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Developing countries

Spina Bifida in developing countries

Francesca, an adult with spina bifida working in the project in Kijabe

Spina Bifida is a condition that cannot be cured. In many cases several surgical interventions are needed, such as the closure of the back after birth.

Good medical care and intensive training can prevent many complications. Over recent years treatment of Spina Bifida has improved a great deal giving an increased life expectancy for these children.

In particular, developments in continence management and in the prevention of urological complications have improved the quality of life.


Guidelines for treatment Spina Bifida

Dr Carla Verpoorten, medical adviser to IF prepared a document on the care of children with spina bifida in developing countries.

Guidelines for the management of spina bifida were prepared by the participants of the 12th CPEP-Seminar at KCMC, September 2000 coordinated by Dr. M Oneko, c/o KCMC, Paediatric Department and Dr. M Nicol, Dar es Salaam.

The neurogenic bladder and bowel

The kidneys are especially vulnerable to damage from pressure and recurrent infection within the first year of life. 10% of children with myelomeningocele (MM) will develop a dilatation deformity within the first year of life, and 35% by the time they are four years old. Furthermore, it has been reported that over 50% of MM children have a dangerous bladder (having an active sphincter with or without an active detrusor).
Therefore, a management protocol to protect renal function in these children is of vital importance. The milieu of a developing country necessitates an innovative approach to the management of these children, since practicality and compliance are essential to its success.

Read the protocol on the management of the neurogenic bladder for children in developing countries.

more relevant literature:

o Fratta A, Bordenave J, Boissinot C, Le Grand J, Esquirol C, Radideau E, Benoit G. Development of an intravesial oxybutynin chloride solution: from formulation to quality control. Ann Pharm Fr. 2005 Mar;63(2):162-6.

o Buyse G, Waldeck K, Verpoorten C, Bjork H, Casaer P, Andersson K-E. Intravesical oxybutynin for neurogenic bladder dysfunction: less systemic side effects due to reduced first pass metabolism. J Urol 1998; 160: 892–6

o Buyse G, Verpoorten C, Vereecken R, Casaer P. Intravesical application of a stable oxybutynin solution improves therapeutic compliance and acceptance in children with neurogenic bladder dysfunction. J Urol 1998; 160: 1084–7

What volume can a child normally store in the bladder at a safe pressure? Houle AM, Gilmour RF, Churchill BM, Gaumond M, Bissonnette B.  J Urol. 1993 Mar;149(3):561-4. PMID: 8437265


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