Pdoc-09 Evaluation of Health Service Delays for Children With Central Nervous System Tumors at Bugando Referral Hospital Mwanza, Tanzania

Abstract OBJECTIVE Rapid diagnosis and treatment initiation is crucial for children with central nervous system tumors (CNS). Despite advancement in diagnostic modalities, health service delays persist in many LMICs. The current study evaluates the diagnostic and treatment delays experienced by children presenting to a zonal referral hospital in Mwanza Tanzania, with the goal of identifying breakpoints that can be addressed to improve quality of care through a multidisciplinary approach. METHODS All children age 18yrs with a diagnosis of a CNS tumor from 2020-2023 were included in the analysis. Data was extracted from hospital electronic medical system and clinical files and included demographics, diagnosis, and dates at first presentation to the hospital, diagnosis, surgical intervention, oncology presentation and treatment initiation. Treatment initiation included either surgical resection, chemotherapy or radiotherapy. RESULTS A total of 50 patients were included in the evaluation, with average age of 6.4yrs and equal M: F representation. Most of the cases (80%, n=40) were primary CNS tumors, with 20% metastatic disease. Low grade Glioma (LGG) and high-grade Glioma (HGG) tumors were similarly distributed (n=19, n=21). Among those who had a tumor resection, 56% (n=18) were completed before initial oncology evaluation. Delays were frequently experienced, with the average time from presentation to neurosurgery evaluation of 166 days, time to diagnosis of 121 days, time to oncology evaluation of 139 days, and time to treatment initiation of 127 days. 1yr overall survival for LGG was 67% (n=12/18) and 36% (n=8/22) for HGG, with a treatment abandonment rate of 38% overall (n=19/50). CONCLUSIONS There is significant delay in accessing services for patients presenting with CNS tumors. A multidisciplinary approach and social support of children with CNS tumor is necessary to facilitate early diagnosis and timely treatment to improve quality of care and leads to a higher survival rate.