Socio-Economic Challenges in Childhood Cancer Care in a Low-Middle-Income Country

2021 ◽  
Vol 15 (6) ◽  
pp. 1234-1236
Author(s):  
A. Ahmad ◽  
A. Anjum ◽  
M. Hussain ◽  
A. A. Rasul ◽  
A. Mushtaq ◽  
...  
Keyword(s):  
Childhood Cancer ◽  
Treatment Center ◽  
P Value ◽  
Psychosocial Needs ◽  
Middle Income ◽  
Female Ratio ◽  
Children's Hospital ◽  
Middle Income Countries ◽  
Low Middle Income Countries ◽  
Children’S Hospital

Background: Each year, it is estimated that over 200 000 children and adolescents are diagnosed with cancer, and 80% of these reside in low-middle-income countries, with 90% mortality. There are enormous psychosocial needs of these patients, families, and care-givers, which are primarily affected by the communities' social, economic, cultural, and religious factors. Aim: To elucidate the significant psychosocial and socio-economic issues faced by the caregivers of children suffering from different types of cancer at the Children's Hospital Lahore. Study design: Prospective cohort study Place and duration of study: Department of Paediatric Hematology and Oncology, Children's Hospital Lahore Pakistan from 1st January 2018 to 30th June 2018 Methodology: Two hundred family members/caregivers of the patients were enrolled with ages ranging from <1 to 15 years (43% <5 years and 57% >5years old). Results: Male to female ratio was 1.2:1. 52% belonged to hematological malignancies and 48% from solid tumor groups. Most of these children had malnutrition with anemia (81% with Hb <10g%) and small weight forage in 63% cases at presentation. 80% of families had more than three children, with the youngest child being less than five years in 75%. 95% of families relied on public transport, with 65% of them traveling 100-500Km with 2-10 hours duration to reach the primary treatment center. 80% had a monthly income of less than USD150. 68% of these families had to borrow money for trip to hospital (p-Value=0.003), and 58% took a loan for treatment course. Conclusion: The significant socio-economic challenges faced by these families and caregivers included large family size with low incomes increasing their financial difficulties, logistic burden like traveling long distances to access health care, and parental employment and family dynamics disruptions. Keywords: Socioeconomic Challenges, Childhood Cancer, Low-Middle-Income Countries

scholarly journals 66. CLINICAL CHARACTERISTICS AND RESULTS OF PEDIATRIC SOLID TUMORS WITH BRAIN METASTASES: EXPERIENCE FROM A SINGLE REFERRAL CANCER CENTER

2020 ◽  
Vol 2 (Supplement_2) ◽  
pp. ii14-ii14
Author(s):  
Clarissa Aguilar ◽  
Víctor Toro ◽  
Rina Medina
Keyword(s):  
Brain Metastases ◽  
Childhood Cancer ◽  
Solid Tumors ◽  
Metastatic Disease ◽  
Cancer Center ◽  
Middle Income ◽  
Middle Income Countries ◽  
Pediatric Solid Tumors ◽  
Low Middle Income Countries

Abstract BACKGROUND 80% of childhood cancer are located in low- and middle-income countries (LMIC). The most common form of presentation is disseminated or metastatic disease. The rate of survival has not been equitable across the world, since in these countries only 1 of 5 children are cured. OBJECTIVE To evaluate the clinical and histopathological features of patients with metastatic pediatric solid tumors, in a single referral cancer center in Honduras. METHODS We conducted a retrospective review of patients diagnosed with pediatric solid tumors from January 2010 to April 2020. Among the 260 patients through a collection form, we obtained: sociodemographic characteristics, clinical presentation at diagnosis, common histological subtypes, sites of metastasis, treatment and outcome at the time of follow-up. RESULTS During the last 10 years, 260 cases of childhood cancer were referred to our center for treatment. 127 patients (48.8%), have a solid tumor, patients ranged in age from 1 to 18 years and distribution for sex were 38% for males and 62% females. At the time of initial diagnosis 40/127 (31%) have advanced disease (stages III and IV). We found brain metastases in 22/40 cases (55%), the primary cancer was localized at CNS in 13/22 (59%) and the most common extracranial tumors causing brain metastases were neuroblastoma (4/22), rhabdomyosarcoma (3/22), retinoblastoma (2/22). Currently in the follow-up there were 18/22 (82%) died and 4/22 (18%) are in treatment with palliative intent. CONCLUSION There is a lack of information about the epidemiology of brain metastases among children with solid tumors in the low/middle income countries (LMIC) where the prognosis of metastatic disease is very poor, despite efforts, multimodal therapy and multidisciplinary management, in absence of other options like bone marrow transplantation, and reliable access to high-quality medicines. For our countries, timely diagnosis is still the main determining factor for cure.

