1
|
Sanga ES, Mbata DD, Msoka EF, Mchome Z, Karia FP, Pollak KI, Robles JM, Schroeder K. The socio-cultural contexts shaping health-seeking behaviours among community members regarding childhood cancer in Tanzania: A qualitative study. Pediatr Blood Cancer 2024:e31278. [PMID: 39238136 DOI: 10.1002/pbc.31278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 07/03/2024] [Accepted: 08/06/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND Timely diagnosis of childhood cancer, early hospital presentation and completion of treatment significantly improve outcomes. Unfortunately, in Tanzania, thousands of children die of cancer each year without ever being diagnosed or treated. To reduce childhood death from cancer, it is important to understand the social-cultural context, values and beliefs that influence healthcare-seeking behaviours among the Tanzanian community. METHODS This was a cross-sectional qualitative study conducted in Mwanza, Kilimanjaro and Dar-es-Salaam regions between March and June 2021. We purposively selected community members aged ≥18 years from three rural and three urban settings to participate in seven focus group discussions (each with eight to 12 respondents). The participants were from communities without any affiliation to the treatment of children with cancer or treatment facilities. We transcribed, coded and analyzed data using a thematic-content approach with the support of NVIVO 12 software. RESULTS Many had heard of breast or cervical cancer; however, most were unaware of childhood cancer. Adults believe that cancer in children is caused by witchcraft and cannot be cured by modern medicines available at hospitals. These beliefs lead parents to first seek care from traditional healers, which hence delay presentation to the hospital. Other community concerns included the cost of transportation, investigation-related costs, and the long duration of treatment. These have an influence on treatment adherence leading to seeking alternative treatment, such as spiritual or traditional treatment. CONCLUSION Low community awareness, late hospital presentation, and treatment abandonment remain a challenge in childhood cancer in most parts of Tanzania. Belief about childhood cancer being a result of witchcraft and superstition contributes to limited health-seeking behaviours. Cultural and contextually relevant awareness campaign interventions are needed to increase cancer knowledge in Tanzanian communities.
Collapse
Affiliation(s)
- Erica Samson Sanga
- National Institute for Medical Research - Mwanza Centre, Mwanza, Tanzania
| | - Doris D Mbata
- National Institute for Medical Research - Muhimbili Centre, Muhimbili, Tanzania
| | - Elizabeth Francis Msoka
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Zaina Mchome
- National Institute for Medical Research - Mwanza Centre, Mwanza, Tanzania
| | - Francis P Karia
- Duke Office of Clinical Research (DOCR), School of Medicine, Duke University, Durham, North Carolina, USA
| | - Kathryn I Pollak
- Department of Population Health Sciences, Duke University, School of Medicine, Durham, North Carolina, USA
- Cancer Prevention and Control, Duke Cancer Institute, Durham, North Carolina, USA
| | - Joanna M Robles
- Department of Pediatrics, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
- Cancer Prevention and Control Program, Atrium Health Wake Forest Baptist Comprehensive Cancer Centre, Winston Salem, North Carolina, USA
| | - Kristin Schroeder
- Cancer Prevention and Control, Duke Cancer Institute, Durham, North Carolina, USA
- Pediatric Oncology and Global Health, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Oncology, Bugando Medical Centre, Mwanza, Tanzania
| |
Collapse
|
2
|
Chapman H, Ntemi PS, Gisiri M, Vasudevan L, Kashaigili HJ, Schroeder K. Retrospective analysis of pediatric patients with Burkitt lymphoma treated in Tanzania following the implementation of the 2016 National Treatment Guidelines: Poor outcomes to current standard-of-care therapy. Pediatr Blood Cancer 2024; 71:e31145. [PMID: 38924656 DOI: 10.1002/pbc.31145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 05/06/2024] [Accepted: 05/31/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Despite the excellent outcomes achieved in the treatment of pediatric Burkitt lymphoma (BL) in high-income countries (HICs), outcomes remain poor in low- and middle-income countries (LMICs). Efforts to improve BL outcomes in Tanzania included the creation of National Treatment Guidelines in 2016. However, disease outcomes in Tanzania following the creation of these guidelines have not been reported to date. PROCEDURE Historical records from 2016 to 2021 for patients 0-18 years of age with a diagnosis of BL and seen at Bugando Medical Centre (BMC), in Mwanza, Tanzania, were curated into an electronic database and analyzed descriptively. Patients in this cohort were treated per the Tanzanian National Treatment Guidelines, which include six cycles of cyclophosphamide, vincristine, and methotrexate (COM) chemotherapy with intrathecal methotrexate and cytarabine. RESULTS In total, 92 BL patients' records were eligible for analysis. Patients in this cohort were most commonly Murphy stage II (28%) or stage III (34%). Nearly all, 91%, met International Network for Cancer Treatment and Research (INCTR) high-risk criteria at presentation. Forty-two percent of patients did not receive a biopsy and were treated with a presumed diagnosis of BL alone. A 1-year event-free survival of 29.6% (95% confidence interval [CI]: 20.3%-39.5%) and a 1-year overall survival of 38.5% (95% CI: 28%-48.9%) were observed. A high rate of treatment abandonment (34%) was also observed. CONCLUSION In a historical cohort of pediatric patients with BL treated per the 2016 Tanzanian National Treatment Guidelines, we observed poor outcomes and a high rate of abandonment. These outcomes appear inferior to those achieved in the INCTR clinical trial that informed the guidelines' creation, and highlights the importance of "real-world" outcomes data in LMICs. These data reinforce the idea that continued clinical research and capacity building efforts are necessary to improve BL outcomes in LMICs.
