People 05 1.6
Carpenters 05 1.6
Post man 03 1.0
Gramasewaka 02 0.6
Others 13 3.9
Missing data's 63 20.4
 Geographical Distribution
DSD NO % DSD NO %
Mada,ya 53 17 Kabitigo 9 3
NPC 48 16 Rajanga 9 3
NPE 20 7 Rambe 9 3
Kahat,y 19 6 Tabutte 9 3
Padaviy 16 5 Horowp 6 2
Gal,wew 14 5 Palagal 5 2
Galnev 12 4 Kekiraw 4 1
Noch,m 12 4 Ipaloga 2 0.5
Tirappa 12 4 Mahawil 0 0
Mihintal 11 4 Out side 15 5
Talawa 11 4 Missing 13 4
 CRF – Hospital Death and live discharges –
2001 General Hospital - Anuradhapura

900
800
700
600
500
400
300
200
100
0

Live Discharges Deaths

 Number of Cases & Death of CRF in Sri Lanka 2000

7000

6000
No of Cases & Death

5000

4000
Cases
Death
3000

2000

1000

0
 Cases of CRF by Age
 
 

     
No %
Age
0-10 00 00.0

11-20 04 1.3

21-30 29 9.4

31-40 57 17.4

41-50 73 23

51-60 73 23.6

61-70 51 16.5

71-80 10 3.2

Data not available 12 3.9

Total 309 100

2. Survey and Studies conducted
 
At the National level out of the cases of CRF reported at National
hospital Colombo and the General hospital Kandy about 34% of the
patient sought treatment were from the North Central Province.
This alarming sign was reflected over the authorities in the NCP
and motivated to intervene this health problem.
The health authorities of the NCP along with the National Water
Supply & Drainage Board (NWSDB) Anuradhapura were
conducted an initial consultative meeting in order to draw the
attention and make proper interventions in 2003. In the scenario the
Nephrology unit of General hospital Kandy and the university of
Peradeniya joined hand in hands with the health authority of NCP
and conducted a survey in the divisional secretariat division of
Madawachchiya in 2003.
 
The survey was carried out from house to house by checking the
urine for protein using salicylic method and 300 people were
screened and 200 became positive for urine protein. Out of these
positive cases, 5% of the people showed the early signs of Renal
Failure in Ultra Sound Scanning, which was carried out, in the same
DS Division as a part of the survey. As a conclusion about 4% of
the people were positive to show early signs of Renal Failure.
Subsequently selected population was screened in the divisional
Secretary division of Padaviya and Madirigiriya and showed the
positive figures as 6.7% & 8% respectively. These two revealed
figures alarmed the Health Authorities further to motivate activities
to combat this disastrous condition, which is hidden in the
community at present. As the study reveals in year 2006 the disease,
community will be increased by 15% in the Province.
The majority of the community in North Central Province consumes water either from
surface water collections (tanks) or from shallow wells. Another minority uses tube wells
as the sources of drinking water .Agriculture being the main occupation in this province
invariably the community get exposed to high concentrations of Agrochemicals and
various artificial fertilizer. In addition to the direct expose to these chemicals, the water
sources get contaminated with these chemicals and accounts for human ingestion.
Due to the scarcity of the sources of safe drinking water in the province, the community
has to collect water from distance in the process of collection and storage of the water.
The majority of utensils used in these purposes are made out of Aluminum, which are at
substandard quality as far as the health standards are concerned. Some of the utensils are
made out of Aluminum discarded from the automobile trade too. The possibility of
contamination of Lead cannot be excluded.
Subsequently the Medical care needed for these people was felt and a new Renal Care
Unit was established at the District Hospital Madawachchiya. Currently there are nearly
500 patients attend to this clinic following the early identification of signs of Renal
disease.
When identified early, it is possible to manage these patients to avoid the secondary
manifestation of this disease. Also it enhances well-being of the patients. The limitations
in the curative care facilities at the General Hospital Anuradhapura is most felt as this
the only Hospital available with tertiary care facilities in the entire province.
 Improvement of the
Secondary Care
Chronic Kidney Disease
(CRF)
Drugs/Human Resource
Investigation facilities Buildings
Patients with early Divisional / General Hosp.
signs of CRF
Patients not Improvement of the
Tertiary care
detected yet Social
welfare Dialysis facility
expansion
(Buildings/HR/Equip.)
Early Identification &
Healthy community Follow up
(Drugs/Reagents/Recu
(Screening) rrent cost)
(Secondary care)

Prevention / Avoidance of risk factors

diseases magnitude
(Health Education/Media/Sign Board)
Renal Research & Survey

Clinical studies PaPatho/Histo logical post Community

(Facility improvement) Mortem Based
Surveys
OBJECTIVE NO 1. Reduced incidence of CRF in NCP
1. Intermediate Objective - To improve the Secondary Care Facilities at selected Divisional Hospitals
Out put - 1.1 Strengthened Drug availability & Investigation facilities

