title: Baseline status of paediatric oncology care in ten low-income or mid-income countries receiving My Child Matters support: a descriptive study.
abstract: BACKGROUND
  Childhood-cancer survival is dismal in most low-income countries, but initiatives for treating paediatric cancer have substantially improved care in some of these countries. The My Child Matters programme was launched to fund projects aimed at controlling paediatric cancer in low-income and mid-income countries. We aimed to assess baseline status of paediatric cancer care in ten countries that were receiving support (Bangladesh, Egypt, Honduras, Morocco, the Philippines, Senegal, Tanzania, Ukraine, Venezuela, and Vietnam).
  
  
  METHODS
  Between Sept 5, 2005, and May 26, 2006, qualitative face-to-face interviews with clinicians, hospital managers, health officials, and other health-care professionals were done by a multidisciplinary public-health research company as a field survey. Estimates of expected numbers of patients with paediatric cancer from population-based data were used to project the number of current and future patients for comparison with survey-based data. 5-year survival was postulated on the basis of the findings of the interviews. Data from the field survey were statistically compared with demographic, health, and socioeconomic data from global health organisations. The main outcomes were to assess baseline status of paediatric cancer care in the countries and postulated 5-year survival.
  
  
  RESULTS
  The baseline status of paediatric oncology care varied substantially between the surveyed countries. The number of patients reportedly receiving medical care (obtained from survey data) differed markedly from that predicted by population-based incidence data. Management of paediatric cancer and access to care were poor or deficient (ie, nonexistent, unavailable, or inconsistent access for most children with cancer) in seven of the ten countries surveyed, and accurate baseline data on incidence and outcome were very sparse. Postulated 5-year survival were: 5-10% in Bangladesh, the Philippines, Senegal, Tanzania, and Vietnam; 30% in Morocco; and 40-60% in Egypt, Honduras, Ukraine, and Venezuela. Postulated 5-year survival was directly proportional to several health indicators (per capita annual total health-care expenditure [Pearson's r(2)=0.760, p=0.001], per capita gross domestic product [r(2)=0.603, p=0.008], per capita gross national income [r(2)=0.572, p=0.011], number of physicians [r(2)=0.560, p=0.013] and nurses [r(2)=0.506, p=0.032] per 1000 population, and most significantly, annual government health-care expenditure per capita [r(2)=0.882, p<0.0001]).
  
  
  CONCLUSIONS
  Detailed surveys can provide useful data for baseline assessment of the status of paediatric oncology, but cannot substitute for national cancer registration. Alliances between public, private, and international agencies might rapidly improve the outcome of children with cancer in these countries.
authors.affiliation: Department of Oncology and International Outreach Program, St Jude Children's Research Hospital, Memphis, TN 38105, USA. raul.ribeiro@stjude.org
authors.forename: Raul C
authors.initials: RC
authors.lastname: Ribeiro
authors.forename: Eva
authors.initials: E
authors.lastname: Steliarova-Foucher
authors.forename: Ian
authors.initials: I
authors.lastname: Magrath
authors.forename: Jean
authors.initials: J
authors.lastname: Lemerle
authors.forename: Tim
authors.initials: T
authors.lastname: Eden
authors.forename: Caty
authors.initials: C
authors.lastname: Forget
authors.forename: Isabel
authors.initials: I
authors.lastname: Mortara
authors.forename: Isabelle
authors.initials: I
authors.lastname: Tabah-Fisch
authors.forename: Jose Julio
authors.initials: JJ
authors.lastname: Divino
authors.forename: Thomas
authors.initials: T
authors.lastname: Miklavec
authors.forename: Scott C
authors.initials: SC
authors.lastname: Howard
authors.forename: Franco
authors.initials: F
authors.lastname: Cavalli
mesh_terms: D002648:Child; D002662:Child Health Services / Q000191:economics* / Q000592:standards; D002669:Child Welfare / Q000191:economics*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D005378:Financial Support; D019538:Health Care Surveys; D005102:Health Expenditures; D006801:Humans; D007182:Income; D007223:Infant; D008297:Male; D008495:Medical Oncology / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D009369:Neoplasms / Q000401:mortality / Q000628:therapy; D010372:Pediatrics / Q000191:economics / Q000592:standards*; D015397:Program Evaluation; D018570:Risk Assessment; D012959:Socioeconomic Factors; D016019:Survival Analysis