Knowledge and Practices of Healthcare Workers on Early Signs and Symptoms of Childhood Cancers in Levels Three and Four Public Health Facilities in Nairobi County

Abstract

Background: By 2020 about 90% of childhood malignancy mortalities occurred in low and middle-income countries. Various childhood cancers have been found to be curable if detected early and appropriate management instituted early. However, about 80% of cases reported in Kenya are diagnosed at an advanced stage when little can be done for cure. Late diagnosis, along with shortage and uneven distribution of cancer detection and treatment facilities, staff, and equipment, lead to a high mortality rate. The level of knowledge and management practices of healthcare workers(HCWs) has an impact on early diagnosis, management and outcome of childhood malignancy. Primary Objective: To determine the level of knowledge and to describe management practices of HCWs in level three and four facilities in Nairobi County on early signs and symptoms of childhood cancers. Methods: This was a cross-sectional, descriptive, mixed method study on HCWs. Structured questionnaires and key informant interviews(KIIs) were used to collect data. The sample size was 128 HCWs. Medical officers(MOs), clinical officers(COs), and nurses in the paediatric, maternity, outpatient and administrative departments and paediatricians and in-charges of the selected facilities who gave informed consent were included in the study while those who had worked <3 months, interns and students were excluded. Analysis: At the univariate stage, sociodemographic characteristics are presented as frequencies and percentages for categorical variables. Continuous variables are described using medians and IQR if skewed and with means and standard deviations if normally distributed. Regression analysis was done at the multivariate level to determine any statistically significant associations. Statistical significance was set at p <0.05. For qualitative data, broad ideas, concepts or phrases were coded. Deductive and inductive approaches to content analysis were used to arrive at the themes. Data presentation was done using quotes based on the themes and concepts that emerged. Results: Quantitative: 128 HCWs participated in the study. 60.9% were <34 years, 69.5% were females and 60.2% were nurses. Majority of the participants scored less than 50% which was a poor score, and an indicator of poor knowledge on signs and symptoms of childhood cancer.

Unexplained weight loss was the most identifiable sign while nystagmus and diplopia were the least recognizable signs. Only 25% of the HCWs interviewed had ever participated in the management of a child with cancer; with 60.3% involved in referring suspected cases. Qualitative: From KIIs the challenges identified in suspecting and diagnosing childhood cancer were: lack of cancer screening/diagnostic services, lack of training for HCWs and delayed presentation. Conclusions: There was generally poor level of knowledge on childhood cancer among the HCWs though the knowledge on signs and symptoms among the MOs was satisfactory and inadequate among other cadres. A minority of HCWs had participated in the management of childhood cancers. There was significant association between the level of knowledge and cadre and level of knowledge and facility level. Challenges in suspecting, screening and diagnosis of childhood cancer include lack of training, screening and diagnostic services and delayed presentation.