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BACKGROUND: Late presentation of childhood cancers is prevalent across several Sub-Saharan African countries, including Uganda, and is largely driven by delays in diagnosis. These delays often result in disease progression and poorer clinical outcomes. However, data on diagnostic timelines and the underlying factors contributing to these delays remain limited in Uganda. This study aimed to estimate the median duration from initial symptom recognition to confirmed diagnosis and to explore the determinants of diagnostic delays among pediatric cancer patients at Mulago National Referral Hospital in Uganda. METHODS: This mixed-methods study combined quantitative and qualitative data collection approaches. The quantitative component involved reviewing records of children diagnosed with leukemia or lymphoma at the hospital's Pediatric Hematology Oncology department between February 2019 and June 2023. In the qualitative component, six key informant interviews and four focus group discussions were conducted with health workers and caregivers of children diagnosed with cancer. Quantitative data were collected using a tool in Open Data Kit, then analyzed using descriptive statistics, and Kaplan Meier curves. Qualitative data were analyzed through thematic analysis. RESULTS: We analyzed records of 387 pediatric cancer patients, of whom 65.4% (253/387) were male. The median age at diagnosis was 8 years (interquartile range IQR: 4.7-11.7 years). The overall median duration from symptom onset to diagnosis was 47 days. Among specific cancer types, the median time to diagnosis was 31 days (IQR: 16-85 days) for leukemia and 68 days (IQR: 32.3-175.8 days) for lymphoma. Qualitative data identified several factors contributing to diagnostic delays, including caregiver-related challenges-such as limited knowledge, financial constraints, suboptimal health-seeking behaviors, and cultural beliefs-and health system barriers, including insufficient provider expertise, misdiagnoses, limited diagnostic infrastructure, and weak referral pathways. CONCLUSION: The median time to diagnosis among pediatric cancer patients was prolonged, largely attributable to suboptimal caregiver health-seeking behaviors, limited awareness among both caregivers and healthcare providers, inadequate diagnostic capacity, and inefficient referral systems. Targeted interventions to address these barriers are essential to enhance timely diagnosis and initiation of treatment, thereby improving clinical outcomes for children with cancer.
Nakabiri et al. (Wed,) studied this question.