Original Plan -RDPP

8/7/2019 Original Plan -RDPP

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RENAL DISEASE PREVENTIONPROGRAMME

(RDPP)

DEPARTMENT OF HEALTH SERVICESNORTH CENTRAL PROVINCE

SRI LANKA



& DemographyThe 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 thelargest 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 isgenerally 20 C0 in January and February and maximum temperature is

around 30 C0 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, nearly40% 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 andsubsequently 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 resultthe 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

No Division Name Hospital

Date of

Registration

to the Clinic Address

Diagnosed at

(Name of the

hospital)

1 NPC P. Santha 24.03.2005 Puwarsankulama GH - Anuradhapu

2 NPC C.R. Karunawathi 16.07.1998 Railway Town , Medawachchiya GH - Anuradhapu3 NPC Thegis 18.12.2004 Paniyankadawala GH - Anuradhapu

4 NPC P. Seelawathi RH Parasangasw 26.05.2005 Siyabalagaswewa , Parasangaswewa GH - Anuradhapu

5 NPC A. Senarathna 09.06.2005 Peragoda , Parasangaswewa GH - Anuradhapu

6 NPC E. Siripala 29.01.2004 Paniyankadawala GH - Anuradhapu

7 NPC S. Premawathi 21.04.2005 Siyabalagaswewa , GH - Anuradhapu

8 NPC S.P.Ariyarathne RH Willachchiya 20.05.1999 No.27,Ulukkulama,Pemaduwa GH - Anuradhapu9 NPC B. Menikhamy 07.09.2000 No.282,Left Bank,Mahawillachchiya GH - Anuradhapu



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



j l =. vqf r da. Sk ai y ur Kj d¾; d dol l r . k susk a&

Colo bo Matale Kurunegala Puttala a 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 ot

available

ot

available

ot available 151/30 5430/234 988/112

2008 ot

available

ot

available

ot available 156/34 5836/253 1117/108

2009 otavailable otavailable ot available ot available 6432/281 1207/112



Occupational DistributionOccupational Distribution

CategoryCategory NumberNumber %%

FarmersFarmers 174174 56.3[71%]56.3[71%]

House wifeHouse wife 2929 9.49.4

LaborsLabors 1515 4.94.9

Business PeopleBusiness People 0505 1.61.6

CarpentersCarpenters 0505 1.61.6

Post manPost man 0303 1.01.0

GramasewakaGramasewaka 0202 0.60.6OthersOthers 1313 3.93.9

Missing data'sMissing data's 6363 20.420.4



Geographical DistributionGeographical Distribution

DSDDSD NONO %% DSDDSD NONO %%Mada,yaMada,ya 5353 1717 KabitigoKabitigo 99 33

NPCNPC 4848 1616 RajangaRajanga 99 33

NPENPE 2020 77 RambeRambe 99 33

Kahat,yKahat,y 1919 66 TabutteTabutte 99 33PadaviyPadaviy 1616 55 HorowpHorowp 66 22

Gal,wewGal,wew 1414 55 PalagalPalagal 55 22

GalnevGalnev 1212 44 KekirawKekiraw 44 11

Noch,mNoch,m 1212 44 IpalogaIpaloga 22 0.50.5

TirappaTirappa 1212 44 MahawilMahawil 00 00

MihintalMihintal 1111 44 Out sideOut side 1515 55

TalawaTalawa 1111 44 MissingMissing 1313 44



CRFCRF Hospital Death and live dischargesHospital Death and live discharges

2001 General Hospital2001 General Hospital -- AnuradhapuraAnuradhapura

0

100

200

300

400

500

600

700

800

900

1993

1994

1995

1996

1997

1998

1999

2000

2001

Live Discharges Deaths



Number of Cases & Death of CRF in Sri Lanka 2000

0

1000

2000

3000

4000

5000

6000

7000

Colom

bo

Matale

Kuruneg a

la

Puttalam

Anuradha

pura

Polon

naruwa

Sri Lanka

No of Cases

& Deat

Cases

Death



Cases of CRF by Age

Age

No %

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 divisionalSecretary 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 aremade 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.



Patients with early

signs of CRF

Chronic Kidney Disease

(CRF)

Patients not

detected yet

Healthy community

Renal Research & Survey

Clinical studies

(Facility improvement)

PaPatho/Histo logical post

Mortem

Community

BasedSurve s

Improvement of the

Secondary Care

Drugs/Human Resource

Investigation facilities BuildingsDivisional / General Hosp.

Social

welfare

Improvement of the

Tertiary care

Dialysis facility

expansion

(Buildings/HR/Equip.)

