CHAPTER ONE
INTRODUCTION

1.1 Background of the Study

Childhood leukemia is a malignant condition that is characterized by an uncontrolled growth of immature white blood cells in the bone marrow that leads to inhibition of normal hematopoiesis, with systemic complications. At the biological level, the abnormal leukemic blasts crowd out the healthy cells causing anemia, thrombocytopenia, and impaired immune function, which accounts for many of the clinical features that are noted in the early stages of the disease in children. The most common types are acute lymphoblastic leukemia and acute myeloid leukemia with acute lymphoblastic leukemia being the most common in pediatric cases in the world as noted by Sharma et al. (2022) and reinforced by Min et al. (2025). Advances in cytogenetics and immunophenotyping have led to a better understanding of the mechanisms of disease and treatment stratification, but early diagnosis is of the utmost importance. Hopkins (2025) states that the delay leads to progression of the disease with overtreatment and long-term problems, so it is important to identify early in order to survive and have a good quality of life.

According to Camerini et al. (2025), children leukemia is the highest percentage of pediatric cancer globally, which is almost one in three. Incidence rates are said to be higher in high income countries, partly because of stronger cancer surveillance and diagnostic systems, and lower in low-income settings, and are often underdiagnosed rather than not being present. Survival outcomes show stunning global inequalities with more than 80 percent of 5-year survival in many high-income countries, but these rates are considerably lower in other parts of the world, as Tomaszewska et al. (2025) discuss. The world despite the advancements in therapeutic regimes still sees leukemia as a significant cause of cancer deaths in children. Pudenko (2025) points out that inequities in the recognition in the early stages and access to adequate treatment in the early stages of the disease are largely responsible for these differences, emphasizing the global relevance of caregiver awareness and early health seeking behavior.

Within the sub-Saharan African region, childhood cancer is becoming an important public health issue, with leukemia always being among the most common pediatric malignancies. In Nigeria, based on hospital-based studies and new registry data, it can be assumed that childhood leukemia represents a significant percentage of pediatric oncology cases; however, national estimates have been conservative because of underreporting as suggested in a study by Yaya et al. (2021). Adamu and Ango (2024) note that a large number of children are diagnosed at later stages, which has a direct impact on treatment outcomes. Nevertheless, recent initiatives to drive the development of pediatric oncology services has led to improved awareness of the national childhood cancer burden. Apuleni et al. (2021) believe that the knowledge of caregiver level factors are essential for contextualizing these epidemiological patterns, and notifying strategies for the improvement of early detection in the Nigerian health system.

Clinically the early signs and symptoms of childhood leukemia are often vague and often have a lot of clinical overlap with the common childhood illnesses. Symptoms such as persistent fever, pallor, fatigue, recurrent infections, unexplained bruising, bleeding, and bone pain could at the onset look a lot like malaria, nutritional deficiencies, or minor infections, as was described by Kakaje et al. (2020). Tekalign et al. (2022) continue by stating that such an overlap in symptoms makes them difficult to recognize early, especially in an environment where infectious diseases are highly common. Uribe-Ortiz et al. (2022) also note that these symptoms may develop insidiously, which may slow the process of suspecting malignancy. Consequently, it is imperative to interpret patterns of symptoms in a timely fashion and with early recognition, referral and diagnostic evaluation can be initiated before disease advancement.

In this context, mothers’ figure at the heart of primary care and key decision making in child health. Their close daily contact with children places them in good position to detect any departures from normal health and thus maternal perception is important for the early detection of symptoms. Budu et al. (2021) point out that frequently mothers decide when and where care is sought, especially in young children. Khasanah et al. (2023) similarly comments that the response to childhood illness is strongly influenced by maternal knowledge, beliefs and previous healthcare experiences. Koutra et al. (2025) also add that informed mothers are more likely to know the warning signs and initiate timely healthcare seeking and the importance of maternal awareness in the early diagnosis of childhood leukemia.

Evidence from low and middle-income settings shows a range of maternal knowledge on childhood cancers including many caregivers having limited knowledge of the early warning signs and outcomes of disease. Demelash et al. (2021) report that first response to childhood illness is often home-based care or informal treatment options based on familiarity and accessibility. Oljira et al. (2025) note that the perception of the severity of the symptoms and expectations of the expected benefits of formal care affect health seeking trajectories. Saharoy et al. (2023) further shows the association of given better maternal knowledge with shorter periods between the onset of the symptoms and presentation at appropriate health facilities. Together, these results highlight the importance of the maternal awareness in the development of early detection routes.

Beyond the individual level of knowledge, a broader sociocultural, economic and health system contexts interact to determine maternal health seeking behavior. Cultural beliefs concerning the causation of illnesses, social norms on the care choice, and the economic capacity of households affect the decision on when and where care is sought, as discussed by Uribe-Ortiz et al. (2022). Min et al. (2025) state that perception of healthcare quality and accessibility also directs the choice of mothers while Yaya et al. (2021) assert the impact of community level influence on health behaviors. These interconnected factors work alongside the maternal knowledge creating a complex framework in which early childhood illness recognition and care seeking occur.

Within this broad perspective, the current study in Alimosho Local Government Area is an opportunity to explore maternal knowledge and behaviors in a high population urban area. Located in Lagos State, Alimosho is typical of how urbanization, varied socioeconomic and healthcare options coexist. Adamu and Ango (2024) postulated that urban communities involve unique dynamics on health seeking behavior due to the proximity of the health facilities and the persistence of traditional beliefs. A knowledge of maternal views on this matter helps to develop a more detailed perception of the recognition of the initial symptoms in Nigeria, where urban life keeps growing at a great pace.

