ABSTRACT

Background: Acute lymphoblastic leukemia (ALL) is the most prevalent childhood cancer, accounting for nearly 20-25% of all pediatric malignancies globally. Contemporary childhood ALL studies have shown improved 5-year overall survival (OS) rates exceeding 90%. However, this remarkable progress has not been mirrored in low- and middle-income countries (LMICs). Evidence show that high treatment abandonment in these LMICs contributes to decreased child survival rates.

Objective: To identify determinants of treatment abandonment/refusal among children with lymphoblastic leukemia attended Addis Ababa University , Tikur Anbessa Specialized Hospital, Pediatrics hemato-oncology treatment Unit, 2025.

Methods: A facility based unmatched case control study was conducted among 414 (142 cases and 272 controls). The cases were those patients who refused or abandoned treatment and the controls are those who completed treatment. All Acute lymphoblastic leukemia patients who fulfil inclusion criteria for both the cases and controls were included consecutively to the study till the sample size fulfilled. The data was collected using structured questionnaires, via a phone call and medical record review. Data were analyzed by SPSS version 30. Bivariate and multivariable logistic regression analysis was done to identify independent determinants of treatment abandonment.

Result: In the multivariate analysis, malnutrition (AOR=3.13, 95%:1.44, 6.83), parental/guardian occupation (AOR= 0.3, 95% CI:0.07, 0.92), belief in Curability (AOR=2.92, 95% CI: 1.28, 6.66), day 29 bone marrow status (AOR= 5.80, 95% CI: 1.29, 25.95), Counseling (AOR=0.31, 95% CI :0.11, 0.86) and role in treatment decisions (AOR=2.26, 95% CI: 1.04, 4.94)  were determinants of treatment abandonment among ALL children.

Conclusion and recommendation: Due to significant effect on overall survival of children on ALL treatment; proper counseling, good nutritional support, parental support economically and availing treatment centers so that both parents can care will significant impact in reducing treatment abandonment.  

Key words: Pediatrics, Acute lymphoblastic leukemia, Determinants, Treatment, Abandonment.