(Drugs/Reagents/Recu

rrent cost)

Early Identification &

Follow up (Screening)

(Secondary care)

Prevention / Avoidance of risk factors diseasesmagnitude

(Health Education/Media/Sign Board)



No Activity Cost Responsibility

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

1

Requisition of revised drug & reagen t estimates for 2005 for

selected divisional Hospitals in Anuradhap ura District -

PDHS/DPDHS

A'pura

2

Requisition of revised Drug & reagent estimates for 2005 for

selected divisional Hospitals in Polonnaruwa District -

PDHS/DPDHS

Polon'ruwa

3

Provision of Laboratory Equipment to selected ho spitals in

Anuradhapu ra District -

PDHS/DPDHS

A'pura

4

Provision of Laboratory Equipment to selected ho spitals in

Polonn aruwa Districts -

PDHS/DPD

Polon'ruwa

1

Requisition of Human Resources for selected hosp itals in

Anuradhapu ra District -

PDHS/DPDHS

A'pura

2

Requisition of Human Resources for selected hosp itals in

Polonnaruwa District -

DPDHS

Polon'ruwa

2008

Out put - 1.1 Strengthened Drug avail abil ity Investigation facili ties

Out put 1.2 Adequate Human Resource available

20072006

OBJECTIVE NO 1. Reduced incidence of CRF in NCP

1. Intermediate Objective - To improve the Secondary Care Facili ties at selected Divisi onal Hospitals



1Requisition of revised drug & reagent estimates for 2005 forG.H. Anu radhap ura MS GH - A'pu ra

2

Requisition of revised drug & reagent estimates for 2005 for

G.H. Polonnaruwa

MS GH-

Polon'ruwa

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

4 Provision of Laboratory Equipment to G.H. Polonnaruwa

DPDHS/MS

GH- Polon'ruwa

Total

1 Provision of 08 Haemodialysis Unit to G.H. Anuradhapu ra 16,000,000.00

MS

GH - A'pura

2 Provision of 02 Haemodialysis Unit to G.H. Polonnaruwa 4,000,000.00

DPD/MS

GH-Polon'ruwa

3 Provision of 02 water Treatment Plant to G.H. Anuradhapu ra 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 Establish ment of a Rena l Care & Research Centre at Provincial level 150,000,000.00 PD/MS

Total 174,500,000.00

1

Renovation and Conversion of ICU to Haemodialysis Unit at

G.H. Polonnaruwa 6,000,000.00

DPD/MS

GH-Polon'ruwa

2

Extention o f the building of the Haemodialysis un it at

G.H. Anu radhap 2,000,000.00 MS GH - A'pura

Total 8,000,000.00

2.Intermediate Objective - Renal Care facilities improved at General Hospitals

Out put -2.3 Improved Infrastructure Facilities

Out put 2.1 Secondary Care Facilities Strengthen

Out put -2.2 Tertiary Care Facilities Strengthen



1 Requisition of Human Resources for G.H. Anuradhapura MS GH - A' pura

2 Requisition of Human Resources for G.H. Polonnaruwa District

DPD/MS

GH - Polon'ruwa

Sub Total 182,50 0,000.00

1

Conduction of Screening Clinics at Divisional levels in

Anuradhapura Districts RRT/DPD A'pura

2

Conduction of Screening Clinics at Divisional levels in

Polonnaruwa Districts

RRT/DPD

Polona'ruwa

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

Total

Out put -3.1 Patients wi th early signs of CRF identifi ed

Out Put 2.4 Adequate Human resource avail able

3. Intermediate Objective - Strengthen the early identification of Renal disaese



1

Construct ion of Clinic Buildings with Inve stigat ion Facilities at

Divisional Hospitals in Anuradhapura District 3,000,000.00

PDHS/DPDHS

A'pura

2

Construct ion of Clinic Buildings with Inve stigat ion Facilities at

Divisional Hospitals in Polonnaruwa District 2,000,000.00

PD/DPDHS

Polon'ruwa

3

Construction of quarters buildings for Health staff at divisional

hospitals in A'pura District 4,000,000.00

PD/DPDHS

A'pura

4

Construction of quarters buildings for Health staff at divisional

hospitals in Polon'ruwa District 3,000,000.00

PD/DPDHS

Polon'ruwa

Total 12,000,000.00

1

Conduction of Programmes on Management update Protocols in

CRF in Anuradhapura District. 50,000.00

2

Conduction of Programmes on Management update Protocols in

CRF in Polonnaruwa District 25,000.00

Total 75,000.00

1

Conduction of Programmes to other Health staff on management of

CRF 30,000.00

DPDHS A'pura /

Polon'ruwa

otal 30,000.00

Sub otal 12,105,000.00

Out put 1.3 Improved infrastructure f aci lities provided

Out put - 1.4 Improved knowledge & skill s on CRF among MOO in NCP

MS / DPD

/A'pura /

Polon'ruwa

Out put - 1.5 Improved knowledge & skill s on CRF among Other HealthStaff in selected Hospitals



