Nepali migrant workers are returning from hot regions like the Middle East with kidney disease, requiring dialysis at abnormally young ages compared to non-migrants. A survey of dialysis patients in Nepal revealed that one-in-three male patients had migration histories.
This study supports earlier data collected by La Isla Network in 2023, showing that 31% of patients in two large dialysis centers based in Kathmandu were returnee migrants and that 50% of these returnee migrants were less than 40 years old when their kidneys failed. Both studies are part of ENSURE-Nepal, an occupational health project led by La Isla Network in collaboration with the Nepal Development Society (NeDS), the National Kidney Center Nepal, the University of Gothenburg and Johns Hopkins University.
ENSURE-Nepal’s data corroborates other studies conducted globally pointing to emerging public health crises consisting of occupational heat-driven kidney injury. A similar crisis emerged in Mesoamerica in the mid-2000s, which La Isla Network has largely mitigated thanks to the Adelante Center of Excellence.
Excessive heat is an emerging occupational safety and health (OSH) problem requiring novel solutions that not only protect workers but also safeguard the economy. The International Labour Organization (ILO) estimates that 2.41 billion workers are exposed to excessive heat, or 71 percent of the global working population. Every year excessive heat results in 22.85 million injuries and 18,970 deaths on the job.
Furthermore, in 2020 there were 26.2 million people living with chronic kidney disease attributable to excessive heat in the workplace worldwide, constituting approximately 3% of all chronic kidney disease cases.
Now, results from ENSURE-Nepal are pointing to a similar emerging crisis in the Middle East and South Asia.
In this new study three main patient groups from the National Kidney Center in Kathmandu were identified. The first were returned labor migrants who were diagnosed abroad with kidney disease and started dialysis already in their early thirties. A second group consisted of returned labor migrants diagnosed in Nepal starting dialysis in their forties. The final group was people who did not have a migration history, starting dialysis in their mid-fifties.
Kristina Jakobsson, lead author of the study and senior researcher at the University of Gothenburg, said, “This pattern strongly suggests the presence of acute or very rapidly progressing kidney injuries among migrants. We suspect that heat stress is an important risk factor and are now investigating this more in detail in extended studies.”
Executive director of NeDS Sweta Koirala said, “Is it not heartbreaking to know that the median age of a migrant with diagnosed kidney disease while abroad is only 33 years? We should level up our policies to protect workers, keeping in mind the occupational health hazards they may face abroad.”
Yoko Inagaki, researcher at Johns Hopkins, said, “There is still much to learn about the relationship between working conditions and their impact on health. This report is a crucial step towards filling that knowledge gap.”
There is an urgent need for interventions at workplaces abroad, including enhanced workplace heat stress management. Other preventative measures (pre-migration health screenings, health checks during migration and post-migration health follow-ups) are essential to address this growing crisis.
O Dr. Rishi Kafle, Nefrologista Chefe e Diretor Executivo do Nepal Kidney Center, disse: “Compreender os riscos que os trabalhadores migrantes enfrentam mostrará como podemos intervir para prevenir a insuficiência renal para que menos pessoas sofram”.
Immediate, concerted action by policymakers, employers and health authorities globally is required to address emerging public health crises. By understanding and addressing the root causes of these crises, thousands of lives can be protected.
La Isla Network é uma organização de pesquisa e consultoria em saúde dedicada a acabar com lesões, doenças e mortes relacionadas ao calor entre trabalhadores em todo o mundo. Desenvolvemos intervenções de proteção ao trabalhador baseadas em dados e conduzimos o gerenciamento de mudanças, melhorando a resiliência das forças de trabalho e empresas à exposição ao calor. A LIN impulsiona mudanças duradouras trabalhando com governos e instituições multilaterais para informar e criar políticas. Para obter mais informações, use nosso formulário de contato.
ENSURE-Nepal é financiado por uma bolsa do Departamento de Estado dos Estados Unidos. As opiniões, descobertas e conclusões aqui declaradas são do(s) autor(es) e não refletem necessariamente aquelas do Departamento de Estado dos Estados Unidos.
