Department of Pediatrics; Department of Quantitative Health Sciences; School of Medicine
Epidemiology | Health Services Administration | Hemic and Lymphatic Diseases | Immune System Diseases | Infectious Disease | International Public Health | Neoplasms | Pediatrics
BACKGROUND: Survival rates for children diagnosed with Burkitt lymphoma (BL) in Africa are far below those achieved in developed countries. Late stage of presentation contributes to poor prognosis, therefore this study investigated factors leading to delays in BL diagnosis and treatment of children in Uganda and western Kenya.
METHODS: Guardians of children diagnosed with BL were interviewed at the Jaramogi Oginga Odinga Teaching and Referral Hospital (JTRH) and Uganda Cancer Institute (UCI) from Jan-Dec 2010. Information on sociodemographics, knowledge, attitudes, illness perceptions, health-seeking behaviors and prior health encounters was collected using a standardized, pre-tested questionnaire.
RESULTS: Eighty-two guardians were interviewed (20 JTRH, 62 UCI). Median "total delay" (1st symptoms to BL diagnosis) was 12.1 weeks [interquartile range (IQR) 4.9-19.9] in Kenya and 12.9 weeks (IQR 4.3-25.7) in Uganda. In Kenya, median "guardian delay" (1st symptoms to 1st health encounter) and "health system delay" (1st health encounter to BL diagnosis) were 9.0 weeks (IQR 3.6-15.7) and 2.0 weeks (IQR 1.6-5.8), respectively. Data on guardian and health system delay in Uganda were only available for those with < 4 prior health encounters (n = 26). Of these, median guardian delay was 4.3 weeks (range 0.7-149.9), health system delay 2.6 weeks (range 0.1-16.0), and total delay 10.7 weeks (range 1.7-154.3). Guardians in Uganda reported more health encounters than those in Kenya (median 5, range 3-16 vs. median 3, range 2-6). Among Kenyan guardians, source of income was the only independent predictor of delay, whereas in Uganda, guardian delay was influenced by guardians' beliefs on the curability of cancer, health system delay, by guardians' perceptions of cancer as a contagious disease, and total delay, by the number of children in the household and guardians' role as caretaker. Qualitative findings suggest financial costs, transportation, and other household responsibilities were major barriers to care.
CONCLUSIONS: Delays from symptom onset to BL treatment were considerable given the rapid growth rate of this cancer, with guardian delay constituting the majority of total delay in both settings. Future interventions should aim to reduce structural barriers to care and increase awareness of BL in particular and cancer in general within the community, as well as among health professionals.
Africa, Uganda, Cancer, Children, Burkitt lymphoma, Delay, Delayed diagnosis
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Copyright 2013 Buckle et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
DOI of Published Version
Buckle GC, Collins JP, Sumba PO, Nakalema B, Omenah D, Stiffler K, Casper C, Otieno JA, Orem J, Moormann AM. Factors influencing time to diagnosis and initiation of treatment of endemic Burkitt Lymphoma among children in Uganda and western Kenya: a cross-sectional survey. Infect Agent Cancer. 2013 Sep 30;8(1):36. doi: 10.1186/1750-9378-8-36. Link to article on publisher's site
Infectious agents and cancer
Buckle, Geoffrey C.; Collins, Jennifer Pfau; Sumba, Peter Odada; Nakalema, Beccy; Omenah, Dorine; Stiffler, Kristine; Casper, Corey; Otieno, Juliana A.; Orem, Jackson; and Moormann, Ann M., "Factors influencing time to diagnosis and initiation of treatment of endemic Burkitt Lymphoma among children in Uganda and western Kenya: a cross-sectional survey" (2013). University of Massachusetts Medical School Faculty Publications. 295.
Epidemiology Commons, Health Services Administration Commons, Hemic and Lymphatic Diseases Commons, Immune System Diseases Commons, Infectious Disease Commons, International Public Health Commons, Neoplasms Commons, Pediatrics Commons