Experts fear that there is a growing epidemic of childhood blood cancer in Nigeria and it seems to be predominant among boys.
Childhood leukemia, the most common type of cancer in children and teens, is a cancer of the white blood cells. Abnormal white blood cells form in the bone marrow. They quickly travel through the bloodstream and crowd out healthy cells. This raises the body’s chances of infection and other problems.
Of late, there appears to be an increasing incidence of childhood leukaemia in Nigeria. More often than not, the affected children lose the battle of survival after untold sufferings, leaving their parents in trauma and anguish.
According to experts, more boys than girls have been coming down with the ailment, and for those diagnosed, accessing treatment remains a forlorn dream.
Families devastated by childhood leukaemia
In September 2020, 12-year-old, Emmanuel Adindu, was diagnosed with acute myeloid leukaemia, a type of cancer that affects immature white blood cells in the body.
Emmanuel, the last in a family of four, woke up one morning with severe joint pains that defied analgesics. When the pains became intolerable, he was rushed by his parents to the Lagos University Teaching Hospital, Idi-Araba, for treatment.
After weeks of paying for drugs and carrying out tests, while on admission at the LUTH Paediatric Oncology Ward, left the family’s pocket depleted, Emmanuel was taken home by his parents against doctor’s advice.
Unfortunately, he died two weeks later, in the arms of his mother, Clara.
Speaking with PUNCH Healthwise, the distraught mother said they were left with no other option than to take their child home, when they could no longer afford most of his drugs.
She said Emmanuel was referred for a bone marrow transplant in India, which was estimated to cost 15 million naira, and that they stood no chance of ever raising the money.
“It was a hopeless situation,” she said in tears.
“The worst thing to happen to any parent is to bury a child. My son died within months of being diagnosed with leukaemia. The hospital tried their best, but God knows best.”
For Nkechi Okafor, an urgent call to pick up her 14-year-old son, Uchenna, from a boarding school in Ogun State, started a nightmare that lasted for six months.
She recalled that her son never exhibited any sign of illness, and had been dropped off in school three days earlier with his elder brother, by their father. She explained:
“They came home for mid-term break. Nothing was wrong with him. I was told he had been vomiting for two days, and he looked quite pale.”
Uchenna was later diagnosed with acute lymphoblastic leukaemia – a type of cancer that affects lymphocytes, a type of white blood cell.
Like these families, several homes have been ravaged by this deadly scourge. Quite a handful are still battling with it, and desperately hope for a cure that experts say, remains elusive in this clime.
However, based on reports, leukaemia is not peculiar to children alone, as adults are also prone to the condition.
One person that recently succumbed to the disease is Nigeria’s civil society leader, Innocent Chukwuma, who died on Saturday, April 3, 2021, at the age of 55. He was diagnosed with Acute Myeloid Leukaemia.
A growing scourge
According to the World Health Organisation, cancer burden continues to grow globally, exerting tremendous physical, emotional and financial strain on individuals, families, communities and healthcare systems.
The organisation says many health systems in low- and middle-income countries like Nigeria are least prepared to manage this burden, and large numbers of cancer patients globally do not have access to timely quality diagnosis and treatment.
Experts say childhood cancer mortality rate is high in Nigeria due to factors such as lack of accessibility to, and affordability of, care; misdiagnosis or delayed diagnosis; inadequate and poorly trained manpower, and poorly developed health insurance services.
The WHO highlighted high poverty rate, lack of medical cover and high cost of funding cancer treatments as major setbacks to cancer detection, treatment, and management in Africa generally.
The global health body noted that even when diagnosed, lack of treatment centres becomes a challenge that leads to high mortality.
Nature of disease
According to WebMD, childhood leukaemia, the most common type of cancer in children and teens, affects the white blood cells.
It explained that the abnormal white blood cells form in the bone marrow and quickly travel through the bloodstream and crowd out healthy cells.
WebMD noted that this raises the body’s chances of infection and other problems.
The online medical site noted that as tough as it is for a child to have cancer, it is encouraging to know that most children can be successfully treated.
Death sentence in Nigeria
However, a professor of paediatrics at the University of Nigeria Teaching Hospital, Enugu, who chose to remain anonymous, said childhood leukaemia is very fatal, and that the chances of survival are very slim in Nigeria.
According to her, unlike other types of cancers, childhood leukaemia is akin to a death sentence in the country.
The paediatric expert said there is acute and chronic leukaemia, but that the acute type is more common, especially the lymphoma cancerthat affects the lymphocytes – the infection-fighting cells of the immune system. She said,
“We have had a few survivors of childhood cancers, but not for leukaemia. I can’t remember anybody that we treated for leukaemia that has done more than two to three years.
“It is fatal in children because we don’t have the resources for effective treatment. In Europe and America, it’s not fatal because the government bears the cost.”
The UNTH professor added that the incidence continues to increase in Nigeria, unlike the situation in most advanced countries. She said:
“It used to be rare but there has been an increase in numbers recently. It’s becoming quite common. At a time in the ward, we had about three or four children at the same time.
“The commonest type of cancer we used to have in children was the Burkitt lymphoma, but it is now dying down and leukaemia is coming up.”
