Paediatric cancer burden in Namibia, A 10 year retrospective, analytical study of patients admitted at Windhoek Central Hospital

Paediatric cancer burden in Namibia, A 10 year retrospective, analytical study of patients admitted at Windhoek Central Hospital | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Paediatric cancer burden in Namibia, A 10 year retrospective, analytical study of patients admitted at Windhoek Central Hospital Ndapewa Kaholongo, Runyararo Mashingaidze-Mano This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2054100/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract BACKGROUND Research in Namibia has come a long way over the past two decades. Even so, research in the field of paediatric oncology is still lagging behind. Therefore, this study looked at the pattern of paediatric cancer patient over a ten-year period. METHODS A cross-sectional study was done to analyse the paediatric oncology cases that were admitted to the paediatric oncology unit (ward 8 west) at Windhoek Central Hospital (WCH) between 01 January 2011 and 31 December 2020. The study analysed the files of paediatric patients admitted with a paediatric cancer diagnosis from the age of 0 to 16 years. RESULTS A total of 174 paediatric cancer patient files met the inclusion criteria. Haematopoietic cancers were the most commonly occurring diagnosis of a paediatric cancer type in the study population (44.8%), of which leukaemias were the most common type of haematopoietic cancer. The other types of cancer apart from haematopoietic cancers consisted of embryonal cancers (37.9%), soft tissue and bone sarcomas (13.8%), and brain or CNS cancers (3.4%). The median age at diagnosis was 5.13 years with an age range of 0 to 15 years. HIV exposure had an incidence of 6.4%. CONCLUSIONS Haematopoietic cancers remains the number one most common type in Namibia. However, there has been a change in the ranking of the other childhood cancer subtypes over the last 3 decades. The recommendation is that there be better recordkeeping of cancer patient files to capture important information. For follow-up studies, prospective studies are recommended in the future. Pattern Paediatric cancer Ten-year review Figures Figure 1 Figure 2 Background Childhood or paediatric cancers are known to cause significant morbidity and mortality and are the leading cause of death in children under 19 years of age [20]. Many of these cases (about 70%) occur in developing countries [15]. While there are no age-specific cancers in the paediatric age group, there are certain cancers which present in specific childhood years [11]. Childhood cancer is curable [20], and nearly 80% of paediatric cancer patients in developed countries can be cured of cancer [15]. However, Africa bears a heavy burden of childhood cancer [7], as more than 80% of children in Africa diagnosed with cancer die without access to adequate treatment [3]. Stefan [15] suggests that the survival rate of paediatric cancers in Namibia was a mere 17%, in comparison to the higher rates in western countries, such as the United States, where the survival rate is 85% [1]. In Africa, the incidence rates of some childhood cancers are much higher in comparison to those of developed countries [15]. Little research has been done in the field of paediatric oncology in Namibia, like many other developing countries in Africa and yet, worldwide the majority of research in paediatric oncology comes from developed countries such as the United States [15]. This is counter-intuitive to the fact that Africa carries a heavy burden of paediatric cancer [6]. Therefore, there is a significant need for more research to be done in African developing countries such as Namibia. The last national cancer registry was reported in 2014, which included the total incidence of cancers in the whole Namibian population [23]. Namibia is a diverse nation of approximately 2.59 million people [4]. Of this number, a total of 11 248 Namibians were diagnosed with a malignant neoplasm in the last Namibian National Cancer Registry in 2014 [23]. Children under 15 years diagnosed with a cancer constituted 3.3% [23]. However, it is known that in many African developing countries such as Namibia, this estimate could be higher due to under-diagnosis or misdiagnosis of paediatric cancers [15]. A study done in Zimbabwe looked at the pattern of paediatric cancers in children aged 0-14 years that were registered in the Zimbabwean Cancer Registry from 2000 to 2009 [2]. The study found that there was a prevalence of childhood cancer of 3.8% of all the malignancies recorded at the Zimbabwe National Cancer Registry over a ten-year period. The most common cancers were nephroblastoma, retinoblastoma and Kaposi sarcoma. Haematological cancers, specifically leukaemias and lymphomas, were also prevalent but were not the most common cancers. Two studies done in Namibia in 1988 and 2010 have shown changes in the pattern of paediatric cancers over the years. There is a constant need to have updated statistics on the changing trends in the frequency of different types of cancers [15,18]. There has been a significant change in the prevalence of paediatric cancers in Namibia since the last study was done in 2010 by Stefan [15]. Methods A retrospective, analytical study of cancers in children aged 0-16 years registered and admitted at the Windhoek Central Hospital (WCH) from 01 January 2011 to 31 December 2020 was carried out. Formal consent for the study was obtained from the Ministry of Health and Social Services (MOHSS), Office of the Executive Director (reference number NOK 2021). The MOHSS also granted a waiver for informed consent from study participants, and gave ethical clearance to publish the research (reference number 22/4/2/3). Further approval was obtained from the Medical Superintendent of Windhoek Central Hospital in Windhoek before commencement of the study. Verbal consent was obtained from the matron at the paediatric oncology ward (8 west) at the hospital, where data for this study was abstracted from patient record files that are kept in the ward. Windhoek Central Hospital is the only referring state hospital for paediatric oncology cases in Namibia. Namibia is a country located in Southern Africa, which is divided into 14 regions, with Windhoek being the capital city, located in Khomas region. See Figure 1 Below: Data recording and analysis Information collected for each patient included patient demographics: age, sex, region or area of residency, date at diagnosis, type of cancer diagnosed, method of diagnosis, HIV status (exposed versus unexposed), outcome, date of discharge or death. Patients whose type of cancer was not recorded were excluded from the study. We employed a data-collecting template using a Microsoft Excel spreadsheet, which was used to collect the study variables. The raw data on the Microsoft Excel spreadsheet was then analysed using the (Statistical Package for Social Sciences) SPSS statistical tool. In this study we characterized childhood cancers in Namibia with regard to the type of cancer diagnosed, sex and age distribution, age of diagnosis and date at discharge or death (whichever is applicable), region or area of residency, the impact of HIV (exposed versus unexposed), and eventual outcome of the patient. Eventual outcome consists of the treatment and/or management that the patient received, before discharge or death (whichever is applicable). Method of diagnosis was also evaluated, and methods were grossly grouped into three main classifications: clinical (patient history and physical examination); imaging [ultrasound, radiology (X-ray, Computed Tomography (CT) scan, Magnetic Resonance Imaging (MRI))]; and histology (biopsy). Results Demographic characteristics of the study participants Figure 2 shows a summarized flow chart of the patient files analysed. A total of 1000 paediatric oncology files were available for the study. Eight hundred and twenty-six (826) were excluded from the study for various reasons. Three hundred and sixty-three files had poorly recorded information whilst 463 files were not admitted during the study period. Only 174 patient files met the study criteria (admitted from 01 January 2011 to 31 December 2020) and were included in the study. The median age at diagnosis was 5 .0 years with an age range being 1 to 15 years and mean age of 5.13 years. Of the 174 patient files 97 (55.7%) were males and 77 (44.3%) females with a male female ratio of 1,26: 1. See Table 1 below for the sex distribution. Table 1 Demographic characteristics of paediatric oncology patients admitted at Windhoek Central Hospital during the study period. Variable Frequency Percentage (%) Sex Male 97 55.7 Female 77 44.3 Total 174 100.0 HIV Status Exposed 11 6.3 Unexposed 162 93.1 HIV Status unknown 1 0.6 Total 174 100.0 Region of Residence Khomas 36 20.7 Zambezi 7 4.0 Otjozondjupa 9 5.2 Kavango 19 10.9 Erongo 17 9.8 Oshana 29 16.7 Ohangwena 17 9.8 Oshikoto 12 6.9 //Karas 2 1.1 Hardap 3 1.7 Omusati 8 4.6 Omaheke 4 2.3 Kunene 11 6.3 Total 174 100.0 Urban/Rural Frequency Valid Percent (%) Urban* 36 20.7 Rural* 138 79.3 Total 174 100.0 *Urban is referring to Khomas Region, *Rural is all other regions other than Khomas. Region of Residence The Khomas region hand the highest number of patient files admitted during the study period (20.7%), followed closely by Oshana region (16.7%). Kavango region contributed 10.9%, Erongo and Ohangwena were both 9.8%, Oshikoto 6.9%, Kunene 6.3%, Otjozondjupa 5.2%, Omusati was 4.6%, and Zambezi 4.0%. Karas, Hardap and Omaheke contributed the lowest number of admissions with 1.1%, 1.7% and 2.3%, respectively. Most paediatric cancer cases diagnosed originated from the rural area,139 (79.3%) compared with 36 (20.7%) from urban area. Khomas region was considered the urban area while the other 12 regions were grouped as the rural region or area, as those regions usually look after patients from rural areas, and Khomas has the only referring hospital for all oncology cases and caters for the urban area. See Table 1 above. Paediatric Cancer Types Table 2 Frequency of the types of paediatric cancer in Paediatric patients admitted at an Oncology unit. Type of cancer diagnosed Frequency Valid Percent (%) Brain or CNS cancers 6 3.4 Embryonal cancers 66 37.9 Haematopoietic cancers 78 44.8 Soft tissue and bone sarcomas 24 13.8 Total 174 100.0 Table 2 shows the frequency of the types of paediatric cancers. Haematopoietic cancers were the most commonly occurring cancer type constituting 78 (44.8%) of all the 174 recorded patients in this study. Embryonal cancers were the second most common cancer type in children with an frequency of 66 (37.9%). Soft tissue and bone sarcomas had an incidence of 13.8% of the 174 total patients in the study, while brain or CNS cancers were the least commonly occurring with a mere 3.4% incidence. Table 3 shows the specific subtypes for each cancer types. Subtypes of Paediatric Cancer Table 3 Frequency of the subtypes of the paediatric cancers in patients admitted in a Paediatric Oncology unit. Paediatric cancer type Paediatric cancer subtype Frequency Valid Percent (%) Haematopoietic cancers Leukaemias 59 33.91 Lymphomas 19 10.92 Brain or CNS cancers Astrocytomas 3 1.72 Ependymal tumours 2 1.15 Glioma-pontine tumours 1 0.57 Soft tissue and bone sarcomas Rhabdomyosarcomas 17 9.77 Fibrosarcomas 2 1.15 Kaposi sarcomas 2 1.15 Melanomas 1 0.57 Osteosarcomas 1 0.57 Squamous cell carcinomas 1 0.57 Embryonal cancers Nephroblastomas 29 16.7 Neuroblastomas 14 8.05 Retinoblastomas 13 7.47 Teratomas 3 1.72 Germ cell tumours 3 1.72 Yolk sac tumours 2 1.15 Hepatoblastomas 1 0.57 Dysgerminomas 1 0.57 Total 174 100.0 Leukaemias were the most common cancer subtype. 