Collapse
Affiliation(s)
- Hutton Chapman
- Duke University Hospital, Durham, North Carolina, USA
- Duke Global Health Institute, Durham, North Carolina, USA
| | | | | | - Lavanya Vasudevan
- Duke Global Health Institute, Durham, North Carolina, USA
- Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA
| | - Heronima J Kashaigili
- Bugando Medical Centre, Mwanza, Tanzania
- Catholic University of Allied and Health Sciences, Mwanza, Tanzania
| | - Kristin Schroeder
- Duke University Hospital, Durham, North Carolina, USA
- Duke Global Health Institute, Durham, North Carolina, USA
- Bugando Medical Centre, Mwanza, Tanzania
| |
Collapse
|
3
|
Gwanika Y, Rice HE, Metcalf M, Espinoza P, Kajoka HD, Rice HE, Staton C, Mmbaga BT, Majaliwa E, Smith ER, Cotache-Condor C. Impact of the COVID-19 pandemic in childhood and adolescent cancer care in northern Tanzania: a cross-sectional study. BMC Cancer 2024; 24:457. [PMID: 38609910 PMCID: PMC11010397 DOI: 10.1186/s12885-024-12168-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
INTRODUCTION The SARS-CoV-2 (COVID-19) pandemic has strained healthcare systems and presented unique challenges for children requiring cancer care, particularly in low- and middle-income countries. This study aimed to assess the impact of the COVID-19 pandemic on access to cancer care for children and adolescents in Northern Tanzania. METHODS In this cross-sectional study, we assessed the demographic and clinical characteristics of 547 pediatric and adolescent cancer patients (ages 0-19 years old) between 2016 and 2022 using the population-based Kilimanjaro Cancer Registry (KCR). We categorized data into pre-COVID-19 (2016-2019) and COVID-19 (2020-2022) eras, and performed descriptive analyses of diagnostic, treatment, and demographic information. A secondary analysis was conducted on a subset of 167 patients with stage of diagnosis at presentation. RESULTS Overall admissions nearly doubled during the pandemic (n = 190 versus 357). The variety of diagnoses attended at KCMC increased during the pandemic, with only five groups of diseases reported in 2016 to twelve groups of diseases in 2021. Most patients were diagnosed at a late stage (stage III or IV) across eras, with the proportion of under-five years old patients increasing late-diagnoses from 29.4% (before the pandemic), 52.8% (during the pandemic), when compared to the overall cohort. Around 95% of children in this age category reported late-stage diagnosis during the pandemic. Six out of the twelve cancer site groups also reported an increase in late-stage diagnosis. During the pandemic, the proportion of children receiving surgery increased from 15.8 to 30.8% (p < 0.001). CONCLUSION Childhood and adolescent cancer care changed in Northern Tanzania during the COVID-19 pandemic, with increased late-stage diagnoses presentations among younger patients and the increased use of surgical therapies in the context of a growing practice. Understanding the impact of the COVID-19 pandemic on pediatric and adolescent cancer care can help us better adapt healthcare systems and interventions to the emerging needs of children and adolescents with cancer in the midst of a health crisis.
Collapse
Affiliation(s)
- Yotham Gwanika
- Pediatric Hematology and Oncology Services, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Hannah E Rice
- Duke Primary Care, Population Health, Duke University, Durham, NC, USA
| | | | - Pamela Espinoza
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Happiness D Kajoka
- Pediatric Hematology and Oncology Services, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Henry E Rice
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Duke Center for Global Surgery and Health Equity, Duke University, Durham, NC, USA
| | - Catherine Staton
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Blandina T Mmbaga
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Esther Majaliwa
- Pediatric Hematology and Oncology Services, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.
| | - Emily R Smith
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Cesia Cotache-Condor
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Duke Center for Global Surgery and Health Equity, Duke University, Durham, NC, USA
| |
Collapse
|
4
|
Calisti A, Salman DY, Belay K, Mombo A, Tresphory B, Giuliani G, Sertori M, Parigi GB. The hidden burden of Pediatric urology in Sub-Saharan Africa: an analysis of hospital admission data from three East African Health Centres. LA PEDIATRIA MEDICA E CHIRURGICA 2024; 46. [PMID: 38270180 DOI: 10.4081/pmc.2024.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/09/2024] [Indexed: 01/26/2024] Open
Abstract
Specialist facilities for children are still unavailable in some Sub-Saharan African contexts. It is the case of pediatric urology, whose recent advances are still largely unshared. Prenatal diagnosis of urinary abnormalities (CAKUT) is largely unknown. Early recognition and referral of Undescended testis (UDT), Hypospadia, bladder exstrophy epispadias complex, ambiguous genitalia, stone disease, and tumours are uncommon in rural areas. Missed diagnosis is not uncommon and delayed management is associated with poor outcomes. We present a cross-sectional, descriptive study about the epidemiology of Pediatric urological admissions to three sub-Saharan East African Hospitals. All the urological cases between 0-18 years referred to three distinct East African Hospitals over 124 weeks were considered. Prevalence of different groups of diseases, age, and mode of presentation were reported. We found 351 cases (M/F 127/24) out of 2543 surgical referrals (13%). Seventy percent of cases were Hypospadias and UDT. Fifty percent of UDT were beyond 6, and most Hypospadias were between 4 and 7 yrs. CAKUT had a very low prevalence (4.84%), and about 50% of Wilms Tumours came too late to be resectable. In many African contexts, urology is still a tiny portion of the pediatric surgical workload compared to the 25% of European and American reports. There are also differences in the epidemiology of genitourinary conditions. A hidden burden of diseases may be presumed, remaining undiagnosed due to the shortage of specialist facilities.