scholarly journals ORAL/ENTERAL NUTRITIONAL SUPPLEMENTATION IN CHILDREN TREATED FOR CANCER IN LOW-MIDDLE-INCOME COUNTRIES IS FEASIBLE AND EFFECTIVE: THE EXPERIENCE OF THE CHILDREN'S HOSPITAL MANUEL DE JESUS RIVERA "LA MASCOTA" IN NICARAGUA.

2018 ◽  
Vol 10 (1) ◽  
pp. e2018038 ◽  
Author(s):  
Nicolò Peccatori ◽  
Roberta Ortiz ◽  
Emanuela Rossi ◽  
Patricia Calderon ◽  
Valentino Conter ◽  
...  
Keyword(s):  
Solid Tumor ◽  
Nutritional Assessment ◽  
Malignant Tumors ◽  
Nutritional Intervention ◽  
Nutritional Supplementation ◽  
Middle Income ◽  
Children's Hospital ◽  
Low Middle Income Countries ◽  
Pediatric Cancer Patients ◽  
Children’S Hospital

Background and objectives. The prevalence of malnutrition in children diagnosed with malignant tumors in Nicaragua has been reported to be 67%. Thus, a nutritional program for children with cancer has been developed at the Children’s Hospital Manuel de Jesus Rivera (Managua, Nicaragua).Methods. A qualified nutritionist evaluated all patients and prescribed oral/enteral supplementation. The nutritional assessment was based on weight, height or length, mid upper arm circumference (MUAC) and triceps skin fold thickness (TSFT). In this descriptive study, pre and post-nutritional intervention data were compared and analyzed in terms of event free survival.Results. 104 patients (median age 7.0 years, 52 with leukemia/lymphoma and 52 with solid tumor) underwent oral/enteral nutritional supplementation; 64 of these patients had pre and post supplementation nutritional assessment. Overall, 55% of patients in the leukemia/lymphoma group and the 35% in the solid tumor group improved their condition or remained in an adequately nourished status.Conclusion. This experience demonstrates that nutritional supplementation in pediatric cancer patients who are inadequately nourished is feasible also in countries with limited resources and is effective in improving the nutritional conditions.

Burden of chemotherapy-induced febrile neutropenia in paediatric oncology in developing countries: The Children's Hospital Lahore Pakistan experience.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e22021-e22021
Author(s):  
Alia Ahmad
Keyword(s):  
Hospital Stay ◽  
Childhood Cancer ◽  
Low Income ◽  
Social Issues ◽  
P Value ◽  
Gastrointestinal Infections ◽  
Duration Of Symptoms ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Tract Infections

e22021 Background: The Oncology Department Of The Children’s Hospital Lahore is a 60 bedded unit providing free treatment to over 1000 new childhood cancer cases each year.The aim of this prospective study was to analyze the burden of chemotherapy induced FN and to assess the leading risk factors . Methods: Prospective review of 100 patients with FN admitted in July to August 2016 was done. Data regarding their age, sex, and clinical features, baseline CBC, course of therapy, hospital stay and understanding of caregivers regarding FN analyzed. Results: Total 100 patients with age ranging from < 1 to 15 years (67% < 5 yrs) were included.M: F Ratio was 1.7:1, 72% of cases had ALL and 28% with solid tumors. 28% had last chemotherapy received in 72 hours, 30% in last week and rest in more than a week time 36% had respiratory tract infections, 18% gastrointestinal infections, 20% mucositis, 10% no focus found and rest 16% had other manifestations Only 2 % presented in < one hour of start of symptoms, 27% < 24 Hours, 61% in < 5 Days and 10% > 5 days duration of symptoms. 45% had Hb < 8 gm%, 33% had platelets < 50000, and 54% had WBC < 1000 and 63% had ANC <100 (p-Value = 0.003- Hospital Stay). 29% presented with first episode while 51 % had 3 or more FN episodes.28% cases stayed 1 hour distance from CHL while 72% had to travel > 1-5 hrs to reach the primary treatment center. 66% received paracetamol at home, 17 had oral antibiotics while 17% had no treatment before reached PTC. Only19% caregivers had adequate awareness regarding FN, 72% had some understanding while 9% had no knowledge about FN (p-value = 0.000). 40% had social issues, 41% were unaware while 13% showed negligence in seeking treatment .46% stayed for 5 days and 48% for more than 5 days. 21% patients had increased doses of oral chemotherapy not adjusted timely according to CBC. Conclusions: Health educationof caregivers and health professionals is of utmost importance to prevent and manage FN effectively. Need of capacity building in pediatric oncology in low income countries along with sustainable social support is essential for provision of standard childhood cancer care and implementation of effective infection control measures.

