Published: 2021-05-25

Predictors of mortality and loss to follow up among children with malignancies in a resource constraint community in Nigeria

Fatima B. Jiya, Nma M. Jiya, Mika’ilu A. Jangebe, Paul K. Ibitoye, Umar Muhammed, Tahir Yusuf, Jibrin Baba, Asma’u Adamu, Khadijat O. Isezuo


Background: Childhood malignancies are on the increase globally and are of public health concern with associated poor outcome in resource constraint settings. The objective of the study was to determine the factors associated with in-hospital mortality in children with malignant tumours, the predictors of mortality and those of loss to follow up.

Methods: A 2 year prospective survey of children aged 1 month-14 years admitted into the paediatric ward of Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto with histologic diagnosis of malignant tumour.

Results: There were 26 (74.3%) males and 9 (25.7%) females diagnosed of malignant tumours with male:female=3:1 and mean age at presentation of 6.8±4.0 years. Majority 25 (71.4%) were from low social class. Twenty-four (68.6%) of the subjects had metastasis at presentation. Tumours diagnosed were mainly nephroblastoma 12 (34.3%), rhabdomyosarcoma 09 (25.7%), retinoblastoma 4 (11.4%), and leukaemias 4 (11.4%). Eighteen (51.4%) subjects were discharged after initial course of treatment 15 (42.9%) died and 02 (5.7%) left against medical advice. Of the 18 subjects that were discharged, 16 (88.9%) were lost to follow up. Shock (p=0.01), multiple organ failure (p=0.02), hyperleucocytosis (p=0.04), acute kidney injury (p=0.04) and metastatic disease (p=0.04) were associated with in-hospital mortality. On logistic regression analysis, shock (p<0.001), multiple organ failure (p=0.04) and hyperleucocytosis (p=0.04) were independent predictors of mortality. Residence outside the study location was associated (p=0.04) with loss to follow up.

Conclusions: The high in-hospital mortality and loss to follow-up in this study can be reduced by prompt identification and management of oncologic emergencies, and the provision of support services to the children and their caregivers.


Malignancy, Children, Nigeria, Mortality factors, Follow-up

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Naghavi M, Wang H, Lozano R, Davis A, Liang X, Zhou M, et al. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death 1990-2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2015;385(9963):117-71.

Federal ministry of Health. Fact sheet: Nigeria national cancer control plan 2018-2022. Available at: Accessed on 22 March 2021.

Agnihotri AK, Bahorun T, Aruoma OI. Cancer: global health perspectives. Arch Med Biomed Res. 2014;1:1‑9.

National Population Commission (NPC) [Nigeria] and ICF. 2019. Nigeria Demographic and Health Survey 2018. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF. Available at: Accessed on 22 March 2021.

Institute for Health Metrics and Evaluation. Fact sheet: What causes the most deaths, 2017. Available at: Accessed on 22 March 2021.

Johnston WT, Lightfoot TJ, Simpson J, Roman E. Childhood cancer survival: A report from the United Kingdom childhood cancer study. Cancer Epidemiol. 2010;34(6):659‑66.

Sloan FK, Gelband H. Cancer control opportunities in low‑ and middle‑income countries. committee on cancer control in low‑ and middle‑countries board on global health. Nat Acad. 2007.

Akinsete MA, Odugbemi BA, Ogundowole GE, Anene-Nzelu UU, Temiye E, Akinsulie A. Pediatric oncology in Nigeria: a panoramic view. J Glob Oncol. 2019;5:1-7.

Brown BJ, Bambgoye EA, Sodeinde O. Early deaths and other challenges to childhood cancer survival in Ibadan, Nigeria. Cent Afr J Med. 2008;54(5-8):32-9.

James BO, Ajayi SO, Ogun OA, Oladokun RE. Factors influencing time to diagnosis of childhood cancer in Ibadan, Nigeria. Afr Heal Sci. 2009;9(4):247-53.