Collapse
Affiliation(s)
| | | | - Kibreab Belay
- Department of Surgery, Orotta National Referral Hospital, Asmara.
| | - Andrea Mombo
- Department of Urology, Consolata Hospital Ikonda, Makete.
| | | | | | | | - Gian Battista Parigi
- Department of Pediatric Surgery, University of Pavia, IRCCS Policlinico S. Matteo, Pavia.
| |
Collapse
|
5
|
Monko DJ, Martin HD, Mpolya EA. Correlating food and nutritional patterns with cancers in the pediatric oncology population at two specialized hospitals in Tanzania. BMC Nutr 2024; 10:10. [PMID: 38212830 PMCID: PMC10782733 DOI: 10.1186/s40795-024-00824-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 01/05/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND This study of nutritional patterns in relation to cancers among pediatric oncology population in Tanzania was motivated by the lack of up-to-date information about the nutritional practices, the controversy around the importance of nutritional support and the lack of consistent nutritional criteria among pediatric oncology populations. METHODS A survey study in two cancer referral hospitals of children diagnosed with any cancers, aged between 1 and 17 years inclusive and being eligible for enteral feeding included 131 children. Their demographic, nutritional, feeding and cancer profiles were analyzed descriptively through mapping and other approaches as well as inferentially using multinomial regression models to understand different aspects of nutrition for children suffering from cancers. RESULTS The majority (15% or higher) of pediatric oncology population originated from the lake zone. Between 7 and 12% of pediatric oncology population originated from the Western zone. The top-three cancers with their percentages in the brackets were: Wilms Tumor (32%), Acute Lymphoblastic Leukemia (26%) and Retinoblastoma (13%). About 69% of the pediatric oncology population ate foods that are rich in energy but poor in protein such as rice (21.5%), porridge (19.3%), banana (11.7%) and potatoes (10.2%). On the other hand, only 17.5% ate foods that are generally protein-rich such as meat (8.0%), fish (5.3%) and chicken (4.2%); and 12.7% ate milk (4.2%), beans (3.4%), vegetables (2.7%), eggs (1.9%) and fruits (1.5%). Cancers impacted food intake in about 60% of all children with cancers and affected appetite in 18.3% of them. Cancers caused vomiting in 16% and diarrhea in 6.1% of children. The majority of children with cancers (61.8%) took at least one meal while 34.4% took just snacks (p < 0.001). CONCLUSIONS The majority of pediatric oncology population had erratic nutritional patterns and took foods high in energy and poor in proteins. There is a two-way interaction between cancers and nutrition in which cancers affect general nutritional intake which could affect the cancer treatment outcomes in return. Therefore, it is important to consider these interactions while managing pediatric oncology populations in this and similar settings.
Collapse
Affiliation(s)
- Dafrosa Joseph Monko
- Department of Food and Nutritional Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, 447, Arusha, Tengeru, Tanzania.
- Bugando Medical Center, Wurzburg Street, 1370, Mwanza, Tanzania.
| | - Haikael David Martin
- Department of Food and Nutritional Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, 447, Arusha, Tengeru, Tanzania
| | - Emmanuel Abraham Mpolya
- Department of Global Health and Bio-Medical Sciences, S chool of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, 447, Arusha, Tengeru, Tanzania
- Institute of Bioaffiliationersity, Animal Health & Comparative Medicine, University of Glasgow, G12 8QQ, Glasgow, Scotland, UK
- Center for Global Health (CGH), Perelman School of Medicine, University of Pennsylvania, 240 John Morgan Bldg, 3620, 19104, Hamilton Walk, Philadelphia, PA, USA
- Institute for Health Metrics and Evaluation, Population Health Building/Hans Rosling Center, 3980 15th Ave. NE, UW Campus Box #351615, 98195, Seattle, WA, USA
| |
Collapse
|
6
|
Kabahweza HM, Spencer A. Childhood Hodgkin Lymphoma in Sub-Saharan Africa: A Systematic Review on the Effectiveness of the Use of Chemotherapy Alone. Glob Pediatr Health 2024; 11:2333794X231223266. [PMID: 38188077 PMCID: PMC10771044 DOI: 10.1177/2333794x231223266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 11/12/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction. Childhood Hodgkin lymphoma (HL) is often curable, but in Sub-Saharan Africa (SSA), access to standard treatments like combined chemotherapy and radiotherapy is limited. This study aimed at evaluating the effectiveness of using chemotherapy alone for children with HL in SSA. Methods. We searched Medline, Embase, Cinahl Plus and Cochrane Central databases for records of studies that evaluated childhood HL survival outcomes from January 2000 to December 2022. Results. Six observational studies were identified for inclusion, and 3 were included in the meta-analysis. Most HL cases included in the analysis presented with lymphadenopathy and the nodular sclerosing subtype, with a high percentage (80%) in advanced stages. The GRADE certainty of the evidence for the assessed outcomes was rated as very low. Overall survival with chemotherapy was 67.8% (95% CI: 42.1%-88.8%). Conclusion. Chemotherapy is a potential treatment choice for childhood HL in SSA. However, it is crucial to approach this option cautiously due to the limited certainty of the supporting evidence. To improve outcomes for affected children in SSA, more robust studies are needed, along with a focus on early detection and supportive care.
Collapse
|
7
|
Afungchwi GM, Kiteni E, Ndagire M, Maliti B, Kunkel R, Challinor JM, Hollis R. Current status and priorities of paediatric oncology nursing in Africa: a synthesis of perspectives from SIOP Africa nurses. Ecancermedicalscience 2023; 17:1585. [PMID: 37799941 PMCID: PMC10550298 DOI: 10.3332/ecancer.2023.1585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Indexed: 10/07/2023] Open
Abstract
Introduction As African countries adopt the global goal of improving childhood cancer survival to 60% by 2030, intentional actions are required to improve nursing. This report aims to describe the current status of paediatric oncology nursing in Africa. Methods We report on nursing-related aspects of a survey to map paediatric oncology services in Africa (2018-2019), document perceived nursing strengths and weaknesses (2017) and share nurses' research priorities (2019). Additionally, we report on a survey to identify topics for a foundation course (2019) and the expressed perspective of African nurses about the status of paediatric oncology nursing across the continent (2022). Results Only 21% of respondents in the African mapping survey reported having nurses who care for children with cancer at least 75% of the time. Many centres do not have allied health workers like dieticians and play therapists, thus contributing to the nursing burden of care. The main strength of African paediatric oncology nurses was the humanisation of care, while the major weakness was the lack of training follow-up. The top research priorities focused on professional practice and psychosocial support. The Delphi survey identified 57 topic areas grouped into a 12-module curriculum for nurses new to paediatric oncology. The nurses affirmed their dedication to providing compassionate care, however, noted their vulnerability to harm and called for better specialisation, recognition and remuneration. Conclusion This paper amplifies the voice of African paediatric oncology nurses. It illuminates the room for improvement and provides a reference point for future comparison.
