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[Retinoblastoma in Malawi: why are admissions too late?]
M Schulze Schwering1, M Gandiwa, G Msukwa
1College of Medicine, University of Malawi, P Bag 360, Blantyre 3, Blantyre, Malawi, mssoculus@web.de.
Insights
Most childhood retinoblastoma cases in Malawi present late due to delays in diagnosis and treatment. Improving education and providing free transport could significantly improve outcomes for these non-painful eye diseases.
Area of Science:
- Ophthalmology
- Pediatric Oncology
- Public Health
Context:
- 82% of retinoblastoma admissions in Malawi presented with advanced disease.
- Delays in presentation are common for non-painful childhood eye conditions.
Purpose:
- To investigate reasons for delayed presentation of retinoblastoma in Malawian children.
- To compare delays in cancer patients with those of other serious pediatric eye conditions.
Summary:
- Delays primarily occurred at the family and primary health center levels.
- Lack of transport funds contributed to delays across all care levels.
- Children with painful conditions presented earlier and without transport concerns.
Impact:
- Educational interventions, like poster campaigns, are needed for parents and healthcare professionals.
- Free transport services for affected children are recommended.
- Improvements in diagnosis, referral, and management within the tertiary healthcare system are necessary.
Background:
A total of 82 % of stationary admissions with the diagnosis of retinoblastoma (2009-2011) to the tertiary ophthalmology unit in Blantyre, Malawi (n = 58) presented with advanced stage disease.
Patients And Methods:
In another study in 2012 we sought to identify why children mostly presented in advanced stages of disease and whether the delay was unique to children with cancer. In-depth interviews (IDI) were conducted at the hospital with 40 parents or guardians of children with retinoblastoma, congenital cataract, congenital glaucoma and corneal perforation (10 each).
Results:
Most delays and delayed admissions occurred at the family (27.5 %, 11 out of 40) and primary health centre levels (30.0 %, 12 out of 40). Lack of money for transport caused delays (15.0 %, 6 out of 40) at all care levels. In contrast, children with painful conditions presented to a health facility within 24 h of onset without any complaints about lack of money for transport.
Conclusion:
Education about retinoblastoma and other non-painful eye diseases could be improved by a poster campaign to both parents and professionals at all medical healthcare levels. Transport for such cases between the various healthcare centers should be provided free of charge. There is room for improvement in initial diagnosis, referral and management within the healthcare service in the tertiary sector.
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