“It’s his cheerfulness that gives me hope”: A Qualitative Analysis of Access to Pediatric Cancer Care in Northern Tanzania

ABSTRACT Background Pediatric cancer is a significant and growing burden in low- and middle-income countries. The objective of this project was to describe the factors influencing access to pediatric cancer care in Northern Tanzania using the Three Delays Model. Methods This was a cross-sectional qualitative study conducted between June and September 2023 at Kilimanjaro Christian Medical Centre (KCMC). Parents and caregivers of children obtaining pediatric cancer care at KCMC were approached for participation in in-depth interviews (IDIs) and a demographic survey. All IDIs were facilitated in Swahili by a bilingual research coordinator. Thirteen IDIs and surveys were completed during the study period. Analysis utilized inductive and deductive coding approaches to identify dominant themes and sub-themes impacting access to pediatric oncology care. Results Participants reported significant financial barriers to accessing pediatric cancer care along the entire care continuum. Early delays were impacted by waiting for symptoms to resolve or worsen. The most substantial delays resulted from health infrastructure at mid-level health facilities, misdiagnoses, and delayed referral to KCMC for treatment. Participants did not describe delays after arrival to KCMC and rather offered perspective on their child’s cancer diagnosis, their concerns while obtaining care, and their hopes for the future. Financial support provided by the Tanzanian government was the only facilitator noted by participants. Conclusions We suggest targeted interventions including 1) empowerment of CHWs and local traditional healers to advocate for earlier care seeking behavior, 2) implementation of clinical structures and training at intermediary medical centers aimed at earlier referral to a treatment facility, 3) incorporation of support and education initiatives for families of children with a cancer diagnosis. Lastly, we suggest that national health plans include pediatric cancer care.