Why Do Women with Breast Cancer Get Diagnosed and Treated Late in Sub-Saharan Africa Perspectives from Women and Patients in Bamako, Mali

Background: Breast cancer, the most common cancer among women worldwide, has a high mortality rate in low-income countries. In sub-Saharan Africa, most breast cancer patients are diagnosed with advanced disease. Some studies have quantified the time delay to diagnosis in sub-Saharan Africa, but very few have used qualitative methods to understand barriers leading to delay. This study analyses barriers throughout a breast cancer patient's pathway from symptom recognition to treatment in Mali. Method: Three focus group discussions were conducted. The model of pathways to treatment was used to structure the results into 4 time intervals: appraisal, help-seeking, diagnosis, and treatment, with a focus on barriers during each interval. Results: The main barriers during the appraisal interval were a low level of breast cancer knowledge among women, their families, and medical professionals, and during the help-seeking interval, mistrust in the community health care centers and economic hardship. Barriers during the diagnosis interval were low quality of health care services and lack of social support, and during the pretreatment interval high costs and lack of specialized services. Conclusion: Multilevel interventions are needed to ensure access, availability, and affordability of a minimum standard of care for breast cancer patients in sub-Saharan Africa.

Download Full-text

Tackling Late-Stage Diagnosis of Breast Cancer Patients in Sub-Saharan Africa: A Case Study From Mali

Journal of Global Oncology ◽

10.1200/jgo.18.30800 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 64s-64s

Author(s):

K. Grosse Frie ◽

B. Kamaté ◽

C.B. Traoré ◽

M. Ly ◽

E.J. Kantelhardt

Keyword(s):

Breast Cancer ◽

Health Care ◽

Cancer Patients ◽

Sub Saharan Africa ◽

Breast Cancer Patients ◽

Symptom Recognition ◽

Care Visit ◽

Time To Diagnosis ◽

Health Care Visit ◽

Sub Saharan

Introduction: Breast cancer is the most frequent cancer among women in sub-Saharan Africa with high mortality rates. As 60%–100% of the patients are diagnosed at late stages, downstaging strategies have been the focus of international discussions to improve survival. The aim of this study was to analyze the entire breast cancer patient´s pathway from first symptom recognition to begin of treatment and survival in Mali to advice on such strategies. Methods: The model of pathways to treatment was used as a framework to assess important time intervals during the patient´s pathway and to match results of the mixed-methods approach. For the quantitative part, N=64 breast cancer patients were interviewed, with a structured questionnaire at the only pathology department in Mali, about breast symptom recognition and first health care visit. Information on begin of treatment and survival were collected at 18-months follow up. Simple Cox regression analyses were performed. To discover additional barriers, three focus group discussions in the communities in Bamako were conducted (2). Results: Median time to first health care visit was 4.8 months, from first health care visit to diagnosis 0.9 months, and for the patients who started treatment (N=46) time from diagnosis to treatment was 1.3 months. Knowledge of breast-self-examination, and correct symptom interpretation increased the chance to visit health care earlier. Shorter duration to first health care visit, working women compared with housewives, and living within Bamako prolonged time to diagnosis. Living outside Bamako, and smaller tumor size (T1/T2) prolonged time to treatment. Visit of a traditional healer, and larger tumor size (T3/T4) shortened survival time, while time to first health visit, and subsequent time to diagnosis had no influence on survival. In the focus groups, low level of breast cancer knowledge, mistrust in the community health care centers, and economic hardship were reported as additional barriers to first health care visit. Low quality of health care services, and lack of social support were reported as barriers to diagnosis and high costs, and lack of specialized services for treatment begin. Discussion: Patients are diagnosed with late stage diseases, due to low knowledge of breast cancer. A weak health care system and out of pocket expenses discourage patients to seek health care, to have diagnostic services, and to start treatment. Conclusion: The continuum of care has to be warranted for the majority of patients to benefit from down-staging strategies.

Download Full-text

Health Care Utilization From Chemotherapy-Related Adverse Events Among Low-Income Breast Cancer Patients

North Carolina Medical Journal ◽

10.18043/ncm.75.4.231 ◽

2014 ◽

Vol 75 (4) ◽

pp. 231-238 ◽

Cited By ~ 3

Author(s):

Ravi K. Goyal ◽

Stephanie B. Wheeler ◽

Racquel E. Kohler ◽

Kristen H. Lich ◽

Ching-Ching Lin ◽

...