Collapse
Affiliation(s)
| | | | | | | | - Rachael Kunkel
- Arkansas Children's Hospital, Little Rock, AR 72202, USA
| | - Julia M Challinor
- University of California San Francisco, 2 Koret Way, San Francisco, CA 94143, USA
| | - Rachel Hollis
- Leeds Children's Hospital, Clarendon Wing, LS1 3EX Leeds, UK
| |
Collapse
|
8
|
Campbell LR, Silverstein A, Peckham-Gregory E, Kamiyango W, Villiera J, McAtee CL, Bacha JM, Kovarik CL, Mehta PS, Chanroo T, Kapesa A, Malingoti B, Mzikamanda R, Ozuah NW, Allen CE, Scheurer ME, El-Mallawany NK. Divergent clinical presentations and outcomes among children and adolescents with Kaposi sarcoma in Malawi and Tanzania. HIV Med 2023; 24:664-675. [PMID: 36627111 PMCID: PMC10257738 DOI: 10.1111/hiv.13455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/18/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVES The Kaposi sarcoma (KS) T0 versus T1 staging classification does not address the unique clinical features of paediatric KS in human gammaherpesvirus 8 (HHV-8) endemic regions of Africa. This study seeks to define patterns of childhood KS using a paediatric-specific approach. METHODS The Lilongwe paediatric KS staging classification categorizes disease based on clinical phenotype: stage 1 = mild/moderate KS limited to cutaneous/oral involvement, stage 2 = primarily lymphadenopathic disease, stage 3 = woody edema KS, stage 4 = visceral and/or severe/disseminated mucocutaneous disease. Characteristics and outcomes were evaluated from paediatric referral centres in Lilongwe, Malawi, and Mbeya, Tanzania. RESULTS Among 171 patients, the median age was 9.3 years, 37% (n = 63) were female, and 87% (n = 149) had HIV. Breakdown by stage was as follows: 18% (n = 31) stage 1, 33% (n = 56) stage 2, 19% (n = 33) stage 3, and 30% (n = 51) stage 4. Age (younger stage 2 and older stage 3), severe CD4 count suppression (lower CD4 for stages 1 and 4), and presence of severe anaemia and thrombocytopenia (worse for stages 2 and 4) differed across stages. Estimated 2-year event-free survival/progression-free survival/overall survival by stage was as follows: stage 1, 81%/81%/87%; stage 2, 50%/50%/63%; stage 3, 24%/49%/81%; and stage 4, 29%/34%/54%. Sub-analysis of stage 2 lymphadenopathic KS demonstrated superior long-term 6-year event-free survival of 70% (95% confidence interval [CI] 49-83) for younger children (aged <7 years) versus 27% (95% CI 8-51) for older children. CONCLUSIONS This paediatric-specific staging classification categorizes patients with distinct characteristics and patterns of treatment response. This platform may guide clinicians to provide risk-stratified treatment with the hope of improving survival among children with KS.
Collapse
Affiliation(s)
- Liane R. Campbell
- Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital, Houston, TX, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Baylor College of Medicine Children’s Foundation - Tanzania, Mbeya, Tanzania
| | - Allison Silverstein
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
- Texas Children’s Cancer and Hematology Centers Global HOPE (Hematology-Oncology Pediatric Excellence) Program, Lilongwe, Malawi
| | - Erin Peckham-Gregory
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - William Kamiyango
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
- Texas Children’s Cancer and Hematology Centers Global HOPE (Hematology-Oncology Pediatric Excellence) Program, Lilongwe, Malawi
| | - Jimmy Villiera
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
- Texas Children’s Cancer and Hematology Centers Global HOPE (Hematology-Oncology Pediatric Excellence) Program, Lilongwe, Malawi
| | - Casey L. McAtee
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
- Texas Children’s Cancer and Hematology Centers Global HOPE (Hematology-Oncology Pediatric Excellence) Program, Lilongwe, Malawi
- Global HOPE, Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, TX, USA
| | - Jason M. Bacha
- Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital, Houston, TX, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Baylor College of Medicine Children’s Foundation - Tanzania, Mbeya, Tanzania
| | | | - Parth S. Mehta
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Global HOPE, Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, TX, USA
| | - Toni Chanroo
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
- Texas Children’s Cancer and Hematology Centers Global HOPE (Hematology-Oncology Pediatric Excellence) Program, Lilongwe, Malawi
| | - Asulwisye Kapesa
- Baylor College of Medicine Children’s Foundation - Tanzania, Mbeya, Tanzania
| | - Beatrice Malingoti
- Baylor College of Medicine Children’s Foundation - Tanzania, Mbeya, Tanzania
| | - Rizine Mzikamanda
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
- Texas Children’s Cancer and Hematology Centers Global HOPE (Hematology-Oncology Pediatric Excellence) Program, Lilongwe, Malawi
| | - Nmazuo W. Ozuah
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
- Texas Children’s Cancer and Hematology Centers Global HOPE (Hematology-Oncology Pediatric Excellence) Program, Lilongwe, Malawi
- Global HOPE, Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, TX, USA
| | - Carl E. Allen
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Global HOPE, Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, TX, USA
| | - Michael E. Scheurer
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Nader Kim El-Mallawany
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Global HOPE, Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, TX, USA
| |
Collapse
|
9
|
Sherief ST, Wu F, O'Banion J, Teshome T, Dimaras H. Health Services Needs Assessment for Retinoblastoma in Ethiopia. JCO Glob Oncol 2023; 9:e2200445. [PMID: 37348044 PMCID: PMC10497293 DOI: 10.1200/go.22.00445] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/10/2023] [Accepted: 04/06/2023] [Indexed: 06/24/2023] Open
Abstract
PURPOSE The aim of this study was to document the available resources and needs for the detection, diagnosis, and treatment of retinoblastoma (RB) in Ethiopia. METHODS A health services needs assessment focused on RB care in Ethiopia was conducted. Information was obtained through a web-based survey and field visits. Facilities offering RB service delivery were categorized into three tiers, on the basis of the ability to detect (tier 1) and manage simple (tier 2) or complex (tier 3) patients with RB. Descriptive statistics were performed to quantify human and material resources available at each facility. RESULTS The web survey received 29 responses from ophthalmologists at 19 health care facilities. Of the 19 units surveyed, seven (36.8%) had an ophthalmologist dedicated to RB treatment, classifying them as either a tier 2 or 3 facility. All tier 3 facilities had an affiliated health facility offering access to off-site pediatric oncology and pathology services. Of the focal therapies offered at tier 3 facilities, none included local chemotherapy or brachytherapy. Enucleation was offered at all tier 2 facilities, but availability of orbital implants and ocular prostheses was variable. None of the health facilities offered genetics services. CONCLUSION This study demonstrated that the human and material resources needed for RB care in Ethiopia are constrained. Tier 3 RB facilities are rare and concentrated in urban areas, which could make it difficult for many patients to access. With focused capacity-building efforts, it is possible to increase the efficiency of RB therapy.
