Abstract
<title>Abstract</title> <p> <bold>Background:</bold> Paediatric rheumatic diseases in low-resource settings are often under-recognised and underdiagnosed because of limited specialist availability, scarce diagnostic tools, and high treatment costs. Children frequently experience prolonged, fragmented care pathways with delayed diagnosis and suboptimal outcomes. Formal documentation of these patient journeys in sub-Saharan Africa remains limited. <bold>Methods:</bold> We conducted a descriptive, case series of three children with distinct paediatric rheumatic disorders managed at Kilimanjaro Christian Medical Centre (KCMC), a zonal referral hospital in Northern Tanzania, between 2024 and 2025. Clinical data were extracted from electronic medical records. Structured interviews with caregivers documented symptom onset, time to diagnosis, facilities visited before definitive diagnosis, financial barriers, treatment interruptions, and outcomes. Journeys were analysed across three barrier domains: recognition; monitoring and complications; and delayed diagnosis with irreversible organ damage. <bold>Results:</bold> The three children had juvenile dermatomyositis (JDM), systemic juvenile idiopathic arthritis (sJIA), and systemic lupus erythematosus (SLE) with lupus nephritis. Median time from symptom onset to definitive diagnosis was 24 months (range 7–36 months). All initially presented to peripheral facilities and were treated for presumed infections or orthopaedic conditions without early autoimmune evaluation or timely referral. Autoantibody testing was unavailable on site and required outsourcing at approximately USD 50 per assay. One child with JDM improved after methotrexate under regular follow-up. One child with sJIA experienced more than twenty admissions and life-threatening methotrexate-induced myelosuppression amid limited laboratory surveillance. One child with advanced lupus nephritis died during admission after approximately three years of undiagnosed disease. <bold>Conclusions:</bold> Prolonged diagnostic delay, limited diagnostics, fragile monitoring systems, and financial barriers substantially compromise paediatric rheumatology care in this Tanzanian referral setting and contribute to severe morbidity and mortality. Strengthening frontline recognition, referral pathways, affordable diagnostics, drug-safety monitoring, and access to advanced therapies is urgently needed. </p>