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Survival from pediatric cancers in low-middle-income countries is often very low compared to that of high-income countries due to multifactorial etiologies, including late presentation, delayed diagnosis, difficulty with accessing health care, drug unavailability and treatment abandonment. The St. Jude Pediatric Oncology Facility Integrated Local Evaluation Tool (PrOFILE) was developed to identify the strengths and weaknesses of individual institutions, as well as whole countries. Following the completion of data analysis from Kenyan institutions, the first PrOFILE hybrid in-person and virtual workshop was held. Multi-disciplinary stakeholders prioritized recommendations for improving care and developed smart objectives to accomplish identified goals over the following 2 years. Strengths and weaknesses of conducting a hybrid global workshop were identified.

Summary Haematological malignancies account for almost 10% of all cancers diagnosed in sub-Saharan Africa, although the exact incidences and treatment outcomes are difficult to discern because population-based cancer registries in the region are still underdeveloped. More research on haematological malignancies in sub-Saharan Africa is required to establish whether these cancers have a natural history similar to those diagnosed in high-income countries, about which more is known. Several factors negatively affect the outcome of haematological malignancies in sub-Saharan Africa, showcasing a need for improved understanding of the clinicobiological profile of these cancers to facilitate prevention, early detection, diagnosis, and appropriate treatment through increased capacity building, infrastructure, community awareness, coordinated resource mobilisation, and collaboration across the world. The east African governments have pooled resources for common investments to tackle non-communicable diseases, developing the East Africa's Centres of Excellence for Skills and Tertiary Education project funded by the African Development Bank, an initiative that could be replicated for the care of haematological malignancies in other countries in sub-Saharan Africa. Translation For the French translation of the abstract see Supplementary Materials section.

Ç, Dilara Karagu, Karaas,, Çağatay, Kaba, A5 Mahmut (2022): Comparisons of two cryptic Ampedus species (Coleoptera: Elateridae) by using classical systematics, ecological niche modeling, and DNA barcoding. Zootaxa 5175 (5): 600-600, DOI: https://doi.org/10.11646/zootaxa.5175.5.9

The rising burden of multiple myeloma in Kenya has not been met by a commensurate effort for control. Patients and practitioners struggle with unavailability and unaffordability of diagnostics, drugs and stem cell transplant leading to presentation at advanced stages and under-treatment with increased morbidities and mortality. A concerted effort among stakeholders is urgently needed to develop strategies for myeloma control. The scarcity of providers also carries grave consequences for Kenyan patients. The Academic Model Providing Access To Healthcare (AMPATH) multiple myeloma program organized the Inaugural Virtual Multiple Myeloma Congress to achieve both interactive specialist instruction and stakeholder engagement. Expert presenters and panellists from diverse disciplines were invited to offer in-depth presentations on myeloma care and case studies from panellists´ practice were used to contextualize learning points and form a basis for generating debate on the challenges facing providers and opportunities for care improvement. An audience of health professionals offering care to myeloma patients was invited. The underlying principle of recommendations developed during the congress was collaboration among in-country and international practitioners, researchers and policy experts from private and public sector. This partnership of stakeholders bears the potential of pooling scarce resources and for collective advocacy towards better patient care.

Cancer research is essential to the development and implementation of effective control strategies and interventions. In Kenya, cancer is the third leading cause of death. Country specific research conducted by local and international investigators can inform a national plan to address local needs across the cancer care continuum. This analysis aims to provide information about the trends and types of cancer research collaborations, funding, and outputs from 2007 to 2017, to understand gaps and opportunities to strengthen Kenya-led cancer research capacity.This analysis included 243 studies from a previously published phase 1 scoping review of oncology research conducted and published in Kenya from 2007 to 2017. The citation metadata was drawn from the Web of Science and PubMed and normalized in Microsoft Excel. Using Sci2, a series of bibliometric network analyses were conducted to identify funding patterns, collaborations between authors and institutions, and the types of cancer research conducted in Kenya. Gephi and Excel provided descriptive analyses and graphs of the network. The analyses are categorized into three themes: article production, collaboration, and research topics.The bibliometric analysis found 5 US-based government agencies are funding cancer research in Kenya. Kenya-Kenya institutional collaborations were most common, and half of authors with the most co-authored publications were from Kenya. The publication trend showed a gradual increase from 2011 to 2014 with a subsequent drop through 2017.This study identifies the funders and most often published Kenyan authors and Kenyan-based institutions publishing oncology research in Kenya. It also identifies future areas to focus research and the importance of continuing to build the writing and publishing capacity on oncology research by Kenyans.

