Choosing Wisely Africa: 10 low-value or harmful practices that should be avoided in cancer care.

e19213 Background: Choosing Wisely Africa, builds on Choosing Wisely (CW) in the USA, Canada and India, and aims to identify low-value, unnecessary, or harmful cancer practices that are frequently used on the African continent. Methods: The CWA Task Force was convened by African Organization for Research and Training in Cancer (AORTIC) and included representatives in surgical, medical and radiation oncology, the private and public sectors and patient advocacy group. Consensus was built through a modified Delphi process shortening a long list of practices to a short list then to a final list. Results: Of the 10 practices on the final list, one is a new suggestion, 9 are revisions or adaptations of practices from previous CW campaign lists. One item relates to palliative care, 8 concern treatment, and 1 relates to surveillance. Conclusions: The success of this campaign will be measured by how the list is implemented across sub-Saharan Africa and whether it improves the delivery of high-quality cancer care. [Table: see text]

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Choosing Wisely Africa: Ten Low-Value or Harmful Practices That Should Be Avoided in Cancer Care

JCO Global Oncology ◽

10.1200/go.20.00255 ◽

2020 ◽

pp. 1192-1199

Author(s):

Fidel Rubagumya ◽

Gunita Mitera ◽

Sidy Ka ◽

Achille Manirakiza ◽

Philippa Decuir ◽

...

Keyword(s):

Cancer Care ◽

Task Force ◽

The United States ◽

Sub Saharan Africa ◽

Choosing Wisely ◽

Short List ◽

Middle Income ◽

Quality Cancer Care ◽

Private And Public ◽

Sub Saharan

PURPOSE Choosing Wisely Africa (CWA) builds on Choosing Wisely (CW) in the United States, Canada, and India and aims to identify low-value, unnecessary, or harmful cancer practices that are frequently used on the African continent. The aim of this work was to use physicians and patient advocates to identify a short list of low-value practices that are frequently used in African low- and middle-income countries. METHODS The CWA Task Force was convened by the African Organization for Research and Training in Cancer and included representatives from surgical, medical, and radiation oncology, the private and public sectors, and patient advocacy groups. Consensus was built through a modified Delphi process, shortening a long list of practices to a short list, and then to a final list. A voting threshold of ≥ 60% was used to include an individual practice on the short list. A consensus was reached after a series of teleconferences and voting processes. RESULTS Of the 10 practices on the final list, one is a new suggestion and 9 are revisions or adaptations of practices from previous CW campaign lists. One item relates to palliative care, 8 concern treatment, and one relates to surveillance. CONCLUSION The CWA initiative has identified 10 low-value, common interventions in Africa’s cancer practice. The success of this campaign will be measured by how the recommendations are implemented across sub-Saharan Africa and whether this improves the delivery of high-quality cancer care.

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Identifying Breast Cancer Care Quality Measures for a Cancer Facility in Rural Sub-Saharan Africa: Results of a Systematic Literature Review and Modified Delphi Process

JCO Global Oncology ◽

10.1200/go.20.00186 ◽

2020 ◽

pp. 1446-1454

Author(s):

Lydia E. Pace ◽

Lauren E. Schleimer ◽

Cyprien Shyirambere ◽

André Ilbawi ◽

Jean Marie Vianney Dusengimana ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Care ◽

Quality Measurement ◽

Quality Measures ◽

Care Quality ◽

Delphi Process ◽

Sub Saharan Africa ◽

Breast Cancer Care ◽

Modified Delphi ◽

Sub Saharan

PURPOSE The burden of cancer is growing in low- and middle-income countries (LMICs), including sub-Saharan Africa. Ensuring the delivery of high-quality cancer care in such regions is a pressing concern. There is a need for strategies to identify meaningful and relevant quality measures that are applicable to and usable for quality measurement and improvement in resource-constrained settings. METHODS To identify quality measures for breast cancer care at Butaro Cancer Center of Excellence (BCCOE) in Rwanda, we used a modified Delphi process engaging two panels of experts, one with expertise in breast cancer evidence and measures used in high-income countries and one with expertise in cancer care delivery in Rwanda. RESULTS Our systematic review of the literature yielded no publications describing breast cancer quality measures developed in a low-income country, but it did provide 40 quality measures, which we adapted for relevance to our setting. After two surveys, one conference call, and one in-person meeting, 17 measures were identified as relevant to pathology, staging and treatment planning, surgery, chemotherapy, endocrine therapy, palliative care, and retention in care. Successes of the process included participation by a diverse set of global experts and engagement of the BCCOE community in quality measurement and improvement. Anticipated challenges include the need to continually refine these measures as resources, protocols, and measurement capacity rapidly evolve in Rwanda. CONCLUSION A modified Delphi process engaging both global and local expertise was a promising strategy to identify quality measures for breast cancer in Rwanda. The process and resulting measures may also be relevant for other LMIC cancer facilities. Next steps include validation of these measures in a retrospective cohort of patients with breast cancer.

