Childhood Cancer Early Detection Training Program for Primary Healthcare Providers

Abstract

Background and context: Over 250,000 new pediatric cancer cases are diagnosed yearly worldwide. Health care providers (mainly nurses) at health centers (HC) level are the children´s first opportunity for correctly recognizing and responding to early signs and symptoms of childhood cancers by appropriately referring them to district hospitals but studies show that 83% of nurses did not receive training on pediatric cancers. Insufficient knowledge about the warning signs and symptoms of pediatric cancer usually leads to improper diagnosis or delay to diagnosis and hence loss of many lives of these children. After realizing that majority in our community lack information on childhood cancers, our efforts since 2017 has been concentrated on training primary healthcare providers to recognize early signs and symptoms of childhood cancers. Aim: Improve survival of children with cancer by early detection of symptoms and signs and prompt referral by nurses at health centers. Strategy/Tactics: The program is consisted of trainings in selected regions of Rwanda. The first step is a “train the trainer workshop” where volunteering medical students and doctors are trained to train the nurses and community health workers. A two days workshop is organized subsequently in each province bringing together at least with one nurse from each selected health center. These trained nurses go back with materials to train their colleagues. They are followed up every three months with a survey to assess how much they retain the learned knowledge and the impact made. Prior to trainings, RCCR and pediatric oncologists develop training materials that include training curriculum for both the trainers and for the trainees (nurses), educational and awareness material (posters, fliers, brochures). Trained nurses are kept in RCCR database for their follow-up and track any case of a childhood cancer at their health facilities. Program/Policy process: The program is run in 4 phases, Phase 1: Develop training materials materials Phase 2: Recruitment and train the trainer phase Phase 3: Selection of health center and recruitment of healthcare providers Phase 4: The execution phase. Trainings are carried out in selected health centers. Phase 5: Post training follow-up. Outcomes: In 2017, the program was conducted in 4 health centers and around 90 health care providers were trained with more than 800 posters, 950 brochures and 300 flyers distributed. According to reports, after the training, the number of referrals from health centers increased and the posttraining showed how accurate nurses were in stating their differential diagnoses. What was learned: Childhood cancers are curable when detected and treated early, there is a need to build strong partnerships with private and public sectors to address the challenge of early detection and late presentation at the hospital because the program of training primary healthcare providers showed a good impact.

Interventions to improve early detection of childhood cancer in low‐ and middle‐income countries: A systematic review

“…All 12 studies were published between 2004 and 2018. Ten studies (83%) were conducted in a single LMIC, 14,16,17,[22][23][24][25][26][27][28] while two (17%) were conducted across multiple LMICs. 15,18 All 12 studies used a pre-post design to evaluate the effectiveness of their interventions, comparing postintervention data to baseline data collected retrospectively.…”

“…Five studies (42%) 14,16,18,22,23 focused on retinoblastoma only, while the remaining seven (58%) 15,17,[24][25][26][27][28] focused on all childhood cancer types. Six studies (50%) 14,22,[24][25][26]28 evaluated interventions that targeted health care professionals, while four studies(33%) 15,17,18,23 reported on training of health care professionals and public awareness campaigns. Two studies (17%) 16,27 focused on public awareness campaigns only.…”

“…Sample size was not consistently reported across all included studies. Only seven studies (58%) 14,15,17,[24][25][26]28 provided the number of health care professionals trained, ranging from 55 to 14 553. Table 1 shows additional study characteristics.…”

“…Table 2 provides details of the EWSS interventions studied. Ten studies (83%) 14,15,17,18,[22][23][24][25][26]28 reported on the training of health care professionals on recognizing the EWSS of childhood cancer. Studies were extremely heterogeneous in terms of intervention scope and duration, and reported outcomes.…”

“…22 Several studies described EWSS interventions in conjunction with other initiatives, including the establishment of satellite clinics and referral centers/systems, developing treatment protocols, building local professional networks, online conferences, e-consultations, continuing education, and clinical research infrastructure support. Of 10 studies (83%) 14,15,17,18,[22][23][24][25][26]28 targeting health care professionals, four studies (40%) 15,17,18,23 had a public awareness campaign component. In all studies that implemented multiple interventions, outcomes were reported collectively without attribution to a specific intervention component.…”