Access to cancer chemotherapy and predictors of early mortality for childhood cancers in Uganda.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 10070-10070
Author(s):  
Innocent Mutyaba ◽  
Jackson Orem ◽  
Henry Wabinga ◽  
Warren Phipps ◽  
Corey Casper
Keyword(s):  
Childhood Cancer ◽  
Cancer Patients ◽  
Performance Status ◽  
Significant Proportion ◽  
Early Mortality ◽  
Sub Saharan Africa ◽  
Childhood Cancers ◽  
Risk Of Death ◽  
Increased Risk ◽  
Sub Saharan

10070 Background: Although many childhood cancers respond well to chemotherapy, survival among children with cancer in sub-Saharan Africa is poor. Little is known about children’s access to specialized cancer care in SSA or factors contributing to poor early outcomes. We aimed: 1) To estimate the proportion of childhood cancer patients without access to chemotherapy in Uganda; 2) To describe 30-day survival rates and predictors of mortality post diagnosis among children with lymphoma or Kaposi sarcoma (KS), the two most common pediatric cancers in Uganda. Methods: A retrospective study of incident childhood (age< 20 years) cancers diagnosed in Kyandondo County, Uganda from 2006-2009. We compared records of the population-based Kampala Cancer Registry (KCR) and patient records at the Uganda Cancer Institute (UCI), Uganda’s sole dedicated cancer treatment center. Patient characteristics were compared using Mann-Whitney and Pearson’s chi-square tests. Kaplan-Meier method and Cox regression models were used to describe mortality. Results: Of the 658 pediatric cases recorded in the KCR, only 238 (36%) presented to UCI. Patients identified in the KCR who did not present for care were more likely to be female, diagnosed in earlier years of the study, and to have a cancer other than KS or lymphoma. Of the 177 lymphoma and KS cases at UCI, 43.7% were Burkitt lymphoma (BL), 32.5% KS, and 23.8% other lymphomas. The post diagnosis 30-day overall survival rate was 77%. In multivariate analysis, age, gender, HIV status, platelets, and stage of cancer did not impact mortality. An increased risk of death at 30 days was predicted by presence of B-symptoms (HR=10.3, p=0.05), a diagnosis of BL compared to other lymphomas (HR=14.8, p=0.007), poor performance status (Karnofsky score <70, HR=14.7, p<0.001), and anemia (HR 1.5-fold per 1g/dL decrease in hemoglobin, p=0.002). Conclusions: Childhood cancer patients in Uganda have limited access to comprehensive care. Among those presenting to the UCI, a significant proportion die before they can benefit from chemotherapy. BL diagnosis, B-symptoms, performance status and hemoglobin level may be important predictors of early mortality among childhood cancer patients in sub-Saharan Africa.

Effects of parental psychiatric and physical illness on child development

2012 ◽  
pp. 1752-1758
Author(s):  
Paul Ramchandani ◽  
Alan Stein ◽  
Lynne Murray
Keyword(s):  
Significant Proportion ◽  
Postnatal Period ◽  
Physical Illness ◽  
Sub Saharan Africa ◽  
Adult Disease ◽  
Psychiatric Illnesses ◽  
Physical Conditions ◽  
The United Kingdom ◽  
Increased Risk ◽  
Sub Saharan

A broad range of physical and psychiatric illnesses commonly affect adults of parenting age. For example, approximately 13 per cent of women are affected by depression in the postnatal period, and the prevalence of depression in parents of all ages remains high. Many parents will also experience severe physical illness; breast cancer affects approximately 1 in 12 women in the United Kingdom, about a third of whom have children of school age. Worldwide HIV has an enormous impact on adults of parenting age. In some parts of sub-Saharan Africa up to 40 per cent of women attending antenatal clinics are HIV positive. Many of these parental disorders are associated with an increased risk of adverse emotional and social development in their children, and in some cases cognitive development and physical health are also compromized. It must be emphasized that a significant proportion of children at high risk do not develop problems and demonstrate resilience, and, many parents manage to rear their children well despite their own illness. Nonetheless these risks represent a significant additional impact and burden of adult disease (both physical and psychiatric) that is often overlooked. This chapter reviews the current state of evidence regarding selected examples of psychiatric and physical conditions, from which general themes can be extracted to guide clinical practice. Some of the key mechanisms whereby childhood disturbance does or does not develop in conjunction with parental illness are considered, and strategies for management and intervention reviewed.

