This document discusses a study examining whether enrollment in Kenya's National Hospital Insurance Fund (NHIF) improves survival rates for children with Wilms tumor. The study found that 52.7% of patients had a 2-year event-free survival, compared to 35% in previous studies. Patients enrolled in NHIF were more likely to complete all required therapy, and had greater survival rates. Enrollment in NHIF was associated with a 12.3% higher rate of completing all therapy and improved 2-year event-free survival. The authors conclude that small interventions to boost NHIF enrollment and reduce loss to follow-up could significantly increase survival for children with Wilms tumor in Kenya.

1. DOES NHIF IMPROVE
SURVIVAL OF WILMS
TUMOR KENYA ?
Dr F. K. Abdallah

2. huge
vascular
advanced stage
Wilms tumor
Photo courtesy of Dr. Russ White, Tenwek Mission Hospital, Kenya

3. Stage of Wilms tumor in Kenya by age
Abdallah et al. East African Medical Journal, July 2001
Data collected from 1990-96
84%

4. Relapse 6 months post-resection
HIV+
38 month old girl with Wilms tumor
diagnosed at 12 months of age
resection in December 2010
palliative chemo
Photos courtesy of Dr. Jason Axt: taken at Kenyatta National Hospital, Nairobi, Kenya

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East African Medical Journal, July
2001

6. 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

7. KNH
KMH
Moi

8. Established Kenya WT Consortium

9. Data Entry
• JJaannuuaarryy 11,, 22000088 –– AApprriill 11,, 22001122
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• 222211 ccaannddiiddaattee ppaattiieennttss
• 113333 mmeett aallll ccrriitteerriiaa::
• kkiiddnneeyy mmaassss,, hhiissttoollooggiicc ddiiaaggnnoossiiss,, aanndd
ffiilleess ccoouulldd bbee ffoouunndd

10. National Hospital
Insurance Fund (NHIF)
• Primary provider of health insurance in
Kenya
• Compulsory membership for all salaried
employees
• Cost $2 – $4 monthly

11. 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

12. Gender Distribution of Wilms

13. Renal Mass Frequency

14. Wilms Tumor Staging

15. Adherence to treatment

16. Effect of enrollment in NHIF on vital status
Kenyan National Hospital Insurance Fund

17. Effect of enrollment in NHIF on vital status
Kenyan National Hospital Insurance Fund
p=0.002

18. Overall Survival
52.7%
In contrast to 35% in 2001

19. NHIF enrollment and level of care completed
12.3% difference in
completion of all
therapy

20. NHIF enrollment and 2-year event-free survival

21. Care completion and 2-year event-free survival

22. 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

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• VVaannddeerrbbiilltt CCTTSSAA ggrraanntt,, UULL11 RRRR002244997755
• NNaattiioonnaall CCaanncceerr IInnssttiittuuttee ggrraanntt,, 55TT3322CCAA110066118833--
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• NNCCII ggrraanntt 11RR2211CCAA115555994466--0011 ((HHNNLL))

24. 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

25. THANK YOU!!!