1871

Background: Chronic kidney disease of unknown etiology (CKDu) is a disease that is devastating healthcare systems in Central America, Sri Lanka and India, yet population level data about this disease is very sparse.
Methodology: We reviewed cross-sectional, cross-shift and ecological studies (n=24) published between 2015 and 2019 as well as prevalence data available prior to 2015. Surveillance systems (SS) in affected countries were assessed based on reports from countries participating in an international workshop held in Costa Rica in March 2019. Finally, barriers, solutions and ethical aspects related to CKDu SS were discussed.
Results: Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Mexico, Panama, Sri Lanka, India and Tanzania have different degrees of certainty about the prevalence of CKDu. Lack of comparability between the studies remains a major challenge. Great progress has been made in collecting and analyzing health service records in many countries, and these developments should be supported and strengthened. However, much work is still needed to obtain comparable population prevalence data.
Discussion and Conclusions: It remains unclear whether CKDu epidemics represent a global phenomenon or whether there are different regional or national causes for the same outcomes. Compelling evidence supports claims that CKDu is mainly an occupation driven disease, particularly in agricultural communities where informal or temporary contracts create barriers to screening and follow-up. We recommend using the published Disadvantaged Populations eGFR Epidemiology Study (DEGREE) protocol to harmonize data collected. We also make recommendations for SS at three levels: community, healthcare facility, and national (policy) levels. In CKDu endemic areas, we recommend SS at the workplace and strengthening healthcare facilities to allow CKDu screening as part of primary healthcare. Public health SS of CKDu must be associated with guaranteed universal access to healthcare and should be linked to continuous research.

2720

The use of solid fuels and kerosene for cooking is one of the main environmental risks to health worldwide, affecting more than 2.8 billion people. In Latin-American and the Caribbean, 90 million people (13% of population) concentrated primarily in nine countries still live in homes using these polluting fuels for cooking. In 2019, the Directing Bodies of the Pan American Health Organization approved an elimination initiative to provide an integrated sustainable approach to orient and guide Member States as they work toward the elimination of a group of priority communicable diseases and related conditions. One of the conditions targeted for elimination is the use of polluting fuels for cooking. This paper analyzes the public policies that have accelerated the access to cleaner energy sources for cooking in Bolivia, Ecuador and El Salvador. These countries implemented different schemes to subsidize the consumption of liquefied petroleum gas (LPG). In Ecuador the price of LPG has remained the same since 2002, and in Bolivia since 2005, with subsidies that have reached 90% in Ecuador and 70% in Bolivia. In El Salvador, a universal subsidy of 65% was removed in 2013 and replaced with a targeted subsidy to the poor that covers almost 70% of the population. As a result, 98%, 86%, and 81% of the population of Ecuador, El Salvador and Bolivia, respectively, now cook with LPG or electricity. These case studies corroborate our previous findings that public policies with economic incentives that promote universal access to cleaner energy sources are important for the transition to clean energy use. Even though most energy subsidies can be regressive, this is not the case for the energy subsidies for cooking as shown in these case studies. This should be taken into consideration when designing the necessary interventions to meet the 2030 Sustainable Development Goals.