scholarly journals Effect of health systems context on infant and child mortality in sub-Saharan Africa from 1995 to 2015, a longitudinal cohort analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ryan A. Simmons ◽  
Rebecca Anthopolos ◽  
Wendy Prudhomme O’Meara
Keyword(s):  
Health Service ◽  
Cohort Analysis ◽  
Child Survival ◽  
Sub Saharan Africa ◽  
Survival Models ◽  
Poor Child ◽  
Risk Of Death ◽  
Increased Risk ◽  
Sub Saharan ◽  
The Impact

AbstractEach year, > 3 million children die in sub-Saharan Africa before their fifth birthday. Most deaths are preventable or avoidable through interventions delivered in the primary healthcare system. However, evidence regarding the impact of health system characteristics on child survival is sparse. We assembled a retrospective cohort of > 250,000 children in seven countries in sub-Saharan Africa. We described their health service context at the subnational level using standardized surveys and employed parametric survival models to estimate the effect of three major domains of health services—quality, access, and cost—on infant and child survival, after adjusting for child, maternal, and household characteristics. Between 1995 and 2015 we observed 13,629 deaths in infants and 5149 in children. In fully-adjusted models, the largest effect sizes were related to fees for services. Immunization fees were correlated with poor child survival (HR = 1.20, 95% CI 1.12–1.28) while delivery fees were correlated with poor infant survival (HR = 1.11, 95% CI 1.01–1.21). Accessibility of facilities and greater concentrations of private facilities were associated with improved infant and child survival. The proportion of facilities with a doctor was correlated with increased risk of death in children and infants. We quantify the impact of health service environment on survival up to five years of age. Reducing health care costs and improving the accessibility of health facilities should remain a priority for improving infant and child survival. In the absence of these fundamental investments, more specialized interventions may not achieve their desired impact.

scholarly journals Disease spectrum and outcomes among elderly patients in two tertiary hospitals in Dar es Salaam, Tanzania

2019 ◽  
Author(s):  
Basil Tumaini ◽  
Patricia Munseri ◽  
Kisali Pallangyo
Keyword(s):  
Elderly Patients ◽  
Hospital Mortality ◽  
Disease Diagnosis ◽  
Sub Saharan Africa ◽  
Risk Of Death ◽  
Disease Spectrum ◽  
Increased Risk ◽  
Barthel Score ◽  
Sub Saharan ◽  
Medical Wards

AbstractBackgroundThere has been an increase in the number of individuals aged ≥60 years in Tanzania and in sub Saharan Africa in general due to improved survival. However there is scarcity of data on the disease burden, patterns and outcomes following admission in this population. We therefore describe the pattern of diagnoses, outcomes and factors associated with the outcomes among elderly patients admitted at Muhimbili National Hospital (MNH) and Jakaya Kikwete Cardiac Institute (JKCI) medical wards.MethodologyWe prospectively enrolled patients aged ≥60 years (elderly) admitted through MNH Emergency Medicine to the MNH medical wards and JKCI. ICD 10 was used to code for disease diagnosis at discharge or death. Modified Barthel index was used to assess for functional activity on admission and at discharge.ResultsWe enrolled 336 elderly participants, who comprised 30.1% of all medical admissions. The mean age was 70.6 years; 50% were female and 263 (78.3%) had comorbidities with an average of 2 diagnoses per participant. The most common diagnoses were: hypertension (44.9%), stroke (31.5%), heart failure (18.5%), pneumonia (17.9%), diabetes mellitus (17.3%) and chronic kidney disease (16.4%). The median duration of hospital stay was 5 days and in-hospital mortality was 25.6%. Non-communicable diseases (NCDs) accounted for 65% of the deaths and 50% of the deaths occurred within 72 hours of hospitalization. A modified Barthel score of ≤20 on admission was associated with 15 times increased risk of death (p<0.001).ConclusionNCDs were the most common diagnoses and cause of death among patients aged ≥60 years admitted to the medical wards. In-hospital mortality was high and occurred within 72 hours of hospitalization. A modified Barthel score <20 on admission was associated with mortality.

