Prevalence and factors associated with stunting in children and adolescents 1- 18 years with nephrotic syndrome attending the Renal Clinic at Mulago Hospital

Abstract

Background: Nephrotic syndrome (NS) is the most common glomerulopathy in children aged 2-18 years. It occurs at an annual incidence of 2-7 per 100,000 cases worldwide, 5.6 per million children in Tropical Africa and is estimated at 160 per million population in Uganda. Stunting has been closely associated with nephrotic syndrome and is thought to be multifactorial. It is a major public-health concern in low-income countries like Uganda. Early detection and prompt intervention help prevent the negative consequences associated with stunting. However, there is little or no published data on the prevalence of stunting in children with NS particularly in low-income countries like Uganda. General Objective: To determine the prevalence and factors associated with stunting among children and adolescents aged 1- 18 years with NS attending the renal clinic at Mulago Hospital.

Methodology: This was a cross-sectional descriptive study. A total number of 94 participants were recruited. All children and adolescents with NS who had been on steroid treatment for atleast 3months, aged 1 to 18 years and were registered at the Paediatric renal clinic department in Mulago Hospital were included in the study. Data was collected using a structured questionnaire, entered into Epi data 3.1 and exported to STATA version 14 for analysis.Means, standard deviation, median interquartile range, frequencies and percentages were used to summarize baseline characteristics and the outcome measures. Bivariate analysis was used to test the association between the stunting and independent variables in the study group. Multivariate analysis used conditional logistic regression models to determine the factors associated with stunting and check for cofounding and interaction.

Results: Out of the 94 participants, the median age (IQR) at diagnosis was age was 6 years (3-9) years and 48 (51.1%) were boys.15 children were stunted which accounted for a prevalence of 16%, with 12(12.8%) being moderately stunted and 3 (3.2%) being severely stunted. The only factor that was associated with stunting was presence of urine protein (proteinuria) with cOR; 95% CI 4.11(1.05-15.98).

Conclusion and recommendations: The prevalence of stunting among children and adolescents with nephrotic syndrome was high at 16%. Children and adolescents with proteinuria were more likely to be stunted which also correlated with poor disease control. Routine growth monitoring and plotting of WHO growth charts of children and adolescents with persistent proteinuria and nutritional counseling is crucial to curb stunting in this group of children and adolescents.

Key words: Nephrotic syndrome, stunting