title: The role of traditional healers in the diagnosis and management of Burkitt lymphoma in Cameroon: understanding the challenges and moving forward.
abstract: BACKGROUND
  Burkittlymphoma(BL) is the most common childhood cancer in Cameroon with a reported incidence of 3 per 100,000 children under 15 years in the Northwest region. Treatment at three Baptist mission hospitals has a recorded cure rate of over 50%. Traditional medicine(TM) is recognized by the national health system, but its scope is undefined and entraps children with BL. The aim of this study was to investigate the attitudes and practices of parents and traditional healers (TH) towards TM in children with BL in order to develop recommendations for an integrative approach and improved access to life-saving treatment for children with BL.
  
  
  METHODS
  This is a descriptive case series of children diagnosed with BL treated at Banso, Mbingo, and Mutengene Baptist Hospitals between 2003 and 2014. A questionnaire was used to obtain the following information: demographic information, religion, the rate of use of TM, reasons why guardians chose to use TM, the diagnoses made by the TH, treatment offered, and the type of payment requested, based on the accounts of patient caregivers. Data was analyzed using Center for Disease Control Epi Info 7.
  
  
  RESULTS
  Three hundred eighty-seven questionnaires were completed by parents/guardians. 55% had consulted a TH, of whom 76.1% consulted the TH as first choice. Common diagnoses provided by TH included liver problem, abscess, witchcraft, poison, hernia, side pain, mushroom in the belly and toothache. Methods of management included massage, cuts, concoctions, and incantations. The fee for these services included chickens, farm tools, and cash ranging from 200FCFA (0.4USD) to 100,000FCFA(200USD). The choice of TM was based on accessibility, failed clinic/hospital attendance, recommendation of relatives, and belief in TM.
  
  
  CONCLUSIONS
  TH are involved in BL management in Cameroon. TH are ignorant about BL, resulting in non-referral, and thus delay in diagnosis and treatment. Collaboration with TH could reduce late diagnosis and improve cure rates of BL and other childhood cancers.
authors.affiliation: Banso Baptist Hospital, Bui Division, Northwest region, Kumbo, Republic of Cameroon. mbahlos@yahoo.com.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Afungchwi
authors.affiliation: Department of paediatrics and child health, Tygerberg children's Hospital, Stellenbosch University, Cape Town, South Africa.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Hesseling
authors.affiliation: Division of Pediatric Hematology/Oncology/Stem Cell Transplant and Institute of Human Nutrition, Columbia University Medical Centre, 3959 Broadway, New York, New York, CHN 10-06A, USA.
authors.forename: Elena J
authors.initials: EJ
authors.lastname: Ladas
mesh_terms: D000293:Adolescent; D000818:Animals; D002051:Burkitt Lymphoma / Q000175:diagnosis* / Q000191:economics / Q000628:therapy; D002163:Cameroon; D002645:Chickens; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D016488:Medicine, African Traditional / Q000191:economics / Q000295:instrumentation / Q000379:methods* / Q000639:trends; D026443:Spiritual Therapies / Q000191:economics / Q000295:instrumentation / Q000379:methods; D011795:Surveys and Questionnaires; D000078329:Workforce
keywords: Burkitt lymphoma; Cameroon; Supportive care; Traditional healer; Traditional medicine