High child cancer deaths at top Kenya hospital explained

Poor survival rates of children with blood cancer at Moi Teaching and Referral Hospital (MTRH), Kenya, have largely been blamed on absent senior doctors.

An in-house evaluation of childhood leukemia treatment at the hospital has reported poor outcomes characterized with low survival rates.

The outcomes are also characterized with high death rates, relapses and treatment abandonments.

The poor outcomes are blamed on several factors including a chronic absenteeism of senior doctors while attending their private patients.

Consequently, complex cancer treatment protocols, the evaluation say are left to unsupervised junior staff hence the poor outcomes.

Now the study team wants the issues of dual practices of doctors and absenteeism to be addressed and regulated.

Cancer care

The evaluation by a team of cancer experts from the hospital, Moi University and several collaborating foreign universities reports death rates of up to a third of patients.

Most of the deaths occur early in treatment while disease relapses and abandonment of care were also high.

Only 20 per cent of children on treatment had an event free survival which reduced to 18 percent after one year.

This, the study authors say is extremely low compared to survival rates of up to 80 per cent in developed countries.

The report is published this week (26th September 2021) in the journal Pediatrics Blood and Cancer.

MTRH is the second largest hospital in Kenya after Kenyatta National Hospital and the only two public institutions offering comprehensive cancer care in the country.

“Event-free survival for childhood with acute lymphoblastic leukemia (ALL) at MTRH is very low,” says the study.

The authors had reviewed medical records for 136 children under 16 years, treated for blood cancer at the hospital for a five-year period.

Treatment-related complications

The team had also engaged 245 personnel providing cancer care at the facility. Both the data and care providers had generally agreed on poor treatment outcomes.

“The primary reason for treatment failure is early death from treatment-related complications.”

Health workers especially told of high non adherence to the treatment protocols, some which can take up to two years.

Non adherence, the report say may be caused by either parents or health care providers and in this case worsened when experienced doctors “spend more time and efforts in their private practice than in public hospitals.”

The result, the authors say is that complex leukemia treatment protocols are being administered by junior health care providers who lack the necessary expertise.

They want experienced doctors to enhance their supervision of junior staff to ensure effective implementation of the treatment protocols.

“Unfortunately, the culture within many public hospitals is highly tolerant toward absenteeism,” the report says.

This results to understaffed facilities with complex treatment protocols being taken care of by junior staff with limited supervision.

Weight changes

Such junior staff, the authors say may fail to adjust dose with weight changes, lack knowledge of protocol, and postpone treatment until they can ask advice from experienced doctors.

“There is need for advocacy and regulation of the problem of physician dual practices and absenteeism if equal access to quality cancer treatment is to be achieved,” the study suggests.

The study also found many health workers, especially nurses did not believe blood cancer can be cured, hence poor motivators for parents with cancer patients.

“Only 57 percent of health care providers believed childhood leukemia can be cured.” says the study.

Parents were also likely to abandon treatment due to financial challenges and use of alternative treatments.

By Gatonye Gathura

 

About Gatonye Gathura 142 Articles
Science Journalist

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