cooperation with developing countries the example of nicaragua l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Cooperation with developing countries: the example of Nicaragua PowerPoint Presentation
Download Presentation
Cooperation with developing countries: the example of Nicaragua

Loading in 2 Seconds...

play fullscreen
1 / 35

Cooperation with developing countries: the example of Nicaragua - PowerPoint PPT Presentation


  • 273 Views
  • Uploaded on

Cooperation with developing countries: the example of Nicaragua A. Edefonti 1 , G. Marra 1 , F. Sereni 1 , M. Sandoval 2 , Y. Silva Galàn 2 1 UOC. Nefrologia e Dialisi Pediatrica, Clinica Pediatrica G e D. De Marchi, Milano, Italy

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Cooperation with developing countries: the example of Nicaragua' - JasminFlorian


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
cooperation with developing countries the example of nicaragua

Cooperation with developing countries: the example of Nicaragua

A. Edefonti1, G. Marra1, F. Sereni1 , M. Sandoval2, Y. Silva Galàn2

1UOC. Nefrologia e Dialisi Pediatrica, Clinica Pediatrica G e D. De Marchi, Milano, Italy

2 Departamento de Nefro-Urologia Pediatrica, Hospital Infantil de Nicaragua MJR, Managua, Nicaragua

42° Annual ESPN Meeting, Lyon, September 11-14, 2008

introduction
Introduction
  • No specific pediatric workshop dedicated so far to the initiatives of cooperation, but increased awareness of the matter
  • ISN organizing a COMGAN workshop during WCN, Milan 2009
  • Pediatric contributions in the literatureabout the epidemiology of renal diseases in the developing countries, but not about models of cooperation
slide3

(Cont.)

  • Pediatric Nephrologists always open to educational matters (courses, stages for doctors of developing countries)
  • ESPN members regularly receiving trainees from abroad and developing differents types of projects
  • No systematic documentation so far of the initiatives of pediatric cooperation worldwide
    • IPNA Fellowship Committee starting to require feed-back and track doctors receiving educational grants
is cooperation with developing countries only an educational teaching training issue
Is cooperation with developing countries only an educational (teaching /training) issue?

A provocative question

the start of the cooperation with the pediatric nephrology unit of managua
The start of the cooperation with the Pediatric Nephrology Unit of Managua
  • 1997-1999 Stage in Milano of Dr. Mabel Sandoval Dìaz
  • 1999-2000 Complain about lack of tools to properly diagnose and treat renal diseases in the Nicaraguan Hospitals
  • 2000 Visit to Nicaragua of Italian pediatric nephrologists and recognition of the paucity of human, instrumental and economic resources at Hospital Infantil MJR
  • 2001 Start of the project of cooperation, financed initially by the Associazione per il Bambino Nefropatico, Milano
topics
Topics
  • Methodology of the project
  • Results of the project
    • Clinical activity
    • Epidemiology
  • Points of discussion
slide7

Nicaraguan demographic indicators

www.inec.gob.ni

Censo de Poblaciòn 2005.

characteristics of the initial project
Characteristics of the initial project
  • Free of charge basic assistance for children with renal diseases
    • Lab test, drugs, imaging (in the private system, whenever necessary)
  • Establishing shared nephrologicalprotocols for the main kidney and UT diseases (the 10 clinical syndromes)
  • Establishing a Pediatric Nephrology Unit in a public Children University Hospital in Managua
    • Scaled training in Milano of the different components of the team, (Pediatric Nephrologists, Urologists, Imaging specialist, Pathologists, Dialysis Nurse)
    • Building a new Pediatric Nephrology ward
characteristics of the initial project9
Characteristics of the initial project
  • Implementation of a database
    • to gather data on the epidemiology of renal diseases (with special regard to CKD)
    • to record and monitor clinical activity
    • to make quality control of the diagnoses

5. Web connection between Milano and Managua for clinical consultation

expansion of the initial project
Expansion of the initial project
  • Start of a RRT program (2 beds for HD, CAPD and 6 living donor Tx per year) for selected children with ESRD
  • Establishing a Pediatric Nephrology Network including 5 District Hospitals covering about 55% of the Nicaraguan population
    • to increase diagnostic and therapeutic power in each hospital (supply of lab test, medications, imaging tools, shared protocols)
    • to avoid patient and family unnecessary transfer to Managua, whenever possible
expansion of the initial project11
Expansion of the initial project
  • Proposal of the model of cooperation to other Central America countries
    • Sharing database with Guatemala
    • Conference on the Prevention and Management of CKD in five Central America countries (29th of February 2008)
  • Extension of the project to a 6th District Hospital where CKD prevalence is allegedly high (61% of population covered)
  • Project of early diagnosis and treatment of kidney and UT diseases in the peripheral “Unidades de Salud” depending from the 6 District Hospitals
slide13