Collapse
Affiliation(s)
- Sadik Taju Sherief
- Department of Ophthalmology, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Fran Wu
- Al-Qabas International Eye Center, Tripoli, Libya
| | | | - Tiliksew Teshome
- Department of Ophthalmology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Helen Dimaras
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Canada
- Child Health Evaluative Sciences Program, Centre for Global Child Health, SickKids Research Institute, Toronto, Canada
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| |
Collapse
|
10
|
Assessing the cost and economic impact of tertiary-level pediatric cancer care in Tanzania. PLoS One 2022; 17:e0273296. [PMCID: PMC9674137 DOI: 10.1371/journal.pone.0273296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 06/14/2022] [Indexed: 11/19/2022] Open
Abstract
Background Worldwide, an estimated 400,000 children develop cancer each year. The bulk of the mortalities from these cases occur in low-and-middle-income countries (LMICs). In Sub-Saharan Africa, there is a tremendous need to strengthen the capacity of health systems to provide high-quality cancer care for children. However, a lack of data on the economic impact of cancer treatment in low-resource settings hinders its consideration as a healthcare priority. To address this gap, this study models the clinical and financial impact of pediatric cancer care in Tanzania, a lower-middle income country in East Africa. Methods We conducted a retrospective review of patients with cancer under the age of 19 years treated at Bugando Medical Centre from January 2010 to August 2014. Information was collected from a total of 161 children, including demographics, type of cancer, care received, and five-year survival outcomes. This data was used to calculate the number of averted disability-adjusted life-years (DALYs) with treatment. Charges for all direct medical costs, fixed provider costs, and variable provider costs were used to calculate total cost of care. The societal economic impact of cancer treatment was modeled using the value of statistical life (VSL) and human capital methods. Findings The total health impact for these 161 children was 819 averted DALYs at a total cost of $846,743. The median cost per patient was $5,064 ($4,746–5,501 interquartile range). The societal economic impact of cancer treatment ranged from $590,534 to $3,647,158 using VSL method and $1,776,296 using a human capital approach. Interpretation Despite the limitations of existing treatment capacity, economic modeling demonstrates a positive economic impact from providing pediatric cancer care in Tanzania. As many countries like Tanzania progress towards achieving Universal Health Coverage, these key economic indicators may encourage future investment in comprehensive pediatric cancer care programs in low-resource settings to achieve clinically and economically beneficial results not only for the individual patients, but for the country as a whole.
Collapse
|
11
|
Morgan A, Watt M, Zullig L, Sued H, Schroeder K. Pediatric cancer outcomes after the implementation of a residential hostel in Tanzania. Pediatr Blood Cancer 2022; 69:e29758. [PMID: 35593643 DOI: 10.1002/pbc.29758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 03/19/2022] [Accepted: 04/11/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND A large survival disparity exists for pediatric cancer patients in low- and middle-income countries compared with high-income countries. A variety of factors contribute to this gap, including late-stage disease at presentation, high rates of abandonment of care, and lack of supportive care infrastructure. A residential hostel was established in Mwanza, Tanzania, to reduce barriers to accessing and maintaining care among patients being treated for childhood cancer at a regional referral hospital. This study examines the effect of the hostel on one-year survival and treatment abandonment for children diagnosed with cancer. METHODS Medical records were retrospectively reviewed for all patients presenting from May 2017 to April 2018, following the establishment of a pediatric cancer hostel at the referral hospital. Active follow-up was used to confirm survival data. RESULTS There were 149 patients who presented to the referral hospital during the study period with 130 eligible for evaluation. A total of 34% (n = 44) used the hostel services and 66% did not use the hostel (n = 86). Patients who used the hostel did not significantly differ by age, sex, or diagnosis compared with patients who did not use the hostel. Patients who used the hostel had lower treatment abandonment (27% vs 37%) and higher one-year overall survival (47% vs 37%) compared with patients who did not use the hostel. CONCLUSION Our findings suggest key supportive programs such as a family hostel may be beneficial for patients with childhood cancer and can improve pediatric cancer treatment outcomes in LMICs.
