Case records and commentaries in obstetrics and gynaecology

Abstract

Background: Cancer of the cervix is the commonest gynecological malignancy among women in Kenya accounting for almost 85% of the total. Kenyatta National Hospital is the main referral center in Kenya and thus handles the bulk of the patients. Objective: To determine the caseloads and the financial cost to the hospital in the management of cancer of the cervix at KNH. Study design: This was a retrospective descriptive study. Method: These comprised records of gynaecological patients who were seen at Kenyatta National Hospital, either referrals or diagnosed at the hospital with cancer of the cervix, at any stage for the year 2005. All in-patient and out patients files for the whole one year study period were retrieved from the record department and a questionnaire filled. Data management: The data was precoded and entered into a computer using d- base. Analysis was done using SPSS program. Study results: A total of 357 patients with cancer of the cervix were seen during the study period but only 350 files could be retrieved apd they formed the sample size. The patient's mean age was 45 yrs, median age was 55 yrs, range of 20 - 80 yrs and a mode age was 55 yrs. One hundred and eighty two patients (52%) were admitted once or several times within the year. Sixty percent of all the patients seen during the year were referred from other hospitals mostly for radiotherapy. Out of the total number of patients seen, 36% were from Nairobi province, 25.4% from Central Province and 20.3% from Eastern and Nyanza referred 10.0 %. Of all the patients seen in 2005, 60.6% were diagnosed in the 2005 and only 39.4% diagnosed in the previous years. Cancer of the cervix complications accounted for a total of3,812 days of admission within the year with 183 admissions with an average of20.83 days hospital stay per admission. Each patient was admitted for an average of 20.9 days. Majority i.e. 31.1% were admitted due to anaemia. External beam radiotherapy was given to 96.7% of those who received radiotherapy and only 3.3% received both external and intra cavitary radiotherapy for which they were either sent to Tanzania or Uganda. By end of2005, only 11.2% were still waiting to start radiotherapy. At the end of the study period, 20.6% of the patients seen during the year 2005 were dead. The cost oftreating cervical cancer patients at KNH for the year 2005 was kshs 4,313,144. At least kshs.366, 967 was 306 credited to the patients suffering from cancer of cervix during the study period. The number of patients that could not pay their full bills were about 16% of the total. Conclusion: Three hundred and fifty patients with cervical cancer were seen with 60010 of them being referrals and the hospital lost at least kshs 366,967 due to non-payment of the bills. Recommendations: I.Encourage screening and early health seeking behavior 2. Stringent financial management be employed as a management tool. 3.Establish brachytherapy services in the hospital 4. Routine pap smears be done in the ANe clinics. 5.Reduction of the minimum age to start screening in the guidelines to 20 year of age .