León

Jinotega

Chinandega

Milano

Managua

Matagalpa

Masaya

Granada

The Pediatric Nephrology Network in Nicaragua

at September 1 st 2008

funds from nicaraguan health ministry
Funds from Nicaraguan Health Ministry
  • Salaries for 4 Pediatric Nephrologists, 2 Urologists, 1 Pathologist, 11 Nurses, 1 part time Dietician and 1 Psychologist in Managua and 6 Pediatricians of District Hospitals
  • Costs of hospitalization, essential medications, lab test and imaging
  • Costs of Peritoneal Dialysis, (CAPD and APD) in Managua
  • Cost of immunosuppressive medications for renal transplant in Managua since 2008
topics17
Topics
  • Methodology of the project
  • Results of the project
    • Clinical activity
    • Epidemiology
  • Points of discussion
clinical activity of the pediatric nephrology unit of hinmjr during the year 2007
Clinical activity of the Pediatric Nephrology Unit of HINMJR during the year 2007

Number of hospitalizations 818

Number of outpatient visits

  • Nephrology3096
  • Urology 1842

Number of renal biopsies 29

Number of urodynamic tests 61

clinical activity of the pediatric nephrology unit of hinmjr at 31 th of december 2007
Clinical activity of the Pediatric Nephrology Unit of HINMJR at 31 th of December 2007

Number of children with CRI/ESRD 166

Number of children treated with chronic HD 13

Number of children treated with PD 9

Number of transplanted children 17

  • 2004 – 2007 14
  • 2008 3
slide20

Cumulative number of children with kidney and UT diseases entered in the database

Pediatric Nephrology Unit of HINMJR (2002 – 2007)

2019 patients

slide21

300

Granada

Jinotega

Masaya

250

Leon

Matagalpa

200

150

100

50

june-05

sept-05

dic-05

mar-05

june-06

sept-06

dic-06

mar-07

june-07

sept-07

dic-07

Cumulative number of children with kidney and UT diseases entered in the database

District Hospitals (2005 – 2007) 858 patients

Managua

slide22

Main diagnoses of kidney and UT diseases in Nicaragua

Pediatric Nephrology Unit of HINMJR (2002 – 2007) 2019 patients

main diagnoses of kidney and ut diseases in nicaragua
Main diagnoses of kidney and UT diseases in Nicaragua

5 District Hospitals (2005 – 2007) 858 patients

slide24

Epidemiology of CRI in Nicaragua

* Ardissino GL. et al. Epidemiology of chronic renal failure in children data from ITALKID project (2003) Pediatrics 111;4:382-387

slide25

Primary renal diseases causing CRI

at HINJMR (2002 – 2007) 166 patients

GFR:≤90ml/min/1,73

slide26

Prevalence of CRI (patients/pmp) in the

Nicaraguan Districts

Districts inside the project

Districts outside the project

follow up of patients with cri
Follow-up of patients with CRI

* Medical decision 27 %

Family decision 48 %

(socioeconomic reasons)

Deceased before the onset of the RRT program 25 %

topics28
Topics
  • Methodology of the project
  • Results of the project
    • Clinical activity
    • Epidemiology
  • Points of discussion
points of discussion
Points of Discussion
  • The problem of allocation of financial resources to pediatric subspecialties by Health Ministries of developing countries
    • Low budget expected
    • More for primary care than for tertiary care
  • Top-down model (development of a central unit prior to peripheral hospitals) preferable for pediatric subspecialties?
  • Financial feasibility of the assistance to CKD/ESRD in a developing country and scaled transfer of the costs to the government
points of discussion30
Points of Discussion
  • Need for fund-raising programs from private and public institutions to finance a cooperation project
  • Role of data-bases to assess and monitor the efficacy of a project and to allocate financial resources
  • Ethical issues, like allocation of financial resources to dialysis/Tx vs prevention programs of CKD or selection criteria for patients in need for RRT
  • Extension of the cooperation model to other countries (methodological aid instead of financial aid)
is cooperation with developing countries only an educational teaching training issue31
Is Cooperation with developing countries only an educational (teaching/training) issue?

A provocative question

No. There’s something more to do than just giving the instructions to catch the fish

You should provide also (at least one) fishing rod

what is the fishing rod
What is the fishing rod?
  • Experience in the development and management of a Pediatric Nephrology Unit and Pediatric Nephrology Network
  • Financial resources, through fund-raising programs, both in the developing and industrialized countries
  • Experience in scientific communication
what about scientific communication
What about scientific communication?
  • Need for discussing models of cooperation and confronting different experiences
  • Need for spreading a culture of cooperation among pediatric nephrologists

Dedicated workshops?

Publications in pediatric journals?

Internet?

Registry?