Presentation and Types of Childhood Cancer at the Muhimbili National Hospital (MNH), 2023

Presentation and Types of Childhood Cancer at the Muhimbili National Hospital (MNH), 2023 | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 5 May 2025 V1 Latest version Share on Presentation and Types of Childhood Cancer at the Muhimbili National Hospital (MNH), 2023 Authors : Malaz Adam Ali Salih Arga 0009-0008-9911-9066 [email protected] , Rehema H. Laiti , Ghada Abd El-Raheem 0000-0001-5668-0859 , and Yasar Hammor Authors Info & Affiliations https://doi.org/10.22541/au.174644501.14893606/v1 358 views 122 downloads Contents Abstract Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract BACKGROUND In sub-Saharan Africa, particularly in Tanzania, the incidence of childhood cancer is 1.4 per 100,000 cases. Many cancer cases in Tanzania are not diagnosed until later stages because limited healthcare institutions are offering cancer-related care and treatment. When cancer manifests in its later stages, it not only reduces the chances of survival but also places a heavy burden on the healthcare system. As a lower-middle-income country, Tanzania faces numerous barriers to providing treatment for childhood cancers. This research aims to study the clinical presentation and types of childhood cancers at Muhimbili National Hospital. By investigating the types of childhood cancers commonly diagnosed and their clinical presentations, the study will provide valuable insights into the challenges of early diagnosis and treatment. The findings could help identify strategies to improve cancer care in Tanzania, ultimately improving survival outcomes and reducing the strain on the healthcare system. METHODS A hospital-based cross-sectional survey using a convenience sampling technique was conducted to assess the presentation and associated factors of childhood cancer. Descriptive statistics were used, and associations among variables were analyzed using the Chi-square (χ 2 ) test and one-way ANOVA, A p-value of <0.05 was considered statistically significant. RESULTS A total of 141 patients were assessed. The most common types of cancer among children aged 1 to 5 years were blastoma and leukemia. The Sukuma tribe had the highest percentage of patients, and most cases were from Dar es Salaam. The majority of patients presented with masses and abdominal distention. There was a statistically significant association between family history of cancer and the type of cancer, as well as between disease stage and treatment response. Additionally, a significant difference was observed in age distribution across cancer types. However, no statistically significant association was found between the type of cancer and a history of chronic illness or exposure. CONCLUSION Childhood cancer has a high mortality and morbidity rate in Tanzania. Most patients die before the age of five, and many arrive at the hospital with late-stage disease and severe symptoms. Additionally, some patients do not complete treatment, possibly due to financial difficulties or a low level of education among caregivers. Presentation and Types of Childhood Cancer at the Muhimbili National Hospital (MNH), 2023 1\ Malaz Adam Ali Salih Arga*, Facilaty of medicine University of Medical Science and Technology E-mail: [email protected] , City: Kigali, Country: Rwanda, E-mail: [email protected] . City: Egypt, Country: Ciro, Phone number: +201151295670. 2 Dr. Rehema H. Laiti, Pediatric department , Senior Medical Specialist, Head of the pediatric oncology unit Muhimbili National Hospital (MNH), and Tel: +255 222153679 E-mail: [email protected] . P.O Box: 65000 City: Dar es Salaam, Country: Tanzania, E-mail: [email protected] . Phone number: +255767253008 3\ Dr. Ghada Omer Hamad Abd El Raheem, Pharmacy Department , American Board Certified Critical Care Clinical Pharmacist, Imperial Specialized Hospital, Alsharif Alhindi street, Khartoum, Sudan. Tel: +249 183 773861. E-mail: [email protected] . City: 11114-Khartoum, Country: 79371-Sudan. E-mail: [email protected] . Phone number: +249 922562830 / +249 902623636 4\ Dr. Yasar Hammor, Oncology Department , Consultant Medical Oncologist, St Vincent’s University Hospital, Ass. Professor, University College Dublin (UCD) E-mail: [email protected] City: Ireland, Country: Dublin, Phone number: +353871022059 *Corresponding author: [email protected] BACKGROUND In sub-Saharan Africa, particularly in Tanzania, the incidence of childhood cancer is 1.4 