10018 Background: Globally, 80,000 children die from cancer annually; 80% in low- and middle-income countries (LMICs). Childhood cancer cure is possible in more than 80% of cases, in all economic settings. This study aimed to identify barriers to effective management of childhood cancers in Kenya, for program and policy intervention. Methods: We reviewed childhood cancer cases diagnosed at Kenyatta National Hospital in the period 2015-2019. We also assessed capacity of ten recently established regional cancer centres for childhood cancer diagnosis and treatment. We conducted focused group discussions among childhood cancer survivors’ caregivers and key informant interviews among childhood cancer specialists and policy makers from the Ministry of Health and the National Cancer Institute of Kenya. We estimated diagnostic delays, mapped service availability and deductively summarized the qualitative data into main themes. Results: We abstracted 1,764 cases; median age 6 years (IQR 9); 1013 (57.5%) were male. Most affected age group was 0-4 years (47.3%). Most common cancer types were retinoblastoma (23.3%), nephroblasoma (10.4%) and acute lymphoblastic leukaemia 10.3%). Cases managed at KNH decreased between 2015 and 2017, and then recovered. The median total delay (symptoms onset to treatment initiation) was 32 days (range 0-3666). Regional cancer centres lacked specialized workforce for childhood cancer care. Caregivers identified inadequate cover by National Health Insurance and disorganized care process as major challenges. At health system and policy level, low awareness, fragmented referral systems and in-effective policy implementation are major challenges to childhood cancer control. Conclusions: Increasing number of specialized personnel, creation of a differentiated financing package for childhood cancer and restructuring of referral and the care process can improve childhood cancer outcomes in Kenya.

Purpose Histology and cytopathology services are necessary for cancer diagnosis and treatment. However, the current capacity of Kenya’s pathology laboratories is unknown. A national survey was conducted among public sector pathology laboratories to assess their capacity to perform histology, fine-needle aspiration, and bone marrow aspiration. Methods Between April and June 2017, we identified all public hospitals that provide pathology services in Kenya. In total, two national and 13 county referral hospitals met the inclusion criteria and were sent a standardized, pretested, self-administered questionnaire. Results A total of 11 hospitals (73%) completed the survey. The reported total caseload of histology, fine-needle aspiration, and bone marrow aspiration for 2016 was 26,472. All of the facilities staffed a pathologist and were providing cancer-related diagnostic services. Nine (82%) of the hospitals maintain a register of diagnosed cancer cases, but only one (11%) of those uses an electronic system. Six (55%) of the surveyed hospitals were able to perform histology with a median turnaround time of 14 days. Six (55%) laboratories regularly referred some specimens elsewhere for interpretation, but three of these centers relied on patients for transportation of the specimen to the referral institution. No laboratories were accredited by an external organization; however, 10 (91%) of the laboratories were working toward achieving accreditation, but only for clinical pathology services. Conclusion This study describes the current status of histology and cytopathology capacity in Kenya’s public sector hospitals. It provides useful baseline information needed by the Ministry of Health to develop necessary capacity building and referral-strengthening interventions. A high proportion of hospitals are working to achieve accreditation points toward their commitment to providing quality services to the Kenyan public.

Background: Kenya has implemented a robust response to non-communicable diseases and injuries (NCDIs); however, key gaps in health services for NCDIs still exist in the attainment of Universal Health Coverage (UHC). The Kenya Non-Communicable Diseases and Injury (NCDI) Poverty Commission was established to estimate the burden of NCDIs, determine the availability and coverage of health services, prioritize an expanded set of NCDI conditions, and propose cost-effective and equity-promoting interventions to avert the health and economic consequences of NCDIs in Kenya. Methods: Burden of NCDIs in Kenya was determined using desk review of published literature, estimates from the Global Burden of Disease Study, and secondary analysis of local health surveillance data. Secondary analysis of nationally representative surveys was conducted to estimate current availability and coverage of services by socioeconomic status. The Commission then conducted a structured priority setting process to determine priority NCDI conditions and health sector interventions based on published evidence. Findings: There is a large and diverse burden of NCDIs in Kenya, with the majority of disability-adjusted life-years occurring before age of 40. The poorest wealth quintiles experience a substantially higher deaths rate from NCDIs, lower coverage of diagnosis and treatment for NCDIs, and lower availability of NCDI-related health services. The Commission prioritized 14 NCDIs and selected 34 accompanying interventions for recommendation to achieve UHC. These interventions were estimated to cost $11.76 USD per capita annually, which represents 15% of current total health expenditure. This investment could potentially avert 9,322 premature deaths per year by 2030. Conclusions and Recommendations: An expanded set of priority NCDI conditions and health sector interventions are required in Kenya to achieve UHC, particularly for disadvantaged socioeconomic groups. We provided recommendations for integration of services within existing health services platforms and financing mechanisms and coordination of whole-of-government approaches for the prevention and treatment of NCDIs.

