Patient pathways, presentation time, time to diagnosis, and early survival outcomes in pediatric acute lymphoblastic leukemia at Muhimbili National Hospital, Dar es Salaam, Tanzania.

Background: The Tanzanian healthcare system is complex, and weaknesses in referral pathways for time-sensitive conditions such as cancer contribute to poor outcomes among pediatric oncology patients. Early presentation and timely diagnosis are essential for improving survival in pediatric leukemia; however, evidence describing delays within Tanzania's referral system and their effects on early survival in children with acute lymphoblastic leukemia (ALL) remains limited. This study addresses this gap by characterizing patient pathways, estimating time to presentation and diagnosis, and assessing early survival among children with ALL treated at Muhimbili National Hospital (MNH). Methods: We conducted a hospital-based retrospective observational cohort study among 64 pediatric patients with a confirmed diagnosis of ALL admitted to the Pediatric Oncology Unit of Muhimbili National Hospital between January and December 2024. Descriptive statistics were used to summarize patient pathways, presentation time, and diagnosis. Six- and twelve-month survival probability was estimated using Kaplan-Meier methods, and survival outcome differences were assessed using the log-rank test. Results: Sixty-four children with ALL were included; more than half (67.2%) were boys, and the median age at diagnosis was 6 years. Nearly half of the children (46.9%) were aged 0-5 years. Most children (51.6%) first sought care at primary-level facilities, whereas only 18.8% were referred from secondary-level facilities. The median time from symptom onset to presentation at MNH was 28.5 days, followed by a median time to diagnosis of 14 days. Six- and 12-month survival probabilities were 79% and 72%, respectively. Survival did not differ significantly by gender (log-rank Conclusion: Overall, delays in presentation and referral remain significant barriers in the management of childhood ALL in this setting. Most mortality occurred during the early treatment period, highlighting the critical importance of strengthening supportive care, early complication management, and infection control alongside improvements in referral systems. Efforts to strengthen early detection and build capacity at lower-level health facilities may substantially improve survival among children with ALL in Tanzania and other low-resource settings.