No Activity Cost Responsibility 2006 2007 2008

7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12

Requisition of revised drug & reagent estimates for 2005 for PDHS/DPDHS
1 selected divisional Hospitals in Anuradhapura District - A'pura

Requisition of revised Drug & reagent estimates for 2005 for PDHS/DPDHS
2 selected divisional Hospitals in Polonnaruwa District - Polon'ruwa

Provision of Laboratory Equipment to selected hospitals in PDHS/DPDHS

3 Anuradhapura District - A'pura

Provision of Laboratory Equipment to selected hospitals in PDHS/DPD

4 Polonnaruwa Districts - Polon'ruwa

Out put 1.2 Adequate Human Resource available

Requisition of Human Resources for selected hospitals in PDHS/DPDHS

1 Anuradhapura District - A'pura

Requisition of Human Resources for selected hospitals in DPDHS

2 Polonnaruwa District - Polon'ruwa
2.Intermediate Objective - Renal Care facilities improved at General Hospitals

Out put 2.1 Secondary Care Facilities Strengthen

Requisition of revised drug & reagent estimates for 2005 for

1 G.H. Anuradhapura MS GH - A'pura

Requisition of revised drug & reagent estimates for 2005 for MS GH-
2 G.H. Polonnaruwa Polon'ruwa

3 Provision of Laboratory Equipment to G.H. Anuradhapura MS GH - A'pura

DPDHS/MS
4 Provision of Laboratory Equipment to G.H. Polonnaruwa GH- Polon'ruwa
Total
Out put -2.2 Tertiary Care Facilities Strengthen
MS
1 Provision of 08 Haemodialysis Unit to G.H. Anuradhapura 16,000,000.00 GH - A'pura
DPD/MS
2 Provision of 02 Haemodialysis Unit to G.H. Polonnaruwa 4,000,000.00 GH-Polon'ruwa

3 Provision of 02 water Treatment Plant to G.H. Anuradhapura 3,000,000.00 MS GH - A'pura

4 Provision of 01 water Treatment Plant to G.H. Polonnaruwa 1,500,000.00 PD/DPD/MS

5 Establishment of a Renal Care & Research Centre at Provincial level 150,000,000.00 PD/MS
Total 174,500,000.00

Out put -2.3 Improved Infrastructure Facilities

Renovation and Conversion of ICU to Haemodialysis Unit at DPD/MS
1 G.H. Polonnaruwa 6,000,000.00 GH-Polon'ruwa
Extention of the building of the Haemodialysis unit at
2 G.H. Anuradhap 2,000,000.00 MS GH - A'pura
Total 8,000,000.00
Out Put 2.4 Adequate Human resource available
1 Requisition of Human Resources for G.H. Anuradhapura MS GH - A' pura
DPD/MS
2 Requisition of Human Resources for G.H. Polonnaruwa District GH - Polon'ruwa
Sub Total 182,500,000.00
3. Intermediate Objective - Strengthen the early identification of Renal disaese

Out put -3.1 Patients with early signs of CRF identified

Conduction of Screening Clinics at Divisional levels in
1 Anuradhapura Districts RRT/DPD A'pura
Conduction of Screening Clinics at Divisional levels in RRT/DPD
2 Polonnaruwa Districts Polona'ruwa

3 Strengthen the SMI to Screen students for Proteinuria DPD A'pura/Polo

Total
Out put 1.3 Improved infrastructure facilities provided

Construction of Clinic Buildings with Investigation Facilities at PDHS/DPDHS

1 Divisional Hospitals in Anuradhapura District 3,000,000.00 A'pura

Construction of Clinic Buildings with Investigation Facilities at PD/DPDHS

2 Divisional Hospitals in Polonnaruwa District 2,000,000.00 Polon'ruwa

Construction of quarters buildings for Health staff at divisional PD/DPDHS

3 hospitals in A'pura District 4,000,000.00 A'pura

Construction of quarters buildings for Health staff at divisional PD/DPDHS

4 hospitals in Polon'ruwa District 3,000,000.00 Polon'ruwa
Total 12,000,000.00

Out put - 1.4 Improved knowledge & skills on CRF among MOO in NCP
Conduction of Programmes on Management update Protocols in
MS / DPD
1 CRF in Anuradhapura District. 50,000.00
/A'pura /
Conduction of Programmes on Management update Protocols in Polon'ruwa
2 CRF in Polonnaruwa District 25,000.00
Total 75,000.00

Out put - 1.5 Improved knowledge & skills on CRF among Other Health Staff in selected Hospitals
Conduction of Programmes to other Health staff on management of DPDHS A'pura /
1 CRF 30,000.00 Polon'ruwa
Total 30,000.00
Sub Total 12,105,000.00
OBJECTIVE - NO 2.Established programme to prevent Renal disease in NCP
1.Intermediate Objective - To Improve the Knowledge, attitudes & Practices about the Renal Disease among the Community

Out put -2.1.1 Tools used in IEC/BCC activities developed

1 Preparation of Printed materials 300,000.00
2 Preparation and fixation of permenent display boards 270,000.00 PDHS/DPDHS
3 Production of Audio-Video documentries 25,000.00 /HEO
4 Preparation of Mobile exhibition sets 100,000.00
Total 695,000.00

