Influence of health-insurance access and hospital retention policies on childhood cancer treatment in Kenya.

BACKGROUND: Kenyan national policies for public hospitals dictate that patients are retained on hospital wards until their hospital bills are paid, but this payment process differs for patients with or without access to National Hospital Insurance Fund (NHIF) at diagnosis. Whether these differences impact treatment outcomes has not been described. Our study explores whether childhood cancer treatment outcomes in Kenya are influenced by health-insurance status and hospital retention policies. PROCEDURE: This study combined retrospective review of medical records with an illustrative case report. We identified children diagnosed with malignancies at a large Kenyan academic hospital between 2007 and 2009, their treatment outcomes, and health-insurance status at diagnosis. RESULTS: Between 2007 and 2009, 222 children were diagnosed with malignancies. Among 180 patients with documented treatment outcome, 54% abandoned treatment, 22% had treatment-related death, 4% progressive/relapsed disease, and 19% event-free survival. Health-insurance status at diagnosis was recorded in 148 children: 23% had NHIF and 77% had no NHIF. For children whose families had NHIF compared with those who did not, the relative risk for treatment abandonment relative to event-free survival was significantly smaller (relative-risk ratio = 0.31, 95% CI = 0.12-0.81, P = 0.016). The case report illustrates difficulties that Kenyan families might face when their child is diagnosed with cancer, has no NHIF, and is retained in hospital. CONCLUSIONS: Children with NHIF at diagnosis had significantly lower chance of abandoning treatment and higher chance of survival. Childhood cancer treatment outcomes could be improved by interventions that prevent treatment abandonment and improve access to NHIF. Hospital retention of patients over unpaid medical bills must stop.

Burden and pattern of cancer in Western Kenya.

BACKGROUND: Cancer regisries worldwide have evolved to provide useful information on the burden and diversity of the patterns of cancer, information that is vital for establishing appropriate programmes for disease management. Population based data on cancer in western Kenya as captured in the Eldoret cancer registry established in 1999 is analysed and reported in this paper. OBJECTIVE: To determine the burden and pattern of cancer in Western Kenya by use of data from the Eldoret cancer registry. DESIGN: Retrospective study. SETTING: The cancer registry located in the Department of Haematology at the Moi University, School of Medicine situated at the Moi Teaching and Referral Hospital, Eldoret, Kenya. The hospital has a catchment population of 13 to 15 million people forming about 40% of the Kenyan population. RESULTS: A total of 5,366 patients were diagnosed to have cancer and attended to at the MTRH and other hospitals in Eldoret during the period between January 1999 and December 2006 giving an average of 671 cases per year. Among those treated 2,699 were males and 2,667 were females giving a M: F ratio of 1:1. About 21% of the patients had haematological malignancies with non-Hodgkins lymphoma being the most common. Another 79% of the patients had solid tumours with cancer of the oesophagus being the commonest. Cancer of the cervix and prostrate were the commonest among the females and males respectively. A general increase in the number of patients with Kaposis sarcoma associated with HIV/AIDS pandemic was observed. CONCLUSION: The burden of cancer is a significant health problem in western Kenya and there is need for the development of a comprehensive cancer care programme in the region to address the growing problem.

Presentation and health care seeking behaviour of patients with cervical cancer seen at Moi Teaching and Referral Hospital, Eldoret, Kenya.

OBJECTIVE: To determine the clinicopathological characteristics and health care seeking behaviour of cervical cancer patients seen at Moi Teaching and Referral Hospital (MTRH). DESIGN: Prospective cross-sectional study. SETTING: Gynaecology Unit, Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. SUBJECTS: Forty-two consecutive cervical cancer patients seen at MTRH gynaecology unit between May 1998 and November 1999. RESULTS: The mean age of the patients was 49.4 years (95% CI 45.4 to 53.3 years) range 24 to 80 years. All had been married and 42.9% had been in polygamous unions. Slightly more than seventy six per cent had had five or more confirmed pregnancies. Contraceptive everuse was 22%. The mean duration of clinical symptoms on presentation at MTRH was 8.2 months (95% CI 6.5 to 9.8 months) range 1 to 24 months. Female relatives and husbands were the first to be told about the symptoms by 90.3% of the patients and husbands alone by 48.8% of the patients. More than ninety per cent of patients sought health for the first time at a facility manned by trained health worker, with 39% visiting a dispensary or health centre first. More than 95% of patients had tumour stage 2 and above. Histopathologically, 80.9% of the tumours were squamous cell carcinoma, 11.9% were adenocarcinoma while the rest were anaplastic. CONCLUSION: Patients with cervical cancer present late for treatment at MTRH. They are most likely to have discussed their illness with their female relatives and husbands and to have first visited peripheral facilities manned by trained healthcare workers. Interventions to improve health care seeking behaviour among cervical cancer patients need to include education of husbands in addition to increasing awareness of the disease among private medical practitioners and health workers at dispensary and health centre level.