59 (33.91%) of the recorded patients were diagnosed with a leukaemia, which is over a third of the total 174 patients recorded. Nephroblastomas, lymphomas, rhabdomyosarcomas, neuroblastomas and retinoblastomas were also very common with a frequency of 29 (16.7%), 19 (10.92%), 17 (9.77%), 14 (8.05%), 13 (7.47%), respectively out of the 174 paediatric patients. Astrocytomas, ependymal tumours, fibrosarcomas, Kaposi sarcomas, teratomas, germ cell tumours and yolk sac tumours were less common and together comprised 17 (9.76%). Glioma-pontine tumours, melanomas, osteosarcomas, squamous cell carcinomas, hepatoblastomas and dysgerminomas were rare in this study, each contributing 1 (less than 1% of all the cancers). Age distribution and Paediatric Cancer types The distribution of cancers according to age groups is shown in Table 4 below. Table 4 Age distribution of paediatric cancers according to 3 age categories. Type of cancer diagnosed Age Group in years Total 0–5 6–10 11–15 Brain or CNS cancer Frequency 5 1 0 6 Embryonal cancer Frequency 39 20 7 66 Soft tissue and bone sarcoma Frequency 16 8 0 24 Haematopoietic cancer Frequency 44 31 3 78 Total Frequency 104 60 10 174 % of Total 59.8 34.5 5.7 100.0 The distribution of paediatric oncology cancer was strongly related to age groups (Table 4 ). There was an inverse relationship between cancer and age, as cancers were more common the younger the age and less common the older the age. There were significantly more cancers diagnosed in the age category of 0–5 years for each of the cancer types. Out of the total 174 admissions, 104 were in the age group of 0–5 years constituting 59.8% of all cancers, 34.5% in the age category 6–10 years, while only 5.70% of all the cancers were diagnosed in children aged 11–15 years. Of note, haematopoietic cancers were the most diagnosed cancer type in the age category 0–5 (the most commonly occurring age category overall) with a frequency of 44, constituting 25.3% of all the cancers recorded in this study. There were no soft tissue and bone sarcomas, nor brain or CNS cancers recorded in the age category 11–15 years. Sex distribution and Paediatric Cancer Type Distribution of paediatric cancer according to sex is shown in Table 5 below. Table 5 Sex distribution of the paediatric cancers in patients admitted at a Paediatric Oncology unit. Type of Cancer diagnosed Sex Total Male Female Brain or CNS cancer Frequency 4 2 6 Embryonal cancer Frequency 41 25 66 Soft tissue and bone sarcoma Frequency 13 11 24 Haematopoietic cancer Frequency 39 39 78 Total Frequency 97 77 174 % of Total 55.7 44.3 100.0 Overall, males were more commonly diagnosed than females for most of the cancer types. Males were twice as affected as females for brain or CNS cancers (4 versus 2), and almost twice as much for embryonal cancers (41 versus 25). For soft tissue and bone sarcomas, males were only slightly more affected than females, with a frequency of 13 within the cancers group itself, compared to the 11 of females. Haematopoietic cancers, the most common cancers in the whole study, occurred in equal proportions for both genders with a frequency of 39 for both. Paediatric cancer type and HIV exposure Table 6 Distribution of paediatric cancers according to the HIV Exposure status. HIV Status Type of cancer diagnosed Exposed Unexposed Total Brain or CNS tumour Frequency 1 5 6 Embryonal tumour Frequency 6 60 66 Soft tissue and bone sarcoma Frequency 1 23 24 Haematopoietic cancer Frequency 3 74 77 - - - - 1* Total Frequency 11 162 174 % of Total 6.40 93.6 100.0 *There is one patient whose HIV status was unknown and not stratified according to type of cancer and HIV exposure status. We also looked at the distribution of cancers according to the HIV exposure status in Table 6 . The majority of paediatric cancer patients were HIV unexposed, together constituting 162 patients (93.6%). Only 11 (6.40%) of patients were exposed. Of these exposed patients, most of the patients (6) had embryonal cancers (3.50%). 3 patients had haematopoietic cancers. Soft tissue and bone sarcomas, and brain or CNS cancers both had 1 patient exposed (less than 1% of exposed patients). Method of diagnosing of Cancer Table 7 Methods used to diagnose the paediatric cancers. Method of diagnosis Frequency Valid Percent (%) Histology (Biopsy)* 130 74.7 Clinical; Imaging; Histology (Biopsy) 3 1.7 Imaging 7 4 Imaging; Histology (Biopsy) 34 19.5 Total 174 100.0 *Histology (Biopsy) includes tumour biopsies, cytology specimens, and bone marrow biopsies. In Table 7 , the methods of diagnosis used during the study are indicated. Histology using biopsies was the most widely used method of diagnosis constituting 74.7% of all diagnosed cancers. Occasionally, imaging [ultrasound, radiology (X-ray, CT scan, MRI)] was also used in conjunction with the histology (19.5%). 7 diagnoses were made using imaging alone (4%). In few cases, the diagnosis was made based on a combination of clinical assessment, imaging, and histology (biopsy) (1.7%). Treatment modalities used for the cancer patients Table 8 below shows the various treatment modalities of paediatric oncology patients used as part of the management plan. The majority of paediatric patients (44.3%) were treated solely using chemotherapy. This is followed by 16.1% of patients who were treated with both chemotherapy and surgery. Of note, these are patients who received either neo-adjuvant chemotherapy or post-op chemotherapy or both, depending on the specific type of cancer and individual cases. The patients who ended up in palliative care in addition to their primary form of treatment and/or management together constituted 21.3%, which is about a quarter of the total recorded patients. The patients who received radiotherapy constituted a tenth of all the patients (14.4%). Of significance, 31% of the patients underwent surgery to remove a tumour, which is a third of the total recorded patients. Table 8 The treatments and/ management used for paediatric cancer patients admitted at an Oncology Unit. Treatment modality Number of cancer patients using each treatment modality Frequency Valid Percent (%) Chemotherapy; Radiotherapy 12 6.9 Chemotherapy 77 44.3 Chemotherapy; Surgery 28 16.1 Chemotherapy; Surgery; Palliation 3 1.7 Chemotherapy; Palliation 20 11.5 Chemotherapy; Radiotherapy; Palliation 5 2.9 Chemotherapy; Radiotherapy; Surgery 6 3.4 Radiotherapy; Surgery 1 0.6 Surgery 12 6.9 Palliation 5 2.9 Surgery; Palliation 4 2.3 Radiotherapy 1 0.6 Total 174 100.0 Length of Hospital Stay Table 9 Length of stay in hospital during course of treatment. Length of Stay In Hospital (days) Mean 241.6 Median 193.0 Std. Deviation 243.834 Range 1605 Minimum 0 Maximum 1605 Table 9 shows the length of stay in hospital during the course of treatment of paediatric cancers during the study period. The length of stay had a mean of 241.6 days and a median of 193.0 days, with a standard deviation of 243.834 days. The maximum number of days spent in the hospital during the study was 1605 days (over 52 months or 4 years). Treatment outcome Table 10 The outcome of paediatric cancer patients after diagnosis and/ treatment. Variable Frequency Valid Percent (%) Died 30 17.2 Alive 144 82.8 Total 174 100.0 The mortality rate was 17.2%, as shown in Table 10 . Only 30 out of the total patients recorded in this study demised either before, during or after treatment and/or management, but all the patients demised after the diagnosis was made. This mortality rate translates to just over a fifth of all the patients who demised during the study period. Discussion Paediatric Cancer types and subtypes This study looked at the paediatric cancer pattern over a 10-year period. Males constituted more than half of the study participants (55.7%) while females constituted 44.3%. The ratio of males to females was 1.26: 1. In general, it is known that male children are at greater risk of developing cancer than their female counterpart [ 12 ]. However, the exact mechanisms that underlie this difference in childhood cancer incidence by sex is mostly unknown [ 19 ]. It may perhaps be due to the fact that male children are often of higher birthweight, contract a higher number of childhood infections, and their pubertal growth is much more accelerated with a completely different hormonal profile, as compared to females [ 19 ]. These risk factors may be what contributes to the higher incidence of cancer in male children. These findings were similar to previous studies were male children were predominantly reported to have cancer compared to female [ 2 , 15 , 18 ]. In this study, cancers were strongly related to age as more cancers were found in the younger age groups. These findings are comparable to previous studies which reported highest incidence of cancer in the same age group 0–4 years [ 2 , 15 ]. However, another study by Wessels [ 18 ] reported highest incidence in the 1–4 years’ age group [ 18 ]. According to literature [ 16 ], between 2016 and 2018 children under 5 years experienced some of the highest incidence rates of cancer in the United States. There is very little research done to explain why children under 5 years get cancer, but that certain cancers tend to occur preferentially in infants, children and adolescents [ 10 ]. In general, childhood cancers are genetic in origin, but certain chronic infections such as HIV, malaria and Epstein-Barr virus are risk factors for childhood cancers [ 20 ], and infants are more susceptible to infections than older children and adolescents due to their immature immune systems [ 8 , 13 ]. Most of the cases in this study originated from the rural areas of Namibia (79.3%). This is most likely due to many parents seeking alternative medicine when their child is ill [ 15 ], and the failure of healthcare workers to diagnose a malignancy because of inexperience in recognizing a childhood malignancy, or because of the difficulty in distinguishing between the overlapping symptomatology of cancer and commonly occurring infectious conditions such as