FACTORS CONTRIBUTING TO BURKITT'S LYMPHOMA AMONG CHILDREN UNDER 10 YEARS OLD IN JARAMOGI OGINGA ODINGA TEACHING AND REFERRAL HOSPITAL PAEDIATRIC WARD

Abstract

Background: In East and Central Africa, children are frequently diagnosed with Burkitt's lymphoma (BL), an aggressive non-Hodgkin's lymphoma. Immune hyper-stimulation is linked to recurrent infections with the Epstein-Barr virus or Plasmodium falciparum. The c-myelocytomatosis (c-myc) gene translocation is thought to be the mechanism by which unintentional cytokine responses to infections either directly or indirectly affect B cell neoplastic transformation. Objectives: the main objective of the proposed study was to determine the factors contributing to Burkitt’s lymphoma among children under 10 years old in Jaramogi Oginga Odinga teaching and referral hospital pediatric ward. Specifically, the study sought to determine the association between sociodemographic characteristics and Burkitt’s lymphoma, to assess the relationship between comorbidities and Burkitt’s lymphoma and to find out the treatment outcomes of children treated for BL. Materials and Methods: The proposed study was a retrospective cross-sectional study design where patient files were reviewed for data extraction with the help of research assistants covering 5-year period from 2019 to 2023. This study was conducted in Kisumu, in Jaramogi Oginga Odinga Teaching and Referral Hospital, in the pediatric oncology ward, and oncology clinic for those children who came to the clinic and were managed for Burkitt's lymphoma. The study population consisted of children who were diagnosed of Burkitt’s lymphoma and received treatment at JOOTRH pediatric ward between 2019 and 2023. The sample size was 92 participants in the study. The data collected and analyzed using SPSS version 29. For objective 1, association between sociodemographic characteristics and Burkitt’s lymphoma was done using chi-square test of association. For objective 2, the relationship between comorbidities and treatment outcomes of lymphoma was done using Pearson test of relationship. Kolmogorov test of normality was done to test normality of the data collected. A p value of <0.05 was regarded statistically significant. Tables and pie-charts were used to display the collected and analyzed data. Results: The highest percentage of children with BL falls within the age of 6-8 years (55.6%) suggesting that this is most at risk group for acquiring BL. Majority of the patients had a Z_score of -1SD accounting for 26.9% for patients below 5 years of age. For patients between 5_10 years of age, most of them had a BMI <18.5kg/m^2 which accounts for 43.6%. A higher number of children with BL are males (58.3%) suggesting that male gender has a higher risk for BL as compared to female gender. A higher number of children with BL has no family history of BL (94.4%). Only 5.6% of children have a family history of BL. Majority of the patients with BL have no history of domestic use of insecticides (90.3%). Only 9.7% of the patients have a history of domestic use of insecticides. Majority of the parents achieved primary level of education (48.6%) and few of them achieved tertiary level of education (13.9%) suggesting that low education level of parents increases the risk of BL. A higher number of parents whose children had BL are self-employed (52.8%). This shows the instability of income. Most of the parents whose children have BL earn an income between 10000-20000ksh per month. A higher number of children with BL have no history of infection with other diseases recently or now (55.6%). A number of children with BL have sickle cell disease (16.6%). 27.8% of the patients have a history of recent malaria infection. Majority of the patients are on methotrexate medication combined with other drugs (29.2%). None of the patient had a history of organ transplant. 41.7% of children with BL did not receive any medication which may be due to unaffordability of medication. 32% of the patients received< 3 cycles of treatment. Only 7% of the patients received > 5 cycles of treatment. Majority of the patients have no history of previous treatment with BL (90.3%). Only 9.7% of the patients have previous history of BL treatment. WBC count in majority of the patients before treatment is between 15_20*10^9u/l which accounts for 43.1%. WBC count after treatment in most of the patients is between 4_12*10^9u/l. Most of the patients with BL are diagnosed at stage ii (38.9%). This research concludes with recommendations to ensure prevention, early detection and proper management of Burkitt's Lymphoma.