per 100,000 cases. Many cancer cases in Tanzania are not diagnosed until later stages because limited healthcare institutions are offering cancer-related care and treatment. When cancer manifests in its later stages, it not only reduces the chances of survival but also places a heavy burden on the healthcare system. As a lower-middle-income country, Tanzania faces numerous barriers to providing treatment for childhood cancers. This research aims to study the clinical presentation and types of childhood cancers at Muhimbili National Hospital. By investigating the types of childhood cancers commonly diagnosed and their clinical presentations, the study will provide valuable insights into the challenges of early diagnosis and treatment. The findings could help identify strategies to improve cancer care in Tanzania, ultimately improving survival outcomes and reducing the strain on the healthcare system. METHODS A hospital-based cross-sectional survey using a convenience sampling technique was conducted to assess the presentation and associated factors of childhood cancer. Descriptive statistics were used, and associations among variables were analyzed using the Chi-square (χ²) test and one-way ANOVA, A p-value of <0.05 was considered statistically significant. RESULTS A total of 141 patients were assessed. The most common types of cancer among children aged 1 to 5 years were blastoma and leukemia. The Sukuma tribe had the highest percentage of patients, and most cases were from Dar es Salaam. The majority of patients presented with masses and abdominal distention. There was a statistically significant association between family history of cancer and the type of cancer, as well as between disease stage and treatment response. Additionally, a significant difference was observed in age distribution across cancer types. However, no statistically significant association was found between the type of cancer and a history of chronic illness or exposure. CONCLUSION Childhood cancer has a high mortality and morbidity rate in Tanzania. Most patients die before the age of five, and many arrive at the hospital with late-stage disease and severe symptoms. Additionally, some patients do not complete treatment, possibly due to financial difficulties or a low level of education among caregivers. Keywords: childhood cancer, chemotherapy, cross-sectional, malignancies, family history. INTRODUCTION Cancer is the most common disease-related cause of death in children. Childhood malignancies, which arise in actively developing tissues, are disorders of dysregulated development. In the United States and other developed countries, cancer is the second leading cause of death among children, following accidents. Pediatric cancers include leukemia, lymphoma, central nervous system tumors, bone and soft tissue sarcomas, neuroblastoma, retinoblastoma, rhabdoid tumors, liver tumors, kidney tumors, germ cell tumors, and other rare cancers. 1 On the other hand, cancer in children and young adults results from a combination of factors that influence its development, including exposure to environmental mutagens and oncogenic pathogens, endogenous developmental mutational processes, and inherited or constitutional cancer predisposition. 27 Nearly 80% of children with cancer reside in low- and middle-income countries (LMICs), where access to treatment is often limited or prohibitively expensive. As a result, only 15–45% of affected children survive, compared to over 80% in high-income nations. The low survival rate in LMICs is further exacerbated by the lack of awareness and availability of palliative care in pediatric oncology. Many pediatric oncologists in these regions are unfamiliar with palliative care, and the number of services available has declined. Expanding access to palliative care remains a crucial aspect of improving childhood cancer outcomes. 23, 24 In sub-Saharan Africa, Tanzania a lower-middle-income country faces numerous challenges in providing treatment for childhood cancers. The country has only six pediatric oncologists: three based in Dar es Salaam, the capital, and one at the Kilimanjaro Christian Medical Centre (KCMC) in the northern region. Additionally, there is only one pathologist for every 1.8 million people. In contrast, the United States has approximately one pathologist per 20,638 residents and nearly 2,000 pediatric oncologists. 