malaria and tuberculosis [ 18 ]. This was not reported by previous other studies [ 2 , 15 , 18 ]. However, other studies show that urban-rural differences in cancer incidence and trends vary across the world. A study done in Sudan [ 5 ] found that about 76% of the Sudanese children diagnosed with cancer lived in rural areas. Another reason for the high frequency of patients coming from the rural regions found in our study, could be that patients in rural areas are often exposed to cancer-associated modifiable risks such as HIV, chronic childhood infections, and secondary smoking [ 22 ]. In our study period it was found that leukaemias were the most commonly occurring cancer in children (33.91%) which also doubled from 22.5% from the last study done, where leukaemias were also found to be the most common [ 15 ]. In this study, nephroblastomas occurred second (16.7%), compared to retinoblastomas (16.2%) in the study by Stefan [ 15 ]. Lymphomas decreased from 12.0–10.92% at Windhoek Central Hospital over the past 12 years since the study done by Stefan [ 15 ]. Of note, there were some specific cancers not mentioned by Stefan [ 15 ]. For example, rhabdomyosarcomas occurred fourthly (9.77%) in this study, but Stefan [ 15 ] does not specifically make mention of rhabdomyosarcomas in their study. Neuroblastomas (8.05%)- also not mentioned- followed rhabdomyosarcomas. Retinoblastomas decreased considerably to 7.47% from the 16.2% reported by Stefan [ 15 ]. Brain or CNS cancers decreased significantly as well from 11.5–3.44% compared to Stefan [ 15 ]. Nephroblastomas increased slightly from 13.6–16.7%. Soft tissue and bone sarcomas together constituted 13.78% of all the cancers recorded in this study, which is a reduction from the 16.2% from Stefan [ 15 ]. Hepatoblastomas were also rare, decreasing from 2.1–0.57%. When looking closely at the cancer subtypes there was a considerate change seen in the ranking compared to previous studies [ 15 , 18 ]. In this study, there were many childhood cancers that decreased since the study by Stefan [ 15 ] 12 years ago, but leukaemias doubled. This is most likely due to better methods of diagnoses of childhood cancers. In another by Chitsike et. al [ 2 ], leukaemias in general were not as common in Zimbabwe as in Namibia. Overall, the incidence of paediatric cancer over a 10-year period was significantly lower for Zimbabwe (16.2%) than for Namibia (33.91%). Nephroblastoma or Wilm’s tumour was the most commonly occurring cancer in children in Zimbabwe, in contrast to the leukaemias for Namibia. This was followed by Kaposi sarcoma (15.7%), retinoblastoma (13.1%), non-Hodgkin’s lymphoma (10.3%), leukaemia (8.9%), brain or nervous tissue (6.1%), connective tissue (5.9%), bone (5.5%), Hodgkin’s lymphoma (3.2%), non-melanoma skin cancer (1.9%), and miscellaneous cancers (13.2%) [ 2 ]. This is most likely due to a difference in incidence of HIV between Namibia and Zimbabwe, resulting in the difference in trends. Hiv Status Of Participants Out of the total 174 recorded patient files, only 6.3% of patients were HIV exposed, whereas 93.1% of patients were unexposed with 1 file HIV exposure was not recorded hence reported as unknown. The actual HIV status (negative versus positive) was unavailable hence not reported. HIV exposure was minimal during the study period, considering that Namibia is an HIV-endemic country. The routine testing for HIV infection in all patients in Namibia presenting with cancer has been introduced since 2009 [ 15 ]. The lack of actual HIV status (negative versus positive) exposed children could have been due to under-diagnosis from poor documentation of routine HIV rapid testing. In another study done in 1988 by Wessels [ 18 ], there was no mention of results from the study on the burden of HIV/AIDS. This is presumably due to the fact HIV was still a relatively new disease, as it was first discovered in 1983 [ 3 ]. The study done by Chitsike et. al [ 2 ] showed a higher incidence of HIV-associated Kaposi sarcoma. In that study Kaposi sarcoma was the second most common cancer in children accounting for 15.7% of all cases. If the documentation in our study was improved, our results would be more comparable to those of Chitsike et. al [ 2 ]. Method of management or treatment modalities The majority of paediatric patients (44.3%) were treated solely using chemotherapy. This is comparable with the above findings of haematopoietic cancers being the most commonly occurring cancer, as haematopoietic cancers such as leukaemia are treated with chemotherapy. The patients who ended up in palliative care in addition to their primary form of treatment and/or management together constituted 21.3%, which is about a quarter of the total recorded patients. This is significant as it may imply that patients present late when the cancer has already progressed. Overall, patients had access to most methods of diagnosis during the study. Wessels [ 18 ] unfortunately did not report on results for management and treatment methods or modalities. Stefan [ 15 ] only mentions that 12 years ago all brain and spinal tumours were treated with radiology, but does not mention other treatment modalities. The study by Chitsike et. al [ 2 ] did not report on the cancer treatment modalities used. Length of hospital stay, Outcome or Mortality Rate In our study we had a mean or average length of stay at Windhoek Central Hospital of 241.6 days or at least 8 months. The longest stay for 1 patient at the Paediatric Oncology unit was 1605 days or at least 4 years. Merill [ 14 ] found that compared to the average stay among children and adolescents without cancer, those for cancer care were more than twice as expensive and slightly longer, which has implications on the financial costs incurred by the hospital. Previous studies done in Namibia and Zimbabwe [ 2 , 15 , 18 ] all did not report on this variable of the length of hospital stay, as well as the treatment outcome. In our study, we had a mortality rate of 17.2%. This is comparable with the United States, where the mortality rate is about 15% [ 1 ]. Contrastingly, in the European region the mortality rate ranges from 9–57% [ 21 ]. This is in contrast to Africa in general, where the survival rate of children with cancer is approximately 20% [ 17 ]. This could be due to reduced availability of resources and late presentation. Limitations during the study Our study was a retrospective study and some files had missing information hence excluded from the study. Therefore, the recommendation is for future studies in paediatric oncology in Namibia to be prospective instead of retrospective, which will ensure required information is captured adequately. The poor documentation of actual HIV status (negative versus positive) means that only HIV exposure status. Conclusions In conclusion, haematopoietic cancers came out as the number one most common cancer in children over the last 10 years, from 01 January 2011 to 31 December 2020 in Namibia. The ranking of the other paediatric cancer types ad subtypes has changed since the last study that was done in 2010 [ 15 ], with the exception of leukaemias which remained the most common cancer type in children since 2010 [ 15 ]. There has been a reduction in the incidence of most paediatric cancer subtypes since the last study was done by Stefan [ 15 ] in 2010, but leukaemias increased significantly. As compared to another African country, namely Zimbabwe, the overall cancer in children was lower. There is a need to improve the documentation of HIV testing in paediatric patients, as evidenced by the difficulty experienced to obtain the HIV status of each patient in this study. Namibia is a HIV-endemic country, like many other African countries, and recording of the HIV status is essential. Overall, there needs to be better patient file documentation and storing in the future. We recommend that prospective studies be done rather than retrospective in the future, as the majority of patient files consisted of poor documentation of information. A cancer registry is needed in the future to determine the true incidence of childhood cancers in Namibia. Abbreviations CDC Centers for Disease Control CNS Central Nervous System CT Computed Tomography HIV Human Immunodeficiency Virus HIV/AIDS Human Immunodeficiency Virus/ Acquired Immune Deficiency Syndrome MOHSS Ministry of Health and Social Services MRI Magnetic Resonance Imaging PMTCT Prevention of Mother to Child Transmission SPSS Statistical Package for Social Sciences Std. Standard WCH Windhoek Central Hospital WHO World Health Organisation Declarations 1. Ethics approval and consent to participate No Ethics Committee or Institutional Review Board exists in the Ministry of Health and Social Services, which is the governing body of Namibia’s health sector. Ethical approval and informed consent waiver was given in written form by the Ministry of Health and Social Services (MOHSS), Office of the Executive Director (reference number 22/4/2/3). Approval was also sort from the Medical Superintendent of Windhoek Central Hospital, which is the site of the study. All research methods were carried out in accordance with guidelines and regulations dictated by the Ministry of Health and Social Services. The data was kept under lock and key in the office of the secretary at 8 west, Windhoek Central Hospital, as the secretary is the person in charge of the storage files of previously admitted patients. The research data was recorded manually at first using the research tool that is attached to this thesis, and then later was recorded electronically onto a laptop device. The electronic data was kept confidential, in order to protect the identities of the study participants. 2. Consent for publication Not Applicable. 3. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. The majority of data generated or analysed during this study are included in this published article. 4. Competing interests The authors declare that they have no competing interests. 5. Funding Not Applicable. 6. Authors' contributions NK collected the data and compiled the data using the data collection tool, and also assisted in analysing the data, as well as compiling the manuscript. RMM assisted in analysing the data, compiling the manuscript, and also provided her expertise and knowledge in the field of paediatrics. All authors read and approved the final manuscript. 7. Acknowledgements Many thanks go to Mr Mondjila Amkongo, assistant lecturer at the Department of Radiology, University of Namibia School of Allied Health Sciences, for his expert and valued statistical input. References American Cancer Society. 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Merill CT, Nagamine M, … Hambrick MM. Pediatric Hospital Stays for Cancer, 2005. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. 