Cancer Management and Research (Jun 2022)
Experience and Perception of Patients and Healthcare Professionals on Acute Leukemia in Rwanda: A Qualitative Study
Abstract
Belson Rugwizangoga,1,2,* Narcisse Niyikora,3,* Angèle Musabyimana,3,* Annie-Isabelle Izimukwiye,4 Johan Aurelius,2 Anna Martner,2 Aline Umubyeyi3 1University Teaching Hospital of Kigali, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda; 2TIMM Laboratory, Sahlgrenska Center for Cancer Research, Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 3School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda; 4Department of Pathology, Rwanda Military Hospital, Kigali, Rwanda*These authors contributed equally to this workCorrespondence: Belson Rugwizangoga, University Teaching Hospital of Kigali, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, P.O.Box 655 Kigali, Rwanda, Tel +250788546597, Email [email protected]; [email protected]: To explore challenges associated with the timely diagnosis, therapy, and prognosis of acute leukemia in Rwanda.Methods: This is a qualitative study using a phenomenological approach that involved patients, patients’ guardians, and healthcare professionals such as physicians from district hospitals and specialists from referral hospitals, as well as healthcare administrators. The primary data were collected from district and referral hospitals and central healthcare administration in Rwanda. The data were collected between July and October 2019. In-depth interviews were conducted, and thematic analysis was employed to interpret the results.Results: We identified barriers to seeking healthcare such as (i) insufficient knowledge within the population may lead patients and their guardians to consult traditional healers before seeking qualified medical care, and (ii) financial constraints that preclude payment of healthcare fees or other out-of-pocket cost related to diagnosis and treatment. We also observed that the referral system is tedious and primary healthcare facilities lack the competence and resources for the necessary diagnostic practices. Both may further delay diagnosis and therapy. Accordingly, healthcare professionals at the referral hospitals stated that most patients were seen at an advanced stage of the disease. For the treatment of acute lymphoblastic leukemia (ALL), only chemotherapy is utilized in Rwanda, while bone marrow (BM) transplantation is not available. Palliation is the only available treatment for the vast majority of Rwandan acute myeloid leukemia (AML) patients.Conclusion: ALL and AML are likely under-reported in Rwanda and diagnosis may be delayed, which may be explained by patient-related factors (lack of knowledge, financial constraints), a tedious referral system, and suboptimal diagnostic resources.Keywords: leukemia, lymphoblastic, myeloid, acute, healthcare delivery, Rwanda
