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Development of a bladder management protocol as part of a comprehensive care program for spina bifida in Kenya
Kimberly Augenstein1, Virginia Simson Nelson, Agnes Jeruto Kogei
1Munson Medical Center, Traverse City, MI, USA AIC CURE Children's Hospital of Kenya/Bethany Kids at Kijabe Hospital, Kijabe, Kenya.
Insights
A nurse-led bladder management program using clean intermittent catheterization (CIC) in Kenya significantly improved renal function and continence for children with spina bifida, reducing deaths from renal complications.
Area of Science:
- Pediatric Urology
- Nephrology
- Global Health
Background:
- Neurogenic bladders are common in children with spina bifida, leading to high rates of renal failure and mortality.
- Historically, lack of clean intermittent catheterization (CIC) in developing countries exacerbates these outcomes.
- Renal complications remain a leading cause of death in spina bifida patients without adequate bladder management.
Purpose of the Study:
- To evaluate the effectiveness of a nurse-run bladder management program utilizing CIC in a developing country setting.
- To assess the impact of CIC on renal function and social continence in children with spina bifida.
- To determine the feasibility of implementing such a program in resource-limited environments.
Main Methods:
- A comprehensive spina bifida program in Kenya was established, managed by nurses.
- Bladder function was assessed using leak point pressure (LPP).
- Clean intermittent catheterization (CIC) was initiated for children with LPP >30 cm water or those requiring social continence.
Main Results:
- Out of 371 children evaluated, 167 were initiated on CIC.
- Only 3 deaths were attributed to renal complications among the 72 deceased patients.
- 45 out of 59 children aged 5 and older achieved social continence.
Conclusions:
- A nurse-led bladder management program incorporating CIC is effective in improving renal outcomes and continence for children with spina bifida in developing countries.
- This model demonstrates successful implementation in resource-limited settings.
- The program significantly reduces mortality associated with renal complications in this vulnerable population.
Abstract:
Most children with spina bifida have neurogenic bladders. Prior to the use of clean intermittent catheterization (CIC) in 1972, approximately 30% of children with spina bifida died of renal failure. In developing countries where CIC is not done, even more children with spina bifida continue to die from renal failure. This article presents data from Kenya collected from a nurse run comprehensive spina bifida program which evaluates bladder function with leak point pressure (LPP) and begins CIC in those children with LPP >30 cm water. 371 children were seen for surgical closure. Urodynamic studies were done in 249 and of these 167 were started on CIC because of high LPP or need for social continence. 99/371 were lost to follow-up. 72 have died. To date, only 3 deaths were from renal complications. Of 59 children age 5 or older, 45 have achieved social continence. We conclude that a nurse run bladder management program including CIC for children with spina bifida can be done in a developing country with good results on renal function and continence.
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