scholarly journals The Role of South-to-South Partnerships in Developing Cancer Services in Africa

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 163s-163s
Author(s):  
F. Kiyange ◽  
V. Walusansa ◽  
G. Mandosela ◽  
H. Nzereka Kambale ◽  
E. Luyirika ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Treatment ◽  
Technical Assistance ◽  
Sub Saharan Africa ◽  
Health Concern ◽  
Government Hospital ◽  
African Countries ◽  
Ministry Of Health ◽  
Cancer Society ◽  
Cancer Management

Background and context: Despite being a growing public health concern in Africa, access to effective cancer treatment and pain relief is still limited in sub-Saharan Africa. The African Palliative Care Association (APCA) in collaboration with the American Cancer Society and the Ministry of Health of Swaziland have successfully implemented a South-to-South partnership which has facilitated the development and operation of a cancer unit in Mbabane National Hospital. Although the cancer burden continues to rise in Africa, many countries do not have established oncology services. They rely on cancer treatment, care and support through referral to neighboring countries or overseas, which is costly for governments and poses multiple challenges for patients and their families. Until recently, Swaziland has relied on cancer treatment and care in South Africa. This paper presents a model where the Uganda Cancer Institute (UCI) in Uganda has been facilitated to support the establishment of a cancer unit in Swaziland. Aim: The intervention aimed at providing technical assistance to the Ministry of Health of Swaziland to initiate and operate a cancer unit in Mbabane Government Hospital through a formal arrangement with the UCI. Strategy/Tactics: The planning and execution of activities was done by a tripartite of APCA, Uganda Cancer Institute a government entity and the Swazi Ministry of Health. Program/Policy process: Over a period of one year (Decemeber 2016 to December 2017) APCA, through a grant from the ACS formerly engaged the UCI to support the initiation and operation of a cancer unit in Swaziland. This was through expert exchange visits through which on-job training and mentorship was provided to a team of staff at Mbabane Government Hospital, with coordination by the Swaziland Ministry of Health. Experiential visits to Uganda were also organized for the lead pharmacist in Swaziland and a doctor to enable them set up and run a cancer unit in their country. The exchange visits provided a forum for both observation and application of knowledge and skills. Outcomes: A cancer unit was successfully established at Mbabane Government Hospital in Swaziland, which now provides services for patients, with breast cancer and expanding to include other cancers. The Swaziland Ministry of Health has been key to the success of this development and continues to identify human, financial and other resources to sustain the cancer unit. To date 69 patients have successfully undergone chemotherapy: 43 breast cancer, 22 Kaposi sarcoma, 2 colorectal cancer, 1 bladder cancer, 1 multiple myeloma. 21 health care workers were trained on cancer management; 9 doctors, 7 nurses and 5 pharmacists. What was learned: There are many opportunities for South-to-South partnership to support the establishment or improvement of cancer care. This model implemented in Swaziland can be replicated in other African countries. Documenting the model for replication in other countries is recommended.

scholarly journals Individual, community and societal correlates of insecticide treated net use among pregnant women in sub-Saharan Africa: a multi-level analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Edward Kwabena Ameyaw
Keyword(s):  
Pregnant Women ◽  
Sub Saharan Africa ◽  
World Health ◽  
Health Concern ◽  
Maternal And Newborn Health ◽  
African Countries ◽  
The World ◽  
Itn Use ◽  
Multi Level ◽  
Sub Saharan

