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.
Publisher
University of Nairobi
Rights
Attribution-NonCommercial-NoDerivs 3.0 United StatesUsage Rights
http://creativecommons.org/licenses/by-nc-nd/3.0/us/Collections
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