Evidence map›Paper›PMID 41680707›Full record

ArticleBMC cancer2026

Prevalence and factors associated with delayed surgery among children with Wilms tumor at Mulago Hospital: a mixed-method study.

Daniel Lule, Shamim Nabidda, Abraham Muhwezi, Ronald Naitala, Anne Akullo, Enid Kawala Kagoya, Ruth Namazzi, Nasser Kakembo, Joan Kalyango

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Article in BMC cancer, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

Authors and funding

9 authors.

Daniel LuleDepartment of Clinical Epidemiology and Biostatistics, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda. luledaniel71@gmail.com.ORCID http://orcid.org/0009-0009-7716-3143
Shamim NabiddaDepartment of Nursing and Midwifery, Aga Khan University, Kampala, Uganda.
Abraham MuhweziDepartment of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
Ronald NaitalaJoint Clinical Research Center, Kampala, Uganda.
Anne AkulloJoint Clinical Research Center, Kampala, Uganda.
Enid Kawala KagoyaDepartment of Clinical Epidemiology and Biostatistics, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
Ruth NamazziDepartment of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
Nasser KakemboDepartment of Surgery, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
Joan KalyangoDepartment of Clinical Epidemiology and Biostatistics, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionWilms tumor (WT) is a highly treatable form of childhood cancer, with five-year survival rates greater than 90% in high-income countries. In low- and middle-income countries, survival is still low. Delayed surgery is one of the leading factors for poor survival, as it leads to tumor complications, making subsequent treatment more complex. However, there is a paucity of information in Uganda on the prevalence and factors associated with delayed surgery. This study aimed to determine the prevalence and factors associated with delayed surgery, and to explore the barriers and facilitators of timely surgery among children with WT at Mulago Hospital.

methodsThe study employed a convergent concurrent mixed-methods design. The quantitative component involved a retrospective cross-sectional design using 261 patient records selected through consecutive sampling and reviewed via a data abstraction tool. Modified Poisson regression was used to assess associated factors. The qualitative component included in-depth interviews with 10 healthcare workers and 10 caregivers selected purposively and was analyzed via inductive thematic analysis.

resultsThe prevalence of delayed surgery was 63.6% (95% confidence interval (CI) 57.0-68.7). The year of diagnosis (2021: adjusted prevalence ratio (aPR) 2.26, 95% CI 1.40–3.65, p value 0.001; 2022: aPR 1.78, 95% CI 1.07–2.99, p value 0.026; and 2023: aPR 2.01, 95% CI 1.24–3.25, p value 0.004), tumor laterality (aPR 1.41, 95% CI 1.07–1.85, p value 0.014), hemoglobin level after preoperative chemotherapy (POPC; aPR 1.22, 95% CI 1.05–1.51, p value 0.032), and chemotherapy regimen (VAD: aPR 1.32, 95% CI 1.11–1.57, p value 0.02; and AV/CE: aPR 1.46, 95% CI 1.07–1.99) were associated with delayed surgery. Qualitative findings revealed systemic, patient-level, chemotherapy, and tumor-related barriers to and facilitators of timely surgery.

conclusionThe prevalence of delayed surgery was high among children with WT. Delayed surgery results from a complex interplay of clinical, systemic, and patient-related factors. Addressing barriers at both the institutional and patient levels may help reduce surgical delays and improve outcomes.

Indexed as

Kidney NeoplasmsTime-to-TreatmentWilms TumorChildChild, PreschoolCross-Sectional StudiesFemaleHumansInfantMalePrevalenceRetrospective StudiesTreatment DelayUgandaLow- and middle-income countriesPediatric oncologySurgical delayTimely surgical careUganda

Identifiers

PMID41680707
PMCPMC13015015

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