Browsing by Author "Schroeder, Kristin M"
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Item Open Access Development of a Media Awareness Campaign to Address Barriers to Childhood Cancer Treatment in Tanzania(2022) Abualhaj, DaliaAccording to Ward et al. 2019, there are 400,000 newly diagnosed pediatric cancer patients each year, with over 85% living in low-and middle-income countries. Even though some pediatric cancer types have more than 90% chance of survival rates in high income countries (HIC), survival outcomes remain significantly lower in Sub-Saharan Africa (SSA) (Stanley et al., 2017). This study aims to understand the cultural misbeliefs on pediatric cancer by targeting the Swahili speaking communities while developing a media awareness campaign with educational materials in Swahili. The findings from this study will inform the professionals, policy makers, and other key players in pediatric cancer on how to best address the barriers and improve survival rates and have better treatment outcomes. The current study focuses on the design, implementation, and evaluation of a media campaign to increase community awareness about childhood cancer. Media development and evaluation were done with feedback from community members through FGDs. We used qualitative approaches to assess impact of media campaign on community’s knowledge on pediatric cancer. Qualitative data for this analysis were conducted through feedback from FGDs. This study has demonstrated that a media campaign can raise awareness and increase knowledge on pediatric cancer in Tanzania, which is influenced by lack of awareness, late presentation for diagnosis, and treatment incompletion. The study results show that through the development of feasible and impactful strategies, such as an educational poster and a song video, awareness can be raised on pediatric cancer in Swahili speaking communities in Tanzania.
Item Open Access Exploring Cancer Stigma Experienced by Pediatric Cancer Patients and Their Caregivers in Mwanza, Tanzania(2023) Posani, SuhanaBackground: Cancer is grossly underreported and underdiagnosed in Africa, as only an estimated 57% of childhood cancers are diagnosed and survival rates for children with cancer are very low; an estimated 20% of children survive cancer in Africa. Several factors can lead to delays in treatment and discontinuing treatment such as lack of knowledge about cancer and negative beliefs or stigma about cancer. The research objective of this paper is to explore the types of stigmas faced by pediatric cancer patients and their families to inform interventions to reduce cancer stigma and increase survival rates of pediatric cancer patients in Tanzania.Methods: The study took place at Bugando Medical Centre (BMC) in Mwanza, Tanzania. The study sample included more than 300 patients who had completed treatment for pediatric cancer at Bugando Cancer Centre. This qualitative study was conducted using structured focus group discussions (FGD) and in-depth interviews (IDI) with patients and caregivers. Data was transcribed and translated into English and NVivo12 was used for qualitative data analysis and coding through an inductive and deductive approach. Results: The main themes of stigma found in both the FGDs and IDIs were severity of condition, avoidance, financial discrimination, beliefs about causes of cancer and stigma due to physical changes. These themes were found among all age groups and were experienced by both caregivers and patients. Conclusions: The results and data gathered from this study illustrate that cancer stigma is still an issue faced by pediatric cancer patients and their families. It also illustrates that, although some aspects of stigma have been described and addressed in the literature through adult stigma studies, there are aspects of stigma for pediatric cancer patients specifically that should be addressed. The data gathered here can be used to develop interventions targeted towards cancer stigma for pediatric populations, to reduce cancer stigma and increase survival rates of pediatric cancer patients in Tanzania.
Item Open Access Protocol Compliance and the Use of mHealth to Reduce Pediatric Cancer Treatment Abandonment in Tanzania(2021) Joo, EmmaBackground: Low treatment compliance is a well-established barrier to survival for pediatric cancer patients, including those with Burkitt Lymphoma (BL). At Bugando Medical Center in Mwanza, Tanzania, an mHealth application, mNavigator, is being used to improve protocol compliance through algorithm-directed BL treatment. With the implementation of mNavigator and the rise of mHealth initiatives globally, there is a need to build evidence for the use of mHealth in improving protocol compliance, to encourage the use of mHealth in the pediatric BL context. Methods: A 21-section checklist was created based on the Tanzanian National Guidelines for BL treatment to systematically calculate protocol compliance. All patients <18 years of age diagnosed with BL at Bugando Medical Center in Mwanza, Tanzania from March 2016 to Feb 2021 were included in the evaluation. The patients were separated into a historic and prospective (intervention) cohort based on the introduction of mNavigator, in August 2019. The compliance scores were calculated and analyzed for each cohort using StataSE 16. Results and discussion: A total of 82 patients were analyzed in this study, 49 in the historic cohort and 33 in the intervention cohort. There was a significant 9.2% (p = 0.02) increase in the total compliance mean after the implementation of mNavigator (from 47% in the historic cohort to 56.2% in the intervention cohort). Most notable increases in provider protocol compliance were seen at proper staging at diagnosis and interim evaluation with 39.4% and 45.2% increases, respectively. Significant increases in provider protocol compliance were observed for every cycle of chemotherapy. Conclusion: The significant increases in protocol compliance in individual treatment sections and overall treatment after the implementation of mNavigator suggest the benefits of including mHealth in pediatric cancer treatment. The study limitations suggested the need for accurate data collection and outcome measurements. Additional studies are required to evaluate the impact of mNavigator on treatment outcomes.