1 Preparation of Printed materials 300,000.00

2 Preparat ion and fixation of permenent display boards 270,000.00 3 Production of Audio-Video documentries 25,000.00

4 Preparation of Mobile exhibition s ets 100,000.00

Total 695,000.00

1 Provision of 2 Malt imedia Projecters at dist rict level 450,000.00

2 Provis ion of 2 VCD Players at dis trict lev el 10,000.00

3 Provis ion of flip chart boards a t Divis iona l Leve l 15,000.00

Total 475,000.00

1 Conduction o f Advocacy Programmes for NGOO & GOO 20,000.00

2 Conduction of A dvocacy Programmes for Education Depart. 25,000.00

3 Conduction of Med ia conference at District level 30,000.00

Total 75,000.00

1

Conduction of TOT Programmes to Health/Others staff at District &

divisonal level. 150,000.00

2

Conduction of A wareness Programmes to Community Leaders at

District & divisonal level. 150,000.00

3 Conduction of awareness to School Childern

4 Conduction of Radio Quiz Programme at Divisional Level 200,000.00

5 Conduc tion o f Schoo l Post er/ Es say Competitions 50,000.00

Total 550,000.00

Sub Total 1,795,000.00

DPDHS/HEO

OBJECTIVE - NO 2.Established programme to prevent R enal disease in NCP

Out put -2.1.1 Tools used in IEC/BCC activiti es developed

1.Intermediate Objective - To Improve the K nowledge, attitudes & Practices about the R enal Disease among the Community

PDHS/DPDHS/HEO

DPDHS

Polon'ruwa

Out put -2.1.3 Intersectrol coordination established

Out put -2.1.4 IEC/BCC Programme conducted

DPDHS/HEO

Out put -2.1.2 Equipment / Materials used inHealth Education provided



1 Mapping of water resources in Anuradhapura district

2 Mapping of water resources in Polonnaruwa district

3

Establishment of a water treatment training centre in A nuradhapura

District 25,000,000.00

4Provision of laboratory equipment and cons umables for the watertreatment centre 400,000.00

5 Manufacturing of water filters 2,400,000.00

6 Conduction of training on water treatment t o st aff/community

7 Provision of required filters to the community

8 Establishment of GIS Data bas e on water s ources PDHS/ DPDHS

Sub Total 27,800,000.00

Out put -2.1 Vulnerable water resources identified

NWSDB/WR B &

PDHS

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



1 E s tablis hm ent o f a web s ite 10,000.00 P D H S

2 P ro vis io n o f in te rn et f ac ilit ie s a t d is tric t le ve l 1 0, 00 0. 00 D P D H S

3 Conduc tion of e-c onferenc e m onth ly DP DH S

T o tal 20,000.00

1 C o n du c t io n o f a m e e t in g t o e s t a bl is h t h e R e n al r e aa e rc h t e a m 5 , 0 00 . 0 0 P D H S / M S

2 C o nd u ct io n o f r ev ie w m ee t in g s o f t h e R e na l r es e ar c h t e am 4 , 00 0. 0 0 P D H S / M S

T o tal 9,000.00

1 P ro vis ion o f ut enc ils f or trans porting s pec im en 5, 000. 00 D P D H S / M S

2 P ro vis ion o f c he mic als f or t he pres erv ation of s pec im en D PD HS /M S

3 R e cr ui tm e n t o f a m e s s en g er f o r t h e t ra n sp or t o f s p ec i m en 2 4, 0 00 . 00 D P D H S / M S

T o tal 29,000.00

1 P ro vis io n o f c he mic als t o t he la bo ra to ry a t G .H . A nu ra dh ap ura M S

2

Provision of equipment to the laboratory at G.H.

A nuradhapura M s

3

Univers ity o f P eradeniya for Im munochemica l invest igat ion

fac ilit ies M S

S u b T o tal 58,000.00

1. In te rm ed ia te Ob jec t ive - Research & Su rvey launched t o f ind the under l ine cause o f CRF

O B J E C T I V E - N O 3 .R e a s e r c h & S e r v e y e s t a b l is h e d t o f in d t h e u n d e r l in g c a u s e o f C R F

Out pu t - 3 .1 .3 Research ac t iv i t ies on Post m o r tem spec im en es tab l i shed

Out pu t - 3 .1 .4 Research on C l in ica l Rena l B iops ies es tab l i s hed

Out pu t - 3 .1.2 Rena l r esearch team es tab l i shed at Prov inc ia l leve l

Ou t pu t - 3 .1.1 Research Oppor t un i t ies adver t i sed

Original Plan -RDPP

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