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Postharvest losses and waste in developed and less developed countries: opportunities to improve resource use

The Journal of Agricultural Science ◽

10.1017/s0021859610000936 ◽

2010 ◽

Vol 149 (S1) ◽

pp. 37-45 ◽

Cited By ~ 232

Author(s):

R. J. HODGES ◽

J. C. BUZBY ◽

B. BENNETT

Keyword(s):

Financial Incentives ◽

Poverty Reduction ◽

Developed Countries ◽

Sub Saharan Africa ◽

Less Developed Countries ◽

The Usa ◽

Private And Public ◽

Food Losses ◽

Sub Saharan ◽

The Uk

SUMMARYThis review compares and contrasts postharvest food losses (PHLs) and waste in developed countries (especially the USA and the UK) with those in less developed countries (LDCs), especially the case of cereals in sub-Saharan Africa. Reducing food losses offers an important way of increasing food availability without requiring additional production resources, and in LDCs it can contribute to rural development and poverty reduction by improving agribusiness livelihoods. The critical factors governing PHLs and food waste are mostly after the farm gate in developed countries but before the farm gate in LDCs. In the foreseeable future (e.g. up to 2030), the main drivers for reducing PHLs differ: in the developed world, they include consumer education campaigns, carefully targeted taxation and private and public sector partnerships sharing the responsibility for loss reduction. The LDCs’ drivers include more widespread education of farmers in the causes of PHLs; better infrastructure to connect smallholders to markets; more effective value chains that provide sufficient financial incentives at the producer level; opportunities to adopt collective marketing and better technologies supported by access to microcredit; and the public and private sectors sharing the investment costs and risks in market-orientated interventions.

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The seasonality of cholera in sub-Saharan Africa

10.1101/2021.11.23.21265642 ◽

2021 ◽

Author(s):

Javier Perez-Saez ◽

Justin Lessler ◽

Elizabeth C. Lee ◽

Francisco J. Luquero ◽

Espoir B. Malembaka ◽

...

Keyword(s):

Large Scale ◽

Task Force ◽

Case Fatality ◽

Sub Saharan Africa ◽

Health Concern ◽

National Differences ◽

Sub Saharan ◽

Eastern And Southern Africa ◽

Positive Correlations ◽

Gates Foundation

Background Cholera remains a major threat in Sub-Saharan Africa (SSA) where some of the highest case fatality risks are reported. Knowing in what months and where cholera tends to occur across the continent can aid in improving efforts to eliminate cholera as a public health concern; though largely due to lack of unified large-scale datasets, no continent-wide estimates exist. In this study we aim to estimate cholera seasonality across SSA. Methods We leverage the Global Task Force on Cholera Control (GTFCC) global cholera database with statistical models to synthesize data across spatial and temporal scale in order to infer the seasonality of excess suspected cholera occurrence in SSA. We developed a Bayesian statistical model to infer the monthly risk of excess cholera at the first and/or second administrative levels. Seasonality patterns were then grouped into spatial clusters. Finally, we studied the association between seasonality estimates and hydro-climatic variables. Findings The majority of studied countries (24/34) have seasonal patterns in excess cholera, corresponding to approximately 85% of the SSA population. Most countries (19/24) also had sub-national differences in seasonality patterns, with strong differences in seasonality strength between regions. Seasonality patterns clustered into two macro-regions (West Africa and the Sahel vs. Eastern and Southern Africa), which were composed of sub-regional clusters with varying degrees of seasonality. Exploratory association analysis found most consistent and positive correlations between cholera seasonality and precipitation, and to a lesser extent with temperature and flooding. Interpretation Widespread cholera seasonality in SSA offers opportunities for intervention planning. Further studies are needed to study the association between cholera and climate. Funding The NASA Applied Sciences Program and the Bill and Melinda Gates Foundation.

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Self Supply

10.3362/9781780448190 ◽

2021 ◽

Author(s):

Sally Sutton ◽

John Butterworth

Keyword(s):

Universal Access ◽

Cost Effective ◽

Sub Saharan Africa ◽

Full Potential ◽

Public Provision ◽

Middle Income ◽

Private And Public ◽

Access To Water ◽

Sub Saharan ◽

Water Provision

While governments and development partners focus on improving community and utility-managed water supplies to ensure access for all, hundreds of millions of people are taking actions to supply their own water. In the WASH sector household investment in construction and improvement of facilities is widely employed in sanitation but in water similar efforts are ignored. Recognition of the contribution of self-supply towards universal access to water and its full potential, is hampered by a lack of data, analysis and guidance. This well-reasoned source book highlights the magnitude of the contribution of self-supply to urban and rural water provision world-wide, and the gains that are possible when governments recognise and support household-led supply development and up-grading. With limited public finances in low- (and many middle-) income countries, self-supply can fill gaps in public provision, especially amongst low-density rural populations. The book focuses on sub-Saharan Africa as the region with the greatest predicted shortfall in achieving the 2030 Sustainable Development Goal for water. Household supplies can be created, or accelerated to basic or safely managed levels, through approaches that build on the investment and actions of families, with the availability of technology options and cost-effective support from the private and public sectors. The role of self-supply needs greater recognition and a change in mindset of governments, development partners and practitioners if water services are to be extended to all and no-one is to be left behind.

