{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T06:37:27Z","timestamp":1777790247037,"version":"3.51.4"},"reference-count":30,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"4","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Glob Oncol"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>PURPOSE<\/jats:title>\n                    <jats:p>Accessing timely childhood cancer care is a significant challenge in low- and middle-income countries. Primary health care workers are key patient navigators through specialized care referral systems. Understanding their perspectives on childhood cancer is critical in improving access to care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A cross-sectional study was conducted from January to June 2023 in Bungoma County, Kenya. The in-charges of 144 level 2 and 3 facilities completed a semistructured questionnaire on childhood cancer perspectives, traditional, complementary, and alternative medicine (TCAM), referral barriers, and health insurance. Descriptive statistical analysis was performed. For baseline data, frequency distributions were calculated. Mann-Whitney test, chi-square test, and Fisher's exact test were performed for comparisons of perspectives and health beliefs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Of 144 facilities, 125 (86%) were level 2 and 19 (13%) were level 3. Only 14% of the facilities offered full insurance from the National Health Insurance Fund. Most in-charges believed that cancer was caused by chemical exposure (98%) or maternal drug use (90%), whereas 25% cited supernatural causes. Financial barriers were the main obstacle to accessing childhood cancer care (90%), with 69% believing that families could not afford health insurance. TCAM use was common, with 50% of respondents supporting its combination with chemotherapy. The participants concluded that referral barriers included financial constraints, lack of insurance, and family fears.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>We found that delays in childhood cancer care in Western Kenya arises from a combination of provider misconceptions, culturally embedded TCAM use, rigid referral systems, financial inadequacy, lack of insurance, and family fears and beliefs. This study contributes uniquely by focusing on primary health care facility in-charges, whose perspectives directly shape the navigation pathway through the referral system.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/go-25-00544","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T19:59:41Z","timestamp":1777492781000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":0,"title":["Primary Health Care Providers' Perspectives on Childhood Cancer, Traditional Medicine, Referral Practices, and Health Insurance in Western Kenya"],"prefix":"10.1200","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8520-8651","authenticated-orcid":true,"given":"Lilian","family":"Apadet Osamong","sequence":"first","affiliation":[{"name":"Pediatric Oncology, Amsterdam UMC, Emma Children's Hospital, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands"},{"name":"Academic Model Providing Access to Healthcare (AMPATH), Moi University, Eldoret, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1928-2250","authenticated-orcid":true,"given":"Larissa","family":"Klootwijk","sequence":"additional","affiliation":[{"name":"Pediatric Oncology, Amsterdam UMC, Emma Children's Hospital, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands"},{"name":"Princess M\u00e1xima Center for Pediatric Oncology, Utrecht, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sally","family":"Kimaiyo","sequence":"additional","affiliation":[{"name":"Academic Model Providing Access to Healthcare (AMPATH), Moi University, Eldoret, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8867-5616","authenticated-orcid":true,"given":"Sandra","family":"Langat","sequence":"additional","affiliation":[{"name":"Academic Model Providing Access to Healthcare (AMPATH), Moi University, Eldoret, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9883-0568","authenticated-orcid":true,"given":"Terry A.","family":"Vik","sequence":"additional","affiliation":[{"name":"Indiana University School of Medicine, Indianapolis, IN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7716-8475","authenticated-orcid":true,"given":"Gertjan","family":"Kaspers","sequence":"additional","affiliation":[{"name":"Pediatric Oncology, Amsterdam UMC, Emma Children's Hospital, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands"},{"name":"Princess M\u00e1xima Center for Pediatric Oncology, Utrecht, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Festus","family":"Njuguna","sequence":"additional","affiliation":[{"name":"Department of Child Health and Pediatrics, Moi University, Eldoret, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"233","reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(17)30186-9"},{"key":"e_1_3_7_3_2","unstructured":"WHO: WHO childhood cancer overview booklet. https:\/\/www.who.int>docs"},{"key":"e_1_3_7_4_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.00.554"},{"key":"e_1_3_7_5_2","unstructured":"World Bank: World Bank country classification. https:\/\/datatopics.worldbankdevelopment-indicators\/the-world-by-income-and-region.html"},{"key":"e_1_3_7_6_2","first-page":"467","article-title":"Influence of health-insurance on treatment outcome of childhood cancer in Western Kenya","volume":"31","author":"Langat S","year":"2023","unstructured":"Langat S, Njuguna F, Olbara G, et al: Influence of health-insurance on treatment outcome of childhood cancer in Western Kenya. 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