Item Open Access The Barriers and Facilitators to Achieving Optimal Nutrition for Pediatric Oncology Patients in Tanzania: A Mixed Methods Analysis(2020) Raveendran, YadurshiniBackground: Each year, approximately 400,000 children are diagnosed with cancer with over 85% of new cases occurring in low- and middle-income countries (LMIC). Survival rates in LMIC are 25% compared to 85% in high-income countries (HIC). Undernutrition is a key factor contributing to this disparity. Children diagnosed with cancer are at a higher risk for undernutrition, especially in low resource settings, but nutritional status remains largely unrecognized and unmonitored in many pediatric oncology hospitals in LMICs. Study aims: This study aims to first, determine the prevalence and severity of undernutrition at diagnosis, and second, evaluate existing barriers and facilitators to optimal nutrition among children with cancer at a large specialty referral hospital in Mwanza, Tanzania.
Methods: A mixed methods approach was used including quantitative surveys, and semi structured interviews that were distributed to caregivers and medical providers for children with cancer treated at Bugando Medical Centre (BMC) from May to December 2019. Results: Quantitative surveys were completed by caregivers(n=65), with a sub group completing a second KAP survey (n=51). Both caregivers (n=10) and stakeholders (n=14) also completed in-depth qualitative interviews. Using Tanzanian nutrition guidelines, the majority of pediatric cancer patients (60%) were classified as undernourished and 78.4% of caregivers reported being food insecure. Key factors perceived to contribute to poor nutrition included 1) food insecurity; 2) lack of education; and 3) community support was reported as facilitator towards achieving optimal nutrition. Additionally, parents expressed interest in being involved in nutritional education and supplementation programs during treatment. Conclusions: The study addresses a major gap in understanding factors contributing to undernutrition among children with cancer in LMIC and provides strategy targets for future interventions and policies to promote nutrition for pediatric oncology patients in Tanzania.
Item Open Access The Impact of a Hostel on Outcomes for Pediatric Cancer Patients in Northern Tanzania(2019) Morgan, AustinBackground: There is a significant disparity in survival rates for pediatric cancer in low and middle-income countries compared to high-income countries. A variety of factors contribute to this disparity including late stage disease at presentation, high rates of abandonment of care, and lack of supportive care. In Mwanza, Tanzania, a residential hostel was created to reduce these barriers among patients being treated for childhood cancer at Bugando Medical Centre (BMC). This study explores the potential benefit of the hostel in terms of event free survival and quality of life and examines the barriers and facilitators for completing care and the perceptions of the hostel. Methods: The study had three major components. A medical record review was conducted for 229 patients who presented to BMC in 2016-17, looking at survival outcomes. Surveys were collected from patients and caregivers who presented in 2018. In-depth interviews were conducted to explore patient/caregiver experiences. Data was collected at BMC and was analyzed with survival curves, hazard models, logistic regression, t-tests and applied thematic analysis. Results: One-year EFS was not significantly different for patients who presented to BMC before the hostel opened compared to those that presented after the hostel opened. However, a proportional hazard model showed a significantly lower hazard for patients that stayed at the hostel compared to patients that did not. Participants that stayed at the hostel also scored significantly higher in emotional functioning compared to patients that did not stay at the hostel. In-depth interview participants highlighted barriers and facilitators for completing care and described the benefits of the hostel including psychosocial support and reduced financial burden. Conclusions: Higher one-year event free survival and better scores in emotional wellbeing were observed for patients that stayed at the hostel. Caregivers and patients shared positive perceptions of the hostel as a facilitator for completing care. Key supportive care programs such as a hostel can be beneficial for improving pediatric cancer outcomes in LMICs.