2007; doi: https://www.ncbi.nlm.nih.gov/books/NBK61974/ . Stefan DC. Incidence of childhood cancer in Namibia: the need for registries in Africa. Pan Afr Med J. 2014;17:191. United States Environmental Protection Agency EPA. https://www.epa.gov/americaschildrenenvironment/health-childhood-cancer (2022). Accessed 22 August 2022. UN United Nations. Childhood cancer care in Africa hit hard by pandemic. UN News. https://news.un.org/en/story/2021/08/1097752#:~:text=In%20Africa%2 C%20the%20childhood%20cancer,cent%20in%20high%2Dincome%20countries (2021). Accessed 23 August 2022. Wessels GH. Incidence and frequency rates of childhood cancer in Namibia. South Afr Med J. 1997;87:885–9. Williams LA, Richardson M, … Spector LG. The association between sex and most childhood cancers is not mediated by birthweight. Cancer Epidemiology. 2018; doi: https://doi.org/10.1016%2Fj.canep.2018.09.002. WHO World Health Organization. Childhood cancer. Newsroom. https://www.who.int/news-room/fact-sheets/detail/cancer-in-children (2021). Accessed 19 August 2022. WHO World Health Organization. New WHO report highlights scale of childhood cancer inequalities in the European Region. Newsroom. https://www.who.int/europe/news/item/15-02-2022-new-who-report-highlights-scale-of-childhood-cancer-inequalities-in-the-european-region#:~:text=%E2%80%9CThe%20 mortality%20rate%20ranges%20from,Technical%20Officer%20at%20WHO%2FEurope (2022). Accessed 23 August 2022. Zahnd WE, James AS, … Brard L. Rural-Urban Differences in Cancer Incidence and Trends in the United States. Cancer Epidemiology, Biomarkers & Prevention. 2018; doi: https://aacrjournals.org/cebp/article/27/11/1265/71426/Rural-Urban-Differences-in-Cancer-Incidence-and. Zietsman AB. Cancer in Namibia, 2006–2009. Windhoek: Namibian Cancer Registry; 2011. 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Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2054100","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":150634329,"identity":"89d79171-3775-4839-924b-137c21fa51b4","order_by":0,"name":"Ndapewa Kaholongo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA20lEQVRIiWNgGAWjYBACCQYGAwiDvQFIGliQooXnAEiLBClaJBKgfEJAcnbzxs8FFYflJWc+v7rhR4EEA397dwJeLdIyx4qlZ5w5bDhbOqfsZg/QYRJnzm7Aq0VOIsdAmrftNuM86Zy0GzxALQYSuQS1GP/m/Xfbfp7kmbSbf4jRIi2RYybN23A7cbYE+7HbRNkiOSOtzHrGsf/JM3ty2G7LGEjwEPSLxI3kzbcLatJsZxw//uzmmz82cvztvfi1gAAzhOIBRxAPQeVIWtgfEKV6FIyCUTAKRh4AANcLRhDWJLliAAAAAElFTkSuQmCC","orcid":"","institution":"Ndapewa Kaholongo, University of Namibia","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Ndapewa","middleName":"","lastName":"Kaholongo","suffix":""},{"id":150634330,"identity":"492fa67b-08f6-446b-b3a7-f7a2e63977ca","order_by":1,"name":"Runyararo Mashingaidze-Mano","email":"","orcid":"","institution":"University of Namibia","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Runyararo","middleName":"","lastName":"Mashingaidze-Mano","suffix":""}],"badges":[],"createdAt":"2022-09-11 15:29:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2054100/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2054100/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":28970685,"identity":"3ba6fdbb-93a3-4c76-a942-737a6449c8f7","added_by":"auto","created_at":"2022-11-11 21:24:23","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":101832,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eNamibia’s Administrative Regions\u003c/strong\u003e.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-2054100/v1/7ef99228275513ea0b9c1bba.png"},{"id":28970684,"identity":"bbd68c01-df38-498f-8e5b-92e5f9d97bd1","added_by":"auto","created_at":"2022-11-11 21:24:23","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":46632,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eScreening of files flow chart\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-2054100/v1/b6aee97aeb9873b7ad9fc6f0.png"},{"id":29585833,"identity":"586e20f9-af6b-4959-9ff7-b76daee8393c","added_by":"auto","created_at":"2022-11-28 10:14:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":814206,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2054100/v1/02923406-30f1-4b1d-a56a-2499d1677284.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Paediatric cancer burden in Namibia, A 10 year retrospective, analytical study of patients admitted at Windhoek Central Hospital","fulltext":[{"header":"Background","content":"\u003cp\u003eChildhood or paediatric cancers are known to cause significant morbidity and mortality and are the leading cause of death in children under 19 years of age [20]. Many of these cases (about 70%) occur in developing countries [15]. While there are no age-specific cancers in the paediatric age group, there are certain cancers which present in specific childhood years [11]. Childhood cancer is curable [20], and nearly 80% of paediatric cancer patients in developed countries can be cured of cancer [15]. However, Africa bears a heavy burden of childhood cancer [7], as more than 80% of children in Africa diagnosed with cancer die without access to adequate treatment [3].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStefan [15] suggests that the survival rate of paediatric cancers in Namibia was a mere 17%, in comparison to the higher rates in western countries, such as the United States, where the survival rate is 85% [1]. In Africa, the incidence rates of some childhood cancers are much higher in comparison to those of developed countries [15].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLittle research has been done in the field of paediatric oncology in Namibia, like many other developing countries in Africa and yet, worldwide the majority of research in paediatric oncology comes from developed countries such as the United States [15]. This is counter-intuitive to the fact that Africa carries a heavy burden of paediatric cancer [6]. Therefore, there is a significant need for more research to be done in African developing countries such as Namibia. The last national cancer registry was reported in 2014, which included the total incidence of cancers in the whole Namibian population [23].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNamibia is a diverse nation of approximately 2.59 million people [4]. Of this number, a total of 11 248 Namibians were diagnosed with a malignant neoplasm in the last Namibian National Cancer Registry in 2014 [23]. Children under 15 years diagnosed with a cancer constituted 3.3% [23]. However, it is known that in many African developing countries such as Namibia, this estimate could be higher due to under-diagnosis or misdiagnosis of paediatric cancers [15].\u003c/p\u003e\n\u003cp\u003eA study done in Zimbabwe looked at the pattern of paediatric cancers in children aged 0-14 years that were registered in the Zimbabwean Cancer Registry from 2000 to 2009 [2]. \u0026nbsp;The study found that there was a prevalence of childhood cancer of 3.8% of all the malignancies recorded at the Zimbabwe National Cancer Registry over a ten-year period. The most common cancers were nephroblastoma, retinoblastoma and Kaposi sarcoma. Haematological cancers, specifically leukaemias and lymphomas, were also prevalent but were not the most common cancers. Two studies done in Namibia in 1988 and 2010 have shown changes in the pattern of paediatric cancers over the years. There is a constant need to have updated statistics on the changing trends in the frequency of different types of cancers [15,18]. There has been a significant change in the prevalence of paediatric cancers in Namibia since the last study was done in 2010 by Stefan [15].\u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA retrospective, analytical study of cancers in children aged 0-16 years registered and admitted at the Windhoek Central Hospital (WCH) from 01 January 2011 to 31 December 2020 was carried out. Formal consent for the study was obtained from the Ministry of Health and Social Services (MOHSS), Office of the Executive Director (reference number NOK 2021). The MOHSS also granted a waiver for informed consent from study participants, and gave ethical clearance to publish the research (reference number 22/4/2/3). Further approval was obtained from the Medical Superintendent of Windhoek Central Hospital in Windhoek before commencement of the study. Verbal consent was obtained from the matron at the paediatric oncology ward (8 west) at the hospital, where data for this study was abstracted from patient record files that are kept in the ward. Windhoek Central Hospital is the only referring state hospital for paediatric oncology cases in Namibia. Namibia is a country located in Southern Africa, which is divided into 14 regions, with Windhoek being the capital city, located in Khomas region. See Figure 1 Below:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData recording and analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformation collected for each patient included patient demographics: \u0026nbsp;age, sex, region or area of residency, date at diagnosis, type of cancer diagnosed, method of diagnosis, HIV status (exposed versus unexposed), outcome, date of discharge or death. Patients whose type of cancer was not recorded were excluded from the study. We employed a data-collecting template using a Microsoft Excel spreadsheet, which was used to collect the study variables. The raw data on the Microsoft Excel spreadsheet was then analysed using the (Statistical Package for Social Sciences) SPSS statistical tool. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn this study we characterized childhood cancers in Namibia with regard to the type of cancer diagnosed, sex and age distribution, age of diagnosis and date at discharge or death (whichever is applicable), region or area of residency, the impact of HIV (exposed versus unexposed), and eventual outcome of the patient. Eventual outcome consists of the treatment and/or management that the patient received, before discharge or death (whichever is applicable). Method of diagnosis was also evaluated, and methods were grossly grouped into three main classifications: clinical (patient history and physical examination); imaging [ultrasound, radiology (X-ray, Computed Tomography (CT) scan, Magnetic Resonance Imaging (MRI))]; and histology (biopsy).\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv class=\"Section2\" id=\"Sec5\"\u003e\n \u003ch2\u003eDemographic characteristics of the study participants\u003c/h2\u003e\n \u003cp\u003eFigure \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e shows a summarized flow chart of the patient files analysed. A total of 1000 paediatric oncology files were available for the study. Eight hundred and twenty-six (826) were excluded from the study for various reasons. Three hundred and sixty-three files had poorly recorded information whilst 463 files were \u003cstrong\u003enot\u003c/strong\u003e admitted during the study period. Only 174 patient files met the study criteria (admitted from 01 January 2011 to 31 December 2020) and were included in the study. The median age at diagnosis was 5 .0 years with an age range being 1 to 15 years and mean age of 5.13 years. Of the 174 patient files 97 (55.7%) were males and 77 (44.3%) females with a male female ratio of 1,26: 1. See Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e below for the sex distribution.