19 At Tanzania’s largest pediatric oncology center, Muhimbili National Hospital (MNH), pediatric sarcomas constitute a significant subset of childhood cancers. Treatment guidelines are based on medication availability, as well as surgical and radiation therapy resources, and are derived from clinical trials conducted by the International Society of Pediatric Oncology and the Children’s Oncology Group. Currently, there are no baseline statistics on the prevalence or types of pediatric sarcomas in Tanzania. Establishing such data would help optimize treatment protocols and allocate resources more effectively. 18 METHODOLOGY Study Design and Setting : A hospital-based, retrospective, cross-sectional observational study was conducted to assess the presentation and associated factors of childhood cancer. The study took place in the Pediatric Oncology Unit of Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. Population and Inclusion Criteria : The study population comprised children under 18 years of age diagnosed with cancer or hematologic malignancies in the Pediatric Oncology Department of MNH. The inclusion criteria encompassed children with a histological or cytological diagnosis of cancer or hematologic malignancies from birth up to 18 years old at MNH. Sample Size and Sampling Technique : The sample size was determined using a convenience sampling technique. Data were extracted from the admission records of the Pediatric Oncology Department for the months of May, June, July, and August 2023, resulting in a total sample of 141 patients. Cases with missing data were excluded from the analysis. These four months were chosen due to time constraints, as this study was part of the final research requirement for my MBBS examination, and we had a limited time to submit the research to the university. Convenience sampling involves selecting readily available subjects without randomization, which may limit the generalizability of the findings. Ethical Approval and Data Collection : Ethical approval was obtained from the University of Medical Science and Technology on December 11, 2023, and subsequently from MNH. Data collection was conducted from December 18, 2023, to March 31, 2024, using patient files from the Pediatric Oncology Department at MNH. All patients’ data will be collected anonymously through a data collection tool. Due to the cross-sectional study design, there were patient files. The participants’ confidentiality was assured with the use of an anonymous data collection tool called Codes to protect the anonymity of the patients. Data Management and Analysis: Data were collected using a structured data collection tool, and quality control measures were implemented to ensure accuracy. The data were analyzed using Microsoft Excel and the Statistical Package for the Social Sciences (SPSS) version 23. Descriptive statistics, including means, standard deviations, medians, graphs, charts, and frequency tables, were used to summarize the data. ArcGIS 10.3 was employed to develop a distribution map of patients across Tanzanian regions to examine the relationship between geographical location and type of cancer. Associations between variables were assessed using chi-square tests for categorical variables and analysis of variance (ANOVA) for numerical variables. Statistical significance was set at a p-value of less than 0.05. It is important to note that chi-square tests require both variables to be categorical, while ANOVA is used when comparing means across different groups. RESULTS A total of 141 pediatric cancer patients aged 0-18 years were analyzed in this cross-sectional retrospective study at Muhimbili National Hospital over four months. Most patients were between 1 and 5 years old (mean age 2.59 years, SD 0.942). There was a male predominance (n=80, 56.7%). The majority of caregivers had primary school education (n=51, 50%). Most patients came from the Dar es Salaam region (n=43, 30.5%) and the Pwani region (n=13, 9.2%). The most common tribes were Sukuma (n=14, 10.3%), Chagga (n=8, 5.9%), Makonde (n=8, 5.9%), and Waha (n=7, 5.1%). The most common cancer types were blastoma (n=41, 29.1%), leukemia (n=37, 26.2%), and sarcoma (n=24, 17%). Among 64 patients with a known cancer stage, most were in Stage 3 (n=32, 50%) or Stage 4 (n=21, 32.8%). Over half of the patients did not present with metastatic cancer (n=81, 57.4%), while the rest did (n=58, 41.1%), with the lungs (n=31, 43.7%) and central nervous system (n=14, 19.7%) being the most common sites. Common presenting symptoms included swelling (n=47, 