Purpose: It is well established that cancer research is essential to the development and implementation of effective control strategies and interventions. In Kenya, cancer is the third leading cause of death. Country specific research conducted by both local and international investigators has the potential to shape a national plan which addresses local needs across the cancer care continuum. This analysis aims to provide information about the trends in research collaborations, funding and outputs from 2007-2017 types of research collaborations, institutional and individual research collaborations, the types of cancer in order to understand gaps and opportunities to strengthen Kenya-led cancer research capacity. Methods: This analysis included 243 studies from a previously published phase 1 scoping review of oncology research conducted in Kenya from 2007-2017. The citation metadata was drawn from Pubmed and manually standardized in Microsoft Excel. Using Sci2, a series of bibliometric network analyses were conducted to identify funding patterns, collaborations between authors and institutions, and the types of cancer research conducted in Kenya. Gephi and Excel provided descriptive analyses and graphs of the network. The analyses are categorized into three themes: article production, collaboration, and research topics. These findings were contextualized by study co-authors from Kenya and the US. Results: The bibliometric analysis described which agencies are funding cancer research in Kenya, which authors and institutions are collaborating with whom, and the cancer research areas most published on in this dataset. The publication trend from 2007-2017 was highlighted, emphasizing the historical development and enabling important recognition of researchers and funders in advancing medical oncology in Kenya. Conclusion: This study identifies future areas for collaborations between investigators in similar sub-fields and cancer research funding priorities for the nation. The findings provide a bigger picture that will guide policymakers on developing evidence-based decision-making, planning to strengthen future research capacity, and funding. Citation Format: Jasmin Vargas, Anyona Joseph, Martha Maina, Alfred Karagu, Mishka Cira, Ya-Ling Lu, Alicia Livinski. Funders and Collaborators of Cancer Research in Kenya, 2007-2017: A Bibliometric Analysis [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 114.

Background Violence and Injuries are a significant global public health concern characterized by marked regional variation in incidence. Approximately five million people die from injuries each year, accounting 9% of all deaths worldwide. In Kenya, injuries are increasingly becoming a cause of hospital admissions and mortality where they account for 10% of all the deaths. The objective of this study was to determine the magnitude, demographic profile and pattern of fatal injuries in Nairobi. Methods Retrospective review of death certificates from the Department of Civil Registration was done for deaths caused by injuries that occurred in Nairobi during the period, January to June 2014. Data was collected using a standardized form. Data entry, cleaning and analysis was done using Epi info version 7.0. Results A total of 11,443 records were reviewed. From this data, deaths resulting from injuries were 1,208 accounting for 10.6% of all recorded deaths. Majority of the deaths resulting from injuries occurred in persons aged 25 to 44 years (48.1%). Males accounted for 85% of all the injuries. The leading cause of injury was assault by blunt force at 30.5%, followed by road traffic injuries at 25.9% and fire arm injuries at 15%. Pre-hospital deaths accounted for 51.4% of all the deaths. Nineteen percent of the deaths resulting from injuries had autopsies performed on them. Conclusion Our study found that injuries are an important cause of fatality in Nairobi, accounting for one in ten deaths. There is need for multisectoral collaboration as some of the preventive measures that target the most prevalent injuries such as assault and road traffic injuries lie outside the health sector. There exists information gaps on the death certificates hence there is need to adequately capacity build both clinicians and death certifiers. There is also a need to revise the death certificates and to improve the pre-hospital care system for the injured persons. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3958-0) contains supplementary material, which is available to authorized users.