Abstract Background Malaria in pregnancy is a crucial public health concern due to the enormous risk it poses to maternal and newborn health. The World Health Organisation therefore recommends insecticide-treated net (ITN) for pregnant women. The world over, sub-Saharan Africa bears the highest prevalence of malaria and its associated complications. This study investigated the individual, community and society level factors associated with ITN use among pregnant women in sub-Saharan Africa. Methods The study was conducted with Demographic and Health Survey data of 21 sub-Saharan African countries. A total of 17,731 pregnant women who possessed ITN participated in the study. Descriptive computation of ITN use by survey country and socio-demographic characteristics was conducted. Further, five multi-level binary logistic regression models were fitted with MLwiN 3.05 package in STATA. The Markov Chain Monte Carlo (MCMC) estimation procedure was used in estimating the parameters whilst the Bayesian Deviance Information Criterion was used for the model fitness test. Results On average, 74.2% pregnant women in SSA used ITN. The highest prevalence of ITN use occurred in Mali (83.7%) whilst the least usage occurred in Namibia (7%). Women aged 30–34 were more likely to use ITN compared with those aged 45–49 [aOR = 1.14; Crl = 1.07–1.50]. Poorest women were less probable to use ITN relative to richest women [aOR = 0.79; Crl = 0.70–0.89]. Compared to women who did not want their pregnancies at all, women who wanted their pregnancies [aOR = 1.06; Crl = 1.04–1.19] were more probable to use ITN. Women in male-headed households had higher likelihood of ITN use compared to those from female-headed households [aOR = 1.28; Crl = 1.19–1.39]. On the whole, 38.1% variation in ITN use was attributable to societal level factors whilst 20.9% variation was attributable to community level factors. Conclusion The study has revealed that in addition to individual level factors, community and society level factors affect ITN use in SSA. In as much as the study points towards the need to incorporate community and societal variations in ITN interventions, active involvement of men can yield better outcome for ITN utilisation interventions in SSA.

scholarly journals Inequities in breast cancer treatment in sub-Saharan Africa: findings from a prospective multi-country observational study

2019 ◽  
Vol 21 (1) ◽  
Author(s):  
Milena Foerster ◽  
Benjamin O. Anderson ◽  
Fiona McKenzie ◽  
Moses Galukande ◽  
Angelica Anele ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Observational Study ◽  
Cancer Treatment ◽  
Breast Cancer Treatment ◽  
Sub Saharan Africa ◽  
Sub Saharan

scholarly journals Pilot Survey of Breast Cancer Management in Sub-Saharan Africa

2017 ◽  
Vol 3 (3) ◽  
pp. 194-200 ◽  
Author(s):  
Verna D.N.K. Vanderpuye ◽  
Olufunmilayo I. Olopade ◽  
Dezheng Huo
Keyword(s):  
Breast Cancer ◽  
Online Survey ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Sub Saharan Africa ◽  
Pilot Survey ◽  
Chemotherapy Drugs ◽  
Cancer Management ◽  
Breast Cancer Management ◽  
Sub Saharan

Purpose To understand the current state of breast cancer management in sub-Saharan Africa. Methods We conducted an anonymous online survey of breast cancer management among African Organization for Research and Treatment in Cancer (AORTIC) members by using a 42-question structured questionnaire in both English and French in 2013. Results Twenty members from 19 facilities in 14 countries responded to the survey. Twelve members (60%) belonged to a multidisciplinary breast cancer team. Radiotherapy equipment was available in seven facilities (36%), but equipment had down time at least once a week in four facilities. Available chemotherapy drugs included methotrexate, cyclophosphamide, fluorouracil, anthracyclines, and vincristine, whereas trastuzumab, taxanes, vinorelbine, and gemcitabine were available in few facilities. Core-needle biopsy was available in 16 facilities (84%); mammogram, in 17 facilities (89%); computed tomography scan, in 15 facilities (79%); magnetic resonance imaging, in 11 facilities (58%); and bone scans, in nine facilities (47%). It took an average of 1 to 3 weeks to report histopathology. Immunohistochemistry was available locally in eight facilities (42%), outside hospitals but within the country in seven facilities (37%), and outside the country in four facilities (21%). Thirteen facilities (68%) performed axillary node dissections as part of a breast protocol. Neoadjuvant chemotherapy was the most common therapy for locally advanced breast cancer in 13 facilities (68%). In three facilities (16%), receptor status did not influence the prescription of hormone treatment. Conclusion This pilot survey suggests that AORTIC members in sub-Saharan Africa continue to make gains in the provision of access to multidisciplinary breast cancer care, but the lack of adequate pathology and radiotherapy services is a barrier. Focused attention on in-country and regional training needs and improvement of health systems deliverables is urgently needed.

