does nhif improve survival of wilms tumor kenya by fatma abdalla
TRANSCRIPT
Photo courtesy of Dr. Russ White, Tenwek Mission Hospital, Kenya
hugevascular
advanced stageWilms tumor
Abdallah et al. East African Medical Journal, July 2001
Stage of Wilms tumor in Kenya by age
Data collected from 1990-96
84%
Relapse 6 months post-resectionHIV+
38 month old girl with Wilms tumordiagnosed at 12 months of ageresection in December 2010palliative chemo
Photos courtesy of Dr. Jason Axt: taken at Kenyatta National Hospital, Nairobi, Kenya
East African Medical Journal, July 2001
late presentationlate presentationpoor availability of chemopoor availability of chemo
frequent treatment frequent treatment interruptionsinterruptions
loss to follow-uploss to follow-upno alternative agents for relapseno alternative agents for relapse
late presentationlate presentationpoor availability of chemopoor availability of chemo
frequent treatment frequent treatment interruptionsinterruptions
loss to follow-uploss to follow-upno alternative agents for relapseno alternative agents for relapse
Disclosures
– I want to make a difference in outcomes of pediatric surgical disease worldwide
– I want to engage you in this effort also– There is no financial benefit– It may cost you money
– I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in this CME activity
• January 1, 2008 – April 1, 2012January 1, 2008 – April 1, 2012
• Multiple visits to each institution over a 6 Multiple visits to each institution over a 6 week periodweek period
• 221 candidate patients221 candidate patients
• 133 met all criteria:133 met all criteria:• kidney mass, histologic diagnosis, andkidney mass, histologic diagnosis, and
files could be foundfiles could be found
Data Entry
National Hospital Insurance Fund (NHIF)
• Primary provider of health insurance in Kenya
• Compulsory membership for all salaried employees
• Cost $2 – $4 monthly
National Hospital Insurance Fund
• The National Hospital Insurance Fund (NHIF) is the primary provider of health insurance in Kenya, with a mandate to enable all Kenyans to access quality and affordable health services.
• The NHIF requires compulsory membership for all salaried employees with premium contributions automatically deducted through payroll: 30-320 KES monthly (salary-dependent)
• For self-employed, 160 KES monthly
Summary
– 52.7 % 2-year event free survival– 94% of those completing all therapy are alive
and without recurrence at 2 years– Enrollment in NHIF is associated with
• Greater completion of therapy• Greater survival
– Small interventions to reduce loss to follow up and boost NHIF enrollment can result in large increases in patient survival
AcknowledgementsAcknowledgements
• Harold Lovvorn IIIHarold Lovvorn III
• Vanderbilt CTSA grant, UL1 RR024975Vanderbilt CTSA grant, UL1 RR024975• National Cancer Institute grant, 5T32CA106183- National Cancer Institute grant, 5T32CA106183-
06A106A1• NCI grant 1R21CA155946-01 (HNL)NCI grant 1R21CA155946-01 (HNL)
ACKNOWLEDMENTS
• Axt, Jason; Axt, Meridith; Githanga, Jessie; Hansen, Erik; Lessan, Joel; Li, Ming; Musimbi, Joyce; Mwachiro, Michael; Newton, Mark; Ndung’u, James; Njuguna, Festis; Nzioka, Ancent, ; Oruko, Oliver; Patel, Kirtika; Tenge, Robert; Ukoli, Flora; White, Russel; O’Neill, James; Lovvorn, Harold