PURPOSE In 2017, the Kenya Ministry of Health launched the National Cancer Control Strategy 2017 to 2022. A scoping review of oncology research in Kenya was conducted to understand the scope of—and gaps in—existing research and inform the development of the national cancer research agenda. METHODS We searched PubMed/MEDLINE, Embase, Scopus, and Global Health databases using controlled vocabulary and keywords to identify oncology research with a study site in Kenya, published in English, from 2007 to 2017. Fifteen journals and additional gray literature sources were hand searched. Screening of titles, abstracts, and full text was completed by pairs of 2 reviewers, with a third reviewer reconciling discrepancies. From included studies, data were extracted and coded using Google Forms. Microsoft Excel was used for descriptive statistics. RESULTS Of the 284 included articles, a majority were analytic observational studies (66.9%). The top 5 cancers studied were cervical cancer (n = 106; 35.9%), breast cancer (n = 25; 11.9%), Burkitt lymphoma (n = 23; 8.5%), esophageal cancer (n = 15; 5.1%), and pediatric cancers (n = 12; 4.1%). Primary focus areas were early detection, diagnosis, and prognosis and cancer control, survivorship, and outcomes research. Kenyatta National Hospital, Moi Teaching and Referral Hospital, and University of Nairobi were most often cited as research host institutions. One hundred twenty-three unique funding sources were reported, with the most prevalent study funding sources by region being North America (48%), Europe (28.8%), and Middle East/Africa (17.6%). The US National Institutes of Health was cited as the leading funding source of cancer research in Kenya. CONCLUSION This scoping review provides an overview of the published literature on cancer research conducted in Kenya. It highlights cancer research by cancer type, location, and focus area. It also focuses attention on research gaps, as well as the need for rigorous, well-conducted population-based studies, longitudinal studies, and randomized controlled trials aligned with the cancer burden in Kenya.

Background Tobacco use contributes to more than 6 million annual deaths globally. A growing body of knowledge shows a rise in the use of water pipe tobacco (shisha), spreading from the traditional Eastern Mediterranean and Northern African regions to other parts of the world. We assessed the prevalence of and factors associated with shisha smoking among undergraduate health profession students in the College of Health Sciences, University of Nairobi, Kenya. Methods We conducted a cross-sectional study among final year undergraduate students enrolled in the medicine, nursing, pharmacy and dentistry programmes in August 2014. Students completed a questionnaire adapted from the Global Tobacco Surveillance System. Information on ever and current use of shisha, social demographic variables, alcohol and cigarette use was obtained. Data was analyzed using Epi Info 3.5.1. Results A total of 246 students were interviewed with a mean age of 23 years. Majority were female 145(59%) and in the Medicine program 128(52%). Fifty three (21.5%) of the respondents were current shisha users, 84(34.1%) had ever used shisha in their lifetime and 11(4.5%) were current cigarette smokers. Majority 36(69%) smoked weekly and at entertainment spots 47(89%). Concurrent alcohol and cigarette use among current shisha users was 47(90%) and 8(15.4%) respectively. Factors associated with current shisha use were catholic faith (OR= 2.03; 95%CI 1.04,3.96), residence in a rented house (OR=2.65; 95%CI 1.25,5.61), alcohol use (OR=13.46; 95%CI 5.47-33.06) and family member who smokes shisha (OR= 6.43 95%CI 3.32-12.43). Conclusions The use of shisha as an alternative form of tobacco is high among university students undertaking health professional courses. There is need for initiatives geared towards behavior change among these students to boost tobacco control efforts among the youth in Kenya.

Background In response to a growing cancer burden and need for improved coordination among stakeholders in Kenya, the US National Cancer Institute and the Kenya Ministry of Health collaboratively hosted a stakeholder meeting in 2014 which identified four priority areas of need (research capacity building, pathology and cancer registries, cancer awareness and education, and health system strengthening) and developed corresponding action plans. Methods Surveys were conducted with participants to collect input on the progress and impact of the 2014 stakeholder meeting. Findings Of 69 eligible participants, 45 responded from academia, healthcare institutions, civil society, government, and international agencies. Of the four technical focus areas, three have continued to conduct working group meetings and two have conducted in-person meetings to review and update their respective action plans. Accomplishments linked to or enhanced by the meeting include: Kenyan and international support for expansion of population-based cancer registries, increased availability of prioritized diagnostic tests in selected regional referral hospitals, a greater focus on development of a national cancer research agenda, strategic planning for a community education strategy for cancer awareness, and improved coordination of partners through in-country technical assistance. Interpretation The Stakeholder Program has successfully united individuals and organizations to improve cancer control planning in Kenya, and has enhanced existing efforts and programs across the country. This model of partners working in parallel on prioritized track activities has supported development of long term coordination of cancer research and control activities sustainable by the Kenyan government and Kenyan institutions.

