Assessment of adverse events among cervical cancer patients at Kenyatta National Hospital

Introduction Due to their cytotoxic nature, anticancer drugs and radiotherapy have the potential to cause toxic adverse events. As a result, they can increase the risk of morbidity and mortality. However, there was a lack of data among cervical cancer patients in our setting. Hence, this study was aimed to assess the prevalence of adverse events among cervical cancer patients at Kenyatta National Hospital. Methods A cross-sectional study design was employed among a consecutive sample of 151 adult cervical cancer patients. The data were collected by reviewing the medical records and interviewing the patients. The data were entered and analyzed using SPSS 27.0 software. The results were presented with frequency tables and graphs. Results A total of 214 adverse events (prevalence of 100%) were identified from 151 patients. The most common adverse events identified were ulcerated sores (52.8%), dysuria (7.5%), thrombocytopenia (5.6%), and loss of appetite (5.6%). The majority of the patients (80.8%) who had adverse events were on radiotherapy. As per the Naranjo causality assessment scale, the predominant (80.1%) proportion of the adverse event was a probable adverse event with a total score of 5–8. Besides, 15.9% of the adverse events had a possible causality. The present study also reported that 61.6% of patients with a probable adverse event were treated with radiotherapy. Conclusion The prevalence of adverse events among cervical patients was high in our setting. The predominant proportion of the adverse event was a probable adverse event and most of them were treated with radiotherapy.

Survival Outcomes among Human Epidermal Growth Factor Receptor 2- (HER2-) Positive Breast Cancer Patients at Kenyatta National Hospital

Introduction. HER2-positive breast cancer is associated with poor outcomes and higher mortality rates than other breast cancer subtypes. The advent of trastuzumab has significantly changed the natural history of HER2-positive breast cancer. However, it is not an affordable treatment option in sub-Saharan African countries. Because of the expense, most patients in our setting do not receive trastuzumab for the optimal control of their disease. Additionally, there is a lack of comprehensive data about the survival outcomes of HER2-positive breast cancer patients in our setting. The present study was aimed at determining the survival outcomes among HER2-positive breast cancer patients at the Oncology Department of Kenyatta National Hospital. Methods. A hospital-based retrospective cohort design was used to evaluate the survival outcomes among patients with HER2-positive breast cancer treated from 1st January 2015 to 31st December 2019 at Kenyatta National Hospital. A total of 50 eligible HER2-positive breast cancer patients were included in the study. In the predesigned data abstraction tool, data were collected by reviewing the medical records of the patients. The data were entered and analyzed using the Statistical Package for the Social Sciences version 27 software. The mean survival time was estimated using Kaplan-Meier survival analysis. Results. The mean age was 45.44 ± 12.218 years, with a majority (80%) of the patients being below 60 years. Most patients (64%) had advanced-stage disease. The median follow-up time for patients with curative stages of breast cancer was 41 months, while the median follow-up time for those with the advanced incurable disease was 8.5 months. The 4-year survival rate was 62.5% for those curable-stage HER2-positive breast cancer compared to 5.6% for those with metastatic disease at presentation. Conclusion. The 4-year survival rate for both early-stage and advanced-stage HER2-positive breast cancer in our setting is suboptimal when compared to existing outcome data from health care systems where trastuzumab is more widely available.

Perceived Demographic and Socio-Economic Factors Contributing to Poor Outcome of Neonatal Sepsis at Paediatric Unit Kenyatta National Hospital