33.8%), abdominal distention (n=33, 23.7%), pain (n=29, 20.9%), and fever (n=24, 17.3%). Most patients (n=113, 80.1%) were referred from other hospitals, mainly Kilimanjaro Christian Medical Centre (n=9, 6.4%) and Mnazi Mmoja Hospital (n=8, 5.7%). New admissions accounted for 19.9% (n=28). The most common cancer subtypes were Wilms’ tumor (n=18, 12.8%), retinoblastoma (n=13, 9.2%), and acute myelogenous leukemia (n=10, 7.1%). Over half of the patients did not have a history of chronic illness (n=126, 89.4%). The most common chronic illnesses were hypertension (n=6, 4.3%) and sickle cell disease (n=4, 2.8%). Most patients did not have a family history of cancer (n=130, 95.6%) or a history of environmental exposure (n=124, 87.9%). Tuberculosis was the most common infectious exposure (n=9, 6.4%). Chemotherapy was the most common treatment (n=72, 51.1%), followed by chemotherapy with surgery (n=28, 19.9%). However, the majority of patients died (n=36, 25.5%) or did not complete treatment (n=30, 21.3%). Cross-tabulation analyses revealed no significant association between gender, tribe, or patient admission with cancer type. There was no significant difference in metastasis based on caregiver education level. However, there was a significant association between family history and cancer type (p=0.004). Age was significantly associated with cancer type (p<0.001), with blastoma and leukemia being most common in children aged 1-5 years. There was no significant difference in treatment response based on age. An independent t-test showed a significant difference between disease stage and treatment response (p=0.006), but no significant difference between disease stage and caregiver education level. Table 1: Demographic characteristics of the patients Gender Frequency % Male 80 56.7 female 61 43.3 Age >10 years 29 20.6 6-10 years 1-5 33 67 23.4 47.5 <1 years 12 8.5 Mean age 2.59 Education status of the caregiver primary school 51 50.0 secondary school 19 18.6 illiterate 16 15.7 college‎\university 15 14.7 Other 1 1.0 Total 102 100.0 Missing 39 27.7 Tribe Sukuma 14 10.3 Chagga 8 5.9 Makonde 8 5.9 Waha 7 5.1 Gogo 6 4.4 Masai 6 4.4 Others 87 60.3 Missing 5 3.7 Total 141 100 Table 2: Cancer Characteristics Type of cancer Frequency % Blastoma 41 29.1 Leukemia 37 26.2 Sarcoma 24 17.0 Lymphoma 19 13.5 Carcinoma 5 3.5 Teratoma 5 3.5 Astrocytoma 4 2.8 Other cancer 6 4.2 Stage 1 8 12.5 2 3 4.7 3 32 50.0 4 21 32.8 Missing 77 54.6 Metastasis No 81 57.4 Yes: 58 41.1 Abdomen 1 1.4 Bone 4 5.6 Bone mar 3 4.2 Central Nervous system 14 19.7 Lymphadenopathy 2 2.8 Liver 9 12.7 Lung 31 43.7 Tumour lysis syndrome 1 1.4 Missing 2 2.8 Presentations Swelling 47 33.8 Abdominal Distention 33 23.7 Pain 29 20.9 Fever 24 17.3 Generalize Body Weakness 17 12.2 Bleeding tendency 10 7.2 Whitish pupillary reflex 9 6.5 Headache 9 6.5 Vomiting 7 5 Protrusion of the eye 6 4.3 Cough 6 4.3 Missing Total 2 141 1.4 100 Table 3: patient admission at hospital Patient admission Frequency % New admission 28 19.9 Kalamnjaro christian medical centre 9 6.4 Mnazi Mmoja Hospital 8 5.7 Temeke Regional Hospital 7 5.0 Amana Regional Referral hospital 6 4.3 Benjamin Mkapa Hospital 6 4.3 Bugando Hospital 5 3.5 Comperhensive Community Based Rehabilitation in tanzania Hospital 5 3.5 Muhimbili orthopedic institute 5 3.5 St.Francis Referral Hospital 4 2.8 Mbeya Zonal Referral Hospital 3 2.1 Morogoro Regional Referral Hospital 3 2.1 St.Benedict Ndanda Referral Hospital 3 2.1 St.Gaspar Referal and Teaching Hospital 3 2.1 Missing 1 0.7 Total 141 100 Table 4: Subtype of the cancer Subtype of cancer Frequency % Total Wilm’s tumor 18 12.8 Retinoblastoma 13 9.2 Acute Myelogenous Leukemia 10 7.1 Osteosarcoma 9 6.4 Acute Lymphocytic Leukemia (B-Cell) 8 5.7 Acute promyelocytic Leukemia 6 4.3 Hodgkin Lymphoma 6 4.3 Neuroblastoma 5 3.5 Classical Hodgkin Lymphoma 4 2.8 Acute Lymphocytic Leukemia 3 2.1 Burkitt’s Lymphoma 3 2.1 Rhabdomyosarcoma (Embryonial) 3 2.1 Sacrococcygeal Teratoma 3 2.1 Soft tissue sarcoma Others subtype Total 3 47 141 2.1 32.9 100 Table 5: Association factors of the disease History of Exposure Frequency % Missing 3 2.1 No history 124 87.9 Infectious agent: 14 9.9 Malaria 2 1.4 Scabies. Tina capitis 1 .7 Tinea corpories 1 .7 Tuberculosis 9 6.4 Tuberculosis. Malaria 1 .7 History of chronic illness Missing 2 1.4 No 126 89.4 Yes: 14 9.9 Amputation 1 .7 Hypertension 6 4.3 Kidney failure 1 .7 Sickle cell disease 4 2.8 Thalassemia 2 1.4 Family history of cancer No 130 95.6 yes 6 4.4 Missing 