Therefore, assessment of the knowledge of mothers, health seeking behavior, early symptom recognition of childhood leukemia in Alimosho Local Government Area is motivated by the need to generate context specific evidence in support of early diagnosis and improved outcomes. Koutra et al (2025), Hopkins (2025) emphasize on how it is important to strengthen caregiver awareness to improve childhood cancer survival globally. Tomaszewska et al. (2025) also state that localized evidence is needed to inform the targeted public health interventions. This study is therefore instigated by the imperative to improve maternal capacity for early recognition and timely involvement of healthcare workers in early recognition for better survival and long-term outcomes for children with leukemia.

1.2 Statement of the Problem

Childhood leukemia is one of the leading causes of death in children with cancer even though it is one of the most treatable childhood cancers if detected at an early stage. In Nigeria, however, diagnosis is often at advanced stages which leads to less-than-ideal treatment outcomes and high mortality rates. The curative potential of modern therapeutic protocols is therefore diminished by delay in presentation which limits treatment options and reduces chances of survival. The trend is indicative of this underlying disparity between biomedical gains in the field of pediatric oncology and the realities of early diagnosis in most Nigerian societies where timely diagnosis is ad hoc and poorly realized.

Another factor that is critical in late diagnosis is the nature of the early signs of leukemia, which is usually imprecise and unspecific. Symptoms such as fever, paleness and lack of energy, bone pain and recurring infections are very much similar to most childhood ailments common in Nigeria. Mothers, who are usually the first to notice changes in the health of a child, may attribute these signs to minor or self-limiting conditions. This ambiguity in symptoms makes it difficult in recognition at an early stage and decreases the urgency in seeking medical opinion to access proper and well-equipped health facilities, leading to increasing time gap between the onset of symptoms and medical presentation.

To make this difficulty worse, there is a lack of maternal education on childhood leukemia and the signs of this condition early on. Many mothers may not be familiar with the fact that persistent or recurring symptoms may mean the presence of a serious underlying condition like cancer. Without having sufficient knowledge, the ability to distinguish between illnesses that are common in children and those that are potentially life-threatening is limited. Such a gap in knowledge inhibits the timely decision making and diminishes the early detection channels especially in environments where formal health education of childhood cancer is either scarce or nonexistent.

Health seeking behavior of the mothers is further influenced by economical, sociocultural and systemic factors. The cost of healthcare services, transportation costs, and indirect financial costs may discourage early presentation to hospitals. Distance to health facilities and perceptions of service quality are also related to care choices. Additionally, cultural beliefs, fear due to a diagnosis of cancer, and preference for alternative and informal treatment options may delay access to specialized medical care. All of these have an effect on whether, when, and where symptomatic children receive appropriate care or not.

The effects of late or improper attending to care are far-reaching. Children tend to present with advanced disease and therefore need more intensive and longer treatment with higher risk of complications. Late presentation is linked to increased emotional and financial burden on families, poor treatment tolerance and preventable child deaths. These consequences are not only an indication of the disease severity but also of the lost chance of early intervention which would have enhanced survival and minimized suffering.

Despite the importance of these problems, there is scant empirical evidence exploring knowledge, early symptom recognition and health seeking behavior of childhood Leukemia by mothers in Alimosho Local Government Area. As one of the most populous localities in Lagos State, Alimosho has some unique urban health dynamics that have not been fully explored. This lack of localized evidence in Nigeria limits the creation of targeted interventions, and shows the need for targeted investigation in this setting.

1.3 Objective of the Study

The broad aim of this study is to assessment of mothers’ knowledge, health-seeking behavior, and early symptom recognition of childhood leukemia. The specific objectives are as follows;

1. To assess the level of mothers’ knowledge of childhood leukemia in Alimosho Local Government Area, Lagos State.

2. To evaluate mothers’ ability to recognize early signs and symptoms of childhood leukemia Alimosho Local Government.

3. To examine the health-seeking behaviors of mothers when confronted with symptoms suggestive of childhood leukemia in their children.

4. To determine the relationship between mothers’ knowledge of childhood leukemia and early symptom recognition in Alimosho Local Government Area.

5. To assess the association between mothers’ knowledge and their health-seeking behavior regarding suspected cases of childhood leukemia.

1.4 Research Questions

1. What is the level of mothers’ knowledge of childhood leukemia in Alimosho Local Government Area, Lagos State?

2. What is the mothers’ ability to recognize early signs and symptoms of childhood leukemia Alimosho Local Government?

3. What is the health-seeking behaviors of mothers when confronted with symptoms suggestive of childhood leukemia in their children?

4. What is the relationship between mothers’ knowledge of childhood leukemia and early symptom recognition in Alimosho Local Government Area?

5. What is the association between mothers’ knowledge and their health-seeking behavior regarding suspected cases of childhood leukemia?

1.5 Research Hypotheses

Ho1: There is no significant relationship between mothers’ knowledge of childhood leukemia and early symptom recognition in Alimosho Local Government Area.

Ho2: There is no significant association between mothers’ knowledge and their health-seeking behavior regarding suspected cases of childhood leukemia.

1.6 Significance of the Study

At the completion of this research, the mothers and primary caregivers of children within Alimosho Local Government Area will be the key beneficiaries. The findings will provide better knowledge of childhood leukemia, especially on early warning signs and proper health seeking response. Improved awareness can help to build the strength of caregivers to know to recognize the symptoms on time and in seeking timely medical treatment to facilitate earlier diagnosis and better treatment outcomes for affected children. This knowledge empowerment is expected to create informed decision-making on child health within households.

---

---