Introduction: Globally sepsis is still a known case of high mortality and mobility rates among neonates. This is despite having been advances in healthcare quality. The World Health Organization estimates that more than 40% of deaths occurring among infants aged below five years happen during the neonatal phase and they result in 3.1 infant deaths annually. Objective: This study sought to establish the perceived demographic and socioeconomic status of poor outcomes of neonatal sepsis at Kenyatta national hospital paediatric unit. Methodology: This was a hospital-based descriptive cross-sectional study conducted in the Paediatric Unit of Kenyatta National Hospital. A total of 175 mothers of neonates with neonatal sepsis admitted in KNH selected using consecutive sampling methods were recruited into the study. A validated researcher-administered semi-structured questionnaire was used to collect the data. Descriptive statistics involved the calculation of measures of central tendencies like means, modes and medians between variables. Association between the study variables was estimated using both chi-square and odds ratio statistics at a 95% confidence interval. The study results were presented in tables, graphs and charts, as appropriate. Results: Maternal demographic factors associated with poor outcomes of neonatal sepsis included - younger or advanced maternal age (X2 = 4.735, df = 2, p = 0.031); low education level (X2 = 6.362, df = 1, p = 0.012) and short birth intervals of < 2 years (X2 = 5.108, df = 2, p = 0.023). Maternal socioeconomic factors associated with poor outcomes of neonatal sepsis included - low household income level (X2 = 6.163, df = 1, p = 0.014); large family sizes of ≥5 members (X2 = 4.844, df = 1, p = 0.028) and lack of a health insurance cover (X2 = 5.382, df = 1, p = 0.019). Conclusion: Various maternal demographics, maternal socio-economic were significant perceived determinants of poor outcomes of neonatal sepsis in Kenyatta National Hospital’s Paediatric Unit. Recommendations: The national government with the help of county governments and development partners should invest in community empowerment programs that aim to improve the socioeconomic status of caregivers and their households. In addition, further investments in the health care system are needed to make it more affordable to all and particularly to the low-income group.

HEALTHCARE PROVIDER PATIENT VERBAL LANGUAGE USE ON DIABETES MELLITUS MANAGEMENT PRACTICES IN SELECTED HOSPITALS IN KENYA

Purpose: To establish the effect of healthcare provider patient verbal language use on diabetes mellitus management practices in selected hospital in Kenya. Methodology: This was a causal comparative research study design with application of quantitative and qualitative methodology. The study was carried out at the outpatient diabetic clinics of Kenyatta National Hospital and MP Shah Hospital. 400 patient participants were involved in the study and comprised of 313 patients at Kenyatta National Hospital (KNH) and 87 patients at MP Shah respectively studied between the months of February 2019 and November 2019. A researcher administered questionnaire was used to collect data. The results were summarized using percentages and means or medians for categorical and continuous data respectively. Comparisons were done using chi square test of association of categorical variables and independent t-test for comparison of means. Linear regression and ANOVA were used to test for associations and hypothesis between healthcare provider patient verbal language use (VLU) and diabetes mellitus management practices (DMMPs). Results: Patients at MP Shah Hospital rated the verbal language use significantly higher than the patients at KNH (p< 0.001). However, linear regression analysis showed that verbal language use was not statistically significant overall in Kenya [β=0.04, (95% CI -0.09, 0.17), p=0.552], at KNH [β=0.05, (95% CI -0.10, 0.19), p=0.513] and MP Shah Hospital [β=0.09, (95% CI -0.21, 0.39), p=0.552]; (P > 0.05), hence the failure to reject the null hypothesis. Therefore, there was no significant effect of verbal language use by the healthcare provider and the patient on diabetes mellitus management practices in selected hospitals Kenya. Unique contribution to theory, practice and policy: Verbal language use though important in healthcare provider patient interactions was not responsible for improvement in the diabetes mellitus management practices among the patients. Therefore, verbal language use by the healthcare providers in their communication interaction with patients need to be reinforced in healthcare practice to ensure improved DMMPs. Strategies should be developed to enhance verbal language use through educational curriculum development and implementation at the medical training institutions.

Thermoregulation Practices among Mothers with New-Born Babies Attending Kenyatta National Hospital, Kenya

Thermal protection is a major challenge for new-born survival in most developing regions. Despite continued emphasis on correct thermoregulation care practices, suboptimal care still persists. This study therefore sought to determine the practices for maintenance of optimal neonatal body temperature among mothers with new-born babies attending Kenyatta National Hospital. The study adopted a mixed methods cross sectional design using qualitative and quantitative methods. The study population comprised of mothers with new-born babies attending the postnatal clinic and paediatric emergency unit at Kenyatta National Hospital. Slovin’s Formula was used determine a sample size of 200 respondents. The study used primary data through questionnaires, focus group discussion and observation. Descriptive statistics and chi-square analysis were conducted with the help of SPSS. Results showed that majority 66.5% (n=133) had good thermoregulation practices. Age (p=0.001) and level of education (p=0.000) were significant. Thermoregulation practices among mothers with new-born babies attending Kenyatta National Hospital were good. All the same, mothers should therefore be sensitised on covering their baby well during movement and checking of wet diapers and clothing to ensure that the baby is kept warm at all times. Keywords: Thermoregulation Practices, Thermal protection, new-born care, neonatal body temperature.

