Factors Influencing Guardians' Health-Seeking Decisions for Children With Burkitt Lymphoma in Northern and Central Malawi

Background: The survival of children with Burkitt lymphoma (BL) in sub-Saharan Africa is disproportionately low compared to high-income countries. In Malawi, many of these children are diagnosed in advanced stages. Early and accurate diagnosis is critical to survival of children with BL. This qualitative study evaluates factors influencing health-seeking decisions of guardians of children with BL in Northern and Central Malawi. Methods: We conducted in-depth interviews of guardians of children (<18 years) diagnosed with BL and admitted to the Pediatric Oncology Unit at Kamuzu Central Hospital, in Lilongwe, Malawi, from February to April 2023. Participants were identified using purposive sampling. Data were analyzed using thematic content analysis. Results: Twenty guardians participated in the interviews. The median age of the respondents was 41 years, and 65% were females. Four main themes emerged as factors influencing health-seeking behaviors as guardians of children with BL navigated the Malawi health system. These included personal, economic, access to healthcare, and social factors. Financial status consistently emerged as a crucial determinant in the health-seeking behaviors of guardians, but thematic analysis also revealed knowledge and awareness, geographical accessibility, and symptom interpretation as key factors shaping health-seeking behaviors for guardians of children with BL. Symptom interpretation was influenced by the limited knowledge of the disease, and the lack of general awareness about childhood cancer. Conclusion: We identified financial and non-monetary barriers affecting health-seeking behavior among guardians of children with BL in Malawi. Targeted initiatives to alleviate the economic burden of cancer on affected families and increased awareness campaigns in the community are critical to improving BL outcomes in Malawi and other low-resourced settings.