scholarly journals Emerging statistics on the Epidemiology of COVID-19: Making prevention in pregnancy less grievous than the disease

2020 ◽  
Vol 3 (1) ◽  
pp. 27-36
Author(s):  
John Imaralu
Keyword(s):  
Pregnant Women ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Mortality Rates ◽  
Sub Saharan Africa ◽  
Main Body ◽  
Risk Of Death ◽  
Increased Risk ◽  
The World ◽  
Sub Saharan

Background: Pregnant women are a vulnerable group to the COVID-19 infection; although it is expected that adaptive changes of pregnancy put them at increased risk of adverse outcome from any respiratory tract infection, interventions for the COVID-19 may put them in more danger. Nigeria is one of the leading countries with very poor maternal mortality indices and many other sub-Saharan African nations are in the same boat. Contingency plans need to be put in place to prevent precipitous deterioration in mortality rates occasioned by the dreaded SARS- Cov-2 pandemic. This mini-review of literature and WHO global statistics is aimed to determine the trends in COVID-19 transmission and mortality rates to provide evidence-based information that may enable governments to tailor their interventions to the peculiar needs, of sub-Saharan African populations. Main body: Emerging epidemiological trends on transmission and mortality within Africa and the worst affected regions of the world suggests better outcomes of this infection in sub-Saharan Africa, than in other regions of the world. Also, present data allude to similar outcomes between pregnant and non-pregnant women. The present containment measures of isolation and quarantine, including city-wide lockdowns, may put pregnant women at higher risk of death from other causes rather than COVID-19. The danger posed, is the limitation of access to emergency obstetric care services when pregnant women develop non-COVID-19 complications of pregnancy. Conclusion: The COVID-19 pandemic has lower local transmission rates and fatality in Africa, the region where the virus arrived last. While special efforts should be geared at shielding the elderly and infirm from contracting the infection, preventive measures in pregnant women must allow for access to emergency obstetric care to forestall iatrogenic adverse maternal outcomes.

scholarly journals Determinants of Early Mortality Among 37,568 Patients With Colon Cancer Who Participated in 25 Clinical Trials From the Adjuvant Colon Cancer Endpoints Database

2016 ◽  
Vol 34 (11) ◽  
pp. 1182-1189 ◽  
Author(s):  
Winson Y. Cheung ◽  
Lindsay A. Renfro ◽  
David Kerr ◽  
Aimery de Gramont ◽  
Leonard B. Saltz ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Group Performance ◽  
Performance Status ◽  
Eastern Cooperative Oncology Group ◽  
Disease Recurrence ◽  
Early Mortality ◽  
Advanced Age ◽  
Cancer Trial ◽  
Risk Of Death ◽  
Increased Risk

Purpose Factors associated with early mortality after surgery and treatment with adjuvant chemotherapy in colon cancer are poorly understood. We aimed to characterize the determinants of early mortality in a large cohort of colon cancer trial participants. Methods A pooled analysis of 37,568 patients in 25 randomized trials of adjuvant systemic therapy was conducted. Multivariable logistic regression models with several definitions of early mortality (30, 60, and 90 days, and 6 months) were constructed, adjusting for clinically and statistically significant variables. A nomogram for 6-month mortality was developed and validated. Results Median age among patients was 61 years, patient demographics included 54% men and 90% White, 29% and 71% had stage II and III disease, respectively, and 79%, 20%, and 1% had an Eastern Cooperative Oncology Group performance status (PS) of 0, 1, and ≥ 2, respectively. Early mortality was low: 0.3% at 30 days, 0.6% at 60 days, 0.8% at 90 days, and 1.4% at 6 months. Of those patients who died by 6 months post–random assignment, 40% had documented disease recurrence prior to death. Early disease recurrence was associated with a markedly increased risk of death during the first 6 months post-treatment (hazard ratio, 82.6; 95%CI, 66.9 to 102.1). In prognostic analyses, advanced age, male sex, poorer PS, increasing ratio of positive to examined lymph nodes, earlier decade of enrollment, and higher tumor stage and grade predicted a greater likelihood of early mortality, whereas treatment received was not strongly predictive. A multivariable model for 6-month mortality showed strong optimism-adjusted discrimination (concordance index, 0.73) and calibration. Conclusion Early mortality was infrequent but more prevalent in patients with advanced age and a PS of ≥ 2, underscoring the need to carefully consider the risk-to-benefit ratio when making treatment decisions in these subgroups.

scholarly journals The Burden of Comorbidities in Cancer Patients in Southwestern Nigeria

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 61s-61s
Author(s):  
O. Salako ◽  
P. Okediji ◽  
M. Habeeb ◽  
O. Fatiregun ◽  
O. Awofeso ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Postoperative Mortality ◽  
Sub Saharan Africa ◽  
Noncommunicable Diseases ◽  
Southwestern Nigeria ◽  
Ulcer Disease ◽  
Management Measures ◽  
Increased Risk ◽  
Sub Saharan ◽  
High Index Of Suspicion

Background: Noncommunicable diseases (NCDs) in sub-Saharan Africa are a major cause of morbidity and mortality. There is especially a paucity of data on the burden of hypertension, diabetes mellitus and other NCDs coexisting with cancer in Nigerian cancer patients. Comorbidities influence the survival of patients with cancer; lead to presentation at advanced disease stages; and result in increased risk of treatment complications, higher rates of postoperative mortality, and a greater consumption of medical resources. Aim: To determine the magnitude and pattern of comorbidities in Nigerian cancer patients. Methods: This is a retrospective study, for which data were extracted from hospital records of patients presenting for oncology care between January 2015 and December 2016 in the Departments of Radiotherapy and Oncology of two tertiary health facilities in Lagos, Nigeria. Comorbidities were identified, ranked and weighted using the Charlson Comorbidity Index (CCI). Results: Eight hundred and forty-eight (848) cancer cases were identified, with breast (50.1%) and cervical (11.1%) cancers being the most prevalent. Comorbidities were present in 228 (26.9%) patients, and the most common comorbidities were hypertension (75.9%), diabetes (25.0%), and peptic ulcer disease (7.9%). Patients with prostate (41.5%), colorectal (34.0%), cervical (25.5%), nasopharyngeal (25.0%), and breast (24.0%) cancers are most likely to have comorbidities. The mean ages of patients with comorbidities and without was 60.1 ± 11.8 years and 52.5 ± 13.7 years respectively ( P < 0.0001). Hypertension-augmented CCI scores were 0 (15.6%), 1-3 (62.1%), 4-6 (21.7%), and ≥ 7 (0.6%). Patients with lower mean CCI scores were more likely to receive chemotherapy (2.2 ± 1.6 vs. 2.5 ± 1.9; P < 0.05) and/or surgery (2.1 ± 1.5 vs. 2.4 ± 1.7; P < 0.05). Conclusion: Comorbidities occur in at least one in four Nigerian cancer patients, and significantly influence the treatment outcome and prognosis of these patients. There is a need for a high index of suspicion and routine evaluation of cancer patients for comorbidities, with the aim of instituting appropriate and immediate multidisciplinary management measures where necessary.

