| dc.description.abstract | Background: In Kenyatta National Hospital, Non Hodgkin's lymphoma represents one
of the major childhood cancers with Burkitt's lymphoma being the most common type at
90%. Burkitt's lymphoma is a very chemosensitive tumor with a five year event free
survival of greater than 90% in developed countries and a one year survival rate of 4050%
in developing countries. Various factors have been attributed to this low survival
rate in developing countries. However, there have been no documented studies done at
Kenyatta National Hospital on the various challenges faced by patients and their
guardians that may hinder its optimal management.
Objective: To investigate the major challenges faced in the management of Non
Hodgkin's lymphoma in pediatric patients in the maintenance phase.
Study design: The study was a cross-sectional study.
Study area: The study was carried out at the Kenyatta National Hospital pediatric
haematology outpatient clinic.
Target population: Pediatric patients who attended the outpatient clinic who had been
diagnosed with Non Hodgkin's lymphoma and were in the maintenance phase of therapy.
Sampling Technique and sample size: convenient sampling was used to select the study
subjects and this involved a total of nineteen study subjects.
Data collection and analysis: Data was collected using structured questionnaires that
were filled by conducting face to face interviews with guardians of children in the target
group and also collection of data from the patient files ofthe same target group
Data was analyzed using the SPSS software version 17 whereby numerical data was
summarized as means. Mann-Whitney test was used to test for difference in medians
values for the continuous variables. Additionally their mean values were computed with
the accompanying 95% confidence intervals. Categorical data was summarized in
percentages and graph form. To test for association between adherence and various
categorical variables Fisher's exact test was used.
Results: Of the 19 patients, 13(68.4%) were found to be male. The mean age for all the
patients was 9.84 years (95% CI : 8.3, 11.3).Majority ofthe guardians had an average
monthly income ofKsh 0-9,999 at 68.4%.A number of the patients were found to be
fairly informed on the disease(52.6%) . Most of the patients had never had any
counseling on side effects of the medication with only 42.1 % having been counseled. All
patients acquired their parenteral medication from the hospital pharmacy while a majority
of them at 73.7% acquired their oral medication from a private pharmacy.
42.1 % of the patients had missed their oral medication in the last two weeks. The method
of acquisition of oral medication, estimated expenditure on medication per month and
whether the guardian was counseled on the side effects of the medication, were found to
be statistically significant (p value 0.037,0.02 and 0.037 respectively).The most
prevalent side effects were loss of hair at 94.7% followed by change in nail/skin
pigmentation at 73.7% with the least observed side effects being dizziness, constipation
and tingling sensation of lower extremities. Cumulative doses of doxorubicin used
showed that majority of the patients (63.1 %) had cumulative doses between 200400mg/m2 while only 10% had cumulative doses above 400mg/m2•
Conclusion: The overall adherence to oral chemotherapy was found to be at 57.9%.The
commonest reasons given for failing to take the oral medication were; being unable to
afford the medication and unavailability of the medication in the hospital or private
pharmacies. Method of acquisition of the oral medication, estimated expenditure on
medication per month and counseling on medication and its side effects were significant
barriers to adherence. Based on cumulative doses of doxorubicin used, 63.1% ofthe
patients in this study stand a low risk of developing cardio toxicity with only 10%
standing a significant risk of cardio toxicity.
Recommendation: There is need for an outpatient oncology pharmacy in the clinic with
improved availability of oral chemotherapy at affordable prices, with a pharmacist to
provide extensive counseling on medication use, side effects and importance of
adherence to medication | en_US |
| dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |
