Factors Associated with Delayed Pediatric Cancer Diagnosis at Kigali University Teaching Hospital.

Abstract

Background Although no study has been done in Rwanda investigating delay in diagnosis of childhood cancer, early diagnosis is a fundamental goal as it allows time for treatment and prevent unnecessary complications. Our study determines the diagnosis delay and factors influencing the time to diagnosis at Kigali University Teaching Hospital (CHUK) Methods: This cross- sectional hospital based study included 100 children diagnosed with cancer at Kigali University Teaching Hospital from January 2018 to December 2018.The interval between symptoms onset and final diagnosis for each child was calculated. This was correlated by univariate and multivariate analyses with the child’s age at diagnosis, sex, type and site of malignancy, family residence, distance to health care facility, family size, socioeconomic status, parents’ age, parental educational level, qualification of the first healthcare provider consulted as well as duration of investigations at CHUK. Findings: The median total diagnosis delay was 34 days categorized into patients and/or parents related delay (12 days) and health system related delay (18 days). Statistically significant patients’ factors associated with delayed diagnosis were age of the child at diagnosis, large family size, low parental education, low socioeconomic status, consulting traditional healers, residence and geographical distance from home to primary health care. There is a moderate positive linear correlation between patient delay and both mother’s age and family size. The qualification of first health care provider consulted and duration of investigations at CHUK influenced health system related delay. Sex and parents’ age didn’t show any statistically significant influence on the delay. Malignancy type and tumor site significantly affected the time of diagnosis. The lowest median delay was associated with lymphomas (18 days) and leukemias (24 days). The highest delay was observed in children with osteosarcoma (54 days). Conclusion: There is a significant delay in diagnosis of childhood cancer at Kigali University Teaching Hospital. Education of parents and health workers on early warning signs of cancer and accurate diagnosis are recommended.