scholarly journals Gender inequality: Bad for men's health

2013 ◽  
Vol 14 (1) ◽  
pp. 12-14 ◽  
Author(s):  
Morna Cornell
Keyword(s):  
Gender Inequality ◽  
Sub Saharan Africa ◽  
Health Seeking ◽  
South Africans ◽  
Risk Of Death ◽  
Increased Risk ◽  
Rural Settings ◽  
Wide Range ◽  
Sub Saharan ◽  
Hiv Negative

Men’s increased risk of death in ART programmes in sub-Saharan Africa is widely reported but poorly understood. Some studies have attributed this risk to men’s poorer health-seeking behaviour, which may prevent them from accessing ART, being adherent to treatment, or remaining in care. In a multicentre analysis of 46 201 adults starting ART in urban and rural settings in South Africa, these factors only partly explained men’s increased mortality while receiving ART. Importantly, the gender difference in mortality among patients receiving ART (31% higher for men than women) was substantially smaller than that among HIV-negative South Africans, where men had twice the risk of death compared with women. Yet, this extreme gender inequality in mortality, both within and outside of ART programmes, has not given rise to widespread action. Here it is argued that, despite their dominance in society, men may be subject to a wide range of unfair discriminatory practices, which negatively affect their health outcomes. The health needs of men and boys require urgent attention. S Afr J HIV Med 2013;14(1):12-14. DOI:10.7196/SAJHIVMED.894

EFFECTS OF SMOKING ON THE DISEASE PROGNOSIS IN CANCER PATIENTS

2019 ◽  
Vol 65 (3) ◽  
pp. 321-329
Author(s):  
David Zaridze ◽  
Anush Mukeriya
Keyword(s):  
Smoking Cessation ◽  
Cancer Patients ◽  
Malignant Tumors ◽  
Scientific Data ◽  
Second Primary ◽  
Primary Tumors ◽  
Smoking Intensity ◽  
Risk Of Death ◽  
Disease Prognosis ◽  
Increased Risk

Smoking not only increases the risk of the development of malignant tumors (MT), but affects the disease prognosis, mortality and survivability of cancer patients. The link between the smoking of cancer patients and increased risk of death by all diseases and oncological causes has been established. Mortality increases with the growth of the smoking intensity, i.e. the number of cigarettes, smoked per day. Smoking is associated with the worst general and oncological survivability. The statistically trend-line between the smoking intensity and survivability was observed: each additional unit of cigarette consumption (pack/year) leads to the Overall Survival Reduction by 1% (p = 0.002). The link between smoking and the risk of developing second primary tumors has been confirmed. Smoking increases the likelihood of side effects of the antitumor therapy both drug therapy and radiation therapy and reduces the treatment efficacy. The smoking cessation leads to a significant improvement in the prognosis of a cancer patient. Scientific data on the negative effect of smoking on the prognosis of cancer patients have a major clinical importance. The treatment program for cancer patients should include science-based methods for the smoking cessation. The latter is fundamentally important, taking into account that the smoking frequency among cancer patients is much higher than in the population.

Accelerated aging and mortality in long-term survivors of childhood cancer: A report from the St. Jude Lifetime Cohort (SJLIFE).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10045-10045
Author(s):  
AnnaLynn M. Williams ◽  
Jeanne S. Mandelblatt ◽  
Mingjuan Wang ◽  
Kirsten K. Ness ◽  
Gregory T. Armstrong ◽  
...  
Keyword(s):  
Childhood Cancer ◽  
Proportional Hazards ◽  
Accelerated Aging ◽  
Cox Proportional Hazards ◽  
Premature Aging ◽  
Self Report ◽  
Deficit Accumulation ◽  
Risk Of Death ◽  
Increased Risk ◽  
Survivors Of Childhood Cancer