Ahmad HR, Faruk JA, Abdullahi M, Olorunkooba AA, Ishaku H, Abdullahi FL, et al. Pattern and outcomes of childhood malignancies at Ahmadu bello university teaching hospital, Zaria. Sub-Saharan Afr J Med. 2016;3:127-31.

Offiong UM. Childhood malignancies in university of Abuja teaching hospital Gwagwalada, Abuja, Nigeria. Niger J Paed. 2012;39(2):60-2.

Irabor OC, Nwankwo KC, Adewuyi SA. The Stagnation and decay of radiation oncology resources: lessons from Nigeria. Int J Radiat Oncol Biol Phys. 2016;95(5):1327-33.

Eke GK, Akani NA. Outcome of childhood malignancies at the university of Port Harcourt teaching hospital: a call for implementation of palliative care. Afri Health Sci. 2016;16(1):75-82.

Utuk EE, Ikpeme EE. Childhood cancers in a referral hospital in south-south Nigeria: a review of the spectrum and outcome of treatment. Pan Afr Med J. 2015;22:325.

Teshager NW, Amare AT, Tamirat KS. Incidence and predictors of mortality among children admitted to the pediatric intensive care unit at the University of Gondar comprehensive specialized hospital, northwest Ethiopia: a prospective observational cohort study. BMJ Open. 2020;10:036746.

Ndom P. Challenges of anticancer chemotherapy in Africa. Canad J Urol. 2008;15:3909-11.

Magrath I, Bey P, Shad A, Sutcliffe S. Cancer funding in developing countries: The next health‑care crisis? Lancet. 2010;376:1827.

Smith MA, Altekruse SF, Adamson PC, Reaman GH, Seibel NL. Declining childhood and adolescent cancer mortality. Cancer. 2014;120(16):2497-506.

Gatta G, Zigon G, Capocaccia R, Coebergh JW, Desandes E, Kaatsch P, et al. Survival of European children and young adults with cancer diagnosed 1995‑2002. Eur J Cancer 2009;45(6):992‑1005.

Stones DK. Childhood cancer: Early warning signs. CME. 2010;28(7):314-6.

Slone JS, Chunda-Liyoka C, Perez M, Mutalima N, Newton R, Chintu C, et al. Pediatric Malignancies, Treatment Outcomes and Abandonment of Pediatric Cancer Treatment in Zambia. PLoS ONE. 2014;9(2):89102.

Oyedeji GA. Socioeconomic and Cultural Background of Hospitalized Children in Ilesha. Niger J Paed. 1985;12(4):111-7.

Agboola AO, Adekanmbi FA, Musa AA, Sotimehun AS, Deji-Agboola AM, Shonubi AMO, et al. Pattern of childhood malignant tumors in a teaching hospital in south-western Nigeria. Med J Aust. 2009;190(1):12-4

Klein-Geltink JE, Pogany LM, Barr RD, Greenberg ML, Mery LS. Waiting times for cancer care in Canadian children: impact of distance, clinical, and demographic factors. Pediatr Blood Cancer. 2005;44(4):318-27.

Byers T, Wolf HJ, Bauer KR, Bolick-Aldrich S, Chen VW, Finch JL, et al. The impact of socioeconomic status on survival after cancer in the United States: Findings from the National Program of Cancer Registries Patterns of Care Study. Cancer. 2008;113(3):582-91.

Kaye EC, DeMarsh S, Gushue CA, Jerkins J, Sykes A, Lu Z, et al. Predictors of location of death for children with cancer enrolled on a palliative care service. Oncologist. 2018;23(12):1525-32

Costa PO, Atta EH, Da-Silva ARA. Predictors of 7- and 30-day mortality in pediatric intensive care unit patients with cancer and hematologic malignancy infected with Gram-negative bacteria. Braz J Infect Dis. 2014;18(6):591-9.

Kumar A, Moulik NR, Mishra RK, Kumar D. Causes, outcome and prevention of abandonment in retinoblastoma in India. Pediatr Blood Cancer. 2013;60(5):771-5.