Determinants of Late Presentation of Retinoblastoma at Tertiary Hospitals in South East and South South Nigeria

Retinoblastoma is the most common primary intraocular malignancy in children globally, and survival outcomes in Nigeria are severely compromised by late presentation, often with extraocular disease. This study investigates the determinants of late presentation of retinoblastoma at tertiary hospitals in South East and South South Nigeria. An analytical cross-sectional study with prospective enrolment will be conducted at University of Nigeria Teaching Hospital, Enugu; University of Port Harcourt Teaching Hospital; and University of Calabar Teaching Hospital over 18 months. Parents or guardians of children with histologically confirmed retinoblastoma will be enrolled. Primary outcome is stage at presentation, classified as early (intraocular) or late (extraocular). Predictors assessed will include parental education, income, rural or urban residence, prior consultation with a traditional healer, geographic distance to hospital, and duration of symptoms before presentation. Multivariable logistic regression will determine independent predictors of late presentation. Sub-Saharan African literature consistently reports 80 to 90 percent of retinoblastoma cases presenting with advanced disease, contrasting with high-income settings where intraocular disease predominates. The reasons are multifactorial but systematically unexplored in South East and South South Nigeria. This study generates evidence for oncology advocacy, community awareness campaigns, and paediatrician training on recognising the key sign of leukocoria. Recommendations will target the development of a national retinoblastoma early detection programme modelled on existing newborn screening frameworks. Keywords: retinoblastoma, late presentation, paediatric cancer, South East Nigeria, leukocoria