Background: Wilms Tumour (WT) is one of the most curable childhood cancers. High cure rates seen in the high-income countries are not duplicated in low and middle-income countries due to several constraints. We reviewed our data over the last 20 years in order to highlight some of these challenges. Methods: This is a retrospective review of medical notes of children with WT under the age of 18 years presenting to our institution between 1 November 1997 and 30 November 2017. Demographic, presentation and treatment details were recorded and factors associated with poor outcome were analysed. Results: Of the 211 children presenting with WT 117(55.5%) were males. Median age at presentation was 3 (Range 0-18) years. One hundred and twelve (53.7%) of these presented without any prior treatment, while 72 (34.1%) presented after tumour excision. Metastatic status was available for 178 patients; 117 (68%) had localised tumours, 36(21.8%) had metastatic disease and 25(11.9%) presented with recurrent mass. Thirty-nine (18.4%) patients refused treatment and 6(2.8%) died before starting treatment. During treatment, 23(13.4%) children died and 21(12.2%) abandoned. Only 99 patients finished treatment, 83 (83.8%) of whom are well off therapy and 15 (15.2%) have relapsed. Six (40%) of the 15 children who relapsed are alive after salvage therapy, while the remaining 9 (60%) have died. Conclusions: Our data highlights the challenges of managing WT in resource poor environments. Prior surgery, incomplete staging work-up and abandonment are some of the most frequently encountered barriers. A multipronged approach is required to overcome these challenges.