scholarly journals Multicountry Distribution and Characterization of Extended-spectrum β-Lactamase–associated Gram-negative Bacteria From Bloodstream Infections in Sub-Saharan Africa

2019 ◽  
Vol 69 (Supplement_6) ◽  
pp. S449-S458 ◽  
Author(s):  
Trevor Toy ◽  
Gi Deok Pak ◽  
Trung Pham Duc ◽  
James I Campbell ◽  
Muna Ahmed El Tayeb ◽  
...  
Keyword(s):  
Bloodstream Infections ◽  
Sub Saharan Africa ◽  
Health Concern ◽  
Reference Laboratory ◽  
Gram Negative Bacteria ◽  
Esbl Production ◽  
African Countries ◽  
Gram Negative ◽  
Extended Spectrum ◽  
Sub Saharan

Abstract Background Antimicrobial resistance (AMR) is a major global health concern, yet, there are noticeable gaps in AMR surveillance data in regions such as sub-Saharan Africa. We aimed to measure the prevalence of extended-spectrum β-lactamase (ESBL) producing Gram-negative bacteria in bloodstream infections from 12 sentinel sites in sub-Saharan Africa. Methods Data were generated during the Typhoid Fever Surveillance in Africa Program (TSAP), in which standardized blood cultures were performed on febrile patients attending 12 health facilities in 9 sub-Saharan African countries between 2010 and 2014. Pathogenic bloodstream isolates were identified at the sites and then subsequently confirmed at a central reference laboratory. Antimicrobial susceptibility testing, detection of ESBL production, and conventional multiplex polymerase chain reaction (PCR) testing for genes encoding for β-lactamase were performed on all pathogens. Results Five hundred and five pathogenic Gram-negative bloodstream isolates were isolated during the study period and available for further characterization. This included 423 Enterobacteriaceae. Phenotypically, 61 (12.1%) isolates exhibited ESBL activity, and genotypically, 47 (9.3%) yielded a PCR amplicon for at least one of the screened ESBL genes. Among specific Gram-negative isolates, 40 (45.5%) of 88 Klebsiella spp., 7 (5.7%) of 122 Escherichia coli, 6 (16.2%) of 37 Acinetobacter spp., and 2 (1.3%) of 159 of nontyphoidal Salmonella (NTS) showed phenotypic ESBL activity. Conclusions Our findings confirm the presence of ESBL production among pathogens causing bloodstream infections in sub-Saharan Africa. With few alternatives for managing ESBL-producing pathogens in the African setting, measures to control the development and proliferation of AMR organisms are urgently needed.

Wisconsin Comorbidity Assessment Scale (WCAS): A novel, comprehensive, performance-based assessment scale of geriatric syndromes and medical comorbidities in older cancer patients

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19619-19619
Author(s):  
M. K. Krishnamachary ◽  
R. J. Swain-Eng ◽  
J. Barnet ◽  
J. Maloney ◽  
J. A. Stewart ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Treatment ◽  
Physical Function ◽  
Assessment Tool ◽  
Assessment Scale ◽  
Adjuvant Radiation ◽  
Geriatric Syndromes ◽  
Medical Comorbidities ◽  
Cancer Management ◽  
Risk Of Falls

19619 Background: Elderly patients with cancer have potential for multiple geriatric syndromes that influence treatment and outcomes. No single clinical assessment tool has targeted all the major geriatric syndromes and their interaction on cancer management and outcomes. We developed WCAS to evaluate cognitive and physical function, risk of falls and gait disorders, polypharmacy, and medical comorbidities. Methods: Eighteen newly diagnosed patients with breast cancer (age 55–82), were enrolled prior to cancer treatment. Cognitive function was evaluated with a comprehensive battery of neuropsychological tests targeting the domains of memory, executive function, attention, language, and praxis. Physical function skills were assessed with novel performance-based tasks (e.g., bed-making) and computerized assessments of balance, gait and risk of falls. Cancer treatment included surgery in all patients with variable use of adjuvant radiation and medical therapy. WCAS was administered at baseline and at month 6. Results: Ten subjects have completed both baseline and month 6 visits. Surgical treatment occurred at a mean of ten days after baseline assessment (SD 6.7). The mean (SD) of the age, years of education and baseline Mini Mental Status Exam (MMSE) was 66 years (7.3), 15.2 years (3.7) and 29.3 (1.1). From baseline to month six assessment performance on the WAIS Digit Symbol test, a measure of working memory and processing speed, declined (mean change −11.7, p<0.01). Likewise, the performance on the WAIS letter number sequence test (mean change −1.3, p=0.09) and the MMSE (mean change −1.1, p=0.12) declined. Interestingly, four subjects with pre-existing hypothyroidism on replacement treatment showed a greater decline (p<0.01) in memory than those without this common condition. Conclusions: Findings indicate that breast cancer diagnosis and therapy can be associated with significant decline in aspects of cognition in older adults with cancer. These changes can last at least 6 months and are more pronounced in those with hypothyroidism. Larger, longer term prospective studies utilizing WCAS are necessary to confirm our preliminary findings. No significant financial relationships to disclose.

scholarly journals Spectrum of heart diseases in children presenting to a paediatric cardiac echocardiography clinic in the Lake Zone of Tanzania: a 7 years overview

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Antke Zuechner ◽  
Tumaini Mhada ◽  
Naizihijwa G. Majani ◽  
Godwin G. Sharau ◽  
William Mahalu ◽  
...  
Keyword(s):  
Heart Diseases ◽  
Interventional Therapy ◽  
Sub Saharan Africa ◽  
Morbidity And Mortality ◽  
Health Concern ◽  
Interventional Treatment ◽  
African Countries ◽  
Lake Zone ◽  
Infancy And Childhood ◽  
Sub Saharan

Abstract Background Congenital heart diseases (CHD) are among the most common congenital malformations. It is estimated that the incidence of CHD is constant worldwide, but data are rare for most African countries including Tanzania. Even less data are available on the prevalence of acquired heart diseases (AHD) in African children. Rheumatic heart disease (RHD) is the leading cause of AHD and is remaining a public health concern in Sub-Saharan Africa affecting especially the younger population. Both, CHD and AHD contribute substantially to morbidity and mortality during infancy and childhood. Methods This hospital-based, retrospective review of the registry at the paediatric cardiac clinic of Bugando Medical Centre in the Lake Zone of Tanzania analysed the spectrum of heart diseases of paediatric patients during their first presentation by using simple descriptive statistics. Results Between September 2009 and August 2016, a total of 3982 patients received cardiac evaluation including echocardiography studies. 1830 (46.0%) pathologic findings were described, out of these 1371 (74.9%) patients had CHD, whereas 459 (25.1%) presented with AHD. 53.9% of the patients with CHD were female and the most common associated syndrome was Down syndrome in 12.8% of patients. In 807 patients (58.9%) diagnosis of CHD was established within the first year of life. The majority of patients (60.1%) were in need of surgical or interventional therapy at time of diagnosis and 6.3% of patients were judged inoperable at the time of first presentation. Nearly 50% of cases with AHD were RHDs followed by dilated cardiomyopathy and pulmonary hypertension without underlying CHD. Conclusions The spectrum of CHD and AHD from one centre in Tanzania is comparable to findings reported in other countries from the African continent. Echocardiography is a valuable diagnostic tool and the widespread use of it should be enhanced to diagnose heart diseases in a large number and reasonable time. Most patients present late and majority is in need of surgical or interventional treatment, which is still not readily available. Untreated heart diseases contribute substantially to morbidity and mortality during infancy and childhood. Adequate cardiac services should be established and strengthened.

