Social and biological factors influencing the outcomes of children with Wilms tumors in Kenya and other Sub-Saharan countries.

Wilms tumor (WT) is a common pediatric solid tumor, and the 5-year event-free survival rate of patients with this tumor has reached 85-90% in developed countries, whereas those in developing countries were reported to be less than 50%. To overcome these disparities, physicians and investigators in developed and developing countries are currently performing research with the aim of the better management of children with WT in Kenya and other Sub-Saharan countries. Axt and colleagues published a study that increased understanding of clinicopathology of WT in Kenya on the basis of a comprehensive web-based WT registry. The study revealed that patients enrolled in the National Health Insurance Fund (NHIF) showed better completion rate of therapy and better event-free survival than those not enrolled, indicating insufficient health coverage for those not enrolled in the NHIF. Approximately 20-30% of Kenyan population is estimated to be covered by some forms of health insurance, mostly by the NHIF. This could be improved through various approaches. The report described that 2-year event-free survival rate was 52.7% for all patients, although loss to follow up was 50%; the findings indicate large problems both in the study results and also in the completion of treatment. It is crucial to determine at which point patients stopped their treatment and why. The development of standardized treatment protocol for WT is an urgent agenda. We hope that researchers in developed countries and health providers in Kenya can work together in future to conquer disparities in the outcomes of children with WT.