scholarly journals Cost and Cost-Effectiveness of Childhood Cancer Treatment in El Salvador: A Collaborative Budget Model

2017 ◽  
Vol 3 (2_suppl) ◽  
pp. 19s-19s
Author(s):  
Soad Fuentes-Alabi ◽  
Roberto Franklin Vasquez ◽  
Nickhill Bhakta ◽  
Carlos Rodriguez-Galindo ◽  
A. Lindsay Frazier ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Childhood Cancer ◽  
El Salvador ◽  
Cost Effective ◽  
Treatment Center ◽  
Model Framework ◽  
Budget Model ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
The Cost

Abstract 32 Background: Cure rates for childhood cancer in El Salvador (ES) have increased from 5% in 1991 to 68% today as a result of national and international support. Approximately 200 new cases of pediatric cancer are diagnosed annually in ES—all are treated centrally at the National Children’s Hospital Benjamin Bloom. The cost of childhood cancer treatment in low- and middle-income countries (LMICs), such as ES, has not been well investigated. Such data are integral to inform national childhood cancer treatment plans. We undertook this work to determine the cost of operating a national childhood cancer treatment center in ES and to provide an analytic model framework for similar cost analyses in other LMICs. Methods: We conducted a cross-sectional study to evaluate the cost of childhood cancer treatment covered by a collaborative budget model in ES. We calculated costs on the basis of annual cases diagnosed and admitted to National Children’s Hospital Benjamin Bloom, and captured supportive expenses for families that are essential to reducing abandonment. Cost-effective analyses were performed and compared with traditional thresholds. Results: Initial estimates indicate an annual total operating budget of $5.3 million to treat 200 new cases annually. When combined with current survival outcomes, this represents a cost-effective model using WHO-CHOICE thresholds. Conclusion: Providing the first such comprehensive, institution-based estimate for the cost of treatment of childhood cancer in LMICs, we show that a childhood cancer treatment center represents a cost-effective intervention. This baseline information can be used to prioritize future treatments and interventions in ES. This methodology also allows similar studies to be conducted in other LMICs. Together, these data will inform a case for investment in global access to childhood cancer treatment. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Soad Fuentes-Alabi No relationship to disclose Roberto Franklin Vasquez No relationship to disclose Nickhill Bhakta No relationship to disclose Carlos Rodriguez-Galindo Honoraria: Novimmune A. Lindsay Frazier Consulting or Advisory Role: Decibel Therapeutics Rifat Atun No relationship to disclose Sumit Gupta No relationship to disclose Susan Horton No relationship to disclose

scholarly journals Establishing a Pediatric Hematology-Oncology Program in Botswana

2018 ◽  
pp. 1-9 ◽  
Author(s):  
Jeremy S. Slone ◽  
Amanda K. Slone ◽  
Oaitse Wally ◽  
Pearl Semetsa ◽  
Mpho Raletshegwana ◽  
...  
Keyword(s):  
Pediatric Cancer ◽  
Patient Characteristics ◽  
Baylor College ◽  
Blood Disorders ◽  
Middle Income ◽  
Children's Hospital ◽  
Pediatric Hematology ◽  
Middle Income Countries ◽  
Histopathologic Diagnosis ◽  
Children’S Hospital

