Factors influencing time to diagnosis and initiation of treatment of endemic Burkitt Lymphoma among children in Uganda and western Kenya: a cross-sectional survey

Infectious Agents and Cancer

Ann M Moormann⁶  Jackson Orem⁷  Juliana A Otieno⁴  Corey Casper²  Kristine Stiffler²  Dorine Omenah³  Beccy Nakalema⁷  Peter Odada Sumba³  Jennifer Pfau Collins¹  Geoffrey C Buckle⁵ 

[1] School of Medicine, Case Western Reserve University, 10900 Euclid Ave, Cleveland 44106, OH, USA;Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N., Seattle 98109, WA, USA;Center for Global Health Research, Kenya Medical Research Institute, Kisumu 40100, Kenya;Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu 40100, Kenya;University of Massachusetts Medical School, 55 Lake Avenue North, Worcester 01655, MA, USA;Department of Pediatrics, University of Massachusetts Medical School, 373 Plantation Street, Suite 318, Worcester 01605, MA, USA;Uganda Cancer Institute, Upper Mulago Road, Kampala, Uganda

关键词: Delayed diagnosis;    Delay;    Burkitt lymphoma;    Children;    Cancer;    Uganda;    Kenya;    Africa;   

Others  :  802698
DOI  :  10.1186/1750-9378-8-36

 received in 2013-05-26, accepted in 2013-09-17,  发布年份 2013

【 摘 要 】

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.

【 授权许可】

   
2013 Buckle et al.; licensee BioMed Central Ltd.

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