5 3.5 Total 141 100.0 Table 6: Treatment characteristics Type of the treatment Frequency % Valid Chemotherapy 72 51.1 Chemotherapy. Surgery 28 19.9 Surgery 9 6.4 Chemotherapy. Radiation. Surgery 8 5.7 Didn’t receive treatment 8 5.7 Palliative care 7 5.0 Chemotherapy. Radiation 7 5.0 Radiation 2 1.4 Treatment Response Died 36 25.5 Didn’t complete treatment 30 21.3 Recovery 26 18.4 Still on palliative care 26 18.4 Still admitted in the Hospital 6 4.3 Complication 6 4.3 Travel abroad 5 3.5 Didn’t receive treatment 4 2.8 Referred to other Department 2 1.4 Table 7: Cross-tabulation of Gender and the type of cancer Male Count 1 1 22 0 3 1 0 21 12 1 14 4 80 % of Total 0.70% 0.70% 15.60% 0.00% 2.10% 0.70% 0.00% 14.90% 8.50% 0.70% 9.90% 2.80% 56.70% P-value= 0.577 female Count 0 3 19 1 2 0 2 16 7 0 10 1 61 % of Total 0.00% 2.10% 13.50% 0.70% 1.40% 0.00% 1.40% 11.30% 5.00% 0.00% 7.10% 0.70% 43.30% Blastoma Blastoma. sarcoma Carcinoma Leukemia Lymphoma Multiple Endocrine Neoplasia Sarcoma P-value Tribe Waha Count 0 0 2 2 1 0 2 7 % of Total 0.00% 0.00% 4.20% 4.20% 2.10% 0.00% 4.20% 14.60% Sukuma Count 5 0 0 4 2 0 3 14 P-value=0.302 % of Total 10.40% 0.00% 0.00% 8.30% 4.20% 0.00% 6.30% 29.20% Masai Count 0 1 0 2 2 0 1 6 % of Total 0.00% 2.10% 0.00% 4.20% 4.20% 0.00% 2.10% 12.50% Makonde Count 1 0 0 1 2 1 3 8 % of Total 2.10% 0.00% 0.00% 2.10% 4.20% 2.10% 6.30% 16.70% Gogo Count 2 0 1 0 2 0 0 5 % of Total 4.20% 0.00% 2.10% 0.00% 4.20% 0.00% 0.00% 10.40% Chagga Count 2 0 0 3 1 0 2 8 % of Total 4.20% 0.00% 0.00% 6.30% 2.10% 0.00% 4.20% 16.70% Total Count 10 1 3 12 10 1 11 48 % of Total 20.80% 2.10% 6.30% 25.00% 20.80% 2.10% 22.90% 100.00% Table 8: Cross-tabulation of Tribe and Type of cancer Table 9: Cross-tabulation of Admission and the type of cancer Admission Total 0 New Admission Referral p-value Teratoma Count 0 1 4 5 % of Total 0.0% 0.7% 2.8% 3.5% Sarcoma Count 1 7 16 24 % of Total 0.7% 5.0% 11.3% 17.0% P-value=0.844 Multiple Endocrine Neoplasia Count 0 0 1 1 % of Total 0.0% 0.0% 0.7% 0.7% Lymphoma Count 0 4 15 19 % of Total 0.0% 2.8% 10.6% 13.5% Leukemia Count 0 3 34 37 % of Total 0.0% 2.1% 24.1% 26.2% Hemangioma Count 0 0 2 2 % of Total 0.0% 0.0% 1.4% 1.4% Cystic Hygroma Count 0 1 0 1 % of Total 0.0% 0.7% 0.0% 0.7% Carcinoma Count 0 1 4 5 % of Total 0.0% 0.7% 2.8% 3.5% Blastoma.sarcoma Count 0 0 1 1 % of Total 0.0% 0.0% 0.7% 0.7% Blastoma Count 0 9 32 41 % of Total 0.0% 6.4% 22.7% 29.1% Astrocytoma Count 0 1 3 4 % of Total 0.0% 0.7% 2.1% 2.8% Anterior mediastinal mass Count 0 0 1 1 % of Total 0.0% 0.0% 0.7% 0.7% Total Count 1 27 113 141 % of Total 0.7% 19.1% 80.1% 100.0% Table 10: Cross-tabulation of Education Status and Cancer metastasis Cancer Metastasis Total 0 No Yes P-value 0 Count 1 22 16 39 % of Total 0.7% 15.6% 11.3% 27.7% college‎\university Count 0 9 6 15 % of Total 0.0% 6.4% 4.3% 10.6% P-value=0.821 Illiterate Count 0 7 9 16 % of Total 0.0% 5.0% 6.4% 11.3% Other Count 0 0 1 1 % of Total 0.0% 0.0% 0.7% 0.7% primary school Count 1 29 21 51 % of Total 0.7% 20.6% 14.9% 36.2% secondary school Count 0 14 5 19 % of Total 0.0% 9.9% 3.5% 13.5% Total Count 2 81 58 141 % of Total 1.4% 57.4% 41.1% 100.0% Response to treatment Total Recovery Travel abroad Still admitted to the Hospital Didn’t complete treatment Referred to other Department Complication Didn’t receive treatment On palliative care Died Complication P-value Education status caregiver illiterate Count 3 0 0 1 1 0 1 4 6 0 16 % of Total 2.9% 0.0% 0.0% 1.0% 1.0% 0.0% 1.0% 3.9% 5.9% 0.0% 15.7% primary school Count 11 1 4 9 0 1 2 8 14 1 51 % of Total 10.8% 1.0% 3.9% 8.8% 0.0% 1.0% 2.0% 7.8% 13.7% 1.0% 50.0% secondary school Count 4 0 2 5 0 2 0 2 4 0 19 % of Total 3.9% 0.0% 2.0% 4.9% 0.0% 2.0% 0.0% 2.0% 3.9% 0.0% 18.6% P-value=0.855 college‎\university Count 2 2 0 2 1 1 1 2 4 0 15 % of Total 2.0% 2.0% 0.0% 2.0% 1.0% 1.0% 1.0% 2.0% 3.9% 0.0% 14.7% Other Count 0 0 0 0 0 0 0 0 1 0 1 % of Total 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 1.0% 0.0% 1.0% Total Count 20 3 6 17 2 4 4 16 29 1 102 % of Total 19.6% 2.9% 5.9% 16.7% 2.0% 3.9% 3.9% 15.7% 28.4% 1.0% 100.0% Table 11: Cross-tabulation of Education status and Response to treatment Table 12: Cross-tabulation of Age and Response to Treatment Response to treatment Complication Didn’t complete treatment Didn’t receive treatment Died On palliative care Recovery Referred to other Department Still admitted in the Hospital Travel abroad Total P-value Age 10 years Count 1 7 1 5 8 8 1 1 1 33 P-value=0.290 % of Total 