Purpose Annually, 300,000 children are diagnosed with cancer, and the majority of these children live in low- and middle-income countries (LMICs). Currently, there is incomplete information on pediatric cancer incidence, diagnosis distribution, and treatment outcomes in Africa. Since 2007, a pediatric hematology-oncology program has been operating in Botswana through a partnership between the Botswana government, Baylor College of Medicine, and Texas Children’s Hospital. Methods To better understand patient characteristics and outcomes at Botswana’s only pediatric cancer program, a hospital-based data base—the Botswana Pediatric Oncology Database—was established in 2014. Children younger than 18 years of age at the time of diagnosis who presented between 2008 and 2015 were included. Data for this study were extracted in February 2016. Results Of the 240 potential enrollees, 185 (77%) children met eligibility for this study. The median age was 6.4 years, and 50.8% were male. Leukemia was the most common malignancy representing 18.9% of the cohort and 88.1% of the total cohort had a histopathologic diagnosis. HIV seropositivity was confirmed in 13.5%. The 2-year overall survival of all pediatric cancer diagnoses was 52.4%. Abandonment of treatment occurred in 3.8% of patients. Conclusion In the first 9 years of the program, capacity has been developed through a longstanding partnership between Botswana and Baylor College of Medicine/Texas Children’s Hospital that has led to children receiving care for cancer and blood disorders. Although continued improvements are necessary, outcomes to date indicate that children with cancer in Botswana can be successfully diagnosed and treated.

The Impact of Covid 19 on Pregnant Women and Child Health

2020 ◽  
Vol 11 (SPL1) ◽  
pp. 1367-1373
Author(s):  
Nikhil Sanjay Mujbaile ◽  
Smita Damke
Keyword(s):  
Social Issues ◽  
Middle Income ◽  
Web Based ◽  
Middle Income Countries ◽  
Low Middle Income Countries ◽  
The Social ◽  
Social Separation ◽  
The Impact ◽  
And Child Health ◽  
General Wellbeing

The Covid illness (COVID-19) pandemic has spread rapidly all through the world and has had a drawn-out impact. The Pandemic has done incredible damage to society and made genuine mental injury to numerous individuals. Mental emergencies frequently cause youngsters to deliver sentiments of relinquishment, despondency, insufficiency, and fatigue and even raise the danger of self-destruction. Youngsters with psychological instabilities are particularly powerless during the isolate and colonial removing period. Convenient and proper assurances are expected to forestall the event of mental and social issues. The rising advanced applications and wellbeing administrations, for example, telehealth, web-based media, versatile wellbeing, and far off intuitive online instruction can connect the social separation and backing mental and conduct wellbeing for youngsters. Because of the mental advancement qualities of youngsters, this investigation additionally outlines intercessions on the mental effect of the COVID-19 Pandemic. Further difficulties in Low Middle-Income Countries incorporate the failure to actualize successful general wellbeing estimates, for example, social separating, hand cleanliness, definitive distinguishing proof of contaminated individuals with self-disconnection and widespread utilization of covers The aberrant impacts of the Pandemic on youngster wellbeing are of extensive concern, including expanding neediness levels, upset tutoring, absence of admittance to the class taking care of plans, decreased admittance to wellbeing offices and breaks in inoculation and other kid wellbeing programs. Kept tutoring is critical for kids in Low Middle-Income Countries. Arrangement of safe situations is mainly testing in packed asset obliged schools. 

Risk Factors of Mortality Among Patients with Stroke in Low Middle-Income Countries:  A Series of 180 Patients

2020 ◽  
Author(s):  
Larrey Kamabu ◽  
Hervé Monka Lekuya ◽  
Bienvenu Muhindo Kasusula ◽  
Nicole Kavugho Mutimani ◽  
Louange Maha Kathaka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Middle Income Countries

scholarly journals Triaging and adaptations of surveillance of cancer services in the COVID pandemic

2020 ◽  
pp. 1-3
Author(s):  
Shirley Lewis ◽  
Lavanya Gurram ◽  
Umesh Velu ◽  
Krishna Sharan
Keyword(s):  
Cancer Patients ◽  
Clinical Examination ◽  
Cancer Care ◽  
Middle Income ◽  
Face To Face ◽  
Middle Income Countries ◽  
Cancer Services ◽  
Low Middle Income Countries

Abstract Introduction: Coronavirus disease (COVID-19) has significantly challenged the access to cancer care and follow-up for a patient with cancer. Methods: Based on published literature and our experiences, it is reasonable to presume that clinical examination and follow-up visits have been significantly curtailed worldwide in order to adhere to the new norms during the pandemic. Although telephonic and telemedicine consultations may help bridge a few gaps, completely dispensing with in-person consultation has its challenges, especially in low middle-income countries. Telephonic consultations could facilitate triaging of ambulatory cancer patients and allocation of face-to-face consultations for high priority patients. Conclusions: We propose a telephonic consultation-based triaging approach for ambulatory cancer patients in order to identify those needing in-hospital consultations.

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