Background: Acute lymphoblastic leukemia (ALL) is the commonest childhood cancer globally. We described the clinical features at diagnosis and established the overall survival of children diagnosed with ALL at our Pediatric Cancer Unit. Methods: In August 2020, we retrospectively studied children <16 years diagnosed with ALL over a 4-year period (June 2016 to May 2020) at Mbarara Regional Referral Hospital (MRRH) in south west Uganda. Frequencies and proportions of baseline clinical features and treatment outcomes were described. Kaplan-Meier analysis and Cox proportional hazard regression model were performed to estimate overall survival and identify its predictors respectively. Ethical approval was obtained from Research Ethics Committee of Mbarara University of Science and Technology. Results: Within the 4-year period, 301 children were diagnosed with cancer; 51 (16.9%) with ALL. Forty-four (86.3%) presented with fever, 28 (54.9%) cough, 21(41.2%) bleeding tendencies, 20(39.4%) limb pains and 8(15.7%) abdominal distension. Forty-four (86.3%) had pallor, 39(76.5%) lymphadenopathy, 37(72.5%) hepatosplenomegaly, 18(35.3%) pyrexia, 12(23.5%) bone tenderness and 11(21.6%) petechia. Thirty (58.8%) children presented with leukocytosis (WBC>12x109/L), all the children had anemia (Hb) <11.0g/dl) and 48 (94.1%) had thrombocytopenia (<150.0x 109/L), . Thirty-three (64.7%) children completed induction chemotherapy; 27 (81.8%) with remission. Overall one year survival was 42.5%. Remission failure was associated with poor survival. Conclusions and Recommendation: Children with ALL present with non-specific clinical features that mimic common childhood infections and its outcomes are low at our unit. ALL should form part of the differential diagnosis in children with fever, pallor, bleeding, or leukocytosis, anemia and thrombocytopenia.

Introduction - Treatment abandonment contributes significantly to poor survival of children with cancer in low-middle-income countries (LMICs). In order to inform an approach to this problem at our Cancer Unit, we investigated why caregivers withdraw their children from treatment. Methods – In a qualitative study, in-depth interviews were conducted with caregivers of children who had abandoned cancer treatment at the Paediatric Cancer Unit (PCU) of Mbarara Regional Referral Hospital (MRRH) in South Western Uganda, between May 2017 and September 2020. Recorded in-depth interviews with caregivers were transcribed and analyzed to identify themes of caregiver self-reported reasons for treatment abandonment. Results - Seventy-seven out of 343 (22.4%) children treated for cancer at MRRH abandoned treatment during the study period; 20 contactable and consenting caregivers participated in the study. The median age of children’s caregivers was 37 years and most (65%) were mothers. At the time of this study, eight (40%) children were alive and 5 (62.5%) were males; with a median age of 6.5 years. Financial difficulties, other obligations, the child falsely appearing cured, preference for alternative treatments, belief that cancer was incurable, fear that the child’s death was imminent and chemotherapy side-effects were the caregivers’ reasons for treatment abandonment. Conclusions and Recommendation – Treatment abandonment among children with cancer in Uganda is, most times, as a result of difficult conditions beyond the caregivers’ control and needs to be approached with empathy and support.