student research day - Case Western Reserve University School of ...

Jennifer L. Pfau
Barriers to early diagnosis and treatment for endemic Burkitt
Lymphoma in Kenya and Uganda
Jennifer L. Pfau, Jose S. Lozada, Juliana Otieno, Jackson Orem and Ann M. Moormann
Center for Global Health and Diseases
Case Western Reserve Univeirsity
Burkitt lymphoma (BL) was first described 50 years ago and remains the most prevalent paediatric cancer in
Equatorial Africa with an annual incidence of 2 per 100,000 children. BL is extremely responsive to chemotherapy
due to its high tumour proliferation index. The in-hospital survival rate for BL in Kenya and Uganda is nearly 70%
and is associated with early diagnosis and treatment. However, 38% of children are admitted to hospital in latestage
disease. In this study, we sought to identify reasons for delay in early diagnosis and treatment for children
with BL in Kenya and Uganda. Semi-structured key informant interviews were conducted with eight persons
involved in the care of children with BL in Kisumu, Kenya and Kampala, Uganda, including physicians, nurses, and
other supportive staff. This information was used to design a questionnaire administered to parents of children
with BL to determine their knowledge, attitude, and health care practices regarding their child’s illness. A
resonating theme was that few parents had heard of pediatric cancer and many of them believed their child had
been cursed or bewitched. Therefore parents initially sought treatment from traditional healers, witch doctors, or
spiritualists and only came to hospital after these treatments failed. Some parents reported that clinicians at first
misdiagnosed the tumor as a boil (or skin abscess) due to its rapid progression. Lack of money for transportation
and hospital fees was also commonly cited as a barrier to prompt treatment. With regard to cancer, many parents
believed that it was incurable. However, most parents changed their outlook as they saw their child and other
children improve with treatment while in hospital. In conclusion, this investigation identified numerous factors
that contributed to delays in prompt and appropriate care for children with BL. This information will in turn guide
campaigns to increase pediatric cancer awareness in the community and improve early diagnosis within the health
care setting. The ultimate goal is to increase the survival of children diagnosed with BL through improved
recognition of this disease, especially in countries where BL is most prevalent.
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