Out put -2.1.2 Equipment / Materials used in Health Education provided

1 Provision of 2 Maltimedia Projecters at district level 450,000.00
DPDHS
2 Provision of 2 VCD Players at district level 10,000.00
Polon'ruwa
3 Provision of flip chart boards at Divisional Level 15,000.00
Total 475,000.00

Out put -2.1.3 Intersectrol coordination established

1 Conduction of Advocacy Programmes for NGOO & GOO 20,000.00
2 Conduction of Advocacy Programmes for Education Depart. 25,000.00 DPDHS/HEO
3 Conduction of Media conference at District level 30,000.00
Total 75,000.00

Out put -2.1.4 IEC/BCC Programme conducted

Conduction of TOT Programmes to Health/Others staff at District &
1 divisonal level. 150,000.00
Conduction of Awareness Programmes to Community Leaders at
2 District & divisonal level. 150,000.00 DPDHS/HEO
3 Conduction of awareness to School Childern
4 Conduction of Radio Quiz Programme at Divisional Level 200,000.00
5 Conduction of School Poster/Essay Competitions 50,000.00
Total 550,000.00
Sub Total 1,795,000.00
2. Intermediate Objective - To improve the provision of safe drinking water

Out put -2.1 Vulnerable water resources identified

1 Mapping of water resources in Anuradhapura district
2 Mapping of water resources in Polonnaruwa district
Establishment of a water treatment training centre in Anuradhapura
3 District 25,000,000.00
NWSDB/WRB &
Provision of laboratory equipment and consumables for the water
PDHS
4 treatment centre 400,000.00
5 Manufacturing of water filters 2,400,000.00
6 Conduction of training on water treatment to staff/community
7 Provision of required filters to the community
8 Establishment of GIS Data base on water sources PDHS/ DPDHS
Sub Total 27,800,000.00
OBJECTIVE - NO 3.Reaserch & Servey established to find the underling cause of CRF
1. Intermediate Objective - Research & Survey launched to find the underline cause of CRF
Out put -3.1.1 Research Opportunities advertised
1 Establishment of a web site 10,000.00 PDHS
2 Provision of internet facilities at district level 10,000.00 DPDHS
3 Conduction of e-conference monthly DPDHS
Total 20,000.00

Out put -3.1.2 Renal research team established at Provincial level

1 Conduction of a meeting to establish the Renal reaaerch team 5,000.00 PDHS/MS

2 Conduction of review meetings of the Renal research team 4,000.00 PDHS/MS

Total 9,000.00

Out put -3.1.3 Research activities on Post mortem specimen established

1 Provision of utencils for transporting specimen 5,000.00 DPDHS/MS
2 Provision of chemicals for the preservation of specimen DPDHS/MS

3 Recruitment of a messenger for the transport of specimen 24,000.00 DPDHS/MS

Total 29,000.00

Out put -3.1.4 Research on Clinical Renal Biopsies established

1 Provision of chemicals to the laboratory at G.H. Anuradhapura MS

Provision of equipment to the laboratory at G.H.
2 Anuradhapura
Establishment of a linkage with Deprtment of Pathology, Ms
University of Peradeniya for Immunochemical investigation
3 facilities MS

Sub Total 58,000.00

2. Intermediate Objective - To improve the provision of safe drinking water

Out put -2.1 Vulnerable water resources identified

1 Mapping of water resources in Anuradhapura district
2 Mapping of water resources in Polonnaruwa district
Establishment of a water treatment training centre in
3 Anuradhapura District 25,000,000.00
Provision of laboratory equipment and consumables for the NWSDB/WRB
4 water treatment centre 400,000.00 & PDHS
5 Manufacturing of water filters 2,400,000.00

6 Conduction of training on water treatment to staff/community

7 Provision of required filters to the community
8 Establishment of GIS Data base on water sources PDHS/ DPDHS
Sub Total 27,800,000.00

OBJECTIVE - NO 3.Reaserch & Servey established to find the underling cause of CRF
1. Intermediate Objective - Research & Survey launched to find the underline cause of CRF
Out put -3.1.1 Research Opportunities advertised
1 Establishment of a web site 10,000.00 PDHS
2 Provision of internet facilities at district level 10,000.00 DPDHS
3 Conduction of e-conference monthly DPDHS
Total 20,000.00

Out put -3.1.2 Renal research team established at Provincial level

1 Conduction of a meeting to establish the Renal reaaerch team 5,000.00 PDHS/MS

2 Conduction of review meetings of the Renal research team 4,000.00 PDHS/MS
Total 9,000.00

Out put -3.1.3 Research activities on Post mortem specimen established

1 Provision of utencils for transporting specimen 5,000.00 DPDHS/MS
2 Provision of chemicals for the preservation of specimen DPDHS/MS
3 Recruitment of a messenger for the transport of specimen 24,000.00 DPDHS/MS