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Acute glomerulonephritis--changing patterns in Singapore children
H K Yap1, K S Chia, B Murugasu
1Department of Paediatrics, National University of Singapore.
Insights
Acute glomerulonephritis (AGN) incidence in Singapore children significantly declined between 1971 and 1985. This decrease correlates with improved socioeconomic status, healthcare, and urbanization, suggesting these factors impact AGN prevalence.
Area of Science:
- Pediatrics
- Epidemiology
- Public Health
Background:
- Acute glomerulonephritis (AGN) is a kidney disease influenced by socioeconomic and environmental factors.
- A post-streptococcal aetiology was identified in over 70% of cases in a 1980-1984 sample.
- AGN affects children 12 years and under.
Purpose of the Study:
- To compare the pattern of acute glomerulonephritis (AGN) in children in 1971 versus 1985.
- To investigate the epidemiological factors contributing to changes in AGN prevalence.
Main Methods:
- Retrospective analysis of AGN cases admitted to four major pediatric departments.
- Comparison of incidence rates, age at presentation, and housing patterns between 1971 and 1985.
- Correlation with national socioeconomic indicators like GNP and urbanization.
Main Results:
- AGN admissions dropped from 411 in 1971 to 58 in 1985.
- Standardized incidence rates decreased from 0.632 to 0.023 per 1,000 children.
- Housing shifted from 31% in high-rise apartments in 1971 to 86% in 1985.
Conclusions:
- A significant decline in pediatric AGN prevalence was observed in Singapore between 1971 and 1985.
- Improvements in socioeconomic status, healthcare, and urbanization are strongly associated with this decline.
- These factors likely play a crucial role in reducing the incidence of AGN.
Abstract:
This study compared the pattern of acute glomerulonephritis (AGN), a disease known to be influenced by socioeconomic and environmental factors, in children 12 years and under, for the years 1971 and 1985. All children admitted to the four major paediatric departments with haematuria and at least two of the following (oedema, hypertension or oliguria) had an initial diagnosis of AGN. A sample population from one unit from 1980 to 1984 showed that over 70% of these children had evidence of a post-streptococcal aetiology. In 1971, 411 children were admitted with AGN, as compared with only 58 in 1985. The age-sex-race standardized rates for 1971 and 1985 were 0.632 and 0.023/1,000 children 12 years and under, respectively (P less than 0.001). The mean age of presentation was lower in 1971. Over this period, Singapore saw a threefold rise in the gross national product, accompanied by rapid urbanization. On analysis of the housing pattern, only 31% of the children lived in high-rise apartments in 1971, in contrast with 86% in 1985 (P less than 0.001). The majority of non-apartment dwellers had homes in rural districts. From an epidemiological perspective, factors which could have led to the highly significant decline in prevalence of AGN in Singapore children included improvement in the socioeconomic status and health care system, and urbanization of the country.