Abstract:
Introduction Febrile neutropenia is an oncological
emergency in children with cancer, associated with serious
infections and complications. In low-resourced settings,
death from infections in children with cancer is 20 times
higher than in high-resourced treatment settings, thought
to be related to delays in antibiotic administration and
management. The barriers to effective management of
fever episodes in children with cancer have not previously
been described. This convergent mixed-methods study will
provide the evidence to develop fever treatment guidelines
and to inform their effective implementation in children
with cancer at Moi Teaching and Referral Hospital (MTRH),
a level 6 referral hospital in western Kenya.
Methods and analysis Prospective data collection of
paediatric patients with cancer with new fever episodes
admitted to MTRH will be performed during routine
treatment. Clinical variables will be collected from 50
fever episodes, including cancer diagnosis and infectious
characteristics of the fever episode, and elapsed time
from fever onset to various milestones in the management
workflow. Semistructured qualitative interviews with
healthcare providers (estimated 20 to reach saturation)
will explore the barriers to and facilitators of appropriate
management of fever episodes in children with cancer. The
interview guide was informed by a theoretical framework
and Consolidated Framework for Implementation
Research. A mixed-methods analysis use of joint display
tables and process mapping will link and integrate the two
types of data with meta-inferences.