This study was geared towards finding the financial factors influencing performance of SACCOs in Kenya. As a result the study found that funds misappropriation influences performance of Sacco’s. The study concluded that Sacco’s need to improve on their internal audit department and other internal control measures. It also established that investment decisions made by Sacco’s influence their performance. It also emerged from the study that Sacco’s need to invest in prudent projects in order to achieve better returns. It was also found that Sacco’s should put in place loan recovery strategies and introduce collateral securities as a way of eliminating or reducing loan defaulting. The study established that member withdrawal affects Sacco’s performance. The study concluded that Sacco’s should introduce more products in order compete with other organizations such as Micro finance Institutions.

Background and context: A National Cancer Control Strategy (NCCS) provides a strategic framework that guides the systematic approach toward cancer prevention and control based on the existing cancer burden, risk factor prevalence and available resources. Though Kenya developed her first Kenya National Cancer Control Strategy in 2011, its implementation was characterized with various shortcomings. Aim: The Kenyan Ministry of Health set out to develop the second edition of the National Cancer Control Strategy with a focus on greater partnerships, evidence-based interventions and shared accountability of roles informed by lessons learnt from the NCCS 2011-2016. Strategy/Tactics: The Head of the National Cancer Control Program at the Ministry of Health was identified as the National Coordinator to lead the process and keep each stakeholder on track. A clear road map for developing the strategic plan was drawn with specific timelines. The process was further aligned to the Ministry of Health performance contracting system, a mechanism under the Government's public sector reforms aimed at improving performance. Program/Policy process: The Ministry hosted an integrated mission of Program for Action on Cancer Therapy (imPACT) coordinated by the International Atomic Energy Agency in August 2016 that reviewed the implementation of the NCCS 2011-2016. Following submission of the final imPACT report to the Ministry in November 2016, a steering committee led by the National Coordinator was established in December 2016. An initial one-day stakeholder meeting held in January 2017 developed consensus on the general outline of the document. Two multistakeholder retreats were held between March and April to develop the content for the strategy with an intervening review meeting to further refine the draft which was submitted to a set of 3 external reviewers. A final stakeholder validation meeting was held in May 2017 followed by proofreading and printing of the document. The process culminated with a national launch of the second National Cancer Control Strategy held in July 2017. Outcomes: A National Cancer Control Plan covering the entire continuum of care with interventions around 5 key pillars: prevention, screening and early detection; diagnosis and registration; treatment, palliative care and survivorship; coordination, partnerships and financing; monitoring, evaluation and research. The document was developed and launched in a record 6 months and contains an elaborate implementation matrix with clear indicators. What was learned: It is important to identify a focal person to steer the NCCS development process guided by a clear road map with specific timelines. A well-coordinated multisectoral partnership is crucial to developing such a comprehensive document.

Background: Population-based cancer registration represents the gold standard for the provision of information on cancer incidence in a defined population (Bray F, et. al, IARC Technical Report No. 43). In Kenya, the incidence and prevalence of cancer has not been well documented. The existing population-based cancer registries (PBCRs) cover less than 10% of Kenya's population. Kenya is made up of 47 administrative counties and has a population of over 45 million people. Aim: To establish a National Cancer Registry Program that will compile national data on incidence, mortality and trends of cancer in Kenya over time. Methods: Three functional PBCRs have been in existence covering 3 counties: Nairobi, Eldoret and Kisumu. Needs assessment was conducted in the 3 registries. Additional support and resources were provided. New registries were set up in different geographical regions of Kenya. A centralized office to host the national registry was established and equipped at the Centre for Clinical Research, Kenya Medical Research Institute. Sensitization and awareness activities targeting the leaders in the selected counties were undertaken. Similarly trainings and technical support of the regional registries were conducted. Data were collected on to case registration forms, coded using the International Classification of Diseases for Oncology (ICD-O); data entry, validation and analysis done using IARC software CanReg5. Results: Variations in cancer occurrence in the different counties were noted. However the leading cancers were somewhat similar in the 8 counties with prostate and esophageal cancers being the leading in men while breast and cervical cancer being top among women. These variations could provide understanding on causation of certain types of cancers. Data highlights the need to develop and expand intervention programs like HPV vaccination, screenings, early detection and early treatment. Governments' allocation of resources to cancer registries and surveillance programs is important as well as building partnerships. Conclusion: In countries with limited resources it is expensive to develop a national cancer registry covering the entire country. Our program demonstrates that a national cancer registry program can be established by setting up regional population-based cancer registries that covers a reasonable population of the entire country and aggregating the data in a centralized system. Population-based cancer registries are critical in generating data on burden of cancer in specified populations. These data should be used to inform effective cancer control programs and research.