0.7% 5.0% 0.7% 3.5% 5.7% 5.7% 0.7% 0.7% 0.7% 23.4% 6 -10 Year Count 1 8 1 5 10 2 0 2 0 29 % of Total 0.7% 5.7% 0.7% 3.5% 7.1% 1.4% 0.0% 1.4% 0.0% 20.6% 1 - 5 Year Count 4 13 1 22 7 14 1 3 2 67 % of Total 2.8% 9.2% 0.7% 15.6% 5.0% 9.9% 0.7% 2.1% 1.4% 47.5% Total Count 6 30 4 36 26 26 2 6 5 141 % of Total 4.3% 21.3% 2.8% 25.5% 18.4% 18.4% 1.4% 4.3% 3.5% 100.0% Table 13: Cross-tabulation of Age and type of cancer Type of cancer Anterior mediastinal mass Astrocytoma Blastoma Blastoma. sarcoma Carcinoma Cystic Hygroma Hemangioma Leukemia Lymphoma Multiple Endocrine Neoplasia Sarcoma Teratoma Total P-value Age 10 years Count 0 1 0 0 2 0 0 11 8 0 11 0 33 % of Total 0.0% 0.7% 0.0% 0.0% 1.4% 0.0% 0.0% 7.8% 5.7% 0.0% 7.8% 0.0% 23.4% 6 -10 Year Count 0 2 5 1 2 0 0 5 7 0 7 0 29 P-value=0.000 % of Total 0.0% 1.4% 3.5% 0.7% 1.4% 0.0% 0.0% 3.5% 5.0% 0.0% 5.0% 0.0% 20.6% 1 - 5 Year Count 1 1 32 0 1 0 1 18 4 0 6 3 67 % of Total 0.7% 0.7% 22.7% 0.0% 0.7% 0.0% 0.7% 12.8% 2.8% 0.0% 4.3% 2.1% 47.5% Total Count 1 4 41 1 5 1 2 37 19 1 24 5 141 % of Total 0.7% 2.8% 29.1% 0.7% 3.5% 0.7% 1.4% 26.2% 13.5% 0.7% 17.0% 3.5% 100.0% DISCUSSION The current study aimed to describe the demographic characteristics of patients in the pediatric oncology department of Muhimbili National Hospital, the symptoms they presented with upon arrival, and the types of childhood cancer affecting them. This study fills an important gap in this area. We found that most patients were between 1 and 5 years old, similar to findings by de Oliveira et al. in Brazil, as well as studies conducted in Tanzania and Bangladesh. There was a male predominance among patients, consistent with several other studies. 6, 25, 44 The Sukuma tribe had the highest number of cases, followed by the Chagga, Makonde, and Waha tribes. The majority of patients’ caregivers had only primary school education, followed by secondary education. This limited education level may contribute to increased cancer mortality due to financial constraints and a lack of knowledge about managing the illness and its treatment, leading to late-stage diagnoses. A cohort study in Italy separately analyzed the education levels of mothers and fathers and their impacts on childhood cancer survival. 41, 44 The Dar es Salaam region had the highest number of patient admissions due to the location of Muhimbili National Hospital. However, some patients came from other regions, including Pwani (9.2%), Morogoro (6.4%), and Dodoma (6.4%). Distance from a cancer treatment facility was inversely linked with regional incidence. On average, patients traveled 4.55 hours for treatment. Currently, 74.5% of people live more than four hours away from a cancer care facility, delaying diagnosis and treatment. 45 Blastoma was the most common type of cancer (29.1%), followed by Leukaemia (26.2%) and Sarcoma (17%). A similar study in Tanzania by Luke Maillie et al. found that Blastoma and Leukaemia were the most prevalent, with Leukaemia being the most common. 6, 25, 11, 44 However, two other studies in Tanzania reported Lymphoma as a leading childhood cancer. 19, 42 the most common Blastoma subtypes were Wilms’ tumor, Retinoblastoma, Acute Myelogenous Leukaemia, and Acute Lymphocytic Leukaemia (B-cell). Osteosarcoma was the most frequent Sarcoma subtype. These findings differed from a 2019 study conducted at Muhimbili National Hospital. 19 The Sukuma tribe had the highest number of patients, as it is the largest ethnic group in Tanzania. Most Sukuma patients had Leukaemia or Blastoma. There was no statistically significant difference (p = 0.302) between tribe and cancer type. More than half of the patients (80.1%) were referred from another hospital, with the highest number coming from Kilimanjaro Christian Medical Centre, a zonal consultant hospital in northern Tanzania. Mnazi Mmoja Hospital accounted for 5.7% of referrals. Since Muhimbili National Hospital is the largest pediatric oncology center in Tanzania, the lack of decentralized treatment facilities leads to diagnostic delays. A study in Japan found that long travel distances negatively impact hospital attendance and timely treatment completion. Special accommodations should be made for families traveling long distances, as hospital stays can last weeks or months. 33 The shortage of pathologists and paediatric oncologists in Tanzania contributes to frequent referrals to Muhimbili National Hospital. 