Abstract:
Background: Acute myeloid leukemia (AML) and acute lymphoblastic leukemia
(ALL) are hematological malignancies characterized by clonal expansion of myeloid
(AML) or lymphoid (ALL) blasts in the bone marrow, blood or other tissue.
Epidemiological information of acute leukemia (ALL and AML) in Sub-Saharan
Africa is scarce; available information is usually based on extrapolated data from
other regions. The number of reported cases of ALL and AML in Rwanda is even
lower than expected, when comparing with the extrapolated data for Rwanda. This
low reporting rate may be due to factors specific to the patients or their families, to
the health system itself and/or healthcare professionals and infrastructure. The aim of
this study was to explore challenges associated with the timely diagnosis, therapy
and good prognosis of acute leukemia in Rwanda.
Methods: This is a qualitative study using phenomenological approach. It involved
41 participants including patients, patients’ guardians and key informants, that is,
physicians from district hospitals and specialists in different fields from referral
hospitals, as well as directors from Rwanda Biomedical centres (RBC). In-depth
interview was done; we used thematic analysis to analyse the data. Ethical clearance
was obtained before starting the data collection.
Results: The identified barriers to healthcare seeking behaviors, on the side of
patients and their families, are poor knowledge usually causing them to consult
traditional healers, financial constraints such as covering co-payment fees and
transport costs to the diagnosis and treatment sites. Moreover, there is a tedious
referral system that can lead to the loss of some patients before diagnosis.
Furthermore, healthcare professionals in referral hospitals ascertain to receive most of
patients at end stage. The existing diagnostic facilities are not used in a way that
speeds up the diagnosis. ALL therapy in Rwanda uses only chemotherapy; bone
marrow (BM) transplantation is not available. Palliation is the only available option
for AML treatment in Rwanda.
Conclusion: ALL and AML exist in Rwanda, though under-reported. This underreporting is due to patients’ factors, tedious referral system and sub-optimal existing
diagnostic capacities. This affects negatively the outcome. All these, together with
the existing therapeutic options, need to be improved.
