A Situational Assessment of the Diagnostic Landscape and Organizational Readiness to Implement Next-Generation Sequencing at Two Childhood Cancer Treatment Centers in Ghana.

PURPOSE: Next-generation sequencing (NGS) has emerged as a promising approach to improve diagnostic accuracy, but its feasibility in low- and middle-income countries remains unknown. This study characterized the diagnostic landscape and assessed organizational readiness for NGS implementation at two childhood cancer treatment centers in Accra, Ghana. METHODS: A situational assessment of pediatric cancer diagnostics at Korle Bu Teaching Hospital (KBTH) and the Greater Accra Regional Hospital (GARH) was conducted between October and December 2024. Data were collected through site assessments, interviews, and the Organizational Readiness for Implementing Change (ORIC) scale. Descriptive statistics and the Wilcoxon rank-sum tests were used for analysis. RESULTS: In 2024, approximately 211 and 41 new pediatric cancer cases were diagnosed at KBTH and GARH, respectively. Morphology remained the primary diagnostic modality, with limited access to immunohistochemistry and outsourcing required for immunophenotyping, cytogenetic analyses, and molecular testing. Both centers reported access to essential laboratory resources for NGS testing through a public-private research partnership providing sequencing equipment and technical expertise. However, notable gaps in research infrastructure were identified. Pediatric oncology providers at KBTH and GARH demonstrated high organizational readiness for NGS implementation (median ORIC score: 50/60). Cited barriers to NGS implementation in Ghana included high equipment costs, limited training opportunities, and insufficient political prioritization. CONCLUSION: While morphology remains the cornerstone of pediatric cancer diagnosis at KBTH and GARH, both centers demonstrated readiness and emerging capacity to implement NGS. However, addressing financial, infrastructural, and workforce barriers will be critical for its sustainable integration into pediatric oncology care in Ghana.