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Year : 2021  |  Volume : 6  |  Issue : 1  |  Page : 4-12

Non-compliance in pediatric nephrotic syndrome

Department of Pediatric Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh

Correspondence Address:
Prof. Ranjit Ranjan Roy
Department of Pediatric Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka
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Source of Support: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, Conflict of Interest: None

DOI: 10.4103/pnjb.pnjb_8_21

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Background: Non-compliance to medications and health advice significantly impact care of patients as well as impose financial burden in nephrotic syndrome (NS) patients. Aim: The aim of this article is to determine the cause and consequence of non-compliance in NS patients. Materials and Methods: This prospective study was conducted between March 2020 and February 2021 in the department of Pediatric Nephrology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Seventy-seven NS patients were recruited randomly. In-person interviews were conducted with attendents of patients, along with patients if possible. Clinical and laboratory data were collected from medical records. Residence, financial constraints, educational status, health advices (daily bed side urine test), relapses of disease, different types of immunosuppressive medications, etc. were provided for the cause of non-compliance. Consequences of non-compliance were observed through the experience of relapses, asthma attack or infection, and drug toxicity. Data were analyzed using SPSS software version 20. Results: A total of 77 patients were analyzed and among them 74.02% were non-compliant and 25.98% were compliant. Among the non-compliant patients, non-compliance to asthma medication, prednisolone, second-line immunosuppressive drugs, and third-line immunosuppressive drugs were 43.87%, 31.57%, 14.03%, and 10.53%, respectively. About 56.14% of the patients did not do bed side urine for albumin (BSUA). Remote location (63.15%), financial constraints (36.84%), low parental education (35.09%), ignorance (17.54%), and undetermined cause (17.50%) were observed as main contributing factors for non-compliance. Among study populations, 77.19% experienced more relapses in comparison to compliance (10%). Non-compliant patients experienced more asthma attack (70.17%, 40/57), pneumonia (63.2%), and steroid toxicity (36.8%) in comparison to the compliance group (45%, 36.8%, and 10%, respectively). About 31.57% of the non-compliant group had spent 30,000–70,000 taka in comparison to 5% in the compliance group and it was statistically significant (P = 0.031). Conclusion: Poor compliance to medications and health-related advices have diverse effects including frequent relapse, drug toxicity, higher rates of complications and hence increased healthcare cost. Remote location, ignorance, and idiopathic causes were major contributing factors behind non-compliance issue. Appropriate counseling might change this prevailing non-compliance scenario in future.

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