"It's his cheerfulness that gives me hope:" A Qualitative Analysis of Access to Pediatric Cancer Care in Northern Tanzania

Abstract

Background:Pediatric cancer is a significant and growing burden in low- and middle-income countries such as Tanzania. The objective of this project was to describe the barriers and facilitators to accessing pediatric cancer care in Northern Tanzania using the Three Delays Model Methods:This was a cross-sectional qualitative study conducted between June and September 2023 at Kilimanjaro Christian Medical Center (KCMC). Parents and caregivers of children obtaining pediatric cancer care at KCMC were approached for participation in in-depth interviews (IDIs) and complimentary demographic surveys. This study is part of an ongoing collaboration between researchers from Duke Global Health Institute at Duke University and KCMC.Results:Participants suggested significant financial barriers to accessing pediatric cancer care along the entire care continuum. Early delays were impacted by waiting for symptoms to resolve and the use of traditional medicine. Additional delays resulted from health infrastructure at mid-level health facilities, misdiagnoses, and delayed referral to KCMC for definitive treatment. Participants did not describe clinical delays after arrival to KCMC and rather offered perspective on their child’s cancer diagnosis, their concerns while obtaining care, and their hopes for the future.Conclusions: The most significant clinical delays occurred within Delay 1 (the decision to seek care) and Delay 2 (reaching a medical facility). Advancements in clinical infrastructure and training at intermediary medical centers should be considered to support the prompt diagnosis and treatment for pediatric cancer. Lastly, financial and social schemes which limit out-of-pocket expenses should be considered.