Survival Outcomes Among Pancreatic Cancer Patients at Kenyatta National Hospital

Purpose: The mortality rate of pancreatic cancer varies throughout the world, with industrialized countries being hard hit. In addition, mortality has risen fast in the past two decades in Kenya and East Africa. However, there was a paucity of conclusive data about the survival of pancreatic cancer patients in the study setting. Hence, this study aimed to assess the survival outcomes of pancreatic cancer patients at Kenyatta National Hospital.Methods: A hospital-based retrospective cohort analysis was used to evaluate the survival outcomes among pancreatic cancer patients admitted in the study setting between 2015 and 2019. A total of 64 eligible pancreatic cancer patients were included in the study. In the pre-designed data abstraction tool, the data were collected by reviewing the medical records of the patients. The data were entered and analyzed using the Statistical Package for the Social Sciences version 22 software. The mean survival time was estimated using Kaplan Meier survival analysis. Cox regression analysis was employed to estimate the predictors of mortality among pancreatic cancer patients.Results: The mean age of the study participants was 60.38±12.61 years. Most of the patients had adenocarcinoma (96.9%) and were diagnosed at an advanced stage of the disease. The overall mean and median survival estimate for pancreatic cancer was 48.7±9.7 and 39.0±23.9 months, respectively. The present study showed that the overall survival rate of pancreatic cancer patients was 79.7%. Conclusion: The mortality rate of pancreatic cancer in the present was 20%. The overall mean survival estimate for pancreatic cancer was 48.7±9.7 months, and the majority had disease progression in the last follow-up period.

Final report of Breast Cancer Care Registry at the Kenyatta National Hospital, Nairobi.

e12552 Background: Breast cancer is the commonest cancer among women in Kenya. We wanted to examine breast cancer seen at the Kenyatta National Hospital in relation to local factors that influence prognosis and quality of life, local variations in treatment and outcomes; describe the clinical care patterns, monitor the safety of the therapies provided to patients in a routine clinic setting. Methods: A prospective study of patients with breast cancer between 11.08.2011 and 11.09.2014 inclusive. Data included demographic details, diagnostic and staging procedures, stage, treatment and outcome. Estimates of relative survival used period approach. hi-square tests and analysis of variance (ANOVA) were utilised to make comparisons. Cross sectional data are presented in proportions, means and medians. Results: Four hundred patients were included, age range 20 to 83, median 49 years. Out 312, 65 (20.8%) were obese. Eight of 397 (2%) were smokers and 22(5.5%) took alcohol. Early disease was diagnosed in 269 out of 354 (76%) and metastatic disease in 85(24%). Breast lump presented in 388 out of 400 (97%), breast pain in 104 out of 388 (26.8%). Fifteen of 394 (3.8%) had second breast cancer, 4 (1%) had had ovarian cancer and 9 (2.3%) had had had other malignancy. History of breast cancer in first and second-degree relative was elicited in 41 out of 394 (10.4%). Ductal carcinoma NOS was commonest in 343 (88.2%), lobular carcinoma in 9(2.5%). Cases by T stage were T1 - 25(7.2%), T2 -130(37.4%), T3 - 96(27.6%), T4 - 87(25%). Of 322 cases, 187(58.1%) were ER positive and 175 (54.4%) PR positive. Her2 positive cases were 78 out of 322 (24.2%). Neo adjuvant and adjuvant chemotherapy mainly consisted of combinations of cyclophosphamide and doxorubicin [AC] +/- a taxane[AC→T] ( mainly by medical oncologists) or AC+ 5-FU [CAF] (mainly by clinical oncologists). Of 305 cases 272 (89.2%) completed adjuvant therapy, 8(2.6%) died during treatment. Median overall survival was 57.1 months (95% CI; 55.6 to 59.5 months). For metastatic disease, median PFS was worse for patients < 40 years. Conclusions: Pathology and biology mirrored global situation, over 75% of patients had non metastatic disease. A significant proportion of early disease patients did not complete treatment.