Keyword(s):

Breast Cancer ◽

Health Care ◽

Adverse Events ◽

Health Care Utilization ◽

Cancer Patients ◽

Low Income ◽

Care Utilization ◽

Breast Cancer Patients

Download Full-text

Monetary Policy in Sub-Saharan Africa

10.1093/oso/9780198785811.001.0001 ◽

2018 ◽

Cited By ~ 1

Keyword(s):

Monetary Policy ◽

Low Income ◽

Sub Saharan Africa ◽

Low Income Countries ◽

African Countries ◽

Policy Regimes ◽

Export Prices ◽

Policy Work ◽

Sub Saharan ◽

Policy Guidance

Having broadly stabilized inflation over the past two decades, many policymakers in sub-Saharan Africa are now asking more of their monetary policy frameworks. They are looking to avoid policy misalignments and respond appropriately to both domestic and external shocks, including swings in fiscal policy and spikes in food and export prices. In many cases they are finding current regimes—often characterized as ‘money targeting’—lacking, with opaque and sometimes inconsistent objectives, inadequate transmission of policy to the economy, and difficulties in responding to supply shocks. At the same time, little existing research on monetary policy is targeted to low-income countries. What do we know about the empirics of monetary transmission in low-income countries? (How) Does monetary policy work in countries characterized by a huge share of food in consumption, underdeveloped financial markets, and opaque policy regimes? (How) Can we use methods largely derived in advanced countries to answer these questions? And (how) can we use the results to guide policymakers? This book draws on years of research and practice at the IMF and in central banks from the region to shed empirical and theoretical light on these questions and to provide practical tools and policy guidance. A key feature of the book is the application of dynamic general equilibrium models, suitably adapted to reflect key features of low-income countries, for the analysis of monetary policy in sub-Saharan African countries.

Download Full-text

COVID-19 pandemic: the implications of the natural history, challenges of diagnosis and management for care in sub-Saharan Africa

Beni-Suef University Journal of Basic and Applied Sciences ◽

10.1186/s43088-021-00106-x ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Lawrence Omo-Aghoja ◽

Emuesiri Goodies Moke ◽

Kenneth Kelechi Anachuna ◽

Adrian Itivere Omogbiya ◽

Emuesiri Kohworho Umukoro ◽

...

Keyword(s):

Public Health ◽

Natural History ◽

Low Income ◽

Sub Saharan Africa ◽

Low Income Countries ◽

Diagnosis And Management ◽

Severe Acute Respiratory Infection ◽

Identification Technique ◽

Sub Saharan ◽

Policies And Programs

Abstract Background Coronavirus disease (COVID-19) is a severe acute respiratory infection which has afflicted virtually almost all nations of the earth. It is highly transmissible and represents one of the most serious pandemics in recent times, with the capacity to overwhelm any healthcare system and cause morbidity and fatality. Main content The diagnosis of this disease is daunting and challenging as it is dependent on emerging clinical symptomatology that continues to increase and change very rapidly. The definitive test is the very expensive and scarce polymerase chain reaction (PCR) viral identification technique. The management has remained largely supportive and empirical, as there are no officially approved therapeutic agents, vaccines or antiviral medications for the management of the disease. Severe cases often require intensive care facilities and personnel. Yet there is paucity of facilities including the personnel required for diagnosis and treatment of COVID-19 in sub-Saharan Africa (SSA). It is against this backdrop that a review of key published reports on the pandemic in SSA and globally is made, as understanding the natural history of a disease and the documented responses to diagnosis and management is usually a key public health strategy for designing and improving as appropriate, relevant interventions. Lead findings were that responses by most nations of SSA were adhoc, paucity of public health awareness strategies and absence of legislations that would help enforce preventive measures, as well as limited facilities (including personal protective equipment) and institutional capacities to deliver needed interventions. Conclusion COVID-19 is real and has overwhelmed global health care system especially low-income countries of the sub-Sahara such as Nigeria. Suggestions for improvement of healthcare policies and programs to contain the current pandemic and to respond more optimally in case of future pandemics are made herein.

Download Full-text

Could Mucuna pruriens be the answer to Parkinson's disease management in sub-Saharan Africa and other low-income countries worldwide?

Parkinsonism & Related Disorders ◽

10.1016/j.parkreldis.2020.03.002 ◽

2020 ◽

Vol 73 ◽

pp. 3-7 ◽

Cited By ~ 2

Author(s):

Natasha Fothergill-Misbah ◽

Harshvadan Maroo ◽

Momodou Cham ◽

Gianni Pezzoli ◽

Richard Walker ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Disease Management ◽

Low Income ◽

Sub Saharan Africa ◽

Low Income Countries ◽

Mucuna Pruriens ◽

Sub Saharan

Download Full-text

Breast Cancer in Low- and Middle-Income Countries: An Emerging and Challenging Epidemic

Journal of Oncology ◽

10.1155/2010/490631 ◽

2010 ◽

Vol 2010 ◽

pp. 1-5 ◽

Cited By ~ 32

Author(s):

Arafat Tfayli ◽

Sally Temraz ◽

Rachel Abou Mrad ◽

Ali Shamseddine

Keyword(s):

Breast Cancer ◽

Health Care ◽

Low Income ◽

Therapeutic Interventions ◽

Low Income Countries ◽

Middle Income ◽

Major Health ◽

Middle Income Countries ◽

Low And Middle Income

Breast cancer is a major health care problem that affects more than one million women yearly. While it is traditionally thought of as a disease of the industrialized world, around 45% of breast cancer cases and 55% of breast cancer deaths occur in low and middle income countries. Managing breast cancer in low income countries poses a different set of challenges including access to screening, stage at presentation, adequacy of management and availability of therapeutic interventions. In this paper, we will review the challenges faced in the management of breast cancer in low and middle income countries.

Download Full-text