title: Retinoblastoma referral pattern in Kenya.
abstract: OBJECTIVE
  Kenya is a large country with a widely dispersed population. As retinoblastoma requires specialized treatment, we determined the referral pattern for patients with retinoblastoma in Kenya to facilitate the formulation of a national policy.
  
  
  METHODS
  A retrospective study was performed for retinoblastoma patients who presented from January 1, 2006 to December 31, 2007. Data were collected on the referral process from presenting health facility to the hospital where patient was treated. Data were also collected on the time interval when the first symptoms were noticed to the time of presentation at a health facility (lag time). For cases that could be traced to a referral hospital, the time delay due to referral (referral lag time) was recorded.
  
  
  RESULTS
  There were 206 patients diagnosed with retinoblastoma in 51 Kenyan and 2 foreign healthcare facilities, and they received final treatment at a Kenyan hospital. Mean lag time was 6.8 months (±6.45). Of all patients, 18% (38/206) were treated at the hospital where they first presented and 82% (168/206) were referred elsewhere. Of those referred, 35% (58/168) were lost to follow-up. The mean referral lag time was 1.7 months (±2.5).
  
  
  CONCLUSIONS
  A significant proportion of cases presented late, and either delayed seeking further treatment or were lost after initial referral. We recommend the implementation of a national strategy that emphasizes early detection, documentation and follow up of retinoblastoma patients.
authors.affiliation: The Department of Ophthalmology, University of Nairobi, Kenya.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Nyamori
authors.affiliation: The Department of Ophthalmology, University of Nairobi, Kenya.
authors.forename: Kahaki
authors.initials: K
authors.lastname: Kimani
authors.affiliation: The Department of Ophthalmology, University of Nairobi, Kenya.
authors.forename: Margaret W
authors.initials: MW
authors.lastname: Njuguna
authors.affiliation: The Department of Ophthalmology and Vision Sciences, University of Toronto, Canada ; Division of Vision Science, Toronto Western Research Institute, Canada ; Sick Kids Research Institute, The Hospital for Sick Children, Toronto, Canada.
authors.forename: Helen
authors.initials: H
authors.lastname: Dimaras
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D002675:Child, Preschool; D042241:Early Diagnosis; D015353:Eye Enucleation; D005134:Eye Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006801:Humans; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D008297:Male; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012175:Retinoblastoma / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents
keywords: Cancer; East Africa; Kenya; Lag Time; Referral; Retinoblastoma