Barriers to care for newly diagnosed children with cancer from Bungoma County after an awareness campaign: insights from parental interviews and registry data

Abstract

Introduction: Children in low- and middle-income countries face barriers to timely access to cancer care. Between January and June 2023, an awareness campaign in Bungoma County, Kenya, aimed to address this issue. This study describes sociodemographic and clinical characteristics of children diagnosed with cancer after the campaign, explores health-seeking behaviors and delays, and compares cancer referrals pre- and post-campaign. Methods: Parental interviews were conducted for all children newly diagnosed with cancer from Bungoma County at Moi Teaching and Referral Hospital between January 2023 and December 2024 using structured questionnaires. Hospital registry data from January 2014 to December 2024 were analyzed to compare referrals pre- and post-campaign (2014-2022 versus 2023-2024). Results: Following the campaign, 30 children were diagnosed with cancer (40% female, median age 5.5 years). Diagnoses included hematological cancers (23%), solid tumors (60%), rare solid tumors (7%), and brain tumors (10%), with 57% of solid tumors presenting at advanced stages. Delays were substantial: the median patient-, physician-, diagnosis-, treatment-, health system-, and total delays were 30, 104, 114, 6, 114, and 146 days, respectively. Barriers included the use of traditional medicine, cultural beliefs, financial strain, travel costs, lack of insurance, income loss, and fear. Annual referral rate before and after the campaign (2014-2022 versus 2023-2024) showed no statistically significant difference (Chi-square test, p = 0.071; Fisher's exact test, p = 0.063). Conclusion: The campaign did not increase cancer diagnoses, highlighting ongoing barriers to timely access to childhood cancer care. Addressing these barriers is essential for improving access to childhood cancer care. Factors such as healthcare worker strikes, supply shortages, and treatment seeking at other facilities may have contributed to the lower-than-expected numbers.