Collapse
Affiliation(s)
- Austin Morgan
- Duke University, Durham, North Carolina, Oregon Health and Science University School of Medicine, Portland, Oregon
| | | | | | | | | |
Collapse
|
12
|
Efraim J, Munisi C, Magige A, Msuya K, Marealle AI, Kilonzi M, Mlyuka H, Mikomangwa W, Mallya B, Aswile W, Zimbwe KB, Mutagonda RF. Drug utilization pattern and adverse drug reactions of chemotherapy in pediatric patients at Muhimbili National Hospital, Tanzania. F1000Res 2022; 11:396. [PMID: 38680229 PMCID: PMC11053343 DOI: 10.12688/f1000research.110079.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 05/01/2024] Open
Abstract
Background: Cancer is a highly debilitating non-communicable disease and an essential contributor to the global burden of disease. Pediatric patients are highly exposed to multiple drugs for the management of cancer. Monitoring drug utilization patterns helps to provide feedback to healthcare providers to ensure the rational use of medicines; as a result, it increases the therapeutic efficacy and decreases the frequency and severity of adverse drug reactions (ADRs). Therefore, this study assessed the utilization pattern and ADRs of chemotherapy in pediatric patients at Muhimbili National Hospital (MNH). Methods: A descriptive cross-sectional study was conducted for three months from February to April 2021 in pediatric cancer patients undergoing chemotherapy at MNH. A total of 123 children diagnosed with cancer and on chemotherapy were enrolled in this study. Patients' socio-demographics, clinical information, chemotherapy status, prescribed medications, and prevalence of ADRs were collected. Descriptive statistics was used in data analysis, whereby frequency and proportions were used to summarize data. Results: Out of 123 patients, 62.6% were male. Most patients received an average of four anticancer drugs. Vincristine (55.3%) was the most used anticancer drug, followed by cytarabine (44.7%) and methotrexate (42.3%). The most used adjuvant drugs were ondansetron (30.9%), hydrocortisone (27.6%), and piperacillin/tazobactam (23.6%). The percentage of drugs prescribed from the Tanzania Essential Medicine List (TEML) and World Health Organization (WHO) list was 66.4% and 93%. Most (87%) of the patients reported having experienced ADRs whereby nausea and vomiting (45.8%), hair loss (33.6%), and neutropenia (32.7%) were more prevalent ADRs reported. Conclusions: This study found the drug prescribing pattern to be in line with the essential medicine list, but the average number of drugs prescribed was higher than recommended. ADRs were prevalent among pediatric cancer patients.
Collapse
Affiliation(s)
- Josephine Efraim
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania, 0255, Tanzania
| | - Castory Munisi
- Department of Pharmaceutics and Pharmacy Practice, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania, 0255, Tanzania
| | - Auson Magige
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania, 0255, Tanzania
| | - Kelvin Msuya
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania, 0255, Tanzania
| | - Alphonce Ignace Marealle
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania, 0255, Tanzania
| | - Manase Kilonzi
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania, 0255, Tanzania
| | - Hamu Mlyuka
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania, 0255, Tanzania
| | - Wigilya Mikomangwa
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania, 0255, Tanzania
| | - Bertha Mallya
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania, 0255, Tanzania
| | - Wema Aswile
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania, 0255, Tanzania
| | - Kauke Bakari Zimbwe
- Pharmacy department, Benjamin Mkapa Hospital, Dodoma, Tanzania, 0255, Tanzania
| | - Ritah Francis Mutagonda
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania, 0255, Tanzania
| |
Collapse
|
13
|
Makene FS, Ngilangwa R, Santos C, Cross C, Ngoma T, Mujinja PGM, Wuyts M, Mackintosh M. Patients' pathways to cancer care in Tanzania: documenting and addressing social inequalities in reaching a cancer diagnosis. BMC Health Serv Res 2022; 22:189. [PMID: 35151290 PMCID: PMC8841053 DOI: 10.1186/s12913-021-07438-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 12/21/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This article investigates the extent and sources of late diagnosis of cancer in Tanzania, demonstrating how delayed diagnosis was patterned by inequities rooted in patients' socio-economic background and by health system responses. It provides evidence to guide equity-focused policies to accelerate cancer diagnosis. METHODS Tanzanian cancer patients (62) were interviewed in 2019. Using a structured questionnaire, respondents were encouraged to recount their pathways from first symptoms to diagnosis, treatment, and in some cases check-ups as survivors. Patients described their recalled sequence of events and actions, including dates, experiences and expenditures at each event. Socio-demographic data were also collected, alongside patients' perspectives on their experience. Analysis employed descriptive statistics and qualitative thematic analysis. RESULTS Median delay, between first symptoms that were later identified as indicating cancer and a cancer diagnosis, was almost 1 year (358 days). Delays were strongly patterned by socio-economic disadvantage: those with low education, low income and non-professional occupations experienced longer delays before diagnosis. Health system experiences contributed to these socially inequitable delays. Many patients had moved around the health system extensively, mainly through self-referral as symptoms worsened. This "churning" required out-of-pocket payments that imposed a severely regressive burden on these largely low-income patients. Causes of delay identified in patients' narratives included slow recognition of symptoms by facilities, delays in diagnostic testing, delays while raising funds, and recourse to traditional healing often in response to health system barriers. Patients with higher incomes and holding health insurance that facilitated access to the private sector had moved more rapidly to diagnosis at lower out-of-pocket cost. CONCLUSIONS Late diagnosis is a root cause, in Tanzania as in many low- and middle-income countries, of cancer treatment starting at advanced stages, undermining treatment efficacy and survival rates. While Tanzania's policy of free public sector cancer treatment has made it accessible to patients on low incomes and without insurance, reaching a diagnosis is shown to have been for these respondents slower and more expensive the greater their socio-economic disadvantage. Policy implications are drawn for moving towards greater social justice in access to cancer care.
