Prof. Chris Esezobor: Tackling Kidney Diseases in Children 

Chris Esezobor, a Professor of Paediatrics and Paediatric Nephrology at the University of Lagos and a Consultant Paediatrician and Paediatric Nephrologist at the Lagos University Teaching Hospital, in this interview with Sunday Ehigiator sheds some light on  kidney disease in children, prevention and even possible treatments. He also discussed Nigeria’s’ efforts towards reducing child mortality rate, the recent mass Exodus of doctors, his contribution to humanity, as well as his outlook for the Nigerian health sector for the year 2024

As paediatrics and paediatric nephrology professors, briefly describe your career progression and educational background.

I graduated MBBS from the University of Benin and obtained a fellowship in Paediatrics from both the National Postgraduate Medical College of Nigeria and the West African College of Physicians after undergoing specialist training in paediatrics at the Lagos University Teaching Hospital from 2003 to 2008. This was followed by paediatric nephrology training in South Africa, the UK, Portugal and Belgium. I joined the University of Lagos in 2010 as a lecturer 1 and rose to the position of Professor in 2020. I have also maintained a paediatric nephrologist role with the Lagos University Teaching Hospital since 2010.

In layman’s terms, tell us how a paediatric nephrologist is different from a paediatrician. 

Paediatrics is concerned with the health and well-being of children (those less than 18 years old). A paediatric nephrologist is specifically concerned about children’s kidneys. As mentioned in my educational background, a paediatric nephrologist must first train as a paediatrician.

Statistically, how often do children suffer from kidney issues?

It is difficult to put a number for many reasons, including underdiagnosis. In one of the research publications, we showed that about 10 per cent of children admitted to large hospitals such as LUTH have one form of kidney disease or the other. Generally, the more severe an illness is in a child, be it malaria, diarrhoea, or pneumonia, the more likely the kidney may become affected. So, kidney involvement is a marker of severe illness in a child.

What are the major kidney-related issues that affect children?

Common kidney diseases in children include acute kidney injury, nephrotic syndrome, acute glomerulonephritis, urinary tract infection, chronic kidney disease and congenital anomalies of the kidneys and urinary tract (CAKUT).

Are they hereditary?

 Some children are born with kidney diseases like CAKUT. This does not necessarily mean they inherited the conditions. For many of these CAKUT, the heritability is unknown. However, most of the kidney diseases children suffer are acquired after birth. In newborns, for instance, perinatal asphyxia (not crying immediately after birth) and infection are leading causes of kidney diseases.

What are some of the other predisposing factors?

Lack of immunisation; delay in seeking healthcare for a sick child; indiscriminate use of drugs, both orthodox and unorthodox; lack of antenatal care; delivering outside hospitals; altogether, these vulnerabilities act in concert to make a child more likely to be ill and more likely to develop severe illness including kidney disease.

How can this be prevented?

Some can be prevented while others are not. Pregnant women should receive adequate antenatal care, deliver in places with skilled manpower; ensure their children get fully immunised; visit the hospital early when children are sick rather than self-medicate; and give oral rehydration solution for diarrhoea.

Are there habits or diets children take that can expose their kidneys to danger?

Too much salt in the diet, becoming overweight or obese, following a sedentary lifestyle and tobacco use are some of the habits that put everyone, including children, at risk of non-communicable diseases, including kidney disease.

What are some of the early symptoms of kidney challenges in a child, and what should parents look out for? 

These include poor growth, poor/weak urine stream in a male child, swelling of the skin around the eyes, reduced urine volume, dark or bloody urine, excessively foamy or frothy urine, swelling of the abdomen and shortage of blood.

What steps can parents take immediately if these symptoms are noticed in their kids?

Visit the hospital as soon as these symptoms are noticed. Seek a second opinion from other hospitals if you are not convinced about the care you have received.

How would you rate Nigeria’s’ efforts towards reducing child mortality rate?

Using the UN report, major challenges remain with SDG 3; we are stagnating or progressing at less than 50 per cent of the required rate and ranked 146 out of 166 countries. To address our less-than-assured progress and ensure that countries like Nigeria do not prevent the world from reaching the SDG 3.2 goals, the world recently curated the Child Survival Actions to help countries like Nigeria accelerate progress to attaining the SDG for child health.

Do you think Nigeria can meet up with SDG Goal 3 (end preventable deaths of newborns and children under 5 years of age) by 2030? 

That is 6-7 years away. According to the recent UN report on our progress, we need to do more if we are to meet SDG goal 3.2; we are, at best, crawling to meet this target. 

How can this be further strengthened?

Scale up access to low-cost, high-impact interventions: scale up the percentage of pregnant attending antenatal clinic, scale up the number of deliveries attended to be skilled manpower, increase the proportion of exclusively breastfed children, reduce the number of one-year-olds who have not received a single dose of vaccine; reduce hurdles to access healthcare. This entails more efficient use of budgetary allocation, attracting a high-quality health workforce, and a multisectoral approach from all. 

Tell us about some of your contributions to the field of knowledge and humanity?

