Delay in diagnosis of cancer in Iraq: Implications for survival and health outcomes at Children’s Welfare Teaching Hospital in Baghdad

Abstract

BackgroundDecades of political and economic instability have taken a significant toll on health outcomes among children in Iraq. In a health system with optimal resources, five-year rates of survival for childhood cancer would exceed 80%; however, a study in Iraq demonstrated a much lower survival rate of 50%, reflecting a disrupted health care infrastructure. Under such conditions, it is a struggle to sustain good treatment outcomes. The aims of the present study are to: i) estimate the median time from initial presentation to diagnosis of childhood cancer at a tertiary center in Iraq; and ii) examine sociodemographic and clinical factors associated with delay in diagnosis in this vulnerable population. MethodsA cohort of 346 children presenting for cancer care between January 1-December 31, 2012 was included in the study. Data were obtained through structured interviews with caregivers and from medical charts. The median total delay in cancer diagnosis was calculated in addition to the median patient delay and physician delay. Factors associated with delay in diagnosis were also examined. ResultsThe majority of the patients were less than five years of age and 59% were boys. The median number of days from the onset of symptoms to diagnosis was 55 (range: 3-1,093). This was largely due to physician delay. Clinical factors associated with a longer delay to diagnosis included number of doctors visited, as well as tumor location and type. ConclusionsDespite recent advances in cancer treatment outcomes, there are persistent disparities between high-resource versus low-and middle-income countries in childhood cancer survival. Lack of access to care, medication shortages, and inadequate access to medical equipment fuel these disparities. Such factors contribute to delay in access to care and increased mortality risk for children suffering from cancer. The situation will continue unless action to improve access to quality care is taken at national and international levels.During the last several decades the health care infrastructure in Iraq has been seriously compromised as a result of war, economic sanctions, and political violence. 1 During the 1970s, Iraq had one of the more robust health care sys-tems in the Middle East, with 172 hospitals and 1,200 primary care clinics that provided free services through a public single-payer financing mechanism. 2 However, the first Gulf War (1980)(1981)(1982)(1983)(1984)(1985)(1986)(1987)(1988), i.e. the Iran-Iraq war, ushered in a Equal contribution author with Mazin F. Al-Jadiry. Equal contribution author with Widad Yadalla. a b Yadalla W, Al-Jadiry MF, Faraj SA, et al. Delay in diagnosis of cancer in Iraq: Implications for survival and health outcomes at Children's Welfare Teaching Hospital in Baghdad.

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