Novel approach to improve the diagnosis of pediatric cancer in Kenya via telehealth education

Severance, T.; Olbara, G. K.; Njuguna, F.; Treff, M.; Loehrer, P. J.; Vik, T. A.

Background: Childhood cancer has an annual incidence of 150-160 cases per million children worldwide but remains vastly under-diagnosed in low to middle income countries (LMIC) such as in Sub-Saharan Africa. Moi Teaching and Referral Hospital (MTRH) is the only tertiary referral hospital in western Kenya and serves a population of 25 million people, including 10 million children. The average number of pediatric cancer diagnoses was 216 cases annually in 2017-2019, well below the anticipated 1500 cases based on cancer epidemiology data. We recently completed a comprehensive Needs Assessment suggesting that due to inadequate pediatric oncology education, many clinical diagnoses are missed and correct diagnostic tests are not obtained at county hospitals. Local medical staff expressed interest in educational programs to help augment their understanding and diagnostic evaluation of pediatric oncology. Methods: To address these disparities in medical knowledge, we implemented Project ECHO - a validated virtual guided practice and telementoring model - to connect multidisciplinary specialists at MTRH with staff in medically underserved communities in western Kenya for ongoing training, technical assistance, and mentorship. The ECHO program follows a Hub-and-Spoke design where the specialists at MTRH and pediatric oncologists at Riley Hospital functioned as the 'hub' team and the health care workers at county hospitals were the 'spokes'. Sessions were freely available on Zoom twice monthly and featured both a didactic topic presented by experts and a spoke-led case-based discussion. The discussion utilized dialogue education to promote learning and engagement among the spokes with mentorship from the hub team. Results: The ECHO program launched successfully in January 2020 with a curriculum focused on pediatric oncology for general health care workers. A total of 22 sessions occurred with an average of 23 learners (primarily staff at community hospitals within the referral region) per session. Despite the COVID-19 pandemic, the year-end analysis in January 2021 demonstrated 286 new pediatric patients were diagnosed with cancer at MTRH representing a 33% increase over the 3-year average. Conclusions: The implementation of a telehealth education platform - Project ECHO - focused on diagnosing pediatric cancer in medically underserved communities in Kenya, is a useful model to increase the recognition and earlier referral of childhood cancer in LMICs.