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G255(P) Where there is no specialist – advocating for children with nephrotic syndrome in rural bangladesh
  1. R Rhodes1,
  2. M Christian2,
  3. H Imam3,
  4. S Sarker3,
  5. A Cowper3,4,
  6. LT Day3
  1. 1General Medicine, Derby Hospitals Foundation Trust, Derby, UK
  2. 2Paediatric Nephrology, Nottingham Children’s Hospital, Nottingham, UK
  3. 3Paediatric Department, LAMB Hospital, Parbatipur, Bangladesh
  4. 4Paediatric Department, Barts Health NHS Trust, London, UK

Abstract

Background Although global child health focuses mainly on child survival priorities, addressed through Integrated Management of Childhood Illness, some common chronic diseases emerge. Nephrotic Syndrome (NS) in children of the Indian sub-continent is six times more prevalent than in white children. Most children have steroid-sensitive disease, presumed to be minimal change disease. In rural areas of low income countries, the early stages of NS are often not recognised by carers and presentation to appropriate medical services occurs late, when serious complications (ascites, thrombosis, infection, hypertension) are already present. Furthermore, concomitant presentation with malnutrition makes clinical assessment more difficult.

This project aimed to describe the demographics and complications of children needing admission at a developing paediatric nephrotic service in rural Bangladesh.

Method A retrospective review of medical records of children admitted with NS between January 2008 and April 2014 was undertaken.

Results As the quality of outpatient service improved with in-service training, structured proformas and guideline-based management, increasing numbers of patients presented. Most were successfully managed as outpatients but there were 79 admissions in 67 children (0.5% of all paediatric admissions). More children presented in the cool season in contrast to the usual increase in paediatric admissions during rainy season. There was an expected 2:1 male:female ratio but, less typically, a bimodal age distribution, peaking at 3 and 9 years. Median (IQ range) duration of inpatient admissions was 8 (5–12) days. 8 children (10%) received treatment for sepsis. 22 admissions (28%) were for first presentations, 27 (34%) were for subsequent relapses and 27 (34%) had received treatment elsewhere for an unknown number of previous relapses. 3 cases lacked record of this detail. Telemedicine advice from a UK specialist was taken for complex cases. There were 4 deaths.

Conclusion In a rapidly changing world, common chronic diseases in the low income setting are emerging as important causes of morbidity and mortality. Establishing a quality, resource-appropriate service for children with NS is important to build trust and relationships which promote good follow-up and early diagnosis of relapse.

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