We showed for the first time in 2012 that the common causes of acute kidney injury (previously known as acute renal failure) in Nigerian children were infections, primary kidney diseases and malaria and that diarrhoea was no longer as prominent as previously reported. After several subsequent studies replicated the finding, that finding has become a settled fact. Recently, we elegantly showed, using the largest to date database, that our children with nephrotic syndrome (a kidney disease that presents with generalised body swelling and loss of large amounts of protein in the urine) frequently respond to steroids contrary to early assumptions. This is a key finding because children with nephrotic syndrome who respond to steroids maintain good kidney function in the long term. Again, we published works showing that our children bedwet more frequently than children in developed regions of the world and that those with sickle cell anaemia were 2-5 times more likely to have bed wetting (enuresis). In LUTH, my team have established a thriving dialysis program for children; ours is one of only 1-2 centres in Lagos that provide dialysis for children as old as a few days. We run a one-stop clinic for children with diverse kidney diseases, and a twice-a-month clinic called the Children’s’ Continence Clinic for bedwetting in children. I have successfully supervised about 15 medical doctors who are now paediatricians. We are currently collaborating across the global north and south to understand the genetic underpinnings of nephrotic syndrome in children. Also, a key achievement of mine is the role I play as the Admin and logistic coordinator of the West African College of Physicians Doctors As Educators Program; we are entrusted with the mandate to train specialist doctors across the West African sub-region as effective and efficient medical educators; the program is called Doctors As Educators.

There is a surge in Nigerian Doctors, including surgeons leaving the country for greener pastures; what’s’ your take on this?

While the horde of doctors leaving the country hugs the headlines, the same is happening in the universities, IT, and financial sectors; skilled manpower is being lost daily from all sectors of the knowledge ecosystem. Value seeks value. The dominating narrative is that our society no longer attaches a premium to its skilled manpower; you see that in how the society renumerates its manpower. As a professor at a premier federal university in Nigeria, my monthly salary is less than 400,000 naira. Thematically, the factors responsible for the massive brain drain are the push and pull factors. Unfortunately, our society appears to be actively pushing its knowledge workforce to leave the country.

What does this portend for the country’s health sector?

Overall, it means suboptimal healthcare for the Nigerian populace. Go to the private and public hospitals today, and you will hear tales of the populace not being able to see the specialists they need promptly. The loss of manpower is also taking its toll on medical research and advocacy for health.

There are talks in some quarters for the introduction of a bill to mandate Nigerian Doctors to practice in Nigeria for at least five years post service years; what’s’ your take on this?

The idea of such a bill points to a limited understanding of the issues fuelling the mass brain drain in the health sector. First, the loss of skilled manpower from Nigeria affects every sector. Ask the vice-chancellors of universities how many lecturers they have lost in the last three years. Ask those in the IT sector the same question. Currently, anyone of value is attracted to emigrate. Second, in the health sector, doctors and nurses are more likely to migrate over five years post qualifications; they have the knowledge, experience, reach and money to finance emigration. Third, does the bill intend to make reading medicine 12 years; five more years of provisional licence after 7 years of training to become a doctor? If they care enough to dig deeper, it will become evident that the interest in becoming a doctor has waned noticeably among our youths; those whose parents are doctors have learnt first-hand that investing in another career may be more fulfilling in terms of overall well-being and personal wealth. Fourth, many areas of Nigeria, especially the rural and insecure regions, are underserved in health; that crisis needs more urgent attention. They are underserved because health manpower would migrate internally to urban, more secure areas with more resources. The response of hurdling migration of doctors until 5 years post-graduation is symptomatic of a less than rigorous approach to solving matters of national importance

What’s’ your outlook for the Nigerian health sector for the year 2024?

The negatives (reduced government and family income, acute and deep shortage of manpower, fewer drug options due to exit of pharmas) are formidable. The positives include unveiling the Health Sector Renewal Investment Initiative to accelerate Universal Health Coverage. This would include reform of the Basic Health Care Provision fund. If the trajectory of recent years is anything to go by, then the outlook for the health sector in 2024 does not look great.

Outside the theatre, who is Dr Esezobor?

I am a financial investor.

What’s’ your life mantra?

“For all labour, there is profit”.

How do you unwind?

Cycling; Read investment articles; watch football; read productivity book.

Is there anything else not covered in the interview that you would like to share? 

Yes, the Paediatric Association of Nigeria (PAN) will be hosting its 55th Annual Scientific Conference, tagged Eko Akete, at the Oriental Hotel, Lekki, from 17-19th January 2024. I am the chair of the scientific subcommittee of the Local Organising Committee. During this meeting, we will create platforms for academia, government agencies, developmental partners and industry partners to review the current state of child health in Nigeria and co-create strategies to accelerate progress towards attaining SDG 3.2. The themes and sub-themes for PANConf 2024 include the state of the Nigerian Child, zero-dose vaccinated Child, lessons learned from the COVID-19 pandemic, ongoing diphtheria epidemic and pandemic preparedness, adolescent addiction pandemic; safeguarding children at home and on the Online expressway; manpower and infrastructure for optimal child care; the business of medicine and the net impact of the Japa syndrome on healthcare. 

We expect about 700 participants, most of them paediatricians. Dr Olufemi Mobolaji-Lawal will deliver the inaugural Bolaji Ajenifuja Annual Memorial Lecture, titled: Bringing down the elephant: key to improving the health status of the Nigerian Child. Confirmed speakers to date include UNICEF, WHO, NCDC, NPHCDA, NPMCN, NAFDAC, NDLEA, Bank of Industry, CECE YARA Foundation, and PwC. More information about PAN and PANConf 2024 can be found on our website: https://panconf.pan-ng.org/

Quote

Generally, the more severe an illness is in a child, be it malaria, diarrhoea, or pneumonia, the more likely the kidney may become affected. So, kidney involvement is a marker of severe illness in a child