43, 19 the most commonly referred cases were Blastoma (41%), Leukaemia (33.7%), and Sarcoma (22.4%). There was no statistically significant difference (p = 0.577) between patient admission and cancer type. A strong association was observed between patients’ age and cancer type (p = 0.000). Among patients aged 1 to 5 years, Blastoma (22.7%) and Leukaemia (12.8%) were the most common, consistent with a study in Brazil. 28 According to the World Health Organization (WHO), Leukaemia, brain cancer, and Lymphoma are the most common childhood cancers. 46 However, in Tanzania, the most prevalent childhood cancers include Wilms’ tumor, Retinoblastoma, and Acute Lymphoblastic Leukaemia, findings that align with this study. 45 The most common presenting symptom was a mass (33.8%), followed by abdominal distention (29%), pain (20.9%), and fever (17.3%). Wilms’ tumor was the most common Blastoma subtype, 39 with most patients presenting with abdominal distention (21.9%) or pain (18.8%). Retinoblastoma was the second most common Blastoma subtype, with patients presenting with a whitish pupillary reflex (18.8%), fever, or eye swelling. Among Leukaemia subtypes, Acute Myelogenous Leukaemia was the most common, with fever (50%) and generalized body weakness (35.7%) as predominant symptoms. 26 A significant proportion of patients were diagnosed at advanced stages, with 50% in stage 3 and 32% in stage 4. A study by Thecla W. Kohi et al. highlighted that late diagnosis is common in Tanzania due to a lack of healthcare facilities offering cancer-related care. 42 research in three sub-Saharan African populations found that poor cancer survival is primarily due to late-stage diagnosis. Callum J. R. Mullen et al. discussed the impact of diagnostic delays on survival and treatment outcomes. 30 metastasis was observed in 41% of cases, with the lungs (43.7%) and central nervous system (19.7%) being the most common sites. Late-stage presentation may be influenced by caregivers’ limited education and socioeconomic challenges. However, statistical analysis found no significant correlation between cancer stage, metastasis, and caregiver education (p = 0.821, p = 0.818). Incomplete data regarding caregivers’ educational status may have influenced these results. Most patients had no history of chronic illness, family cancer history, or exposure to carcinogens. Hypertension (4.3%) and sickle cell disease (2.8%) were the most common chronic illnesses. The only notable exposure was to infectious agents like tuberculosis (6.4%). Other exposures, such as radiation, chemicals, and pesticides, were not observed. Previous studies have examined various exposure types, including infectious agents and lifestyle factors, 17 pesticide exposure, 2 environmental influences, and hereditary predispositions. 29 A statistically significant association (p = 0.004) was found between family history of cancer and cancer type, consistent with a Swedish study on childhood Leukaemia patients. 38 Almost half of the patients received chemotherapy (51.1%), similar to findings by Olívia Lopes et al. 32 Others underwent chemotherapy with surgery (19.9%) or surgery alone. The mortality rate was 25.5%. 13, 23, 24, 34, 35 several studies agree that financial problems and long treatment waiting times contribute to incomplete treatment. 8, 31, 23 Out-of-pocket medical costs create stress for families, affecting treatment outcomes and financial security. 37 There are studies explaining that. 10, 12, 19 among patients aged 1 to 5 years, the mortality rate was 17.1%, while 12.4% recovered. Deaths were predominantly observed in cases where caregivers had only primary education. However, statistical analysis found no significant correlation between treatment outcomes, caregiver education (p = 0.855), or patient age (p = 0.290). A significant association (p = 0.006) was found between cancer stage and treatment response, with most patients diagnosed at late stages. 