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDemographic characteristics of paediatric oncology patients admitted at Windhoek Central Hospital during the study period.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e174\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIV Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExposed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnexposed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHIV Status unknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e174\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegion of Residence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKhomas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eZambezi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOtjozondjupa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKavango\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eErongo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOshana\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOhangwena\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOshikoto\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e//Karas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHardap\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOmusati\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOmaheke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKunene\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e174\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eUrban/Rural\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eValid Percent (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrban*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRural*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e174\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cstrong\u003e*Urban is referring to Khomas Region, *Rural is all other regions other than Khomas.\u003c/strong\u003e\u003c/p\u003e\n \u003cdiv class=\"Section3\" id=\"Sec6\"\u003e\n \u003ch2\u003eRegion of Residence\u003c/h2\u003e\n \u003cp\u003eThe Khomas region hand the highest number of patient files admitted during the study period (20.7%), followed closely by Oshana region (16.7%). Kavango region contributed 10.9%, Erongo and Ohangwena were both 9.8%, Oshikoto 6.9%, Kunene 6.3%, Otjozondjupa 5.2%, Omusati was 4.6%, and Zambezi 4.0%. Karas, Hardap and Omaheke contributed the lowest number of admissions with 1.1%, 1.7% and 2.3%, respectively. Most paediatric cancer cases diagnosed originated from the rural area,139 (79.3%) compared with 36 (20.7%) from urban area. Khomas region was considered the urban area while the other 12 regions were grouped as the rural region or area, as those regions usually look after patients from rural areas, and Khomas has the only referring hospital for all oncology cases and caters for the urban area. See Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e above.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv class=\"Section3\" id=\"Sec7\"\u003e\n \u003ch2\u003ePaediatric Cancer Types\u003c/h2\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab2\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eFrequency of the types of paediatric cancer in Paediatric patients admitted at an Oncology unit.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eType of cancer diagnosed\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eValid Percent (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBrain or CNS cancers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmbryonal cancers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHaematopoietic cancers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e44.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSoft tissue and bone sarcomas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e174\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e100.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e shows the frequency of the types of paediatric cancers. Haematopoietic cancers were the most commonly occurring cancer type constituting 78 (44.8%) of all the 174 recorded patients in this study. Embryonal cancers were the second most common cancer type in children with an frequency of 66 (37.9%). Soft tissue and bone sarcomas had an incidence of 13.8% of the 174 total patients in the study, while brain or CNS cancers were the least commonly occurring with a mere 3.4% incidence. Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e shows the specific subtypes for each cancer types.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv class=\"Section3\" id=\"Sec8\"\u003e\n \u003ch2\u003eSubtypes of Paediatric Cancer\u003c/h2\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab3\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eFrequency of the subtypes of the paediatric cancers in patients admitted in a Paediatric Oncology unit.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePaediatric cancer type\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePaediatric cancer subtype\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eValid Percent (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eHaematopoietic cancers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLeukaemias\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLymphomas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eBrain or CNS cancers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAstrocytomas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEpendymal tumours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGlioma-pontine tumours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSoft tissue and bone sarcomas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRhabdomyosarcomas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFibrosarcomas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKaposi sarcomas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMelanomas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOsteosarcomas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSquamous cell carcinomas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eEmbryonal cancers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNephroblastomas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNeuroblastomas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRetinoblastomas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTeratomas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGerm cell tumours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYolk sac tumours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHepatoblastomas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDysgerminomas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e174\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e100.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eLeukaemias were the most common cancer subtype. 59 (33.91%) of the recorded patients were diagnosed with a leukaemia, which is over a third of the total 174 patients recorded. Nephroblastomas, lymphomas, rhabdomyosarcomas, neuroblastomas and retinoblastomas were also very common with a frequency of 29 (16.7%), 19 (10.92%), 17 (9.77%), 14 (8.05%), 13 (7.47%), respectively out of the 174 paediatric patients. Astrocytomas, ependymal tumours, fibrosarcomas, Kaposi sarcomas, teratomas, germ cell tumours and yolk sac tumours were less common and together comprised 17 (9.76%). Glioma-pontine tumours, melanomas, osteosarcomas, squamous cell carcinomas, hepatoblastomas and dysgerminomas were rare in this study, each contributing 1 (less than 1% of all the cancers).\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv class=\"Section3\" id=\"Sec9\"\u003e\n \u003ch2\u003eAge distribution and Paediatric Cancer types\u003c/h2\u003e\n \u003cp\u003eThe distribution of cancers according to age groups is shown in Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e below.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab4\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eAge distribution of paediatric cancers according to 3 age categories.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eType of cancer diagnosed\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eAge Group in years\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026ndash;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u0026ndash;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u0026ndash;15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBrain or CNS cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmbryonal cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSoft tissue and bone sarcoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHaematopoietic cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Frequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e104\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e60\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e174\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e% of Total\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eThe distribution of paediatric oncology cancer was strongly related to age groups (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e). There was an inverse relationship between cancer and age, as cancers were more common the younger the age and less common the older the age. There were significantly more cancers diagnosed in the age category of 0\u0026ndash;5 years for each of the cancer types. Out of the total 174 admissions, 104 were in the age group of 0\u0026ndash;5 years constituting 59.8% of all cancers, 34.5% in the age category 6\u0026ndash;10 years, while only 5.70% of all the cancers were diagnosed in children aged 11\u0026ndash;15 years. Of note, haematopoietic cancers were the most diagnosed cancer type in the age category 0\u0026ndash;5 (the most commonly occurring age category overall) with a frequency of 44, constituting 25.3% of all the cancers recorded in this study. There were no soft tissue and bone sarcomas, nor brain or CNS cancers recorded in the age category 11\u0026ndash;15 years.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv class=\"Section3\" id=\"Sec10\"\u003e\n \u003ch2\u003eSex distribution and Paediatric Cancer Type\u003c/h2\u003e\n \u003cp\u003eDistribution of paediatric cancer according to sex is shown in Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e below.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab5\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSex distribution of the paediatric cancers in patients admitted at a Paediatric Oncology unit.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eType of Cancer diagnosed\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBrain or CNS cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmbryonal cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSoft tissue and bone sarcoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHaematopoietic cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e174\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e% of Total\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eOverall, males were more commonly diagnosed than females for most of the cancer types. Males were twice as affected as females for brain or CNS cancers (4 versus 2), and almost twice as much for embryonal cancers (41 versus 25). For soft tissue and bone sarcomas, males were only slightly more affected than females, with a frequency of 13 within the cancers group itself, compared to the 11 of females. Haematopoietic cancers, the most common cancers in the whole study, occurred in equal proportions for both genders with a frequency of 39 for both.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv class=\"Section3\" id=\"Sec11\"\u003e\n \u003ch2\u003ePaediatric cancer type and HIV exposure\u003c/h2\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab6\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDistribution of paediatric cancers according to the HIV Exposure status.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eHIV Status\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of cancer diagnosed\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eExposed\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnexposed\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBrain or CNS tumour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmbryonal tumour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSoft tissue and bone sarcoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHaematopoietic cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Frequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e174\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e% of Total\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cstrong\u003e*There is one patient whose HIV status was unknown and not stratified according to type of cancer and HIV exposure status.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eWe also looked at the distribution of cancers according to the HIV exposure status in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e. The majority of paediatric cancer patients were HIV unexposed, together constituting 162 patients (93.6%). Only 11 (6.40%) of patients were exposed. Of these exposed patients, most of the patients (6) had embryonal cancers (3.50%). 3 patients had haematopoietic cancers. Soft tissue and bone sarcomas, and brain or CNS cancers both had 1 patient exposed (less than 1% of exposed patients).\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv class=\"Section3\" id=\"Sec12\"\u003e\n \u003ch2\u003eMethod of diagnosing of Cancer\u003c/h2\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab7\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMethods used to diagnose the paediatric cancers.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMethod of diagnosis\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eValid Percent (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHistology (Biopsy)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eClinical; Imaging; Histology (Biopsy)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImaging\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImaging; Histology (Biopsy)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e174\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\"\u003e\u003cstrong\u003e*Histology (Biopsy) includes tumour biopsies, cytology specimens, and bone marrow biopsies.\u003c/strong\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eIn Table \u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e, the methods of diagnosis used during the study are indicated. Histology using biopsies was the most widely used method of diagnosis constituting 74.7% of all diagnosed cancers. Occasionally, imaging [ultrasound, radiology (X-ray, CT scan, MRI)] was also used in conjunction with the histology (19.5%). 7 diagnoses were made using imaging alone (4%). In few cases, the diagnosis was made based on a combination of clinical assessment, imaging, and histology (biopsy) (1.7%).\u003c/p\u003e\n \u003cdiv class=\"Section4\" id=\"Sec13\"\u003e\n \u003ch2\u003eTreatment modalities used for the cancer patients\u003c/h2\u003e\n \u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e8\u003c/span\u003e below shows the various treatment modalities of paediatric oncology patients used as part of the management plan. The majority of paediatric patients (44.3%) were treated solely using chemotherapy. This is followed by 16.1% of patients who were treated with both chemotherapy and surgery. Of note, these are patients who received either neo-adjuvant chemotherapy or post-op chemotherapy or both, depending on the specific type of cancer and individual cases.\u003c/p\u003e\n \u003cp\u003eThe patients who ended up in palliative care in addition to their primary form of treatment and/or management together constituted 21.3%, which is about a quarter of the total recorded patients. The patients who received radiotherapy constituted a tenth of all the patients (14.4%). Of significance, 31% of the patients underwent surgery to remove a tumour, which is a third of the total recorded patients.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab8\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eThe treatments and/ management used for paediatric cancer patients admitted at an Oncology Unit.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTreatment modality\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eNumber of cancer patients using each treatment modality\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eValid Percent (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChemotherapy; Radiotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChemotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChemotherapy; Surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChemotherapy; Surgery; Palliation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChemotherapy; Palliation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChemotherapy; Radiotherapy; Palliation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChemotherapy; Radiotherapy; Surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRadiotherapy; Surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSurgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePalliation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSurgery; Palliation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRadiotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e174\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/div\u003e\n \u003cdiv class=\"Section3\" id=\"Sec14\"\u003e\n \u003ch2\u003eLength of Hospital Stay\u003c/h2\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab9\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 9\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eLength of stay in hospital during course of treatment.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"2\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLength of Stay In Hospital (days)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e241.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e193.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStd. Deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e243.834\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1605\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMinimum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaximum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1605\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e9\u003c/span\u003e shows the length of stay in hospital during the course of treatment of paediatric cancers during the study period. The length of stay had a mean of 241.6 days and a median of 193.0 days, with a standard deviation of 243.834 days. The maximum number of days spent in the hospital during the study was 1605 days (over 52 months or 4 years).\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv class=\"Section3\" id=\"Sec15\"\u003e\n \u003ch2\u003eTreatment outcome\u003c/h2\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab10\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 10\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eThe outcome of paediatric cancer patients after diagnosis and/ treatment.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eValid Percent (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e82.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eThe mortality rate was 17.2%, as shown in Table \u003cspan class=\"InternalRef\"\u003e10\u003c/span\u003e. Only 30 out of the total patients recorded in this study demised either before, during or after treatment and/or management, but all the patients demised after the diagnosis was made. This mortality rate translates to just over a fifth of all the patients who demised during the study period.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003ePaediatric Cancer types and subtypes\u003c/h2\u003e \u003cp\u003eThis study looked at the paediatric cancer pattern over a 10-year period. Males constituted more than half of the study participants (55.7%) while females constituted 44.3%. The ratio of males to females was 1.26: 1. In general, it is known that male children are at greater risk of developing cancer than their female counterpart [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, the exact mechanisms that underlie this difference in childhood cancer incidence by sex is mostly unknown [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. It may perhaps be due to the fact that male children are often of higher birthweight, contract a higher number of childhood infections, and their pubertal growth is much more accelerated with a completely different hormonal profile, as compared to females [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. These risk factors may be what contributes to the higher incidence of cancer in male children. These findings were similar to previous studies were male children were predominantly reported to have cancer compared to female [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this study, cancers were strongly related to age as more cancers were found in the younger age groups. These findings are comparable to previous studies which reported highest incidence of cancer in the same age group 0\u0026ndash;4 years [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. However, another study by Wessels [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] reported highest incidence in the 1\u0026ndash;4 years\u0026rsquo; age group [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. According to literature [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], between 2016 and 2018 children under 5 years experienced some of the highest incidence rates of cancer in the United States. There is very little research done to explain why children under 5 years get cancer, but that certain cancers tend to occur preferentially in infants, children and adolescents [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In general, childhood cancers are genetic in origin, but certain chronic infections such as HIV, malaria and Epstein-Barr virus are risk factors for childhood cancers [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], and infants are more susceptible to infections than older children and adolescents due to their immature immune systems [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMost of the cases in this study originated from the rural areas of Namibia (79.3%). This is most likely due to many parents seeking alternative medicine when their child is ill [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], and the failure of healthcare workers to diagnose a malignancy because of inexperience in recognizing a childhood malignancy, or because of the difficulty in distinguishing between the overlapping symptomatology of cancer and commonly occurring infectious conditions such as malaria and tuberculosis [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. This was not reported by previous other studies [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. However, other studies show that urban-rural differences in cancer incidence and trends vary across the world. A study done in Sudan [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] found that about 76% of the Sudanese children diagnosed with cancer lived in rural areas. Another reason for the high frequency of patients coming from the rural regions found in our study, could be that patients in rural areas are often exposed to cancer-associated modifiable risks such as HIV, chronic childhood infections, and secondary smoking [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study period it was found that leukaemias were the most commonly occurring cancer in children (33.91%) which also doubled from 22.5% from the last study done, where leukaemias were also found to be the most common [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In this study, nephroblastomas occurred second (16.7%), compared to retinoblastomas (16.2%) in the study by Stefan [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Lymphomas decreased from 12.0\u0026ndash;10.92% at Windhoek Central Hospital over the past 12 years since the study done by Stefan [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Of note, there were some specific cancers not mentioned by Stefan [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. For example, rhabdomyosarcomas occurred fourthly (9.77%) in this study, but Stefan [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] does not specifically make mention of rhabdomyosarcomas in their study. Neuroblastomas (8.05%)- also not mentioned- followed rhabdomyosarcomas.\u003c/p\u003e \u003cp\u003eRetinoblastomas decreased considerably to 7.47% from the 16.2% reported by Stefan [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Brain or CNS cancers decreased significantly as well from 11.5\u0026ndash;3.44% compared to Stefan [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Nephroblastomas increased slightly from 13.6\u0026ndash;16.7%. Soft tissue and bone sarcomas together constituted 13.78% of all the cancers recorded in this study, which is a reduction from the 16.2% from Stefan [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Hepatoblastomas were also rare, decreasing from 2.1\u0026ndash;0.57%. When looking closely at the cancer subtypes there was a considerate change seen in the ranking compared to previous studies [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this study, there were many childhood cancers that decreased since the study by Stefan [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] 12 years ago, but leukaemias doubled. This is most likely due to better methods of diagnoses of childhood cancers.\u003c/p\u003e \u003cp\u003eIn another by Chitsike et. al [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], leukaemias in general were not as common in Zimbabwe as in Namibia. Overall, the incidence of paediatric cancer over a 10-year period was significantly lower for Zimbabwe (16.2%) than for Namibia (33.91%). Nephroblastoma or Wilm\u0026rsquo;s tumour was the most commonly occurring cancer in children in Zimbabwe, in contrast to the leukaemias for Namibia. This was followed by Kaposi sarcoma (15.7%), retinoblastoma (13.1%), non-Hodgkin\u0026rsquo;s lymphoma (10.3%), leukaemia (8.9%), brain or nervous tissue (6.1%), connective tissue (5.9%), bone (5.5%), Hodgkin\u0026rsquo;s lymphoma (3.2%), non-melanoma skin cancer (1.9%), and miscellaneous cancers (13.2%) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This is most likely due to a difference in incidence of HIV between Namibia and Zimbabwe, resulting in the difference in trends.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eHiv Status Of Participants\u003c/h3\u003e\n\u003cp\u003eOut of the total 174 recorded patient files, only 6.3% of patients were HIV exposed, whereas 93.1% of patients were unexposed with 1 file HIV exposure was not recorded hence reported as unknown. The actual HIV status (negative versus positive) was unavailable hence not reported. HIV exposure was minimal during the study period, considering that Namibia is an HIV-endemic country. The routine testing for HIV infection in all patients in Namibia presenting with cancer has been introduced since 2009 [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The lack of actual HIV status (negative versus positive) exposed children could have been due to under-diagnosis from poor documentation of routine HIV rapid testing. In another study done in 1988 by Wessels [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], there was no mention of results from the study on the burden of HIV/AIDS. This is presumably due to the fact HIV was still a relatively new disease, as it was first discovered in 1983 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study done by Chitsike et. al [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] showed a higher incidence of HIV-associated Kaposi sarcoma. In that study Kaposi sarcoma was the second most common cancer in children accounting for 15.7% of all cases. If the documentation in our study was improved, our results would be more comparable to those of Chitsike et. al [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eMethod of management or treatment modalities\u003c/h2\u003e \u003cp\u003eThe majority of paediatric patients (44.3%) were treated solely using chemotherapy. This is comparable with the above findings of haematopoietic cancers being the most commonly occurring cancer, as haematopoietic cancers such as leukaemia are treated with chemotherapy. The patients who ended up in palliative care in addition to their primary form of treatment and/or management together constituted 21.3%, which is about a quarter of the total recorded patients. This is significant as it may imply that patients present late when the cancer has already progressed. Overall, patients had access to most methods of diagnosis during the study. Wessels [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] unfortunately did not report on results for management and treatment methods or modalities. Stefan [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] only mentions that 12 years ago all brain and spinal tumours were treated with radiology, but does not mention other treatment modalities. The study by Chitsike et. al [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] did not report on the cancer treatment modalities used.\u003c/p\u003e \u003cdiv id=\"Sec20\" class=\"Section3\"\u003e \u003ch2\u003eLength of hospital stay, Outcome or Mortality Rate\u003c/h2\u003e \u003cp\u003eIn our study we had a mean or average length of stay at Windhoek Central Hospital of 241.6 days or at least 8 months. The longest stay for 1 patient at the Paediatric Oncology unit was 1605 days or at least 4 years. Merill [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] found that compared to the average stay among children and adolescents without cancer, those for cancer care were more than twice as expensive and slightly longer, which has implications on the financial costs incurred by the hospital. Previous studies done in Namibia and Zimbabwe [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] all did not report on this variable of the length of hospital stay, as well as the treatment outcome. In our study, we had a mortality rate of 17.2%. This is comparable with the United States, where the mortality rate is about 15% [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Contrastingly, in the European region the mortality rate ranges from 9\u0026ndash;57% [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This is in contrast to Africa in general, where the survival rate of children with cancer is approximately 20% [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This could be due to reduced availability of resources and late presentation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section3\"\u003e \u003ch2\u003eLimitations during the study\u003c/h2\u003e \u003cp\u003eOur study was a retrospective study and some files had missing information hence excluded from the study. Therefore, the recommendation is for future studies in paediatric oncology in Namibia to be prospective instead of retrospective, which will ensure required information is captured adequately. The poor documentation of actual HIV status (negative versus positive) means that only HIV exposure status.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, haematopoietic cancers came out as the number one most common cancer in children over the last 10 years, from 01 January 2011 to 31 December 2020 in Namibia. The ranking of the other paediatric cancer types ad subtypes has changed since the last study that was done in 2010 [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], with the exception of leukaemias which remained the most common cancer type in children since 2010 [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. There has been a reduction in the incidence of most paediatric cancer subtypes since the last study was done by Stefan [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] in 2010, but leukaemias increased significantly. As compared to another African country, namely Zimbabwe, the overall cancer in children was lower. There is a need to improve the documentation of HIV testing in paediatric patients, as evidenced by the difficulty experienced to obtain the HIV status of each patient in this study. Namibia is a HIV-endemic country, like many other African countries, and recording of the HIV status is essential. Overall, there needs to be better patient file documentation and storing in the future. We recommend that prospective studies be done rather than retrospective in the future, as the majority of patient files consisted of poor documentation of information. A cancer registry is needed in the future to determine the true incidence of childhood cancers in Namibia.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"627\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"49.920255183413076%\"\u003e\n \u003cp\u003eCDC\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"50.079744816586924%\"\u003e\n \u003cp\u003eCenters for Disease Control \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"49.920255183413076%\"\u003e\n \u003cp\u003eCNS\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"50.079744816586924%\"\u003e\n \u003cp\u003eCentral Nervous System \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"49.920255183413076%\"\u003e\n \u003cp\u003eCT\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"50.079744816586924%\"\u003e\n \u003cp\u003eComputed Tomography\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"49.920255183413076%\"\u003e\n \u003cp\u003eHIV\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"50.079744816586924%\"\u003e\n \u003cp\u003eHuman Immunodeficiency Virus\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"49.920255183413076%\"\u003e\n \u003cp\u003eHIV/AIDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"50.079744816586924%\"\u003e\n \u003cp\u003eHuman Immunodeficiency Virus/ Acquired Immune Deficiency Syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"49.920255183413076%\"\u003e\n \u003cp\u003eMOHSS\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"50.079744816586924%\"\u003e\n \u003cp\u003eMinistry of Health and Social Services\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"49.920255183413076%\"\u003e\n \u003cp\u003eMRI\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"50.079744816586924%\"\u003e\n \u003cp\u003eMagnetic Resonance Imaging\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"49.920255183413076%\"\u003e\n \u003cp\u003ePMTCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"50.079744816586924%\"\u003e\n \u003cp\u003ePrevention of Mother to Child Transmission\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"49.920255183413076%\"\u003e\n \u003cp\u003eSPSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"50.079744816586924%\"\u003e\n \u003cp\u003eStatistical Package for Social Sciences\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"49.920255183413076%\"\u003e\n \u003cp\u003eStd.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"50.079744816586924%\"\u003e\n \u003cp\u003eStandard\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"49.920255183413076%\"\u003e\n \u003cp\u003eWCH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"50.079744816586924%\"\u003e\n \u003cp\u003eWindhoek Central Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"49.920255183413076%\"\u003e\n \u003cp\u003eWHO\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"50.079744816586924%\"\u003e\n \u003cp\u003eWorld Health Organisation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e1. Ethics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo Ethics Committee or Institutional Review Board exists in the Ministry of Health and Social Services, which is the governing body of Namibia\u0026rsquo;s health sector. Ethical approval and informed consent waiver was given in written form by the Ministry of Health and Social Services (MOHSS), Office of the Executive Director (reference number 22/4/2/3). Approval was also sort from the Medical Superintendent of Windhoek Central Hospital, which is the site of the study. All research methods were carried out in accordance with guidelines and regulations dictated by the Ministry of Health and Social Services.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe data was kept under lock and key in the office of the secretary at 8 west, Windhoek Central Hospital, as the secretary is the person in charge of the storage files of previously admitted patients. The research data was recorded manually at first using the research tool that is attached to this thesis, and then later was recorded electronically onto a laptop device. The electronic data was kept confidential, in order to protect the identities of the study participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. Consent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3. Availability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. The majority of data generated or analysed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4. Competing interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5. Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6. Authors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNK collected the data and compiled the data using the data collection tool, and also assisted in analysing the data, as well as compiling the manuscript. RMM assisted in analysing the data, compiling the manuscript, and also provided her expertise and knowledge in the field of paediatrics. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e7. Acknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMany thanks go to Mr Mondjila Amkongo, assistant lecturer at the Department of Radiology, University of Namibia School of Allied Health Sciences, for his expert and valued statistical input. \u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cspan\u003eAmerican Cancer Society. Key Statistics for Childhood Cancers. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.canncer.org\u003c/span\u003e\u003c/span\u003e (2021). Accessed 05 April 2021.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eChitsike IN. Childhood Cancers in Zimbabwe: A 10 year review of the Zimbabwe National Cancer Registry data. The Central African Journal of Medicine. 2014; 60(1/4).\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eDe Cock KM, Jaffe HW, Curran JW. Reflections on 30 years of AIDS. 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Cancer Epidemiology. 2018; doi: https://doi.org/10.1016%2Fj.canep.2018.09.002.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eWHO World Health Organization. Childhood cancer. Newsroom. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/cancer-in-children\u003c/span\u003e\u003c/span\u003e (2021). Accessed 19 August 2022.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eWHO World Health Organization. New WHO report highlights scale of childhood cancer inequalities in the European Region. Newsroom. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/europe/news/item/15-02-2022-new-who-report-highlights-scale-of-childhood-cancer-inequalities-in-the-european-region#:~:text=%E2%80%9CThe%20\u003c/span\u003e\u003c/span\u003emortality%20rate%20ranges%20from,Technical%20Officer%20at%20WHO%2FEurope (2022). Accessed 23 August 2022.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eZahnd WE, James AS, \u0026hellip; Brard L. Rural-Urban Differences in Cancer Incidence and Trends in the United States. Cancer Epidemiology, Biomarkers \u0026amp; Prevention. 2018; doi: https://aacrjournals.org/cebp/article/27/11/1265/71426/Rural-Urban-Differences-in-Cancer-Incidence-and.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eZietsman AB. Cancer in Namibia, 2006\u0026ndash;2009. Windhoek: Namibian Cancer Registry; 2011.\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Pattern, Paediatric cancer, Ten-year review ","lastPublishedDoi":"10.21203/rs.3.rs-2054100/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2054100/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBACKGROUND\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResearch in Namibia has come a long way over the past two decades. Even so, research in the field of paediatric oncology is still lagging behind. Therefore, this study looked at the pattern of paediatric cancer patient over a ten-year period.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMETHODS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional study was done to analyse the paediatric oncology cases that were admitted to the paediatric oncology unit (ward 8 west) at Windhoek Central Hospital (WCH) between 01 January 2011 and 31 December 2020. The study analysed the files of paediatric patients admitted with a paediatric cancer diagnosis from the age of 0 to 16 years.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRESULTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 174 paediatric cancer patient files met the inclusion criteria. Haematopoietic cancers were the most commonly occurring diagnosis of a paediatric cancer type in the study population (44.8%), of which leukaemias were the most common type of haematopoietic cancer. \u0026nbsp;The other types of cancer apart from haematopoietic cancers consisted of embryonal cancers (37.9%), soft tissue and bone sarcomas (13.8%), and brain or CNS cancers (3.4%). The median age at diagnosis was 5.13 years with an age range of 0 to 15 years. HIV exposure had an incidence of 6.4%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONCLUSIONS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHaematopoietic cancers remains the number one most common type in Namibia. \u0026nbsp;However, there has been a change in the ranking of the other childhood cancer subtypes over the last 3 decades. The recommendation is that there be better recordkeeping of cancer patient files to capture important information. For follow-up studies, prospective studies are recommended in the future.\u003c/p\u003e","manuscriptTitle":"Paediatric cancer burden in Namibia, A 10 year retrospective, analytical study of patients admitted at Windhoek Central Hospital","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-11-11 21:24:18","doi":"10.21203/rs.3.rs-2054100/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fa718c22-a0a5-490e-a2a0-4951fe8d4e95","owner":[],"postedDate":"November 11th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-11-28T10:14:22+00:00","versionOfRecord":[],"versionCreatedAt":"2022-11-11 21:24:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2054100","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2054100","identity":"rs-2054100","version":["v1"]},"buildId":"omnImTCwR2MFx8CMYfrG7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}