Metcalf Madeline, Kajoka Happiness D, Majaliwa Esther, Tupetz Anna, Staton Catherine A, Vissoci João Ricardo, Espinoza Pamela, Cotache-Condor Cesia, Rice Henry E, Mmbaga Blandina T, Smith Emily R
Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
Kilimanjaro Christian Medical University College, Moshi, Tanzania.
PLOS Glob Public Health. 2024 Dec 11;4(12):e0003503. doi: 10.1371/journal.pgph.0003503. eCollection 2024.
Pediatric cancer is a significant and growing burden in low- and middle-income countries. The objective of this project was to describe the factors influencing access to pediatric cancer care in Northern Tanzania using the Three Delays Model. This was a cross-sectional qualitative study conducted between June and August 2023 at Kilimanjaro Christian Medical Centre (KCMC). Using purposive sampling methods, caregivers of children obtaining pediatric cancer care at KCMC were approached for participation in in-depth interviews (IDIs) and a demographic survey. All IDIs were facilitated in Swahili by a bilingual research coordinator. Analysis utilized inductive and deductive coding approaches to identify dominant themes and sub-themes impacting access to pediatric oncology care. Data collection concluded once saturation was achieved at 13 IDIs, defined as the absence of new codes after three consecutive interviews. Participants reported significant financial barriers to accessing pediatric cancer care along the entire care continuum. In the first delay, themes included waiting for symptoms to resolve and the identification of initial symptoms. The most substantial delays occurred in delay 2, including health infrastructure at mid-level facilities, misdiagnoses, the referral system, travel, and traditional medicine. Participants did not describe 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. Financial support provided by the Tanzanian government was the only facilitator noted by participants. We suggest targeted interventions including 1) empowerment of CHWs and local traditional healers to advocate for earlier care seeking behavior, 2) implementation of clinical structures and training at intermediary medical centers aimed at earlier referral to a treatment facility, 3) incorporation of support and education initiatives for families of children with a cancer diagnosis. Lastly, national health plans should include pediatric cancer care.
儿科癌症在低收入和中等收入国家是一个日益严重的负担。本项目的目的是使用“三个延误模型”描述影响坦桑尼亚北部儿童癌症护理可及性的因素。这是一项于2023年6月至8月在乞力马扎罗基督教医疗中心（KCMC）开展的横断面定性研究。采用目的抽样方法，邀请在KCMC接受儿科癌症护理的儿童的照料者参与深入访谈（IDI）和人口统计学调查。所有IDI均由一名双语研究协调员用斯瓦希里语协助进行。分析采用归纳和演绎编码方法，以确定影响儿科肿瘤护理可及性的主要主题和子主题。在13次IDI达到饱和（定义为连续三次访谈后没有新代码）后结束数据收集。参与者报告称，在整个护理过程中，获取儿科癌症护理存在重大经济障碍。在第一个延误阶段，主题包括等待症状缓解和识别初始症状。最严重的延误发生在第二个延误阶段，包括中级医疗机构的卫生基础设施、误诊、转诊系统、交通和传统医学。参与者没有描述到达KCMC后的延误情况，而是阐述了他们对孩子癌症诊断的看法、接受护理时的担忧以及对未来的期望。参与者提到的唯一促进因素是坦桑尼亚政府提供的财政支持。我们建议采取有针对性的干预措施，包括：1）增强社区卫生工作者和当地传统治疗师的能力，以倡导更早寻求护理的行为；2）在中间医疗机构实施临床结构和培训，旨在更早转诊至治疗机构；3）为癌症诊断儿童的家庭纳入支持和教育举措。最后，国家卫生计划应纳入儿科癌症护理。
