DIAGNOSIS

Although childhood cancer is sadly on the rise, through medical advancement in treatment and comprehensive care, childhood cancer is largely curable. According to population statistics, an estimated 2,500 children, as opposed to the current 1,000 children, should be diagnosed in South Africa – a severe underdiagnosis with fatal consequences. In Limpopo, about 100 children are diagnosed with cancer annually, and the majority of them are diagnosed late.

Compounding the situation of late diagnosis is the delay in referral of children diagnosed with cancer to appropriate specialised treatment centres, which is the Oncology Unit at Pietersburg/Mankweng Tertiary Hospital Complex, catering for the whole province. The lack of knowledge and cultural beliefs about childhood cancer among healthcare providers and caregivers are major contributing factors to delayed referral, delayed diagnosis and treatment, and insufficient access to palliative care. Without interventions to address these identified bottlenecks, Limpopo will continue losing children to cancer in an era of cancer being curable. 

The early diagnosis of cancer in children is pivotal to a favourable prognosis and outcome. However, the presenting signs and symptoms are often non-specific and can mimic those of common childhood conditions such as viral infections. The index of suspicion tends to be low due to the relative rarity of malignancies in paediatric patients, and primary healthcare providers may have no prior experience in diagnosing a child with cancer and thus be unaware of the signs and symptoms. Raising awareness and educating both healthcare professionals and communities will undoubtedly reduce the number of children with cancer diagnosed before stages 3 and 4 and improve the effective and efficient referral of those diagnosed to the Paediatric Oncology Unit at the Pietersburg/Mankweng Tertiary Hospital Complex.

Tree of Life Development Centre NPC (ToLDC) was awarded a one-year grant by the Discovery Foundation for the 2023/24 financial year to amplify childhood cancer awareness and improve early referral of children identified with early warning signs in Limpopo province. With the grant, the POCs and other healthcare workers working with children in Limpopo conducted awareness and educated hospitals, clinics and the community about the early warning signs of childhood cancer using the St SILUAN criteria. (see poster below)

HISTORY

This grant was to build upon the team’s previous support from the Discovery Foundation under the auspices of the University of Limpopo Trust until 2022. With the previous support:

1. The team collaborated with CHOC SA to capacitate a cadre of Paediatric Oncology Champions (POCs) from 5 Regional Hospitals in 2019 and Master Trainers from the 5 districts in the province in 2022. The POCs and Master Trainers were responsible for training and mentoring frontline healthcare providers from district hospitals and primary healthcare facilities on the timeous and appropriate diagnosis and referral of children with cancer to the Paediatric Oncology Unit at Pietersburg Hospital. Capacitating Champions and Master Trainers already employed the healthcare system, as opposed to external Champions, was to ensure the sustainability of gains made through the initiative even without donor funds.
2. The team developed the first-ever patient-held record for childhood cancer for ease of management at lower levels with their treatment information, details for referrals, and danger signs to note for immediate referral when they are present at clinics and district hospitals.
3. The adaptation of the St SILUAN posters from English into local languages.
4. Traditional health practitioners, leaders, and other community leaders were involved in caring for children with cancer in the entire province during the NCCAM in 2022 to align our activities with the annual theme “Better Survival is achievable #throughyourhands”. A video featuring a segment of a traditional health practitioner from the activities undertaken was produced – https://youtu.be/0W_2vSFreBI .
5. The provincial event in 2022 was held at the Ga-Kgapane community to raise awareness and engage traditional health practitioners, traditional leaders, and other community leaders such as councillors, pastors, local government executives, etc., using the community packs developed for use by the abovementioned stakeholders for shared care and support for children with childhood cancer and their caregivers (see the cover page of the pack below) The packs were also translated to the local languages – Sepedi, Xitsonga, Tshivenda and isiNdebele in addition to the English version. The activity reached over 500 people, including schoolchildren from WM Kgatla Primary School at Ga-Kgapane. The event was live-streamed so to reach more people – https://www.facebook.com/LimpopoDepartmentOfHealthBophelong/posts/424936546414359, https://www.facebook.com/LimpopoDepartmentOfHealthBophelong/posts/426375712937109 and https://www.facebook.com/LimpopoDepartmentOfHealthBophelong/posts/424934773081203.
6. Over 90 awareness and education activities have occurred in Limpopo at the end of the NCCAM in 2022. These covered hospitals, clinics, schools, different mediums such as social media, newspapers, community and regional radio stations, and a half-marathon led by the MEC for Health in Limpopo. These awareness events reached thousands of people in the province.
7. A video of one of the survivors was documented in 2020 in a quest to give a voice to the childhood cancer journey – https://www.youtube.com/watch?v=bMbEBop7UFE. This was when the COVID-19 restrictions were very strict, and the provincial NCCAM event for the year was hybrid, with few people in Polokwane and the POCs virtually joining from each district. This was our first-ever live-streamed activity. The Paediatric Oncology team at Pietersburg Hospitals, together with the caregivers, joined the global phenomenon of the #JerusalemaChallenge as a means to revive their spirits as the COVID-19 pandemic times were tough on everyone, especially healthcare providers and families that had loved ones in the hospital.