Healthcare-Seeking Behaviors and Pathways to Pediatric Oncology Care Among Families of Children with Cancer in a Public Tertiary Hospital in Southeastern Democratic Republic of the Congo: An Observational Study.
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BACKGROUND: The objective of this study was to describe the healthcare-seeking behaviours of families of children with cancer in southeastern DRC by: (i) identifying initial care-seeking options; (ii) characterising the sequence and patterns of pathways leading to paediatric oncology; and (iii) quantifying the interval from symptom onset to the first paediatric oncology consultation and describing its variation by cancer type. METHODS: This retrospective cross-sectional study reviewed medical records of children with cancer managed at the Lubumbashi University Clinics, DRC, between January 2020 and June 2025. The analysis of referral times and treatment pathways was conducted in accordance with the Aarhus conceptual framework. Descriptive analyses and explorations of variation were performed using SPSS Statistics and Epi Info 7.2.6.0 software, in addition to R 4.5.3. RESULTS: A total of 44 children with cancer were included; 54.5% were female, and the median age was 156 months (IQR: 108-156). Retinoblastoma was the most frequent cancer (38.6%), followed by lymphomas (13.6%) and carcinomas (11.4%). The median interval from symptom onset to the first paediatric oncology consultation was 5.5 months (IQR: 2-12), reaching 9 months (IQR: 5-12) among children with retinoblastoma. Initial care-seeking options comprised primary care (54.5%), paediatric oncology (18.2%), tertiary care (15.9%), traditional medicine (6.8%), and secondary care (4.5%). The care pathways highlighted a complex navigation within the formal sector-oriented health system, characterized by multiple transitions between levels of care. Paediatric oncology was reached at the first, second, third, and fourth recorded care-seeking contacts by 8, 15, 16, and 5 children, respectively. CONCLUSION: Primary care was the most common first point of contact, and earlier access to paediatric oncology is a priority, particularly for children with retinoblastoma. The causes of the observed intervals were not established. Prospective mixed-methods studies should identify where time accumulates and explore the experiences of families and healthcare providers.