Socioeconomic constraints to effective management of Burkitt's lymphoma in south‐eastern Nigeria

Abstract

Summary This paper presents health outcomes and associated socioeconomic factors of 41 children admitted to a tertiary care institution in south‐east Nigeria with Burkitt's lymphoma (BL) between 1987 and 2004. BL responds well to chemotherapy and does not pose a significant threat to health in industrialized nations. However, in resource‐poor settings where it is endemic, socioeconomic factors significantly affect access to care for affected children, making this readily treatable condition a cause of considerable distress and early death in affected children. Half of the children reported in this paper presented with late stage disease. Although laboratory facilities were available, they were not accessible to all the children. Nearly a quarter of parents of these children could not afford the cost of confirmatory tests, and about a fifth (n = 8; 19.5%) of the children received no chemotherapy because of their parents’ inability to pay. Only 21 of 41 children (51.2%) remained on treatment long enough (at least 12 weeks) to enable them to be confirmed either as short‐term cure (n = 9; 64.3%), or as early relapse (n = 2; 4.9%). Owing to financial constraint, 13 of the parents (31.7%) withdrew their children against medical advice (n = 7; 17.1%) or left the hospital (n = 6; 14.6%). To address the challenge posed by these factors, we call for the establishment of a regional BL programme in Africa to help establish a critical mass of resources (human and material) to facilitate the development of an effective and accessible control programme in the region.

Childhood malignancies in University of Abuja Teaching Hospital Gwagwalada, Abuja, Nigeria.

“…2,[11][12] As in other studies [1][2][3][4][5][6]14 late presentations with advanced disease compounded by delays in establishing a diagnosis and starting treatment were also problems encountered in management in this study.…”

“…[1][2][3][4][5][6][7]12 These numbers are considerably lower however than the number of new cases per year seen in some developed countries. 8,9 The existence of a National cancer registry in those countries helps greatly to kept accurate statistic of the disease burden.…”

“…Poverty, ignorance and superstition and poorly equipped health facilities are factors that continue to contribute to the poor outcome of patients with this disease. 1,2,3 In Nigeria, the management of cancers is still froth with the problems of poor diagnostic facilities, high cost of drugs, coupled with ignorance, late presentation and poverty leading to continuing poor patient outcome. Furthermore, there are few paediatric oncologists and cancer research and treatment units which makes cancer care a problem for the general practice paediatrician.…”

Childhood cancer in Côte d’Ivoire, 1995 - 2004 – challenges and hopes

“…Similar effects of such economic constraints have been described in detail in a study from Nigeria. 16 In 2004 the Paediatric Hematology Oncology Unit in Cote d'Ivoire joined the GFAO group. 17 As a result, chemotherapy is now free of charge, treatment follows established protocols, and access to radiological investigations has been opened.…”

Celebrating treatment completion in sub-Saharan Africa

“…Despite much effort-which include patient-centred counselling, 2 fee coverage, 3 attentiveness to nutritional status, 4 social support, 5 infrastructure develop ments, 6 gradual adaptation of treatment regimens with decreased toxicity, 7,8 and collabor ative partnerships 9 -the rates of treatment completion remain low, with reported abandonment rates of 40-50%. [10][11][12][13] I recently visited a twinning site in sub-Saharan Africa on the day of a patient's treatment completion. Treatment completion in this region is all too rare and seemingly cherished as a gift, quite timely as we enter the holiday season.…”