An evaluation of the disparities affecting the underdiagnosis of pediatric cancer in Western Kenya

Abstract

Introduction: Western Kenya is home to approximately 24 million people, with 10 mil- lion children under the age of 15 years.1 Based on estimates of cancer incidence in similar populations from around the world, approximately 1500 patients should be diagnosed with pediatric cancer each year. This article describes the international col- laboration that investigates potential barriers preventing the effective diagnosis of pediatric patients with cancer. Methods: Here, we describe a multidisciplinary and sequential approach to better eval- uate the complex factors affecting the lack of appropriate diagnosis of pediatric cancer in Western Kenya. Results: Internal review at a large tertiary hospital noted 200–250 patients were diag- nosed annually, suggesting the remaining 75%–80% of patients go undiagnosed and do not receive treatment. Following our screening process at a local referring hospital, 41 malaria slides demonstrated both morphologic and genetic evidence of leukemia. Knowledge assessments of local providers at referring institutions suggested a lack of education and training as the factors that contribute to lower rates of diagnosis. Discussion: Through a multi-step approach, our teams were better able to isolate potential issues impeding the appropriate and timely diagnosis of pediatric cancer in Kenya.