What type of study is this?

This is a Mixed-Methods study (also classified as: Qualitative Study).

February 14, 2026BMC Cancer0 citationsOpen Access

Prevalence and factors associated with delayed surgery among children with Wilms tumor at Mulago Hospital: a mixed-method study

DLDaniel LuleMakerere University SNShamim NabiddaMulago School of Nursing and Midwifery AMAbraham MuhweziMbarara University of Science and Technology

Key Points

To determine the prevalence and factors associated with delayed surgery among children with Wilms tumor.
Mixed-methods design incorporating quantitative and qualitative components
Retrospective cross-sectional design analyzed 261 patient records
Modified Poisson regression assessed associated factors
In-depth interviews conducted with healthcare workers and caregivers
Inductive thematic analysis used for qualitative data
Prevalence of delayed surgery was 63.6%
Year of diagnosis, tumor laterality, and hemoglobin levels associated with delays
Qualitative analysis revealed systemic and patient-level barriers to timely surgery
Chemotherapy regimen also influenced surgical delays

Abstract

Wilms tumor (WT) is a highly treatable form of childhood cancer, with five-year survival rates greater than 90% in high-income countries. In low- and middle-income countries, survival is still low. Delayed surgery is one of the leading factors for poor survival, as it leads to tumor complications, making subsequent treatment more complex. However, there is a paucity of information in Uganda on the prevalence and factors associated with delayed surgery. This study aimed to determine the prevalence and factors associated with delayed surgery, and to explore the barriers and facilitators of timely surgery among children with WT at Mulago Hospital. The study employed a convergent concurrent mixed-methods design. The quantitative component involved a retrospective cross-sectional design using 261 patient records selected through consecutive sampling and reviewed via a data abstraction tool. Modified Poisson regression was used to assess associated factors. The qualitative component included in-depth interviews with 10 healthcare workers and 10 caregivers selected purposively and was analyzed via inductive thematic analysis. The prevalence of delayed surgery was 63.6% (95% confidence interval (CI) 57.0-68.7). The year of diagnosis (2021: adjusted prevalence ratio (aPR) 2.26, 95% CI 1.40–3.65, p value 0.001; 2022: aPR 1.78, 95% CI 1.07–2.99, p value 0.026; and 2023: aPR 2.01, 95% CI 1.24–3.25, p value 0.004), tumor laterality (aPR 1.41, 95% CI 1.07–1.85, p value 0.014), hemoglobin level after preoperative chemotherapy (POPC; aPR 1.22, 95% CI 1.05–1.51, p value 0.032), and chemotherapy regimen (VAD: aPR 1.32, 95% CI 1.11–1.57, p value 0.02; and AV/CE: aPR 1.46, 95% CI 1.07–1.99) were associated with delayed surgery. Qualitative findings revealed systemic, patient-level, chemotherapy, and tumor-related barriers to and facilitators of timely surgery. The prevalence of delayed surgery was high among children with WT. Delayed surgery results from a complex interplay of clinical, systemic, and patient-related factors. Addressing barriers at both the institutional and patient levels may help reduce surgical delays and improve outcomes.

Ask AI

Helpful

Bookmark

View Full Paper