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Influence of health insurance status on paediatric non-Hodgkin’s lymphoma treatment in Kenya
  1. Hugo A Martijn1,
  2. Festus Njuguna2,
  3. Gilbert Olbara2,
  4. Sandra Langat2,
  5. Jodi Skiles3,
  6. Stephen Martin3,
  7. Terry Vik3,
  8. Peter M van de Ven4,
  9. Gertjan JL Kaspers1,5,
  10. Saskia Mostert1
  1. 1 Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands
  2. 2 Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
  3. 3 Department of Pediatrics, Division of Hemato-Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
  4. 4 Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
  5. 5 Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
  1. Correspondence to Dr Hugo A Martijn; hugo_martijn{at}live.nl

Abstract

Objective Non-Hodgkin’s lymphoma (NHL) is the most common childhood malignancy in sub-Saharan Africa. Survival rates for NHL are higher than 80% in high-income countries.

This study explores treatment outcomes of children with NHL in Kenya, a sub-Saharan low-income country, and the association between health insurance status at diagnosis and treatment outcomes.

Design This was a retrospective medical records study. All children diagnosed with NHL in 2010, 2011 and 2012 were included. Data on treatment outcomes and health insurance status at diagnosis were collected.

Results Of all 63 patients with NHL, 35% abandoned treatment, 22% had progressive or relapsed disease, 14% died and 29% had event-free survival. Most patients (73%) had no health insurance at diagnosis. Treatment outcomes in children with or without health insurance at diagnosis differed significantly (p=0.005). The most likely treatment outcome in children with health insurance at diagnosis was event-free survival (53%), whereas in children without health insurance at diagnosis it was abandonment of treatment (44%). Crude HR for treatment failure was 3.1 (95% CI 1.41 to 6.60, p=0.005) for uninsured versus insured children. The event-free survival estimate was significantly higher in children with health insurance at diagnosis than in patients without health insurance at diagnosis (p=0.003). Stage of disease at diagnosis was identified as a confounder of this association (adjusted HR=2.4, 95% CI 0.95 to 6.12, p=0.063).

Conclusions Survival of children with NHL in Kenya is much lower compared with high-income countries. Abandonment of treatment is the most common cause of treatment failure. Health insurance at diagnosis was associated with better treatment outcomes and survival.

  • childhood cancer
  • non-Hodgkin's lymphoma
  • health insurance status
  • low-income country

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors HAM: data collection, data analysis and interpretation, drafting the article, critical revision of the article, final approval of the version to be published. FN: conception or design of the work, data analysis and interpretation, critical revision of the article, final approval of the version to be published. GO, JS, SM, TV, GJLK: conception or design of the work, critical revision of the article, final approval of the version to be published. SL: data collection, data analysis and interpretation, critical revision of the article, final approval of the version to be published. PMvdV: data analysis and interpretation, critical revision of the article, final approval of the version to be published. SM: conception or design of the work, data analysis and interpretation, drafting the article, critical revision of the article, final approval of the version to be published.

  • Funding The study was conducted through a grant from the International Society of Paediatric Oncology.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Our study was approved by the Research Ethical Committee at MTRH.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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