Abstract 1
Introduction 2
Discussion 4
Intervention Programs 5
Precaution Adoption Process Model 6
The Transtheoretical Model 6
Conclusion 7
Work Cited 9
Abstract
Children mostly learn through vision and hence the vision is imperative for proper development during infancy. Loss of vision has an extensive impact on a child’s development and could lead to delayed walking. One of the conditions that result in loss of vision if not attended to in the early stages is retinoblastoma. This is referred to an intraocular cancer of the eye that majorly affects children before the age of five. It is one of the greatest disease burdens in developing countries. Disease progression to the advanced stages is enhanced by lack of awareness of the retinoblastoma signs and symptoms which leads to delays in seeking diagnosis and treatment. Inadequate diagnostic equipments in health centers and poor staffing in the health care facilities. Poor accessibility to health centers owing to poor road networks or insecurity. In order to ensure that the affected children access treatment at the right time, it is necessary to develop community-based programs in order to address these issues. This essay will look at the factors that contribute to low treatment rates of retinoblastoma in developing countries and the possible intervention programs.
Introduction
Vision impairment at a tender age usually lead to permanent loss of vision in an advanced age and timely intervention is important for proper vision development. The World Health Organization has a Vision 2020 program whose objective is one of eliminating blindness in children. Eye problems affect the children’s personal development, economic productivity, and education. One of the major disorders causing eye problems is Retinoblastoma.
Retinoblastoma has been categorized as one of the most common pediatric tumor of the eye that occurs before five years of age (Lohmann and Gallie). It causes a greater impact in developing countries than in developed countries due to inadequate resources, and insufficient educational support (Ava, Ahme and et, al.,). Globally approximately 9000 new cases of the condition are diagnosed annually (Weaver, Heminger and Lam). That translates to 1 in 15000 births. The cure rate in developed countries is above 90% while it is less than 50% in developing countries (Yun, Li and Xu). Studies from limited resource settings indicate that intraocular cancers may contribute up to 155 of all childhood tumors while in developing countries; it contributes only about 5%. In countries like Ghana and Congo, it is regarded as one of the three most common childhood cancers. It is the second most frequent in Mexico and the most frequent in northern Nigeria (Weaver, Heminger and Lam). The numbers are thought to be under-reported and so the cases could be more than documented.
There are several reasons that are attributed to the high rate of mortality associated with retinoblastoma. One there’s is a long delay period before the condition is reported. It is possible for the disease to progress without the primary care providers noticing the signs. These are very subtle and may only be recognized by a very keen family. They begin with an abnormal eye alignment, a white reflex known as leukocoria, and advances to orbital inflammation, orbital bulge and protruding of extraocular masses (American Cancer Society).
Early diagnosis increases the chances of cure. Studies have shown a delay of up to 24 months in developing countries before seeking medical attention after the onset. This delay is attributed to about 70% of mortality. In contrast, developed countries such as Canada have a mortality rate of only about 1% and only about 5% in the United States and Europe. The high success rate in these countries has been attributed to early diagnosis and accessibility to comprehensive management. The objective of treatment in developed and developing countries is quite varied. While developed countries focus on interventions that save vision, the developing countries concentrate on stressing the need for early diagnosis and management in order to save the life. In order to prioritize sparing the ocular, it is important for the people who spend most of the time with the children can recognize the primary symptoms. Report immediately after recognition of the signs and accept enucleation for the late stage retinoblastoma. The essay shall here in discuss the factors that contribute to delayed diagnosis and treatment.
Discussion
Factors That Contribute to Delayed Diagnosis and Treatment
The social barriers include lack of education, economic and cultural influences (Weaver, Heminger and Lam). There is limited awareness on the signs and symptoms of retinoblastoma, parents fear that the medical team will judge them for seeking help after the condition has advanced. In some circumstances, parents believe that the cancer is incurable and hence no need to seek medical attention. In other cultures, parents believe in traditional medicine and divine intervention due to accessibility and the belief systems. Economic factors also play a significant role. Parents may tend to prioritize school fees and food at the expense of seeking diagnosis. Some regions have very poor road networks and very few health centers. This limits accessibility to prompt medical attention. Sometimes, internal feuds and regional conflicts limit access to health centers.
Even with on time diagnosis, a child’s life is still jeopardized if the treatment is delayed. Factors that contribute to treatment delays include lack of curative treatments, inadequate healthcare specialists, and insufficient surgical supplies and medications. It is of importance for families to comprehend the treatment plans and build trust in the health care team. There are some instances where the family declines to have the eye globe of the child enucleated. This refusal accounts for 40% of the cases and is usually due to the associated stigma and un-acceptance that enucleation could lead to a better quality of life (Weaver, Heminger and Lam).
