BMJ Open · 10 authors, 8 centres
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This systematic review of 57 studies found that diagnostic and treatment delays for solid tumours in sub-Saharan Africa are primarily caused by high costs, poor healthcare coordination, inadequate staffing, and reliance on traditional healers. The evidence base is limited by study quality and geographical gaps.
The study was a systematic review of 57 publications investigating barriers to timely diagnosis and treatment for adult solid tumours in sub-Saharan Africa (SSA). It used the ROBINS-E tool for bias assessment, finding 43 studies with high risk of bias at preliminary stages, and 14 meeting full criteria also had high or very high risk. Key reasons for delays included high out-of-pocket costs for services and transport, lack of coordination between primary and tertiary healthcare, inadequate staffing and infrastructure, and continued use of traditional healers. The review notes that 70% of studies focused on breast or cervical cancer, with research concentrated in Nigeria and Ethiopia, leaving significant gaps for other cancers and countries. A major limitation is the poor quality of the included primary studies, which limits the translational impact of the findings.
