MANAGEMENT AND OUTCOME OF PATIENTS WITH WILMS' TUMOUR (NEPHROBLASTOMA) AT THE MOI TEACHING AND REFERRAL HOSPITAL, ELDORET, KENYA.

BACKGROUND: Wilms' tumour is a common malignant neoplasm of the kidney and is ranked among the top six solid tumours in children in Kenya. Despite its rapid growth and therefore debilitating effects on its victims, it is one tumour that has shown good response to combined modality approach to its treatmentwith encouraging possibilities of survival even in resource poor settings. OBJECTIVE: To evaluate the management and outcome of patients with Wilms'tumour attended to at Moi Teaching and Referral Hospital (MTRH) during the period between January 2000 and December 2007. DESIGN: Retrospective Study. SETTING: The Paediatric Oncology Service (Oncology unit in the Paediatric Ward, the Paediatric Surgical Ward and the Outpatient Oncology Clinic) at the Moi Teaching and Referral Hospital, Eldoret, Kenya. RESULTS: Information of 45 patients diagnosed with Wilms' tumour was analysed. Forty two (93%) of the patients were referrals from various health facilities in the region. Twenty three (51%) were male and 34 (76%) were aged less than 48 months. Twenty five (56%) had the left kidney affected, 19 (42%) the right kidney and one (2%) bilateral. All the 45 (100%) had an abdominal ultrasound done but none had exhaustive investigations done to stage the disease. Only eight (18%) of the patients had a medical insurance cover. Fourty one (91%) of the patients received specific cancer treatment with 28 (62%) getting combined modality treatment. Nineteen (42%) were lost to follow up. Thirty (67%), 21 (47%), 15 (33%) and 13 (29%) patients were alive six months, one year, two years and three years respectively from the time of diagnosis. 29% survived beyond three years of diagnosis. CONCLUSION: Staging of Wilms tumour fell short of the expected. Neo-adjuvant chemotherapy reduced morbidity and mortality of patients managed for Wilms' tumour. Loss to follow up and cost of treatment had a negative impact on the outcome, a situation that requires to be improved.

Survey of sickle disease in Kenya.

In Kenya and most of Eastern Africa, sickle haemoglobin (HbS) is the pre-dominant beta-globin chain abnormality; homozygous sickle cell disease, (SCA), is the predominant form of sickle cell disease. Although the prevalence of sickle cell trait (SCT) in Kenya was known, the magnitude of SCA was yet to be established. We performed a national survey in all hospitals from November 1987 to May 1990 and found 3605 cases with SCA. Age was recorded for 2821 patients. Seventy-seven per cent of these patients were below the age of fifteen. The oldest patient was a 50-year-old female. The paediatric to adult ratio was 3:1. More than 80% of the patients were of Luo or Luhya ethnic origin (Luo 58.4%, Luhya 23.9%). There was a discrepancy between SCT rate (SCTr) and the percentage distribution of SCA patients per province. The Kambes of the Mijikenda group in the Coast Province with the highest SCTr (35%) constituted only 8.5%, but the Luos with a SCTr of 28%, 58% of the total SCA patient population in Kenya. We found reports of SCA in the Somali and Turkana, in whom no SCT had been found previously.