dc.description.abstract | Background: GLOBOCAN (Global Cancer Incidence, Mortality and Prevalence) estimates
project cancer burden to have shifted to low and middle income countries (LMICs), posing both
social and economic challenges. Kenya is not a stranger to this trend and under diagnosis and
late diagnosis has been identified as critical aspects associated with poor outcomes. Simple,
relatively easy to perform tests used in cancer diagnosis such as fine needle aspiration (FNA) and
bone marrow aspiration (BMA) are underutilized in Kenya. To tackle this limitation, University
of Nairobi in conjunction with Aga Khan University in collaboration with the Ministry of Health
and the National Cancer Institute (NCI, United States) initiated a capacity building program to
increase the use of FNA, BMA and trephine biopsy for cancer diagnosis. The project intended to
provide capacity building in performing the FNA, BMA and trephine biopsy techniques in the
two hospitals through training, administrative support logistics, quality control and monitoring
and evaluation.
Objective: The main aim of this study was to assess the impact of training clinicians and
laboratory technologists on bone marrow and fine needle aspiration procedures in two level-5
hospitals in order to improve cancer diagnosis.
Study Design: This was an interventional study that assessed the impact of training nonpathologists
in Nyeri Provincial General Hospital (NPGH) and the Coast Provincial General
Hospital (CPGH).
Methodology: The study subjects included clinicians and laboratory technologists. The
clinicians were trained on sample collection using two techniques of bone marrow and fine
needle aspiration. The laboratory technologists were trained on quality aspects of sample
preparation and processing. Necessary equipment and supplies were provided to get the
institutions started as well as expertise support in terms of laboratory result generation was
offered by the University of Nairobi (UoN) and the Aga Khan University Hospital (AKUH).
Monitoring and evaluation sessions were organized periodically to assess progress. Ethical
approval was sought from the Kenyatta National Hospital/ University of Nairobi Ethics and
Research Committee, and permission to perform the study from the hospitals involved before
carrying out the study.
Data Analysis: Data collected included qualitative and quantitative variables. Data was entered
in the statistical software SPSS version 22 for analysis. Descriptive analysis using frequencies
and proportions was computed. Association between dependent variables and independent
variables was analyzed using binary logistic regression.
Results: Of the 23 participants that were trained in this capacity building initiative, 15 (65%)
were medical officers from different departments. In total, 13 were certified proficient ( due to
drop-outs and staff attrition) in sample collection using bone marrow evaluation (BME) and
FNAB techniques through practical steps including pre and post-testevaluations.
There was an increase in the number of fine needle aspiration biopsy (FNAB), BMA and
trephine procedures performed in both CPGH and Nyeri PGH in the year 2016 when the study
was carried out. A total of 588 cases were reported in CPGH compared to 225 in the previous
year (2015); while 783 cases were reported in Nyeri Provincial General Hospital (NPGH)
compared to 420 cases in the year 2015.
There was a marked improvement in the sample quality attributes of smear making, staining and
overall specimen quality in terms of cellularity and diagnostic capability. Similarly, the
unsatisfactory rates improved in both facilities as well as at individual operator level given by
low (2.6%-25%) unsatisfactory rates registered.
Both study sites reported an increase in the number of new cancer cases diagnosed using BME
and FNAB techniques compared to the previous year. A total of 50(8.5%) new cases were
reported in CPGH compared to 27(6.0%) in the year 2015(p-value= 0.132); while 36 (4.6%) new
cases were diagnosed in NPGH compared to 23 (2.7%) in the previous year (p-value=0.047).
Conclusions:
Prior the initiative, few diagnostic procedures were performed due to lack of supporting
infrastructure. Training as an intervention helped improve on quality diagnosis through proper
sample collection and processing therefore reducing the unsatisfactory rates in both facilities. An
increase in the number and proficiency of those performing the diagnostic techniques led to an
increase in the number of new cancer cases diagnosed.
Recommendations:
Training of non-pathologists in BME and FNAB should be maintained and the curriculum
delivery up-scaled to include in-service training at the county and national hospitals. Review of
facility infrastructure support and adoption of standard operating procedures (SOPs) for the
diagnostic tests should be implemented in all level-4 and level-5 hospitals in Kenya. | en_US |
dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |