Identifying Factors Resulting in Delayed Diagnosis and Treatment of Pediatrics Retinoblastoma ,Addis Ababa, Ethiopia:Multicenter Cross-Sectional Study.
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Date
2024-09
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Addis Ababa University
Abstract
Background: Retinoblastoma is the most common pediatric intraocular tumor, it is rare compared
to other pediatric cancers, accounting for approximately 3 to 4% of all childhood malignancies.
More than 60% of cases in low-income countries are advanced retinoblastoma, and mortality is
significant due to delayed presentation, diagnosis, and treatment, with more than 50% of patients
dying. This study determined the sociodemographic profile, clinical profile, diagnosis and
treatment modalities, and factors affecting early diagnosis and treatment of pediatric
retinoblastoma who were treated in TASH, St. Paulos, and Menelik specialized hospitals in
Ethiopia from April 1, 2023, to June 30, 2024.
Objective: The primary aim of this study was to identify factors resulting in delayed diagnosis
and treatment of RB at Tikur Anbessa, St, Paulos, and Menelik specialized hospital, Addis
Ababa, Ethiopia
Method: A prospective multicenter study of all pediatric patients diagnosed with retinoblastoma
at, Tikur Anibessa, St, Paulos, and Menelik the II specialized hospital, Ethiopia. All 111 newly
diagnosed pediatric retinoblastoma cases were included in the analysis to establish the extent of
presentation, diagnosis, treatment, delay, and associated reasons. Data was collected
prospectively for those who fulfilled the inclusion criteria by using a semi-structured checklist
questionnaire prepared from previous literature with amendments. The data was coded, cleaned,
and entered into the SPSS version 26 software program, and analysis was done. The data was
categorized and summarized with descriptive statistics, and univariate and multivariate binary
logistic regression analysis examined the factors associated with the treatment delay of
retinoblastoma. Logistic regression results revealed that adjusted odds ratios (OR) with 95%
confidence intervals and p-value < 0.05 are statistically significant.
Result: The analysis of 111 newly diagnosed pediatric retinoblastoma cases was conducted.
Males accounted for 51.4% of diagnoses. The median age is 40 months for unilateral and 22
months for bilateral retinoblastoma. More than 59.5% of patients have a delayed time to
treatment initiation. The median time before starting treatment was 6.2 months. The most
prevalent reasons for delayed treatment were the guardian's lack of knowledge of the disease,
delayed referral, and being so far from the treatment center.
Moving on to associated factors for delayed presentation, diagnosis, and treatment of
retinoblastoma, far residency from treatment (AOR=1.5, p=0.035), lack of caregiver awareness
(AOR=3.64, p=0.044), and delayed referral (AOR =2.95, p=0.035) emerged as the most
statistically significant variables determining total treatment delay.
Conclusion: Results from our study show that more than half of the pediatric RB patients
experienced a total delay of more than 6 months. Lack of RB awareness among guardians,
referral delays, and travel challenges, were significant barriers to receiving timely care. As a
result, there is an urgent need for high-level actions and an evidence-based approach to
addressing determining factors
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Keywords
Retinoblastoma