Prevalence and factors associated with behavioral problems among children with nephrotic syndrome at Mulago National Referral Hospital

Abstract

Introduction: Nephrotic syndrome (NS) is the commonest glomerulopathy in the pediatric population with corticosteroids as the main stay of treatment. Studies have reported behavioural problems in children with nephrotic syndrome which are likely to influence the overall outcome of the disease. In clinical practice, however, preferential treatments of the disease process over the behavioural problems occurs commonly, unless their importance is stressed by appropriate evidence. Despite a significantly high prevalence of behavioural problems, such as attention deficit and hyperactive disorder, obsessive compulsive disorder, emotional disorder and conduct disorder amongst children with nephrotic syndrome, there is still shortage of literature about these problems in Uganda. In Uganda, these problems continue to be neglected due unclear understanding of their prevalence and associated factors. Objectives: To describe the prevalence and factors associated with behavioural problems among children and adolescents with Nephrotic Syndrome attending the Paediatric Renal clinic Mulago National Referral Hospital in Kampala, Uganda. Methods: This was a cross-sectional study of children and adolescents with Nephrotic syndrome aged between 4 and 17 years attending the Paediatric Renal Clinic at Mulago National Referral Hospital. Three questionnaires were used to collect data; a strength and difficulty questionnaire to describe the behavioural problems, a semi structured questionnaire for the socio-demographic factors and the 8-item Morisky medication adherence scale. Data was analyzed at a significance level of 0.05 in STATA version 14 using logistic regression. Results: Between April 2021 and November 2021, 101 children and adolescents were enrolled, of which 54 (53.5%) were male and 47 (46.5%) females with a median age of 11 years (IQR=9-16) years. The prevalence of behavioural problems was 29 (28.7%), abnormal emotional scores 11(37.6%), abnormal conduct scores 15 (50.5%), abnormal hyperactivity 8(28.7%), and abnormal peer scores 4(13.9%), abnormal pro-social scores 4 (13.9%). Child’s age >10 years (aOR= 0.32, CI (0.17 – 0.69), p value=0.033), age at diagnosis (aOR= 0.82, CI ( 0.72 – 0.94), p value= 0.005), secondary level of education (aOR= 0.08, CI (0.01 – 0.87), p value= 0.038) and child’s care taker being married (aOR= 0.21, CI (0.06 – 0.69), p value= 0.011) were significantly associated with behavioural problems. Conclusion: Behavioural problems are common in children and adolescents with nephrotic syndrome with a prevalence of 28.7% which is three times that reported among children globally. The behavioural problems were more common in children younger than 10 years, children diagnosed at a very young age, children at lower level of education and children from families with unstable marriages. Regular screening for behavioural problems using Strength and Difficulties Questionnaire among children and adolescents with nephrotic syndrome at paediatric renal clinics is needed to enable early diagnosis, appropriate referrals and management.