Ten years of pediatric low-grade glioma care in Kenya: Outcomes, progress, and gaps toward achieving global childhood cancer equity

Abstract

Background: Pediatric low-grade gliomas (pLGGs) are the most common childhood central nervous system tumors and one of the six index cancers prioritized by the WHO Global Initiative for Childhood Cancer because their treatment success depends on strong health system integration, including timely diagnosis, referral to specialist centers, and multidisciplinary care. In low-and middle-income countries like Kenya, these systems are often under-resourced, and outcomes remain poorly described. This study assessed clinical characteristics, care timelines, treatment outcomes, and survival of with pLGGs treated at Kenya's largest referral and teaching hospital. Methods: We conducted a retrospective cohort study of pediatric patients (<19 years) who underwent surgery for low-grade gliomas from January 2014 to December 2023. Data was extracted from clinical, imaging, and pathology records. Descriptive statistics, Kaplan-Meier survival analysis, and Cox regression were performed. Results: The cohort consisted of 84 patients (52 males; median age of 8 years). Headache (76.2%), vomiting (41.7%), seizures (28.6%), and limb weakness (27.4%) were the most frequent presenting symptoms. The median time from symptom onset to imaging was 61 days, and to surgery was 97 days. Gross total resection was achieved in 58.3% of cases, and 76.2% had good immediate postoperative function (Glasgow Outcome Score 5). The most common histology was pilocytic astrocytoma (n = 55, 65.5%). Median overall survival was 1408 days with 1-, 3-, and 5-year survival probabilities of 67%, 56%, and 46%, respectively. Extent of resection and postoperative functional status were key predictors of survival. Conclusions: While surgical care provided favorable short-term functional outcomes, long-term survival for children with pLGGs in Kenya remains substantially low. These findings call for urgent development of robust pediatric neuro-oncology multidisciplinary care and structured long-term follow-up pathways.