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Evaluation of Foliar Diseases for Soybean Entries in the Pan-African Trials in Malawi and Zambia

Plant Disease ◽

10.1094/pdis-12-19-2617-sr ◽

2020 ◽

Vol 104 (8) ◽

pp. 2068-2073

Author(s):

Christabell Nachilima ◽

Godfree Chigeza ◽

Mwila Chibanda ◽

Hapson Mushoriwa ◽

Brian D. Diers ◽

...

Keyword(s):

Disease Severity ◽

The United States ◽

Sub Saharan Africa ◽

Brown Spot ◽

Soybean Rust ◽

Growth Stages ◽

Foliar Diseases ◽

Pan African ◽

Private And Public ◽

Sub Saharan

Soybean production has expanded worldwide including countries in sub-Saharan Africa. Several national and international agencies and research groups have partnered to improve overall performance of soybean breeding stocks and have introduced new germplasm from Brazil and the United States with the goal of developing new high-yielding cultivars. Part of this effort has been to test improved soybean lines/cultivars accumulated from private and public sources in multilocational trials in sub-Saharan Africa. These trials are known as the Pan-African Soybean Variety Trials, and the entries come from both private and public breeding programs. The objective of this research was to evaluate entries in the trials that include commercial cultivars or advanced experimental lines for the incidence and severity of foliar diseases. All trials were planted in December 2018 with six located in Zambia and one in Malawi. Plants were evaluated during the reproductive growth stages using a visual pretransformed severity rating scale. Foliar disease ratings were recorded for three bacterial diseases, six fungal diseases, one oomycete, and viruses. The overall occurrence of most of the diseases was high except for soybean rust and target spot, which were only found at two and one location, respectively. However, disease severity was generally low, although there were differences in disease severity ratings among the entries at some of the locations for brown spot, downy mildew, frogeye leaf spot, red leaf blotch, and soybean rust.

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Comparative analysis of biofuels policy development in Sub-Saharan Africa: The place of private and public sectors

Renewable Energy ◽

10.1016/j.renene.2012.07.023 ◽

2013 ◽

Vol 50 ◽

pp. 614-620 ◽

Cited By ~ 13

Author(s):

Charles B.L. Jumbe ◽

Maxwell Mkondiwa

Keyword(s):

Comparative Analysis ◽

Policy Development ◽

Sub Saharan Africa ◽

Private And Public ◽

Public Sectors ◽

Sub Saharan ◽

Biofuels Policy

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International Radiotherapy Referrals From Rural Rwanda: Implementation Processes and Early Clinical Outcomes

Journal of Global Oncology ◽

10.1200/jgo.18.00089 ◽

2018 ◽

pp. 1-12

Author(s):

Maud Hanappe ◽

Lowell T. Nicholson ◽

Shekinah N.C. Elmore ◽

Alexandra E. Fehr ◽

Jean Bosco Bigirimana ◽

...

Keyword(s):

Rectal Cancer ◽

Head And Neck ◽

Low Income ◽

Cancer Care ◽

Sub Saharan Africa ◽

Resource Limited Settings ◽

Cancer Centre ◽

Resource Limited ◽

Centre Of Excellence ◽

Sub Saharan

Purpose Low- and middle-income countries disproportionately comprise 65% of cancer deaths. Cancer care delivery in resource-limited settings, especially low-income countries in sub-Saharan Africa, is exceedingly complex, requiring multiple modalities of diagnosis and treatment. Given the vast human, technical, and financial resources required, access to radiotherapy remains limited in sub-Saharan Africa. Through 2017, Rwanda has not had in-country radiotherapy services. The aim of this study was to describe the implementation and early outcomes of the radiotherapy referral program at the Butaro Cancer Centre of Excellence and to identify both successful pathways and barriers to care. Methods Butaro District Hospital is located in a rural area of the Northern Province and is home to the Butaro Cancer Centre of Excellence. We performed a retrospective study from routinely collected data of all patients with a diagnosis of cervical, head and neck, or rectal cancer between July 2012 and June 2015. Results Between 2012 and 2015, 580 patients were identified with these diagnoses and were potential candidates for radiation. Two hundred eight (36%) were referred for radiotherapy treatment in Uganda. Of those referred, 160 (77%) had cervical cancer, 31 (15%) had head and neck cancer, and 17 (8%) had rectal cancer. At the time of data collection, 101 radiotherapy patients (49%) were alive and had completed treatment with no evidence of recurrence, 11 (5%) were alive and continuing treatment, and 12 (6%) were alive and had completed treatment with evidence of recurrence. Conclusion This study demonstrates the feasibility of a rural cancer facility to successfully conduct out-of-country radiotherapy referrals with promising early outcomes. The results of this study also highlight the many challenges and lessons learned in providing comprehensive cancer care in resource-limited settings.

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