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For children with cancer in low- and middle-income countries, medical and non-medical expenses are often paid through out-of-pocket (OOP) expenditures, which pose significant barriers to timely care. Our study aims to estimate the impact of OOP expenditures for cancer care for children in Tanzania through a mixed-methods approach. We used an explanatory mixed-method design to evaluate the impact of OOP expenditures for children receiving cancer care at the Kilimanjaro Christian Medical Center in Tanzania based on the Three Delays Framework. Quantitative data were collected to measure OOP expenditures and to assess the risk of catastrophic health expenditure or depth of impoverishment associated. Qualitative interviews were conducted to evaluate financial barriers and facilitators to care and were analyzed using thematic content analysis. Qualitative and quantitative data were triangulated to compare themes, identify areas of agreement or dissonance, and assess for complementarity. Thirteen caregivers of children with cancer at KCMC formed the study cohort. Most lived in a rural setting (92%) and were farmers or livestock keepers (68%). Quantitative analysis showed that total median OOP health expenditures were $53.01 (IQR: 26.50-106.01). All families were pushed further into poverty from the OOP expenses as shown by widening poverty gaps. Qualitative interviews revealed several themes related to financial challenges for families with cancer, particularly during the time period prior to definitive care including worry about job losses and having to sell assets to reach care. Data triangulation confirmed strong agreement between qualitative and quantitative data on the impact of financial barriers on care. However, families stated higher OOP costs in qualitative interviews compared to quantitative data. Protecting families from impoverishment by reducing OOP costs during time periods prior to receiving definitive care may be a strategic way to improve timely diagnosis and early treatment for children with cancer.

Introduction The SARS-CoV-2 (COVID-19) pandemic has strained healthcare systems and presented unique challenges for children requiring cancer care, particularly in low- and middle-income countries. This study aimed to assess the impact of the COVID-19 pandemic on access to cancer care for children and adolescents in Northern Tanzania. Methods In this cross-sectional study, we assessed the demographic and clinical characteristics of 547 pediatric and adolescent cancer patients (ages 0–19 years old) between 2016 and 2022 using the population-based Kilimanjaro Cancer Registry (KCR). We categorized data into pre-COVID-19 (2016–2019) and COVID-19 (2020–2022) eras, and performed descriptive analyses of diagnostic, treatment, and demographic information. A secondary analysis was conducted on a subset of 167 patients with stage of diagnosis at presentation. Results Overall admissions nearly doubled during the pandemic ( n  = 190 versus 357). The variety of diagnoses attended at KCMC increased during the pandemic, with only five groups of diseases reported in 2016 to twelve groups of diseases in 2021. Most patients were diagnosed at a late stage (stage III or IV) across eras, with the proportion of under-five years old patients increasing late-diagnoses from 29.4% (before the pandemic), 52.8% (during the pandemic), when compared to the overall cohort. Around 95% of children in this age category reported late-stage diagnosis during the pandemic. Six out of the twelve cancer site groups also reported an increase in late-stage diagnosis. During the pandemic, the proportion of children receiving surgery increased from 15.8 to 30.8% ( p  < 0.001). Conclusion Childhood and adolescent cancer care changed in Northern Tanzania during the COVID-19 pandemic, with increased late-stage diagnoses presentations among younger patients and the increased use of surgical therapies in the context of a growing practice. Understanding the impact of the COVID-19 pandemic on pediatric and adolescent cancer care can help us better adapt healthcare systems and interventions to the emerging needs of children and adolescents with cancer in the midst of a health crisis.

Background Cervical cancer is the fourth most common cancer globally among women in incidence and mortality. Women living with HIV (WLHIV) are disproportionately at a higher risk of developing the disease. Aim To determine the knowledge, attitude, and practice of cervical cancer screening among WLHIV in the Kilimanjaro region, northern Tanzania, following the integration of these services in routine HIV care in the country. Methods and results A cross‐sectional study was conducted in the Kilimanjaro region among 297 WLHIV attending care and treatment centers (CTC) in Hai district and Mawenzi regional hospitals in northern Tanzania between 21 August and 3 September 2020. A questionnaire was used for data collection using face‐to‐face interviews. Data were analyzed using SPSS version 20.0. Frequencies and percentages summarized categorical variables and numerical variables summarized using median and interquartile range (IQR). About half (50.2%) of 297 WLHIV in this study had ever screened for cervical cancer, and 64% screened within the past 12 months preceding the survey. Although 90% ever heard of cervical cancer screening, only 20.5% knew when WLHIV should start screening. Over half (52.5%) had adequate knowledge of prevention, 38.4% on risk factors, and 27.9% of cervical cancer signs and symptoms. Two‐thirds (66.7%) had positive attitudes toward cervical cancer screening. A major source of cervical cancer screening information was the health care providers (80.1%) and the mass media (66%), particularly radio. Conclusions The WLHIV in this study had inadequate knowledge but favorable attitudes toward cervical cancer screening, while half had screened for cervical cancer. Efforts should be directed to capacity building of health care providers at CTC and scaling up the mass media campaigns as relevant interventions to promote the uptake of cervical cancer screening programs among WLHIV in Tanzania.

Objective: This study aimed to estimates Disability-adjusted life years (DALYs) for pediatric injury patients at a zonal referral hospital. Methods: This is a retrospective cohort study using pediatric injury registry data, DALYs for pediatric injured patients was calculated by adding the Years of life lost (YLL) and Years lived with disability (YLD). Discounting rate of 3%, age weighting parameter of 0.04 and Constant 0.1658 were considered during analysis. Results: This study included 1000 pediatric injury patients with median age of 7 years, mostly male 639 (63.9%). Road traffic injuries were the leading cause 341 (34.1%), and 65 (6.5%) died, burns caused 27 (41.6%) of deaths. Pediatric injuries resulted in over 4500 DALYs, with road traffic injuries contributing the most (1650 DALYs). Conclusion: This study reveals the high burden of pediatric injuries, with males contributing most DALYs. Road traffic injuries significantly contribute to disabilities, highlighting the need for child-focused interventions.