Supportive Care in Cancer

, Volume 28, Issue 2, pp 917–924 | Cite as

Influence of health insurance status on childhood cancer treatment outcomes in Kenya

  • Gilbert OlbaraEmail author
  • H. A. Martijn
  • F. Njuguna
  • S. Langat
  • S. Martin
  • J. Skiles
  • T. Vik
  • G. J. L. Kaspers
  • S. Mostert
Original Article



Survival of childhood cancer in high-income countries is approximately 80%, whereas in low-income countries, it is less than 10%. Limited access to health insurance in low-income settings may contribute to poor survival rates. This study evaluates the influence of health insurance status on childhood cancer treatment in a Kenyan academic hospital.


This was a retrospective study. All children diagnosed with a malignancy from 2010 until 2012 were included. Data on treatment outcomes and health insurance status at diagnosis were abstracted from patient charts.


Of 280 patients, 34% abandoned treatment, 19% died, and 18% had progressive or relapsed disease resulting in 29% event-free survival. The majority of patients (65%) did not have health insurance at diagnosis. Treatment results differed significantly between patients with different health insurance status at diagnosis; 37% of uninsured versus 28% of insured patients abandoned treatment, and 24% of uninsured versus 37% of insured patients had event-free survival. The event-free survival estimate was significantly higher for patients with health insurance at diagnosis compared with those without (P = 0.004). Of patients without health insurance at diagnosis, 77% enrolled during treatment. Among those patients who later enrolled in health insurance, frequency of progressive or relapsed disease and deaths was significantly lower (P = 0.013, P < 0.001, respectively), while the event-free survival estimate was significantly higher (P < 0.001) compared with those who never enrolled.


Childhood cancer event-free survival was 29% at a Kenyan hospital. Children without health insurance had significant lower chance of event-free survival. Childhood cancer treatment outcomes could be ameliorated by strategies that prevent treatment abandonment and improve access to health insurance.


Health insurance Childhood cancer Low-income country Universal health coverage 



We would like to thank the Doctor 2 Doctor program of the Netherlands for their logistical support in the development of this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Child Health and PediatricsMoi Teaching and Referral HospitalEldoretKenya
  2. 2.Department of Pediatric Oncology-HematologyVU University Medical CenterAmsterdamThe Netherlands
  3. 3.Department of Pediatrics, Division of Hemato-OncologyIndiana University School of MedicineIndianapolisUSA
  4. 4.Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands

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