Table 2.

Strategies, actions, and procedures that need to be carried out to prevent and eliminate CKDmfo in Sri Lanka.

Item	Process	Action needed
1	Provision of clean, potable water	•Provide affordable clean water to everyone in the CKDmfo-affected areas and surrounding regions in a cost-effective and sustainable manner
2	Changing agricultural practices	•Reintroduce and enhance grassroots agricultural extension education services; •Curb excessive and haphazard use of chemicals; •Enhance environmentally friendly, sustainable practices; •Encourage organic and hybrid farming; •Issue fertilizer to farmers based only on soil testing
3	Changing lifestyles	•Improve diet, alleviate malnutrition, and increase physical activities; •Educate the public on the use of locally available fruits and vegetables; •Minimize personal exposure to chemicals;
4	Protection of the environment	•Introduce a Clean Air and Safe Water Act, as well as hazardous liquid and solid waste disposal methods; •Reduce soil erosion and deforestation; •Create and implement effective environmental laws
5	Education of the public	•Educate about the importance of nature and protection of the environment; •Protect of watersheds; •Encourage a healthy diet and improve physical fitness
6	Public health measures	•Introduce a region-wide surveillance program; •Minimize exposure to chemicals and frequent dehydration; •Provide social services support for affected families
7	Curative measures	•Identify those with disease at an early stage and implement cost-effective interventions; •Facilitate transportation to dialysis centres and provide affordable, cost-effective renal replacement therapies for those who are affected; •Enhance dialysis capacity and supporting services, trained dialysis nurses, and nephrologists in the country
8	Education of professionals	•Enhance the awareness of healthcare workers and all governmental officials on CKDmfo and its preventative strategies; •Provide them with a simple, uncontroversial set of explanations and advices about the disease so that they can advise public unambiguously with one voice
9	Curbing drug use, illegal alcohol and tobacco	•Prevent abuse of pain relievers—non-steroidal analgesics (and other drugs, such as paracetamol); •Eliminate the use of illegal drugs; •Reduce consumption of illegal alcohol and tobacco
10	Education of farmers and vendors on appropriate use of agrochemicals	•Provide farmers with safety instructions on using chemicals; •Provide farmers protective gear for agriculture; •Provide models of safe disposal of used pesticide containers
11	Research program	•Carry out GIS-based mapping and analysis of the occurrences of the disease in relation to multiple proposed causes in the affected regions; •Plot distance to dialysis centres for majority of patients, determine whether distance (cost of transportation) is a factor in seeking treatment; identify areas of highest risk to intervene with limited resources; •Carry out long-term study of the water system of the entire country in relation to sources of environmental pollution, greatest prevalence of the disease, and highest risk of its spread; create platform for involvement of all stakeholders; use to plot progress in eradicating disease from entire country; •Initiate an interdisciplinary research program to identify the cause(s) of the disease and optimum ways to prevent and eradicate it from the country; •Use a multi-disciplinary approach to combat this complex disease, including research and clinical collaboration; sharing of information, expertise, and equipment; and maximizing resource use, expertise, and information across disciplines