Factors associated with level of knowledge on childhood cancer early warning signs among intern doctors in Tanzania

BACKGROUND: Globally, about 400,000 children are diagnosed with cancer each year, with nearly 90% living in low- and middle-income countries (LMICs), where access to diagnosis and treatment remains limited. While high-income countries report cure rates above 80%, survival in LMICs is often below 30%. In Tanzania, delayed diagnosis contributes to poor outcomes, largely due to low awareness of childhood cancer warning signs among healthcare workers. Existing literature has focused mainly on medical students and community health workers, leaving a gap in understanding intern doctors' knowledge, despite their frontline role in detecting and referring suspected cases. This study aimed to assess the factors influencing intern doctors' knowledge on childhood cancer early warning signs in national and regional referral hospitals in Dar es Salaam, Tanzania. METHOD: An analytical cross-sectional study was conducted among 176 intern doctors from Muhimbili National Hospital and three regional referral hospitals in Dar es Salaam in 2025. Data were collected using a structured, pre-tested, self-administered questionnaire that assessed demographics, clinical exposure, perceptions, and knowledge of childhood cancer early warning signs. Descriptive statistics summarized responses, while chi-square and ordinal regression analyses identified predictors of knowledge. Ethical approval was obtained from the Muhimbili University of Health and Allied Sciences (MUHAS-REC). RESULTS: Only 23% of intern doctors demonstrated high knowledge of childhood cancer early warning signs, while 67% had moderate knowledge and 10% low knowledge. Awareness was greatest for retinoblastoma (91.0%) and least for neuroblastoma (29.5%). Clinical exposure during undergraduate internship and working in hospitals with pediatric oncology services showed positive trends with higher knowledge. A gradual increase in knowledge was observed with the increasing number of workshops attended. Interns who answered "Yes" to pediatric cancers being less curable than adult cancers had higher knowledge compared to those who answered "No" (aOR = 1.35; 95% CI: 0.70-2.60). CONCLUSION: Knowledge of childhood cancer early warning signs among intern doctors remains suboptimal, highlighting the need for improved oncology training during medical education. Strengthening clinical exposure, integrating structured pediatric oncology modules, and addressing misconceptions through targeted training that not only transfers knowledge but also reinforces evidence-based optimism.

Childhood cancer · Internship · Pediatric cancer · Pediatric oncology · Referral · Tanzania · Warning signs · Warning system · Acute Lymphoblastic Leukemia research · Advances in Oncology and Radiotherapy · Childhood Cancer Survivors' Quality of Life