Referral patterns for retinoblastoma patients in Ethiopia

Abstract

Background: Increased lag time between the onset of symptoms and treatment of retinoblastoma (RB) is one of the factors contributing to delay in diagnosis. The aim of this study was to understand the referral patterns and lag times for RB patients who were treated at Menelik II Hospital in Addis Ababa, Ethiopia.

Method: A single-center, cross- sectional study was conducted in January 2018. All new patients with a confirmed RB diagnosis who had presented to Menelik II Hospital from May 2015 to May 2017 were eligible. A questionnaire developed by the research team was administered to the patient's caregiver by phone.

Results: Thirty-eight patients were included in the study and completed the phone survey. Twenty-nine patients (76.3%) delayed seeing a health care provider for ≥ 3 months from the onset of symptoms, with the most common reason being the belief that it was not a problem (96.5%), followed by 73% saying it was too expensive. The majority of patients (37/38, 97.4%) visited at least 1 additional health care facility prior to reaching a RB treatment facility. The mean overall lag time from noticing the first symptom to treatment was 14.31 (range 0.25-62.25) months.

Conclusion: Lack of knowledge and cost are major barriers to patients first seeking care for RB symptoms. Cost and travel distance are major barriers to seeing referred providers and receiving definitive treatment. Delays in care may be alleviated by public education, early screening, and public assistance programs.

Keywords: Lag time; Public Health; Retinoblastoma; Socio economic factors; Sub Saharan African Countries.

Fig. 1

Study Participant Selection. Of 85 eligible records, 42 had valid phone numbers and were invited to participate. All provided informed consent, however 4 were excluded due to incomplete surveys (i.e. caregivers replied to < 50% of the survey questions). The final study number was 38

Fig. 2

Referral Pathway from home to Menelik II Hospital. Of 38 patients, 1 self-referred directly to Menelik II Hospital, while 37 visited at least 1 additional health facility prior to arriving at Menelik II Hospital. One patient refused care at Menelik II Hospital and self-referred to a center in India. FCP = First Care Provider; SCP = Second Care Provider; TCP = Third Care Provider; PECC = Primary Eye Care Center; SECC = Secondary Eye Care Center; TECC = Tertiary Eye Care Center