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Factors influencing time to diagnosis and initiation of treatment of endemic Burkitt Lymphoma among children in Uganda and western Kenya: a cross-sectional survey
University of Massachusetts Medical School Faculty Publications
  • Geoffrey C. Buckle, University of Massachusetts Medical School
  • Jennifer Pfau Collins, Case Western Reserve University
  • Peter Odada Sumba, Kenya Medical Research Institute
  • Beccy Nakalema, Uganda Cancer Institute
  • Dorine Omenah, Kenya Medical Research Institute
  • Kristine Stiffler, Fred Hutchinson Cancer Research Center
  • Corey Casper, Fred Hutchinson Cancer Research Center
  • Juliana A. Otieno, Kenya Ministry of Health
  • Jackson Orem, Uganda Cancer Institute
  • Ann M. Moormann, University of Massachusetts Medical School
UMMS Affiliation
Department of Pediatrics; Department of Quantitative Health Sciences; School of Medicine
Publication Date
9-30-2013
Document Type
Article
Abstract

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.

Keywords
  • Africa,
  • Uganda,
  • Cancer,
  • Children,
  • Burkitt lymphoma,
  • Delay,
  • Delayed diagnosis
Rights and Permissions
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
10.1186/1750-9378-8-36
Source
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
Related Resources
Link to Article in PubMed
PubMed ID
24079452
Citation Information
Geoffrey C. Buckle, Jennifer Pfau Collins, Peter Odada Sumba, Beccy Nakalema, et al.. "Factors influencing time to diagnosis and initiation of treatment of endemic Burkitt Lymphoma among children in Uganda and western Kenya: a cross-sectional survey" Vol. 8 Iss. 1 (2013) ISSN: 1750-9378 (Linking)
Available at: http://works.bepress.com/ann_moormann/47/