10045 Background: Survivors of childhood cancer have functional limitations and health-related morbidity consistent with an accelerated aging phenotype. We characterized aging using a Deficit Accumulation Index (DAI) which examines the accumulation of multiple aging-related deficits readily available from medical records and self-report. DAI’s are used as surrogates of biologic aging and are validated to predict mortality in adult cancer patients. Methods: We included childhood cancer survivors (N = 3,758, mean age 30 [SD 8], 22 [9] years post diagnosis, 52% male) and community controls (N = 575, mean age 34 [10] 44% male) who completed clinical assessments and questionnaires and who were followed for mortality through December 31st, 2018 (mean follow-up 6.1 [3.1] years). Using the initial SJLIFE clinical assessment, a DAI score was generated as the proportion of deficits out of 44 items related to aging, including chronic conditions (e.g. hearing loss, hypertension), psychosocial and physical function, and activities of daily living. The total score ranged 0 to 1; scores > 0.20 are robust, while moderate and large clinically meaningful differences are 0.02 and 0.06, respectively. Linear regression compared the DAI in survivors and controls with an age*survivor/control interaction and examined treatment associations in survivors. Cox-proportional hazards models estimated risk of death associated with DAI. All models were adjusted for age, sex, and race. Results: Mean [SD] of DAI was 0.17 [0.11] for survivors and 0.10 [0.08] for controls. 32% of survivors had a DAI above the 90th percentile of the control distribution (p < 0.001). After adjustment for covariates, survivors had a statistically and clinically meaningfully higher DAI score than controls (β = 0.072 95%CI 0.062, 0.081; p < 0.001). When plotted against age, the adjusted DAI at the average age of survivors (30 years) was 0.166 (95% CI 0.160,0.171), which corresponded to 60 years of age in controls, suggesting premature aging of 30 years. The mean difference in DAI between survivors and controls increased with age from 0.06 (95% CI 0.04, 0.07) at age 20 to 0.11 (95% CI 0.08, 0.13) at age 60, consistent with an accelerated aging phenotype (p = 0.014). Cranial radiation, abdominal radiation, cyclophosphamide, platinum agents, neurosurgery, and amputation were each associated with a higher DAI (all p≤0.001). Among survivors, a 0.06 increase in DAI was associated with a 41% increased risk of all-cause mortality (HR 1.41 95%CI 1.32, 1.50; p < 0.001). Conclusions: Survivors of childhood cancer experience significant age acceleration that is associated with an increased risk of mortality; longitudinal analyses are underway to validate these findings. Given the ease of estimating a DAI, this may be a feasible method to quickly identify survivors for novel and tailored interventions that can improve health and prevent premature mortality.

Rotavirus

2021 ◽  
Author(s):  
Sultan Mahmood
Keyword(s):  
Rna Virus ◽  
Sub Saharan Africa ◽  
Oral Rehydration ◽  
Degree Of Protection ◽  
Rotavirus Vaccines ◽  
Increased Risk ◽  
Hygiene Measures ◽  
Primary Means ◽  
Sub Saharan ◽  
Health System Responsiveness

Rotavirus is a double-stranded RNA virus that causes vomiting and diarrhea among children under 5 years. The main cause of mortality from rotavirus gastroenteritis (RVGE) is dehydration if not corrected appropriately with oral rehydration salts (ORS). Though the prevalence of RVGE is similar across countries and socio-economic groups, the higher mortality in Sub-Saharan Africa and South Asia is presumably due to poor awareness and poor health system responsiveness rather than poor hygiene. Enzyme immunoassays are the most commonly used tools for diagnosis of RVGE from stool samples. ORS and zinc remain the mainstay of treatment. Water, sanitation and hygiene measures did not appear to be very effective leaving vaccination among young children as the primary means of prevention. 4 WHO prequalified live attenuated, oral vaccines are available with different efficacy in high- versus low-mortality countries. There is a high degree of protection in countries with low RV mortality, and lower protection in countries with high RV morbidity and more fatalities. Rotavirus vaccines were associated with intussusception, though larger trials failed to establish increased risk in vaccinated groups compared to placebo recipients.

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