Evidence map›Paper›PMID 40569998›Full record

ArticlePloS one2025

Impact of out-of-pocket expenses on children with cancer in Tanzania: A mixed-methods economic study.

Emily R Smith, Pamela Espinoza, Happiness D Kajoka, Henry E Rice, Madeline Metcalf, Anna Tupetz, Cesia Cotache-Condor, Blandina T Mmbaga, Catherine Staton, Esther Majaliwa

Abstract read
In one paragraph

Article in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Emily R SmithDepartment of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America.ORCID 0000-0002-1745-5728
Pamela EspinozaDuke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
Happiness D KajokaKilimanjaro Christian Medical University College, Moshi, Tanzania.ORCID 0000-0001-8571-3699
Henry E RiceDuke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
Madeline MetcalfDuke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
Anna TupetzDepartment of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America.
Cesia Cotache-CondorDuke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
Blandina T MmbagaDuke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
Catherine StatonDepartment of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America.
Esther MajaliwaKilimanjaro Christian Medical University College, Moshi, Tanzania.

Funding

Improving access to cancer care for children in Tanzania: Designing a health-systems interventionK01TW012181 · FIC · DUKE UNIVERSITY · PI Emily Smith · 2022 to 2026
$816k
FIC NIH HHS K01 TW012181
6 · The paper itself

Abstract

backgroundFor 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.

methodsWe 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.

resultsThirteen 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.

conclusionsProtecting 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.

Indexed as

Financing, PersonalHealth ExpendituresNeoplasmsAdolescentAdultCaregiversChildChild, PreschoolFemaleHumansMaleTanzania

Identifiers

PMID40569998
PMCPMC12200705

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.