Collapse
Affiliation(s)
- Fortunata Songora Makene
- Economic and Social Research Foundation, 51 Uporoto Street, Ursino Estate, P.O Box 31226, Dar es Salaam, Tanzania
| | - Richard Ngilangwa
- Economic and Social Research Foundation, 51 Uporoto Street, Ursino Estate, P.O Box 31226, Dar es Salaam, Tanzania
| | - Cristina Santos
- Faculty of Arts and Social Sciences, The Open University, Walton Hall, Milton Keynes, MK7 6AA UK
| | - Charlotte Cross
- Faculty of Arts and Social Sciences, The Open University, Walton Hall, Milton Keynes, MK7 6AA UK
| | - Twalib Ngoma
- Department of Behavioural Sciences, Muhimbili University of Heath and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania
| | - Phares G. M. Mujinja
- Department of Behavioural Sciences, Muhimbili University of Heath and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania
| | - Marc Wuyts
- International Institute of Social Studies, Erasmus University Rotterdam, Kortenaerkade 12, The Hague, 2518 AX The Netherlands
| | - Maureen Mackintosh
- Faculty of Arts and Social Sciences, The Open University, Walton Hall, Milton Keynes, MK7 6AA UK
| |
Collapse
|
14
|
Schroeder K, Maiarana J, Gisiri M, Joo E, Muiruri C, Zullig L, Masalu N, Vasudevan L. Caregiver Acceptability of Mobile Phone Use for Pediatric Cancer Care in Tanzania: Cross-sectional Questionnaire Study. JMIR Pediatr Parent 2021; 4:e27988. [PMID: 34889763 PMCID: PMC8701707 DOI: 10.2196/27988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND There is a 60% survival gap between children diagnosed with cancer in low- and middle-income countries (LMICs) and those in high-income countries. Low caregiver knowledge about childhood cancer and its treatment results in presentation delays and subsequent treatment abandonment in LMICs. However, in-person education to improve caregiver knowledge can be challenging due to health worker shortages and inadequate training. Due to the rapid expansion of mobile phone use worldwide, mobile health (mHealth) technologies offer an alternative to delivering in-person education. OBJECTIVE The aim of this study is to assess patterns of mobile phone ownership and use among Tanzanian caregivers of children diagnosed with cancer as well as their acceptability of an mHealth intervention for cancer education, patient communication, and care coordination. METHODS In July 2017, caregivers of children <18 years diagnosed with cancer and receiving treatment at Bugando Medical Centre (BMC) were surveyed to determine mobile phone ownership, use patterns, technology literacy, and acceptability of mobile phone use for cancer education, patient communication, and care coordination. Descriptive statistics were generated from the survey data by using mean and SD values for continuous variables and percentages for binary or categorical variables. RESULTS All eligible caregivers consented to participate and completed the survey. Of the 40 caregivers who enrolled in the study, most used a mobile phone (n=34, 85%) and expressed high acceptability in using these devices to communicate with a health care provider regarding treatment support (n=39, 98%), receiving laboratory results (n=37, 93%), receiving reminders for upcoming appointments (n=38, 95%), and receiving educational information on cancer (n=35, 88%). Although only 9% (3/34) of mobile phone owners owned phones with smartphone capabilities, about 74% (25/34) self-reported they could view and read SMS text messages. CONCLUSIONS To our knowledge, this is the first study to assess patterns of mobile phone ownership and use among caregivers of children with cancer in Tanzania. The high rate of mobile phone ownership and caregiver acceptability for a mobile phone-based education and communication strategy suggests that a mobile phone-based intervention, particularly one that utilizes SMS technology, could be feasible in this setting.
Collapse
Affiliation(s)
- Kristin Schroeder
- Department of Pediatric Oncology, Duke University Medical Center, Durham, NC, United States.,Department of Oncology, Bugando Medical Centre, Mwanza, United Republic of Tanzania.,Duke Global Health Institute, Durham, NC, United States
| | - James Maiarana
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Mwitasrobert Gisiri
- Department of Oncology, Bugando Medical Centre, Mwanza, United Republic of Tanzania
| | - Emma Joo
- Duke Global Health Institute, Durham, NC, United States
| | - Charles Muiruri
- Duke Global Health Institute, Durham, NC, United States.,Department of Population Health Sciences, Duke University, Durham, NC, United States
| | - Leah Zullig
- Department of Population Health Sciences, Duke University, Durham, NC, United States.,Durham Veterans Affairs Center of Innovation to Accelerate and Practice Transformation, Durham, NC, United States
| | - Nestory Masalu
- Department of Oncology, Bugando Medical Centre, Mwanza, United Republic of Tanzania
| | - Lavanya Vasudevan
- Duke Global Health Institute, Durham, NC, United States.,Department of Family Medicine and Community Health, Duke University, Durham, NC, United States
| |
Collapse
|
15
|
Maillie L, Masalu N, Mafwimbo J, Maxmilian M, Schroeder K. Delays Experienced by Patients With Pediatric Cancer During the Health Facility Referral Process: A Study in Northern Tanzania. JCO Glob Oncol 2020; 6:1757-1765. [PMID: 33201744 PMCID: PMC7713565 DOI: 10.1200/go.20.00407] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE It is estimated that 50%-80% of patients with pediatric cancer in sub-Saharan Africa present at an advanced stage. Delays can occur at any time during the care-seeking process from symptom onset to treatment initiation. Referral delay, the time from first presentation at a health facility to oncologist evaluation, is a key component of total delay that has not been evaluated in sub-Saharan Africa. METHODS Over a 3-month period, caregivers of children diagnosed with cancer at a regional cancer center (Bugando Medical Centre [BMC]) in Tanzania were consecutively surveyed to determine the number and type of health facilities visited before presentation, interventions received, and transportation used to reach each facility. RESULTS Forty-nine caregivers were consented and included in the review. A total of 124 facilities were visited before BMC, with 31% of visits (n = 38) resulting in a referral. The median referral delay was 89 days (mean, 122 days), with a median of two facilities (mean, 2.5 facilities) visited before presentation to BMC. Visiting a traditional healer first significantly increased the time taken to reach BMC compared with starting at a health center/dispensary (103 v 236 days; P = .02). Facility visits in which a patient received a referral to a higher-level facility led to significantly decreased time to reach BMC (P < .0001). Only 36% of visits to district hospitals and 20.6% of visits to health centers/dispensaries yielded a referral, however. CONCLUSION The majority of patients were delayed during the referral process, but receipt of a referral to a higher-level facility significantly shortened delay time. Referral delay for pediatric patients with cancer could be decreased by raising awareness of cancer and strengthening the referral process from lower-level to higher-level facilities.
