{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T14:21:38Z","timestamp":1791469298383,"version":"4.3.4"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"\n Background<\/jats:title>\n The Tanzanian healthcare system is complex, and weaknesses in referral pathways for time-sensitive conditions such as cancer contribute to poor outcomes among pediatric oncology patients. Early presentation and timely diagnosis are essential for improving survival in pediatric leukemia; however, evidence describing delays within Tanzania's referral system and their effects on early survival in children with acute lymphoblastic leukemia (ALL) remains limited. This study addresses this gap by characterizing patient pathways, estimating time to presentation and diagnosis, and assessing early survival among children with ALL treated at Muhimbili National Hospital (MNH).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We conducted a hospital-based retrospective observational cohort study among 64 pediatric patients with a confirmed diagnosis of ALL admitted to the Pediatric Oncology Unit of Muhimbili National Hospital between January and December 2024. Descriptive statistics were used to summarize patient pathways, presentation time, and diagnosis. Six- and twelve-month survival probability was estimated using Kaplan\u2013Meier methods, and survival outcome differences were assessed using the log-rank test.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Sixty-four children with ALL were included; more than half (67.2%) were boys, and the median age at diagnosis was 6 years. Nearly half of the children (46.9%) were aged 0\u20135 years. Most children (51.6%) first sought care at primary-level facilities, whereas only 18.8% were referred from secondary-level facilities. The median time from symptom onset to presentation at MNH was 28.5 days, followed by a median time to diagnosis of 14 days. Six- and 12-month survival probabilities were 79% and 72%, respectively. Survival did not differ significantly by gender (log-rank\n \u03c7<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u20090.24,\n p<\/jats:italic>\n \u2009=\u20090.63), age group (\n \u03c7<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u20092.01,\n p<\/jats:italic>\n \u2009=\u20090.57), presentation time (\n \u03c7<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u20090.79,\n p<\/jats:italic>\n \u2009=\u20090.37), time to diagnosis [\n \u03c7<\/jats:italic>\n 2<\/jats:sup>\n (1)\u2009=\u20090.04,\n p<\/jats:italic>\n \u2009=\u20090.84], or referral pathway length (\n \u03c7<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u20090.11,\n p<\/jats:italic>\n \u2009=\u20090.74).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Overall, delays in presentation and referral remain significant barriers in the management of childhood ALL in this setting. Most mortality occurred during the early treatment period, highlighting the critical importance of strengthening supportive care, early complication management, and infection control alongside improvements in referral systems. Efforts to strengthen early detection and build capacity at lower-level health facilities may substantially improve survival among children with ALL in Tanzania and other low-resource settings.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fped.2026.1777603","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T05:41:29Z","timestamp":1775022089000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Patient pathways, presentation time, time to diagnosis, and early survival outcomes in pediatric acute lymphoblastic leukemia at Muhimbili National Hospital, Dar es Salaam, Tanzania"],"prefix":"10.3389","volume":"14","author":[{"given":"Ruchius","family":"Philbert","sequence":"first","affiliation":[{"name":"Department of Paediatrics and Child Health, Muhimbili National Hospital","place":["Dar-es-salaam, Tanzania"]},{"name":"Department of Paediatrics and Child Health, Muhimbili National Hospital","place":["Dar-es-salaam, Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hadija","family":"Mwamtemi","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, Muhimbili National Hospital","place":["Dar-es-salaam, Tanzania"]},{"name":"Department of Paediatrics and Child Health, Muhimbili National Hospital","place":["Dar-es-salaam, Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Okade","sequence":"additional","affiliation":[{"name":"Makerere University School of Public Health , Kampala","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huzaifah","family":"Mutyaba","sequence":"additional","affiliation":[{"name":"Makerere University School of Public Health , Kampala","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilian","family":"Ndyetabula","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, Muhimbili National Hospital","place":["Dar-es-salaam, Tanzania"]},{"name":"Tumaini La Maisha Organization","place":["Dar-es-salaam, Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"Shimba","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, Muhimbili National Hospital","place":["Dar-es-salaam, Tanzania"]},{"name":"Clinical Research, Training and Consultancy Unit, Muhimbili National Hospital","place":["Dar-es-salaam, Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nana Jacqueline","family":"Nakiddu","sequence":"additional","affiliation":[{"name":"Muhimbili University of Health and Allied Sciences","place":["Dar -es-salaam, Tanzania"]},{"name":"Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences","place":["Dar-es-salaam, Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Elisha","sequence":"additional","affiliation":[{"name":"Muhimbili University of Health and Allied Sciences","place":["Dar -es-salaam, Tanzania"]},{"name":"Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences","place":["Dar-es-salaam, Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wende Clarence","family":"Safari","sequence":"additional","affiliation":[{"name":"Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine (LSHTM) , London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faraja","family":"Chiwanga","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, Muhimbili National Hospital","place":["Dar-es-salaam, Tanzania"]},{"name":"Directorate of Medical Services, Muhimbili National Hospital","place":["Dar es Salaam, Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lulu","family":"Chirande","sequence":"additional","affiliation":[{"name":"Muhimbili University of Health and Allied Sciences","place":["Dar -es-salaam, Tanzania"]},{"name":"Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences","place":["Dar-es-salaam, Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"719","DOI":"10.1016\/S1470-2045(17)30186-9","article-title":"International incidence of childhood cancer, 2001\u201310: a population-based registry study","volume":"18","author":"Steliarova-Foucher","year":"2017","journal-title":"Lancet Oncol"},{"key":"B2","first-page":"1770","article-title":"Nutritional status, feeding practices, and existing nutritional support among children with cancer, Pediatric Oncology Unit, Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania; prospective cohort study","volume":"26","author":"Mwamtemi","year":"2025","journal-title":"Tanzan J Health Res"},{"key":"B3","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1186\/s13643-022-02040-0","article-title":"The development and education of a workforce in childhood cancer services in low-and middle-income countries: a scoping review protocol","volume":"11","author":"Cayrol","year":"2022","journal-title":"Syst Rev"},{"key":"B4","year":""},{"key":"B5","doi-asserted-by":"publisher","first-page":"1182","DOI":"10.1126\/science.aaw4892","article-title":"Science and health for all children with cancer","volume":"363","author":"Lam","year":"2019","journal-title":"Science"},{"key":"B6","first-page":"967","article-title":"Treatment-related mortality in children with cancer in low-income and middle-income countries: a systematic review and meta-analysis","volume-title":"Lancet Oncol","author":"Ehrlich","year":"2023"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e2200288","DOI":"10.1200\/GO.22.00288","article-title":"Pediatric acute lymphoblastic leukemia: clinical characteristics, treatment outcomes, and prognostic factors: 10 years\u2019 experience from a low-and middle-income country","volume":"9","author":"Ahmad","year":"2023","journal-title":"JCO Glob Oncol"},{"key":"B8","year":""},{"key":"B9","first-page":"1","year":"2021"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e2200263","DOI":"10.1200\/GO.22.00263","article-title":"Childhood and adolescent cancer care at a tertiary hospital in Northern Tanzania: a retrospective study","volume":"9","author":"Majaliwa","year":"2023","journal-title":"JCO Glob Oncol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1111\/j.1365-2354.2005.00513.x","article-title":"A systematic literature review of the clinical and epidemiological burden of acute lymphoblastic leukaemia (ALL)","volume":"14","author":"Redaelli","year":"2005","journal-title":"Eur J Cancer Care (Engl)"},{"key":"B12","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1186\/s41182-025-00760-2","article-title":"Clinical characteristics and outcomes of paediatric acute lymphoblastic leukaemia in a tertiary hospital in Tanzania: a single-centre observational study","volume":"53","author":"Shimizu","year":"2025","journal-title":"Trop Med Health"},{"key":"B13","doi-asserted-by":"publisher","first-page":"e202","DOI":"10.1016\/S2352-3026(17)30052-2","article-title":"Worldwide comparison of survival from childhood leukaemia for 1995\u20132009, by subtype, age, and sex (CONCORD-2): a population-based study of individual data for 89 828 children from 198 registries in 53 countries","volume":"4","author":"Bonaventure","year":"2017","journal-title":"Lancet Haematol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1186\/s12887-019-1848-1","article-title":"Determinants of delayed diagnosis among pediatric cancer patients from Ayder Comprehensive Specialized Hospital, Mekelle, Northern Ethiopia","volume":"19","author":"Berhane","year":"2019","journal-title":"BMC Pediatr"},{"key":"B15","doi-asserted-by":"publisher","first-page":"18","DOI":"10.24966\/PPP-5649\/100018","article-title":"Physician delay for delayed diagnosis of acute lymphoblastic leukemia among children in a tertiary care hospital","volume":"4","author":"Mowla","year":"2020","journal-title":"J Pharmacol Pharm Pharmacovig"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1757","DOI":"10.1200\/GO.20.00407","article-title":"Delays experienced by patients with pediatric cancer during the health facility referral process: a study in Northern Tanzania","volume":"6","author":"Maillie","year":"2020","journal-title":"JCO Glob Oncol"},{"key":"B17","year":""},{"key":"B18","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1055\/s-0041-1732853","article-title":"A retrospective study of factors affecting pathway and time to diagnosis, time to treatment in children with cancer in a single center in South India","volume":"42","author":"Lashkari","year":"2021","journal-title":"Indian J Med Paediatr Oncol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"18","DOI":"10.36648\/1479-1064.32.1.03","article-title":"Clinical profiles and survival of children with acute lymphoblastic leukemia in South West Uganda","volume":"32","author":"Zalwango","year":"2024","journal-title":"Qual Prim Care"},{"key":"B20","volume-title":"WHO Global Initiative for Childhood Cancer: Increasing Access, Advancing Quality, Saving Lives","year":"2021"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1777603\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T05:41:31Z","timestamp":1775022091000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1777603\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":20,"alternative-id":["10.3389\/fped.2026.1777603"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1777603","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,1]]},"article-number":"1777603"}}