More boys coming down with leukaemia than girls
The paediatric expert further said while there is no gender specificity with the disease, boys tend to be more affected than girls.
Her claim was corroborated by KidsHealth, an online medical publication, which revealed that leukaemia is more common in boys than girls.
Similarly, the National Library of Medicine also affirmed that acute leukaemia is more common in males at almost every age, but that the fact remains unexplained.
The International Agency for Research on Cancer, estimates that every year, 163,000 children between ages 0 and 14 are diagnosed with cancer worldwide, and of these, 94,000 are boys and 68,000 are girls.
“This leads to a global ratio of 1.37 – so, four boys are diagnosed with cancer for every three girls,” IARC stated.
On predisposing factors, the professor said there’s no specific cause that has been associated with childhood leukaemia.
She said some studies have linked it to radiation emitted from high voltage power lines, but that this remains unfounded.
“A child that has survived cancer and gone through radiation therapy or chemotherapy can be predisposed to leukaemia later. But there is really nothing specific that has been pinpointed,”
The paediatric expert said childhood leukaemia is very treatable, if the resources and materials needed are available.
She, however, said the challenge is that drugs for the treatment and management of cancer generally, are not readily available in Nigeria. She further noted that the supportive care needed to treat a child with cancer is mostly unavailable.
The professor revealed that Enugu State lacks ‘platelet concentrator’, a machine that gets blood and concentrate platelets that can be transfused into a child with leukaemia. She added:
“Children with leukaemia have problems with platelets. What happens is that the leukaemic cell will displace the bone marrow, and there will be less production of red blood cells and less production of platelets. Platelets are very fragile. If they out of the body, they can only last a few hours.
“There’s only one type in Abakiliki and it costs about N130, 000, which not many people can afford. It’s not as if the child will be transfused with one bag, several bags will be needed.
“Cancer drugs target the whole body, not just the cancer. So, the side effects of the drugs can result in infection and bleeding, and the child will need blood transfusion. This is coupled with all the attendant dangers in transfusion and the rigours of getting a donor.See Also
“Because leukaemia destroys white blood cells, injections will be needed to have it boosted. The original ones cost between N20, 000 to N30, 000, and it has to be taken for a few days before it can work. This is why I said the supportive care is not there.”
Burden of treating leukaemia from out-of-pocket
The UNTH professor further noted that childhood leukaemia is a high maintenance disease, adding,
“Parents that don’t belong to high social economic class can’t afford the treatment because they pay out-of-pocket with the little they earn.”
She explained that treatment usually lasts for a duration of three years and involves three very expensive stages.
“The first six months, the child will undergo ‘induction of remission’. Once they pass through that stage, we consolidate the remission and put the child on maintenance, which is less toxic. This will last for two years.
“Maintenance involves a monthly injection, accompanied by a weekly or daily oral dose. Having a child with leukaemia impacts negatively on the whole family,”
The paediatric expert said a normal civil servant can’t bear the cost of treating a child with the condition due to lack of effective medical insurance coverage.
She bemoaned the fact that the only reprieve the National Health Insurance Scheme can offer is payment for bed fee.
Founder, Children Living with Cancer Foundation, Dr. Nneka Nwobbi, also said treating leukaemia is quite expensive.
She said, sadly, most parents that have children with leukaemia have become impoverished due to out-of-pocket payment.
“Most parents can hardly afford the treatment. With time, they give up and take their children home to patiently wait for the inevitable to happen.
“These parents are not enrolled in the NHIS. I am yet to see anyone on the scheme whose plan covers chemotherapy and radiotherapy or even bone marrow transplant,”
According to The Lancet, a peer-reviewed, online journal, about 70 percent of Nigerians are living in poverty, and out-of-pocket payments can make households and individuals incur catastrophic health expenditure and this can exacerbate the level of poverty.
According to a report by the Global Health Expenditure Database 2018, published by the World Health Organisation, Nigeria may not achieve universal health coverage as out-of- pocket payment for healthcare peaks at 76.6 percent.
Trauma of caring for a child with leukaemia
Nwobbi noted that boys tend to do worse than girls in surviving childhood leukaemia. On likely symptoms parents should look out for, Nwobbi said they include fever, anaemia, swollen abdomen due to affected liver, headaches and vomiting.
“One well known thing about leukaemia in children is that nobody can tell who can have it. However, children with Down syndrome can have it. If there are radioactive elements around an environment, there is the likelihood that children and even adults can come down with leukaemia,”
Nigeria lacking the wherewithal to treat leukaemia
Nwobbi said Nigeria has the manpower but lacks the technology to treat leukaemia in children.
She said while some patients will require bone marrow transplant, others might just need a treatment regimen, which is not readily available in the country.
“Chances of survival are quite slim, which is why very rich parents fly their children abroad for treatment. However, some that don’t require bone marrow transplant still survive here.
“We have very brilliant doctors and nurses, but don’t have the technology. When we go outside Nigeria, we excel. What is required to boost treatment of leukaemia in Nigeria is to get equipment that will help with the treatment we are offering to children,”
She urged the Federal Government to make the treatment of cancer free and also demonstrate the political will to overhaul the country’s inefficient healthcare system, open more cancer testing centres, and bring in modern equipment for cancer treatment to help reduce mortality rate for childhood leukaemia.