Barriers to timely diagnosis and treatment of childhood cancer in Sub-Sahara Africa: a qualitative systematic review.
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BACKGROUND: Childhood cancers pose a significant public health challenge in sub-Saharan Africa (SSA) due to complex interlinked socioeconomic factors that contribute to delayed diagnoses, limited treatment options, and unacceptable survival rates. This systematic review aims to present insights into the barriers to receiving timely diagnosis and treatment of childhood cancers in SSA. METHODS: A systematic literature search was conducted for published full-text articles from January 2000 to June 2024 in SSA across three databases: PubMed, Google Scholar, and Web of Science. We used a qualitative synthesis approach to examine the barriers and reasons for delays in seeking, reaching, or receiving quality care. RESULTS: We identified 12 studies, of which 10 focused on all types of childhood cancer, retinoblastoma, and leukemia. When exploring barriers contributing to delays, eight key themes emerged from the data. The first theme was health service barriers, which included: poor cancer care and health system delays; lack of diagnostic and therapeutic services; and lack of childhood cancer policy. The second theme was healthcare provider-related barriers, which included inadequate knowledge of diagnosis and characterization; service burden and lack of training in cancer screening and diagnosis. The third to eighth themes were limited understanding of childhood cancer among the population (theme 3), financial challenges/household poverty (theme 4), emotional and psychological challenges (theme 5), poor healthcare-seeking behavior (theme 6), stigma and discrimination (theme 7), and limited social support and cultural beliefs (theme 8). CONCLUSIONS: Barriers that contributed to the delay in the timely diagnosis and treatment of childhood cancer were healthcare provider-related barriers, limited understanding of childhood cancer, financial challenges/household poverty, emotional and psychological challenges, poor healthcare-seeking behavior, stigma and discrimination, and limited social support and cultural beliefs. Therefore, targeted education campaigns, community outreach programs, and policy changes to mitigate these barriers and improve outcomes for children with cancer are important.