Umma Staff Publications
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Item Determinants of cancer care pathways at Wajir County, Kenya: patient perspectives(Researchecancer, 2025-02-12) Affey, Fatuma; Halake, Dabo Galgalo; Wainaina, Grace Muira; Osman, Hussein Ali; Ndukui, James G; Abdourahman, Houda; Abdihamid, OmarBackground: Cancer represents a major public health issue with substantial morbidity and mortality in low-resource settings such as Kenya. This study focuses on Wajir County in northern Kenya, a region with limited cancer care infrastructure and high unmet needs. Despite recent efforts to decentralize cancer care in Kenya, including establishing regional cancer centres in Garissa, Nakuru, and Mombasa, access to screening, diagnostics, and treatment remains constrained, particularly in rural areas. The absence of comprehen- sive cancer care pathways and a specialized oncology workforce in Wajir County exac- erbates challenges in early detection, treatment, and palliative care. The study evaluated the availability of cancer care services at Wajir County Referral Hospital (WCRH), includ- ing screening, diagnostic services, treatment modalities, and referral systems. The study further explores the gaps in cancer care, focusing on patient perspectives, and proposes potential solutions to address these challenges. Methods: This study used mixed-methods (qualitative and quantitative) methods to understand cancer care from the perspective of patients at WCRH. It involved adult patients (over 18) with a confirmed cancer diagnosis who were receiving treatment or follow-up care between February and April 2024. Data were gathered through inter- views and surveys, with research assistants helping with language translation and com- munity navigation. The study collected information on demographics, cancer types, and prevalence rates, which were analysed using descriptive statistics. The qualitative data focused on patients' experiences with cancer awareness, treatment, and care gaps, and were analysed for common themes. Ethical approval was obtained, and informed consent was given by all participants. Results: This study involved 25 cancer patients (12 males, 13 females) receiving treat- ment at WCRH. The most common cancers were esophageal (44%), cervical (28%), breast (24%), and prostate (8%). Delays in diagnosis were significant, with 12% of patients wait- ing over 6 years, 24% waiting 4–6 years, and 40% waiting 1–3 years before seeking care. Most diagnoses were made at WCRH (64%), with others diagnosed at the Garissa Can- cer Centre (22%) or in Nairobi (20%). Diagnostic tools available at WCRH included pap smears, mammograms, PSA tests, ultrasound, CT scans, and biopsies. However, access to these tools was limited, with barium swallow (32%) being the most frequently used for esophageal cancer, followed by pap smears, biopsies, and ultrasound (16% each). Patient awareness of cancer screening was higher for cervical (68%) and breast cancer (60%) but lower for prostate cancer (32%) and esophageal cancer (4%). Despite awareness, only 8% had previously undergone screening. Regarding treatment, most patients (80%) were aware of surgical options, while fewer knew about chemo- therapy (28%) or palliative care (12%). When treatment was unavailable at WCRH, most patients preferred the Garissa Cancer Centre (80%) or Nairobi (52%). Financial challenges were the primary barrier to treatment for 88% of patients, and patients suggested improving local cancer care, subsidizing treatment, and enhancing early detection and screening services. Conclusion: The findings indicate a high burden of late-stage cancer diagnoses, insufficient cancer screening and treatment services, and limited access to cancer care pathways and patient navigation systems. These results underscore the urgent need for improved cancer care pathways, enhanced awareness, and increased healthcare capacity to reduce cancer morbidity and mortality in northern Kenya. This study contributes to understanding the cancer care landscape in Wajir County and provides a foundation for future health policy initiatives aimed at bridging existing gaps in cancer care.Item Influence of Cultural Competence Training among Health Care Workers on Patient Satisfaction and Health Outcomes in Diverse Communities(Asian Journal of Research in Nursing and Health, 2024-10-30) Musembi Mary; Affey, FatumaThis study aimed at exploring impact of cultural competence training on enhancing patients satisfaction and improving health outcomes within such communities. Study Design: Analytical-cross sectional study design approach was applied in this study, both qualitative and quantitative methods were utilized to collect data. Relationship between cultural competence training and its effects on patient satisfaction and health outcomes was examined as well as mechanisms through which cultural competence training influences healthcare