Pattern of brain tumours in Kenyatta National Hospital: a 3 year cross-sectional study.
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Date
2015Author
Muriithi, Solomon W
Type
ThesisLanguage
enMetadata
Show full item recordAbstract
Background
The burden of brain tumours in Kenya is still largely unknown though information from the
Nairobi Cancer Registry suggests that they form about 2.3% of all reported male cancers and
0.9% of all female cancers. Kenyatta National Hospital (KNH) remains the main centre for
neurosurgery in Kenya and as a result, the majority of patients with brain tumours continue to
present at the hospital.
Objective
To describe the characteristics of brain tumours including clinical presentation, radiological and
histological patterns in patients aged 13 years and more presenting at the Kenyatta National
Hospital over a period of three years from January 2012 to December 2014.
Study methods and design
This was a 3-year hospital-based descriptive cross-sectional study. The study was conducted at
Kenyatta National Hospital amongst patients aged 13 years and above with brain tumours that
underwent surgery confirmed by histology from January 2012 to December 2014. The clinical
syndromes, radiological features and histological types were described. The prevalence rates of
the different brain tumours were given and tests of association (chi-square or Fischer’s exact test)
where possible were performed to explore the relationship between the three features. Significant
associations were explored further using logistic regression.
Results
It was found that there was an overall mean age of 40.63 yrs for all brain tumours with a range of
13-70 years. Peak was at 40 years. Overall male to female ratio was 1:1.49. Main occupations
seen with brain tumours were farmers and housewives. Kikuyu ethnic group were seen more at
53.29%. Headache and visual deficits were the chief complaints at presentation. Familial history
of brain tumours only occurred in 2.63% of our patients. Most patients operated on had a good
performance score with GCS of 15/15. Most of the tumours seen were supratentorial. Only
1.31% of brain tumours presenting in our setup had any familial associations. Meningiomas at
41.4% and gliomas at 26.3% were the most common tumours seen. Glioblastoma accounted for
55% of all gliomas seen. Male to female ratio for meningiomas was 1: 3.2 with a mean age of
43.97 years. Gliomas had a male to female ratio of 1.35: 1 with an average age of 39.65 years.
Most meningiomas were located in the sphenoid wing and convexity locations while most
gliomas were frontal and temporal.
Conclusion
It was found that we are seeing brain tumours at a younger age at KNH compared to the average
age of brain tumour presentation in the western world with most studies quoting an average age
of above 59 years with glioblastomas and meningiomas having an average of 64 and 65 years
respectively. Females are presenting more commonly with meningiomas while males are
presenting more commonly with gliomas. Ethnic and geographic variables are a key determinant
to access to neurosurgical care in our local setup. Headache and visual deficits are a key
indicator of presence of brain tumour. A lower proportion of brain tumours with familial
associations are been seen in KNH when compared to averages from western studies at 5%.
Most of the tumours seen in the adult population are supratentorial. Meningiomas and gliomas
are the commonest tumours seen in our set up accounting for 67.7% of all brain tumours.
Glioblastoma are still the commonest gliomas seen and carry a grave prognosis. Gliomas occur
in a younger age group compared to meningiomas. More metastatic tumours are been offered
surgical care compared to previous studies done in KNH. Supratentorial tumours are the
commonest tumours in adults. Proximity to neurosurgical care and the socioeconomic status has
a bearing on access to neurosurgical services. Many of the neurosurgical patients from far flung
areas away from Nairobi county where KNH is located are been seen in Eldoret referral hospital
or are not getting proper neurosurgical services due to under diagnosis and lack of specialist
services.
Recommendations
More vigilance needed in our local setup as patients are presenting with brain tumours at a much
younger age. The patients to be empowered economically so that they can be able to access
neurosurgical care promptly which has a direct effect on outcomes and prognosis. Neurosurgical
services need to be decentralized too.
Publisher
University of Nairobi