International Childhood Cancer Day 2022: Nigeria needs to focus on children

    • Brief

      • Nigeria’s cancer control plan expires this year with no review in sight.
      • There is no policy or concerted effort at addressing childhood cancers.
      • Delayed diagnosis and referral contribute to poor outcomes.

      Childhood cancers are a growing global health challenge. The World Health Organization (WHO) estimates that about 280,000 children are diagnosed with cancers yearly, with a majority of them living in low- and middle-income countries (LMICs), like Nigeria.

      In Nigeria, less than 2 out of every 10 childhood cancers are diagnosed, according to Prof. Edamisan Temiye, an oncologist with a specialisation in paediatric cancer. He attributes this to poor access to care, delayed diagnosis, misdiagnosis, high cost of care and abandonment of care.

      These problems also contribute to poor rates of cure for childhood cancers. For example, about 8 in 10 children are cured in high-income countries, while only about 2 in 10 are cured in LMICs. This is because paying for cancer care is expensive and inaccessible for most people in Nigeria. For example, parents of children diagnosed with blood cancer (leukaemia) need to pay out-of-pocket for care for three years. This will include paying for hospital beds, specialist care, medicines, and other services required.

      Other indirect costs for this care are usually not calculated, like the emotional costs and economic losses from not working. Note that though only 3 per cent of Nigerians have health insurance, the National Health Insurance Scheme (NHIS) does not cover childhood cancers.

      What causes childhood cancers?

      The WHO attributes about ten per cent of childhood cancers to genetics, with most cancers being of unknown causes. Inadequate food or nutrient intake, water pollutants, pesticides and other chemicals in food, heavy metals in cosmetics, microbial infections and smoking exposure have been linked to several cancers in childhood.

      Nigeria’s Cancer Control Plan 2018-2022

      This policy document drafted with input from stakeholders has led to the development of the cancer registry and concerted investments in upgrading several cancer centres in Nigeria. The policy has helped direct the efforts of government, stakeholders and investors into addressing some of the challenges of cancers with high incidence in Nigeria. However, its lack of focus on childhood cancers, since they occur less frequently, means this area has not received significant interventions.

      The policy expires this year, and the Federal Ministry of Health needs to review it quickly, paying attention to gaps. For example, within its prevention mechanism, the policy failed to include other coordinating ministries, like the Federal Ministry of Environment and Ministry of Women and Social Affairs and Social Development. There is a need to prioritize activities that reduce pesticides in food, as much as screening activities. This way, we will be dealing with the root causes, not just the parts of the problem we can see.

      In a statement released on Friday 11th February, Babayemi Oyekunle, the vice chairman of the Pharmaceutical Society of Nigeria Lagos, decried the delayed implementation of the procurement mechanism and proposed supply chain for cancer medicines and equipment.

      “Implementing this policy,” according to Babayemi, “will protect children from exposure to poor quality medicines and protect parents from people who want to take advantage of them through exorbitant medicine prices. The mechanism as proposed will also ensure equipment are serviced and maintained locally, reducing downtimes. The Federal Ministry of Health must see this as a priority; it owes a duty to prevent children from dying needlessly.”

      What can you do to prevent delays in the diagnosis of childhood cancers?

      The WHO’s experts think that screening for childhood cancers may not prevent them, but parents and guardians can reduce delays to diagnosis by being watchful.

      • You should speak to your child’s healthcare provider immediately when you see something new on your child’s body, like a growth that is not usual.
      • If your child suddenly develops symptoms or conditions you do not know, speak to your child’s healthcare provider immediately.
      • Any lump or swelling on your child’s body must be monitored. If it doesn’t go away within a week, grows or becomes painful, you should immediately speak to your child’s healthcare provider.
      • You should also report any sudden change in how your child walks, talks or other activities. Pain is a vital sign that something may be wrong, don’t use pain relievers for more than one day before speaking to your child’s healthcare provider.