delivery in diverse settings was explored. Place and Duration of Study: The study was conducted in Kiambu Level 5 Hospital in Kiambu County, Kenya. This region hosts a mixed population with varying cultures, and it is a level 5 hospital with high referrals of various cases from different parts of the county. The area provided conducive environment for this study since it borders Nairobi and its populationItem Prevalence, Effect and Management of Cancer Pain at Garissa, Kenya(IOSR Journal of Nursing and Health Science, 2018-12-25) Affey, Fatuma; Mwenda, Catherine; Too, Wesley; Elmi, MohamedHigh prevalence, negative effect and suboptimal cancer pain management has been reported from resource-limited countries such as Kenya. Precisely, trends of cancer cases are on the increase at Garissa County in Kenya, yet no data exist on the prevalence, effect and management of cancer pain. This study was to examine the prevalence, effect and cancer pain management of adult patients at Garisssa County Referral Hospital. A descriptive cross sectional survey was employed and 94 cancer patients from both outpatient on follow up care and inpatient were recruited to participate. MBPI (Modified Brief Pain Inventory) and ECOG (Eastern Cooperative Oncology Group) tools were used for data collection. Pain Management Index was calculated and significant levels were set at P<0.05 for all tests. Mean age of participants was 50years, composed of 42(44.7%) male and 52 (55.3%) female. Cancers of Breast and prostate were most prevalent with (25%) female and (14%) male respectively. Prevalence of cancer pain was 78% with majority reporting moderate to severe pain and undertreatment with PIM of (p-value < 0.05). Participants accounting 76.9% male and 66.7% female reported cancer pain interference with ability to walk and 91% male and 70% female reported that pain interfered with their mood. Male participants reported to experience more psychological, physical and social pain than female participants. A total of 81.9% (77) participants incorrectly utilised WHO analgesic ladders, 65% (61) and 77.6% (73) considered alternative therapy of Quran and Somali herbs respectively for pain management. This study found a high prevalence of cancer pain with negative impact and suboptimal cancer pain management.Item 'XANNUN’ NURSING CARE MODEL FOR CANCER PAIN MANAGEMENT AMONG ADULT PATIENTS AT GARISSA COUNTY REFERRAL HOSPITAL (GCRH), KENYA(2019) Affey, FatumaNursing care models allows concept application of not only the physical treatment of pain but also synthesis the significance of social-cultural practices, psychological and spiritual pain relief. Cancer pain has high prevalence and negative impact on the quality of life of patients at Garissa County due to limited access to healthcare facilities and unique pastoral lifestyle of the community. This necessitated the development of ‗Xannun‘ model of nursing care for holistic pain management that is clinically proficient and culturally competent. Phase one of the utilised triangulation method approach to recruit 94 cancer patients, 84 clinical nurses and 15 key informants, while phase two was the actual development and testing of Xannun nursing care model. Various sampling procedures that included random, purposive and snowball and recruit participants voluntarily was done. Modified Brief Pain Inventory (MBPI) tool combined with focus group discussion and Eastern Cooperative Oncology Group (ECOG) performance status was used to obtain data from participants. The sample population was 188 participants. Cancer patients had a mean age of 51years, with prevalence of pain at 78 % (73) that ranged from moderate to severe. A total of 78 % (66) of clinical nurses had no tool for pain assessment, 83.2 % (70) of them did not know how to utilise WHO analgesic ladder. Majority of patients 82 % (78) were on incorrect WHO analgesic ladder with negative PMI (p-value < 0.05) of under treatment. Majority of patients considered alternative treatment for cancer pain such as Quran recitation and Somali herbs accounting for 65% (61) and 77.6% (73) respectively. Almost all KI 93% (14) indicated the inadequate availability of pain medication. Phase two, Delphi survey to gain expert opinion was used. Experts‘ opinion of 80% of respondents agreed that the ‗Xannun‘ nursing model captured the challenges of cancer pain management and 60% of them predicted that the model could be utilised. However, 100% of the experts suggested that the model will bring a positive change, though 90% of them upheld that there will be potential challenges of implementing such a model. This study found high prevalence of cancer pain, suboptimal pain care, Knowledge deficit among nurses and inaccessibility of pain medication associated with the dynamic of a nomadic lifestyle. Thus, this study recommends the implementation of ―Xannun‖ Nursing Care model at GCRH, for a better approach of cancer pain management.