Establishing a Pediatric Hematology-Oncology Program in Botswana

Abstract

PurposeAnnually, 300,000 children are diagnosed with cancer, and the majority of these children live in low- and middle-income countries (LMICs). Currently, there is incomplete information on pediatric cancer incidence, diagnosis distribution, and treatment outcomes in Africa. Since 2007, a pediatric hematology-oncology program has been operating in Botswana through a partnership between the Botswana government, Baylor College of Medicine, and Texas Children’s Hospital.MethodsTo better understand patient characteristics and outcomes at Botswana’s only pediatric cancer program, a hospital-based data base—the Botswana Pediatric Oncology Database—was established in 2014. Children younger than 18 years of age at the time of diagnosis who presented between 2008 and 2015 were included. Data for this study were extracted in February 2016.ResultsOf the 240 potential enrollees, 185 (77%) children met eligibility for this study. The median age was 6.4 years, and 50.8% were male. Leukemia was the most common malignancy representing 18.9% of the cohort and 88.1% of the total cohort had a histopathologic diagnosis. HIV seropositivity was confirmed in 13.5%. The 2-year overall survival of all pediatric cancer diagnoses was 52.4%. Abandonment of treatment occurred in 3.8% of patients.ConclusionIn the first 9 years of the program, capacity has been developed through a longstanding partnership between Botswana and Baylor College of Medicine/Texas Children’s Hospital that has led to children receiving care for cancer and blood disorders. Although continued improvements are necessary, outcomes to date indicate that children with cancer in Botswana can be successfully diagnosed and treated.

Factors influencing diagnostic delays of pediatric cancers in Botswana

“…Of the 69 patients for which a time to diagnosis could be calculated, 38 (55%) were male, 60 were under the age of 13 at diagnosis (87%), and 55 lived outside the greater Gaborone area where PMH is located (80%). This is consistent with the larger BPOD cohort analysis recently published which found that out of the total cohort of 185 patients, 95 (50.8%) males, the median age was 6.4 (3.1‐10.5), and 138 lived outside the greater Gaborone area where PMH is located (74.6%) …”

“…Medical care in Botswana is provided to all citizens at the government facilities as part of a nationalized health system. PMH, located in the capital of Gaborone, is the main government referral hospital and the only comprehensive cancer and blood disorders center for children in Botswana …”

“…PMH, located in the capital of Gaborone, is the main government referral hospital and the only comprehensive cancer and blood disorders center for children in Botswana. 5…”

“…In an effort to curb this survival disparity in Botswana, the Botswana Ministry of Health and Wellness (MOHW), Baylor College of Medicine (BCM), Texas Children's Hospital (TCH), the Botswana‐Baylor Children's Clinical Centre of Excellence, and the Baylor International Pediatric AIDS Initiative at Texas Children's Hospital (BIPAI) developed a comprehensive pediatric hematology‐oncology (PHO) program at Princess Marina Hospital (PMH), the country's largest referral hospital. In addition to stationing a pediatric hematologist‐oncologist at PMH since 2007, the program, part of TCH's Global Hematology‐Oncology Pediatric Excellence (HOPE) initiative, has provided training opportunities for healthcare providers to increase the local capacity . However, a major barrier faced in Botswana and other LMICs in treating childhood cancer is timely access to care.…”

“…addition to stationing a pediatric hematologist-oncologist at PMH since 2007, the program, part of TCH's Global Hematology-Oncology Pediatric Excellence (HOPE) initiative, has provided training opportunities for healthcare providers to increase the local capacity. 5,6 However, a major barrier faced in Botswana and other LMICs in treating childhood cancer is timely access to care. The specific characteristics and causes of delayed presentation of pediatric cancer in LMICs remain variable.…”