20, 36 some patients died before receiving treatment due to financial difficulties. This study had limitations, including the exclusion of other pediatric tumours and incomplete medical records. Many files were missing, and patient families were often unresponsive to follow-ups. A full-year dataset would have been ideal, but time constraints limited the study to four months. Our findings can inform clinical practice and policy changes. Identifying common childhood cancers and their clinical presentations can refine diagnostic protocols for earlier and more accurate diagnoses. Understanding cancer prevalence and treatment responses can aid in developing targeted therapies. These insights can help allocate resources for diagnostic radiology and staff training, improve prevention and screening strategies, and guide future research addressing paediatric cancer management challenges at Muhimbili National Hospital. CONCLUSION Childhood cancer in Tanzania remains a significant public health concern, with high mortality and morbidity rates largely due to late-stage diagnosis. The study at Muhimbili National Hospital highlights that Blastoma and Leukemia are the most prevalent cancers, primarily affecting children aged 1 to 5 years. Delayed diagnosis, compounded by socioeconomic challenges such as financial constraints and low caregiver education, often leads to incomplete treatment and poor outcomes. Addressing these issues requires a multifaceted approach, including improved early detection strategies, enhanced diagnostic facilities, and better-trained medical personnel. Additionally, strengthening data management systems is essential to ensure accurate patient records and facilitate long-term research. Providing financial and educational support for families can also improve treatment adherence and survival rates. To reduce the burden of childhood cancer, it is crucial to implement comprehensive public health strategies that focus on early diagnosis, effective treatment, and long-term data collection. Future research should aim to track cancer trends and evaluate the impact of interventions to enhance pediatric oncology care in Tanzania. RECOMMENDATIONS To improve childhood cancer outcomes in Tanzania, it is essential to evaluate and strengthen the medical record system to prevent missing patient files. Accurate and thorough patient histories at the time of hospital admission play a crucial role in diagnosing the disease, informing families, and guiding appropriate treatment. Additionally, reviewing treatment protocols can help identify potential drug resistance, while financial support for underprivileged families may reduce mortality rates by ensuring treatment completion. The findings highlight the urgent need for enhanced public health strategies focusing on early cancer detection and education about pediatric cancers. Strengthening diagnostic facilities and training medical personnel are critical steps toward early and accurate cancer diagnosis. Furthermore, public health policies must address socioeconomic barriers that contribute to late-stage presentations, ensuring equitable access to care and improving survival outcomes for children with cancer in Tanzania. UMST University of Medical Sciences and Technology MNH Muhimbili National Hospital LMICs Low and medial income countries DECLARATIONS Consent for publication All authors have read the final manuscript and given their consent for this article to be published in this journal. no clinical details of participants that might compromise their anonymity were used in the development of this manuscript titled “Presentation and Types of childhood cancer at The Muhimbili National Hospital (MNH), 2023”. Availability of supporting data All supporting data are available. Competing interests The authors declared no competing interest. Funding No funding was applied for this study. Authors’ contributions All authors have read the final manuscript and given their approval for publication. ACKNOWLEDGMENTS I would like to express my special thanks and gratitude to my supervisor, Dr. Yasar Hammor, who made this work possible and provided invaluable guidance throughout this research. 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Keywords general hematology/oncology medical oncology oncology Authors Affiliations Malaz Adam Ali Salih Arga 0009-0008-9911-9066 [email protected] University of Medical Sciences and Technology Faculty of Medicine View all articles by this author Rehema H. Laiti Muhimbili National Hospital View all articles by this author Ghada Abd El-Raheem 0000-0001-5668-0859 University of Medical Sciences and Technology View all articles by this author Yasar Hammor St Vincent's University Hospital View all articles by this author Metrics & Citations Metrics Article Usage 358 views 122 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Malaz Adam Ali Salih Arga, Rehema H. Laiti, Ghada Abd El-Raheem, et al. Presentation and Types of Childhood Cancer at the Muhimbili National Hospital (MNH), 2023. Authorea . 05 May 2025. 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