Pediatric cancer, a disease yearning for attention

Worldwide, about 200,000 children are diagnosed with cancer annually. According to the World Health Organization the disease affects families globally and can be treated with access to quality healthcare. But in Nigeria as in other low and middle-income countries, children like F and A, whose stories you will read below are unable to get the […]

Worldwide, about 200,000 children are diagnosed with cancer annually.

According to the World Health Organization the disease affects families globally and can be treated with access to quality healthcare.

But in Nigeria as in other low and middle-income countries, children like F and A, whose stories you will read below are unable to get the required care or do not complete the treatment process for various reasons, especially finances, making these regions accountable for 90% of deaths from pediatric cancer also called childhood cancer.

 

For five months, five-year-old Fatima, battled an unknown eye ailment before experts at the National Eye Care Hospital in Kaduna, diagnosed it as retinoblastoma – an eye cancer that mostly affects young children.

When it started, her father, Mohammed, said they sought help from a nearby patent medicine store where medicines were prescribed and paid for. “But soon after her right eye started bulging, discharging pus and oozing,” he said.

To help raise money for her treatment, Daily Trust published a story about the youngster who was the 14th child of her father. The story drew sympathy from an individual who offered to cover her medical expenses.

She died three weeks after the offer – another statistic added to Nigeria’s under-five mortality index.

The story is hardly different for three-year-old Abijia who was hospitalized for months at the National Hospital Abuja, receiving palliative care before proper treatment started for his leukaemia. To begin his treatment, doctors presented his mother, Mercy, with an initial down payment of N100,000. She absconded with her son even though nowadays, pediatric leukaemia is eminently curable with treatment.

Initially, she refused to take calls even when she was told the money had been raised. Her fear was, she would be caught and punished for absconding if she showed up to receive the money. Currently, calls put to her number no longer connect. It is difficult to ascertain Abijia’s current fate.

A research, ‘Challenge of pediatric oncology in Africa,’ led by LG Hadley, estimates that nine in 10 children with cancer live in developing countries and in low-income countries with limited access to healthcare. Just one or two in 10 children will survive in developing countries.

While seven to eight of every 10 children with cancer are cured in resource-rich settings, more than 70% of all cancer-related deaths occur in resource-poor settings. More than 80% of children with cancer have little or no access to treatment even though childhood cancers are often treatable,” it revealed.

Hadley’s research also observed that seven in 10 of kidney cancers in children are diagnosed at terminal stages, too late to be cured.

A pediatric oncologist and hematologist at the Ahmadu Bello University Teaching Hospital, Zaria, Dr Hafsat Ahmad, led an eight-year research on pattern and outcomes of childhood malignancies at ABUTH. She said, 247 of the 426 childhood cancer cases between January 2006 and December 2013, were children under five years.

According to findings from the research, surgery and chemotherapy were the most common modalities of treatment offered to about 80% of the cases with one in three of tiny cancer patients die, and less than one in ten of all child patients.

It is difficult to ascertain the survival rate of children with cancer as the Cancer Registry, Abuja neither responded to or acknowledge our reporter’s requests for information on childhood cancers.

Very often there are programmes raising awareness on cancer, prevention and treatment, “But they have all arguably focused on adults and if any has focused on childhood cancer, it most likely did not receive the same attention or buzz as a breast cancer or prostate cancer programme did,” an Abuja resident Ishaya Umar, said.

Speaking on the causes of childhood cancers, Ahmad said, they are generally unknown, “but there are certain things that predispose a child to cancer such as genetics which may be inherited or not. There are other things like infection. Malaria has been implicated in the development of the childhood cancer – Burkitt’s lymphoma.

She explained that, “There is also another virus which has been implicated in the development of so many childhood cancers like lymphoma with HIV infection. Also, children of mothers who underwent radiation while pregnant are also at risk of having cancer.”

Although there is a rise in pediatric cancers like leukaemia, Ahmad says, there is only about one pediatric oncologist for every 40 children with cancer in Nigeria.

Ahmad added that, “They would have gone to traditional healers, prayer houses, primary health centres, general hospitals and private clinics and at this time, it would have affected different parts of the body. By the time they come to us, they would have exhausted all their finances. Our patients make out of pocket payments. Some of the diagnosis facilities are unavailable. Those available are expensive. Diagnosis could take up to two weeks. By the time they come, the cancer has advanced, the child is infected, malnourished and anaemic.

“These have to be first addressed to strengthen the child for treatment. There is bed space payment, feeding and medicines which are not only expensive but also difficult to find. All these take a toll on the patient. That’s why many abscond or leave against doctor’s advice.”

Speaking with Daily Trust, Celestine Ogbudeke Business Development Officer of Clearline, a Health Management Organisation, for Nigeria’s National Health Insurance Scheme, said cancer patients – whether adults or children – are only covered up to N5million in insurance for cancer treatment. This is only available for platinum subscribers who didn’t have cancer before subscribing.

Dr. Ahmad explained that it is difficult to peg the cost of cancer treatment because there are different kind of treatment courses and combinations as well as the stage of the cancer being treated.

The suspended Executive Secretary of the National Health Insurance Scheme (NHIS), Prof. Usman Yusuf, in 2017 said the scheme had at the time covered only one percent of Nigeria’s 170 million population in its 12 years of existence.

On the way forward, Runcie Chidebe, a psychologist, cancer control advocate and the executive director of Project Pink Blue, an organization which has since 2013 advocated cancer control and care, said, “There is a need for government at all levels to prioritise cancer care and treatment. Health financing and budget is very low in Nigeria. Currently, no state in Nigeria has a cancer control plan, the Federal Ministry of Health has just developed a cancer plan but it requires funding for implementation.

“For Nigeria’s population, eight cancer centres where only three or four radiation machines work, are insufficient. Nigerians shouldn’t be travelling to Ghana, Kenya, South Africa for radiotherapy. Nigerians pay about $6,000 for radiotherapy in Kenya.

“It would be extremely significant if cancer screenings are in public health centres and general hospitals. This way, we can detect cancers very early and prognosis would be clearly better.”

It is difficult to determine what proportion of children never gets medical help, but field experience shows the reality is only a tip of the iceberg.

Fatima and Abijia are only part of the 200,000 children diagnosed yearly with cancer globally. Nigeria is neglecting its children with cancer, many of whom could be saved if diagnosed early and treated properly.