Published Paper Details:

Background Botswana, the which is size of Kenya, Texas or France, has only one peadiatric haematology-oncology (PHO) programme currently running out of Princess Marina Hospital (PMH) in the capital of Gaborone. Some patients may have to travel 1000 km or more for medical appointments. The standard mode of transport to the treatment centre is by road. Children with solid tumour malignancy or lymphoma may require monthly visits over six to eight months. Children with leukaemia may require more frequent visits in the first year and monthly for two to three years. While several factors may affect treatment adherence, this investigation focused on the association between the patients' primary residence distances to PMH. Methods Scheduled PHO clinic visits at PMH for two months (March to April 2020) were assessed. A list of appointments and the patient sign-in sheets were used to determine patients who attended or missed clinic appointments. The analysis focused on adherence to with scheduled clinic appointments by patients staying closer (<80km, primarily considered the commutable distance) and further away (>80km) from PMH. Only patients who came before or on the day of the appointment were counted as having good adherence. Late arrivals on the other hand would be patients who reported for their visits after the scheduled appointment. A chi-square test was performed to examine the association between proximity to the facility and on-time attendance to appointments. Results The analysis focused on compliance with scheduled clinic appointments by patients staying closer (<80km, primarily considered the commutable distance) and further away (>80km) from PMH. Only patients who came before or on the day of the appointment were counted as having good adherence. A chi-square test was performed to examine the association between proximity to the facility and on-time attendance to appointments. Results indicated significant differences across Accuracy groups for Appointments with F (2, 1239) = 11.446, p <.001. Findings revealed significant mean differences between each group and the other two groups. That is, there is no association between distance and treatment adherence. Conclusion Whilst adherence to PHO clinic visits at PMH has many factors affecting compliance, further distance from PMH barely appears to be associated with an increased risk of presenting after the scheduled date. However, with nearly a quarter of patients presenting later than their scheduled date, further research is necessary to understand all factors contributing to non-compliance with scheduled PHO clinic reviews. Information gathered would inform the program in the future to identify informed and sustainable strategies to improve patient's adherence to clinic appointments and timely receipt of treatment and monitoring, which are essential for positive cancer outcomes.