title: [Retinoblastoma in Malawi: why are admissions too late?].
abstract: BACKGROUND
  A total of 82 % of stationary admissions with the diagnosis of retinoblastoma (2009-2011) to the tertiary ophthalmology unit in Blantyre, Malawi (n = 58) presented with advanced stage disease.
  
  
  METHODS
  In another study in 2012 we sought to identify why children mostly presented in advanced stages of disease and whether the delay was unique to children with cancer. In-depth interviews (IDI) were conducted at the hospital with 40 parents or guardians of children with retinoblastoma, congenital cataract, congenital glaucoma and corneal perforation (10 each).
  
  
  RESULTS
  Most delays and delayed admissions occurred at the family (27.5 %, 11 out of 40) and primary health centre levels (30.0 %, 12 out of 40). Lack of money for transport caused delays (15.0 %, 6 out of 40) at all care levels. In contrast, children with painful conditions presented to a health facility within 24 h of onset without any complaints about lack of money for transport.
  
  
  CONCLUSIONS
  Education about retinoblastoma and other non-painful eye diseases could be improved by a poster campaign to both parents and professionals at all medical healthcare levels. Transport for such cases between the various healthcare centers should be provided free of charge. There is room for improvement in initial diagnosis, referral and management within the healthcare service in the tertiary sector.
authors.affiliation: College of Medicine, University of Malawi, P Bag 360, Blantyre 3, Blantyre, Malawi, mssoculus@web.de.
authors.forename: M
authors.initials: M
authors.lastname: Schulze Schwering
authors.forename: M
authors.initials: M
authors.lastname: Gandiwa
authors.forename: G
authors.initials: G
authors.lastname: Msukwa
authors.forename: M
authors.initials: M
authors.lastname: Spitzer
authors.forename: K
authors.initials: K
authors.lastname: Kalua
authors.forename: E M
authors.initials: EM
authors.lastname: Molyneux
mesh_terms: D000293:Adolescent; D002648:Child; D015897:Comorbidity; D042241:Early Diagnosis; D058447:Eye Pain / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008295:Malawi; D008297:Male; D008495:Medical Oncology; D009885:Ophthalmology; D010343:Patient Admission / Q000706:statistics & numerical data*; D015995:Prevalence; D019572:Retinal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D012175:Retinoblastoma / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D018570:Risk Assessment; D012959:Socioeconomic Factors; D014186:Transportation / Q000706:statistics & numerical data; D014600:Utilization Review