Edefonti A, Marra G, Castellón Perez M, Sandoval Díaz M, Sereni F
Clinica Pediatrica De Marchi, Via Commenda 9, 20122 Milano, Italy.
Clin Nephrol. 2010 Nov;74 Suppl 1:S119-25.
In low-income countries renal diseases generally and chronic kidney disease (CKD) in particular represent a wide-spread and often underdiagnosed clinical problem. The aim of the cooperative project between the pediatric nephrology units of Milan, Italy, and Managua, Nicaragua was to improve the diagnosis and treatment of renal diseases and CKD in Nicaraguan children. When the project started, in 2000, there were many constraints in human and material resources in the Children's Hospital in Managua. Since 2001, a specialized Unit of Pediatric Nephrology and Urology has developed, offering free of charge basic clinical assistance to hospitalized children, and training abroad of the whole staff. Shared protocols, renovation of infrastructure and an information technology (IT) program were implemented. In 2003, renal replacement therapy (RRT) for selected children was initiated, along with a network of six department hospitals in 2005 and, in 2007, a CKD prevention program in the most peripheral Health Units, so that 61% of the Nicaraguan pediatric population is now covered by the project. To ensure implementation of the project, applications for funds to Italian private and public institutions were made and a Nicaraguan charity foundation was activated. The Nicaraguan Ministry of Health and the hospital directors were always involved in the plans of the development of the project and accepted the progressive transfer of the costs to the government, throughout the 9-year duration of the project. The IT program, inclusive of a database of children with kidney and other urinary tract (UT) diseases and a web connection between Milan and Managua, was crucial in monitoring the activities and providing epidemiological data, in order to better allocate resources. The clinical activities and the number of children managed in Managua in 2008 are similar to those of pediatric nephrology units worldwide and depict the level of clinical autonomy achieved. The sister-center model of cooperation and the top-down strategy we applied, along with the careful consideration of all the economic, logistic and political issues, were and are the key factors which explain the favorable results of this cooperative project.
在低收入国家，肾脏疾病总体上，尤其是慢性肾脏病（CKD），是一个广泛存在且常常诊断不足的临床问题。意大利米兰和尼加拉瓜马那瓜的儿科肾脏病科室之间开展合作项目的目的是改善尼加拉瓜儿童肾脏疾病和CKD的诊断与治疗。2000年项目启动时，马那瓜儿童医院在人力和物力资源方面存在诸多限制。自2001年起，一个专门的儿科肾脏病与泌尿外科科室得以发展，为住院儿童提供免费的基本临床援助，并让全体工作人员到国外培训。实施了共享方案、基础设施翻新以及信息技术（IT）项目。2003年，为选定的儿童启动了肾脏替代治疗（RRT），2005年建立了由六家省级医院组成的网络，2007年在最基层的卫生单位开展了CKD预防项目，如今该项目覆盖了61%的尼加拉瓜儿童人口。为确保项目的实施，向意大利的私立和公立机构申请了资金，并启动了一个尼加拉瓜慈善基金会。在项目为期9年的时间里，尼加拉瓜卫生部和医院院长始终参与项目发展计划，并接受了逐步将费用转由政府承担的做法。包含肾脏及其他泌尿系统（UT）疾病患儿数据库以及米兰与马那瓜之间网络连接的IT项目，对于监测活动和提供流行病学数据至关重要，以便更好地分配资源。2008年在马那瓜开展的临床活动及管理的儿童数量与全球儿科肾脏病科室的情况相似，体现了所实现的临床自主性水平。我们采用的姐妹中心合作模式和自上而下的策略，以及对所有经济、后勤和政治问题的审慎考虑，一直是并仍是解释该合作项目取得良好成果的关键因素。