Intervention Programs
The intervention programs should be multi-factorial in order to address all the factors that affect the effective delivery of service for retinoblastoma cases. The intervention programs should focus on creating a team of multi-disciplinary health care teams comprising of surgeons, pathologists, oncologists, and general health care providers (Lohmann and Gallie). The referral systems should be proficient and a system that ensures reliable access to supplies of diagnostic tools, medication should be developed. Reliable means of transportation should be developed. In India and Guatemala, development of multidisciplinary services has led to improved treatment outcomes in health care delivery (Weaver, Heminger and Lam).
Programs targeted at creating community awareness have shown improvements in the outcomes of retinoblastoma. In Honduras, a national campaign to increase the level of awareness showed that the time from the appearance of signs to diagnosis was reduced by 1.7 months (Weaver, Heminger and Lam). Subsequently, presentation of extraocular cases decreased from 73% to 35%. In Brazil, a campaign to train health care workers and public school teachers to identify signs and symptoms of retinoblastoma led to a decrease in presentation of extraocular disease from 56% to less than 10% (Weaver, Heminger and Lam). These community awareness campaigns should influence families to seek early medical attention in order to affect survival outcomes.
One of the major impediments to early treatment is refusal of parents to consider enucleation as an effective treatment approach. In India, for example, the refusal was rated as the second most common cause for treatment failure. Development of programs that foster behavioral changes is essential in order to prepare families for acceptance of diagnosis and treatment. Such programs have been effective for other types of cancers e.g. cervical cancer and breast cancer (Weaver, Heminger and Lam). Some of the interventions that could prove useful for behavioral change include strategic placement of posters of patients who have had successful treatment in the clinical area and organizing groups of parents whose children have survived retinoblastoma. These groups could prove helpful in counseling other families.
Precaution Adoption Process Model
When diagnosed early, retinoblastoma is curable. The classical sign of retinoblastoma is leukocoria. After presentation of this sign, retinoblastoma is curable up to the sixth month otherwise it spreads to the rest of the eye. The primary care providers are the parents and so they are normally the first to notice this sign. Hence, it is quite imperative that programs aimed at creating symptom awareness prioritize family members. Such programs include the Precaution Adoption Process Model (PAPM) (Weaver, Heminger and Lam). This model addresses the major challenges that affect delay diagnosis including lack of symptom awareness, and refusal to take action. It, therefore, lays emphasize the need to seek diagnosis following recognition of the symptom.
The Trans-theoretical Model
Another model, The Trans-theoretical Model (TTM), is aimed at identifying the factors that influence progression of families after initiation of treatment. It is necessary since behaviour is both complex and non-linear and is characterized by relapse and re-entry. The model illustrates family's level of acceptance and readiness for treatment within the predetermined timelines (Weaver, Heminger and Lam). It, therefore, allows the families to be sensitized on the urgent need of starting treatment and the risks associated with not receiving treatment. The program allows families to formulate goals and make plans through facilitation by the health workers while interacting with parents who have had a successful treatment for their children. These parents help to discuss the parental, community and self-image after enucleation. This enables other families to accept and overcome issues of stigma and fear of being diagnosed with cancer. In case the patient requires undergoing chemotherapy, the program through the health team prepares them for the associated side effects. The program also provides social support to enable the patient comply with the treatment
Conclusion
Retinoblastoma is quite curable if diagnosis is done before progression into the advanced stages. However, prognosis is grave in situations of delayed diagnosis and treatment. Therefore, the various aspects that should be addressed include early diagnosis, timely intervention coupled with a long time follow up. Managing retinoblastoma requires understanding of the potential beneficiaries, knowledgeable health care providers, and tackling the socio-demographic factors that hinder early reporting.
Programs should be developed to create community awareness pertaining to the early disease symptoms and the dangers pertaining to delays in seeking diagnosis and treatment. The frameworks that are developed should be case specific to ensure that they ate culturally relevant, agreeable with the locals, internal and external influences. They should integrate all agents of health including insurance coverage, collaboration among healthcare specialties, communities, families and parents. The programs should inspire and drive towards achievement of measurable health improvement outcomes. Each approach has its intrinsic strengths and weaknesses and hence should be developed to adapt to disease-specific situations.
Work Cited
American Cancer Society. "Retinoblastoma." 12 May 2013. American Cancer Society Website. Web. 03 December 2014.
Ava, Hossain, et al. "Profile of Pediatric Ocular Morbidity in the in-patient Department of an Apex Public Hospital." Austin Journal of Clinical Ophthalmology (2014): 1-3. Print.
Lohmann, Dietmar and Brenda Gallie. "Retinoblastoma." 28 March 2013. NCBI Website. Web. 3 December 2014.
Weaver, Meaghann, Christina Heminger and Catherine Lam. "Integrating Stages of Change Models to Cast New Vision on Interventions to Improve Global Retinoblastoma and Childhood Cancer Outcomes." BMC Public Health (2014): 944-956. Print.
Yun, Jun, et al. "Epidemiology and Rb1 gene of Retinoblastoma." International Journal of Opthalmology (2011): 103-107. Print.
