Purpose: Improving cancer outcomes in Sub-Saharan Africa (SSA) requires effective implementation of evidence-based strategies. This scoping review maps the evidence on lymphoma epidemiology, treatment challenges, and patient pathways in SSA from 2011 to 2022. Methods: A comprehensive three-step search was conducted without language restrictions. Results: Eighty-four publications were included, 83% published after 2017. Southern and Eastern Africa led in output. Most studies were chart reviews (47.6%) and cohort studies (25%). NHL accounted for over 80% of cases, with an age-standardized rate (ASR) reaching 10.9/100,000, while HL had an ASR of 0.4–2.3/100,000. Compared to studies in Europe and US, SSA studies reported lower incidence rates, higher HIV comorbidity, and younger median ages. Diagnosis is often delayed, incomplete and lacks sub-classification with HIV and tuberculosis further complicating care. One-year survival rates are around 50% for NHL and over 75% for HL. Treatment is well-tolerated with an acceptable treatment-related mortality rate. However, outcomes are affected by diagnostic delays, late presentations, and treatment abandonment. Non-clinical aspects of care such as financial constraints negatively impact patient pathways. Conclusion: Addressing diagnostic delays, misdiagnosis, and treatment abandonment is crucial. Strengthening care access, diagnostics, and integrating innovative strategies including a multidisciplinary approach and re-designing efficient clinical diagnostic pathways are vital.

Limited awareness of harmonized guidelines among physicians while capacity is below par even for the basic strata.

Background: Non-Hodgkin lymphoma (NHL) is a significant public health concern in Ethiopia. However, data on non-infectious risk factors are scarce. Methods: We conducted an age- and sex-matched hospital-based case–control study at two referral hospitals in Ethiopia, enrolling 207 NHL cases and 405 controls. Self-reported occupational, medical, and lifestyle-related exposures were collected via structured interviews. Conditional logistic regression was used to estimate adjusted odds ratios (AOR) and 95% Confidence Intervals (CIs), adjusting for education and residence. Results: NHL cases were predominantly male (64.3%) with the majority diagnosed between ages 36–65. Low-grade NHL was the most common subtype (56.4%). Rural residence (AOR = 2.62, 95% CI: 1.71–4.0) and lower educational level (OR = 2.08, 95%CI: 1.33–3.15) were significantly associated with NHL. Occupational exposures, including gardening (AOR = 1.68, 95% CI: 1.04–2.2), pesticide use (AOR = 2.14, 95% CI: 1.34–3.40), agricultural work (AOR = 1.76, 95% CI: 1.12–2.83), and keeping farm animals within the household (AOR = 2.41, 95% CI: 1.51–3.84) were linked to higher NHL odds. In contrast, smoking (AOR = 0.31, 95% CI: 0.17–0.55) and alcohol consumption (AOR = 0.55, 95% CI: 0.35–0.87) were inversely associated with NHL. A history of infection requiring hospitalization (AOR = 2.12, 95% CI: 1.15–3.96) and tonsillectomy/uvulectomy (AOR = 2.61, 95% CI: 1.19–5.71) were associated with increased NHL odds. Subgroup analysis revealed stronger associations between occupational exposures and high-grade NHL, while low-grade NHL was linked to tonsillectomy/uvulectomy. Conclusions: Occupational, medical, and lifestyle-related factors are associated with NHL risk in Ethiopia.

PURPOSE: Detailed understanding of patient pathways and barriers to care is essential in devising context-appropriate cancer care strategies in low-income countries. METHODS: We conducted a mixed-methods study nested within a case-control study among patients newly diagnosed with non-Hodgkin lymphoma (NHL; N = 174) in two referral centers in Ethiopia. Structured interviews and chart reviews were followed by in-depth interviews in a subsample (n = 17). Care intervals were defined via Andersen's model and determinants of delay were assessed with logistic regression; thematic analysis was used for qualitative data. RESULTS: Mean age at diagnosis was 51.4 years (standard deviation, 13.70); 67% had advanced disease. Median patient, primary health care, and tertiary care intervals were 86.5, 15, and 47 days, respectively. Median diagnostic interval was 66.5 days. Delay was associated with lower education (adjusted odds ratio [AOR], 6.3 [95% CI, 1.3 to 25]) and indolent lymphoma (AOR, 2.9 [95% CI, 1.3 to 6.2]). Treatment abandonment was 16.8%, and 9.8% were dead at 3 months. Loss to follow-up (21.8%) was associated with study site (AOR, 6.1 [95% CI, 2.6 to 29.9]) and diagnostic delay >30 days (AOR, 4.8 [95% CI, 1.6 to 14.3]). Qualitative analysis identified symptom misappraisal, misdiagnosis, long waits, high out-of-pocket costs, and long travel distances. CONCLUSION: Delays across Ethiopia's NHL care continuum reflect low health literacy, diagnostic bottlenecks, and persistent financial barriers.