Duration of Hospital Stay Post – Discharge and Associated Factors in Children With Malignancies Age 0 – 14 Years at Kenyatta National Hospital

Abstract

Introduction Cancer is a major cause of mortality and morbidity worldwide. World Health Organization (WHO) estimated that 9.6 million people died from cancer in 2018(1). Most paediatric cancers are managed with chemotherapeutic drugs combined with surgery and sometimes radiotherapy. These treatment modalities require frequent and long durations of hospitalization making cancer management quite expensive (2). This imposes a great financial burden especially among people in developing countries lacking health insurance. As a result, many who are discharged fail to exit hospital, adding to the financial burden and putting them at more risk of Hospital Acquired Infections (HAIs) (3). Study justification The study aims to quantity the burden, factors contributing to and complications associated with post discharge hospital stay in children with malignancies. Findings from this study may influence formulations of policies regarding discharges and advocacy for health insurance for children with malignancies in line with current policy on Universal Health Coverage (UHC). Objectives of the Study The objectives of this study were to determine the duration of hospital stay post- discharge in children with malignancies age 0-14 years at KNH and in a sub-analysis to describe the factors associated with this duration of Hospital stay post-discharge. Study Methodology The study was a Cross-sectional Retrospective Chart review among children age 0-14 years with malignancies treated at KNH between July 2019 and June 2020 and was conducted at KNH medical records department. Only those who had histological diagnosis were included in this study using consecutive sampling. Results A total of 192 files reviewed and analyzed. The duration of hospital stay post-discharge ranged from 1 day to 42 days. The median (IQR) duration of hospital stay post-discharge was 12 days (1-28 days). The duration of hospital admission ranged from 1 month to 9 months, with the median xii

(IQR) being 4 months (3-5 months). The average duration of hospital stay post-discharge of children whose caregiver did not have an active insurance at the time of admission was 14.38 days more than that of children whose caregivers had an active insurance (β =14.38; 95% CI: 11.30-17.45). The mean duration of hospital stay post-discharge among children with haematological cancers was 4.02 days more than that of children with solid cancers (β =4.02; 95% CI: 1.28-6.75). 18.7% of the children acquired infections during hospital stay post-discharge. 7.3% of the children in this study received a waiver of their hospital bill. Conclusion Duration of Hospital stay post-post discharge ranged from 1- 42 days. Having health insurance at admission, solid cancers and shorter duration of hospital admission were associated with reduction in hospital stay post-discharge, with subsequent reduction of patient exposure for more HAIs and waiver cases.