Improving access to cancer care for children in Tanzania: Designing a health-systems intervention

摘要 癌症的负担对低收入和中等收入国家的儿童造成了不成比例的影响， 占全球儿童癌症病例和死亡人数的80%以上。在LMIC中的儿童是 与高收入国家的儿童相比，儿童死于癌症的可能性更大。影响穷人的主要原因之一 LMICs中绝大多数癌症儿童的结果是缺乏强有力的卫生系统，这影响了 在整个护理连续体中及时获得护理。为了改善中国儿童的癌症预后 LMIC，需要干预措施来改善综合护理 利用加强的卫生系统 方法 。我的长期目标是通过以下支持改善LMICs中癌症儿童的预后 加强卫生系统的与当地相关的计划。我是一名全球健康流行病学家，热衷于 LMIC中的儿童保健。尽管我的正式培训和研究经验对 疾病模式和卫生系统的分析，我将利用这个奖项来培养改善健康的技能 并将流行病学数据转化为临床实践。以我丰富的流行病学经验， 我之前曾在LMICs测量并确定了有手术需求的儿童的护理延误是由于 地理、金融和卫生系统障碍。然而，我缺乏将这些发现转化为 通过现实世界的、基于证据的、可持续的解决方案进行实践。在科学和技术之间的鸿沟中进行培训 实践需要对加强卫生系统采取综合办法。为了实现我的职业目标，我需要 卫生服务研究和实施科学方面的额外培训。在K01期间获得的技能 培训补助金将使我有能力在低收入环境中成为一名具有职业目标的独立调查员 成为改善全球儿童卫生系统的研究人员。我的导师团队在 全球儿童关怀、卫生服务研究、实施科学和干预发展将 支持我提出的培训和研究目标。此外，拟议的目标将初步收集 R01提案的下一步需要的数据，旨在测试改善癌症护理的干预措施 坦桑尼亚的孩子们。

ABSTRACT The burden of cancer disproportionally affects children in low- and middle-income countries (LMICs), which accounts for over 80% of global childhood cancer cases and deaths. Children in LMICs are four times more likely to die of cancer than children in high-income countries. One of the main reasons impacting poor outcomes for vast number of children with cancer in LMICs is the lack of strong health systems, which impacts timely access to care along the entire care continuum. In order to improve cancer outcomes for children in LMICs, interventions are needed to improve comprehensive care using a health system strengthening approach . My long-term goal is to improve outcomes for children with cancer in LMICs through support of locally-relevant programs to strengthen health systems. I am a global health epidemiologist with a passion for children’s health care in LMICs. Although my formal training and research experiences have been formative for the analysis of disease patterns and health systems, I will use this award to develop skills to improve health systems and to translate epidemiologic data into clinical practice. With my extensive epidemiologic experience, I have previously measured and identified delays in care for children with surgical needs in LMICs due to geographic, financial, and health system barriers. However, I lack the expertise to translate those findings into practice through real-world, evidence-based, sustainable solutions. Training in this gap between science and practice requires an integrated approach to health system strengthening. To achieve my career goals, I need additional training in health services research and implementation science. The skills acquired during the K01 training grant will equip me to become an independent investigator in low-income settings with my career goal of becoming researcher to improve global health systems for children. My mentorship team’s expertise in global care for children, health services research, implementation science, and intervention development will support my proposed training and research objectives. In addition, the proposed aims will gather preliminary data needed for the next step of a R01 proposal aimed at testing interventions to improve cancer care for children in Tanzania.