Collapse
Affiliation(s)
- Luke Maillie
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nestory Masalu
- Department of Oncology, Bugando Medical Centre, Mwanza, Tanzania
| | - Judy Mafwimbo
- Department of Oncology, Bugando Medical Centre, Mwanza, Tanzania
| | | | - Kristin Schroeder
- Department of Oncology, Bugando Medical Centre, Mwanza, Tanzania.,Division of Pediatric Hematology/Oncology and Duke Global Cancer Program, Duke University Medical Center, Durham, NC
| |
Collapse
|
16
|
Chao CA, Huang L, Visvanathan K, Mwakatobe K, Masalu N, Rositch AF. Understanding women's perspectives on breast cancer is essential for cancer control: knowledge, risk awareness, and care-seeking in Mwanza, Tanzania. BMC Public Health 2020; 20:930. [PMID: 32539723 PMCID: PMC7296642 DOI: 10.1186/s12889-020-09010-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 05/28/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Breast Cancer is the most common cancer in women worldwide. Since 2008, Mwanza, Tanzania, has worked to provide comprehensive cancer services through its Zonal consultant hospital. New national guidelines focused on clinical breast exam requires that women be aware of and seek care for breast concerns. Therefore, this study aims to understand breast cancer awareness in Mwanza and describe women-level barriers, care-seeking behavior, and perspectives on breast cancer. METHODS A community-based survey was administered to conveniently sampled women aged 30 and older to assess women's perspectives on breast cancer and care-seeking behavior. RESULTS Among 1129 women with a median age of 37 (IQR: 31-44) years, 73% have heard of cancer and 10% have received breast health education. Women self-evaluated their knowledge of breast cancer (from 1-none to 10-extremely knowledgeable) with a median response of 3 (IQR: 1-4). Only 14% felt they knew any signs or symptoms of breast cancer. Encouragingly, 56% of women were fairly-to-very confident they would notice changes in their breasts, with 24% of women practicing self-breast examination and 21% reporting they had received a past breast exam. Overall, 74% said they would be somewhat-to-very likely to seek care if they noticed breast changes, with 96% noting severity of symptoms as a motivator. However, fear of losing a breast (40%) and fear of a poor diagnosis (38%) were most frequent barriers to care seeking. In assessing knowledge of risk factors, about 50% of women did not know any risk factors for breast cancer whereas 42% of women believed long term contraceptive use a risk factor. However, 37% and 35% of women did not think that family history or being older were risk factors, respectively. CONCLUSIONS The success of efforts to improve early diagnosis in a setting without population-based screening depends on women being aware of breast cancer signs and symptoms, risks, and ultimately seeking care for breast concerns. Fortunately, most women said they would seek care if they noticed a change in their breasts, but the low levels of cancer knowledge, symptoms, and common risk factors highlight the need for targeted community education and awareness campaigns.
Collapse
Affiliation(s)
- Christina A Chao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Liuye Huang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kala Visvanathan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kisa Mwakatobe
- Tanzania Breast Cancer Foundation, Dar es Salaam, Tanzania
| | - Nestory Masalu
- Department of Oncology, Bugando Medical Centre, Mwanza, Tanzania
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| |
Collapse
|
17
|
Esmaili BE, Stewart KA, Masalu NA, Schroeder KM. Qualitative Analysis of Palliative Care for Pediatric Patients With Cancer at Bugando Medical Center: An Evaluation of Barriers to Providing End-of-Life Care in a Resource-Limited Setting. J Glob Oncol 2019; 4:1-10. [PMID: 30084714 PMCID: PMC6223406 DOI: 10.1200/jgo.17.00047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Palliative care remains an urgent, neglected need in the developing world. Global disparities in end-of-life care for children, such as those with advanced cancers, result from barriers that are complex and largely unstudied. This study describes these barriers at Bugando Medical Center, one of three consultant hospitals in Tanzania, to identify areas for palliative care development suitable to this context. Methods In-depth interviews were conducted with 20 caregivers of pediatric patients with cancer and 14 hospital staff involved in pediatric end-of-life care. This was combined with 1 month of participant observation through direct clinical care of terminally ill pediatric patients. Results Data from interviews as well as participant observation revealed several barriers to palliative care: financial, infrastructure, knowledge and cultural (including perceptions of pediatric pain), and communication challenges. Although this study focused on barriers, what also emerged were the unique advantages of end-of-life care in this setting, including community cohesiveness and strong faith background. Conclusion This study provides a unique but focused description of barriers to palliative care common in a low-resource setting, extending beyond resource needs. This multidisciplinary qualitative approach combined interviews with participant observation, providing a deeper understanding of the logistical and cultural challenges in this setting. This new understanding will inform the design of more effective-and more appropriate-palliative care policies for young patients with cancer in the developing world.
Collapse
Affiliation(s)
- B Emily Esmaili
- B. Emily Esmaili and Kearsley A. Stewart, Duke University; Kristin M. Schroeder, Duke University Medical Center, Durham, NC; and Nestory A. Masalu, Bugando Medical Center, Mwanza, Tanzania
| | - Kearsley A Stewart
- B. Emily Esmaili and Kearsley A. Stewart, Duke University; Kristin M. Schroeder, Duke University Medical Center, Durham, NC; and Nestory A. Masalu, Bugando Medical Center, Mwanza, Tanzania
| | - Nestory A Masalu
- B. Emily Esmaili and Kearsley A. Stewart, Duke University; Kristin M. Schroeder, Duke University Medical Center, Durham, NC; and Nestory A. Masalu, Bugando Medical Center, Mwanza, Tanzania
| | - Kristin M Schroeder
- B. Emily Esmaili and Kearsley A. Stewart, Duke University; Kristin M. Schroeder, Duke University Medical Center, Durham, NC; and Nestory A. Masalu, Bugando Medical Center, Mwanza, Tanzania
| |
Collapse
|
18
|
Akinsete A, Awofeso O, Akere Z, Akinsulie A, Temiye E. Pattern of presentation, treatment, and determinants of outcome of pediatric oncology cases at a tertiary institution in Lagos. JOURNAL OF CLINICAL SCIENCES 2018. [DOI: 10.4103/jcls.jcls_15_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|