scholarly journals The clean development mechanism

2014 ◽  
Vol 6 (2) ◽  
pp. 166-191 ◽  
Author(s):  
Martin Burian ◽  
Christof Arens
Keyword(s):  
Clean Development Mechanism ◽  
Technical Assistance ◽  
Developed Countries ◽  
Sub Saharan Africa ◽  
Low Carbon ◽  
Least Developed Countries ◽  
African Countries ◽  
Content Type ◽  
Per Capita ◽  
Development Mechanism

Purpose – Since the registration of the first clean development mechanism (CDM) project in 2004, the CDM has seen a dynamic expansion: the CDM pipeline currently comprises 6,725 projects generating 2.73 billion certified emission reductions (CERs) up to 2012. These CERs result in a substantial financial flow from Annex I to Non-Annex I countries. But CDM projects also result in investments in low carbon technologies, a substantial share of which is focused on the energy sector. The total installed capacity of all CDM projects amounts to 288,944 MW. However, the CDM is not widely taken up in Africa. This holds true for Africa's share in the CDM project pipeline (2.62 per cent), for Africa's share in CERs generated up to 2012 (3.58 per cent) and for the normalized CERs per capita, per country. Two hypothesizes are commonly discussed: first, the continent features low per capita emissions and low abatement potentials. Second, African countries may be hampered by weak institutional frameworks. This article reviews both hypotheses and presents new empirical data. The paper aims to discuss these issues. Design/methodology/approach – Investigating the greenhouse gas (GHS) abatement potential of 16 energy-related sectors for 11 selected least developed countries in sub-Saharan Africa shows a total theoretical CDM potential of 128.6 million CERs per year. Analyzing investment indicators confirms that most countries are impeded by below average investment conditions. Findings – It is concluded that Africa offers a considerable range of substantial abatement potentials. However, the weak institutional framework is limiting the uptake of the CDM in Africa. This is underpinned by an analysis which shows if a CDM sector has high investment cost, Africa will have a low share in the sector. If the sector has low investment needs per CER, Africa's share in the CDM sector will be bigger. Investment needs and Africa's share in the pipeline feature a negative correlation. Research limitations/implications – Supporting CDM development in Africa should not be constraint to technical assistance. It will be crucial to develop an integrated financing approach, comprising the CDM as a co-financing mechanism, to overcome the institutional challenges. Originality/value – Until today, there are few empirical studies that use concrete criteria and indicators to show why the CDM is underrepresented in Africa. The work presented here contributes to filling this gap.

scholarly journals Prevalence and determinants of breast cancer screening in four sub-Saharan African countries: a population-based study

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e039464
Author(s):  
Djibril M Ba ◽  
Paddy Ssentongo ◽  
Edeanya Agbese ◽  
Yanxu Yang ◽  
Ramata Cisse ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Insurance ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Insurance Coverage ◽  
Reproductive Age ◽  
Sub Saharan Africa ◽  
African Countries ◽  
Factors Associated ◽  
Sub Saharan

ObjectivesBreast cancer is the most prevalent cancer and the second leading cause of cancer-related deaths among women after cervical cancer in much of sub-Saharan Africa. This study aims to examine the prevalence and sociodemographic–socioeconomic factors associated with breast cancer screening among women of reproductive age in sub-Saharan Africa.DesignA weighted population-based cross-sectional study using Demographic and Health Surveys (DHS) data. We used all available data on breast cancer screening from the DHS for four sub-Saharan African countries (Burkina Faso, Ivory Coast, Kenya and Namibia). Breast cancer screening was the outcome of interest for this study. Multivariable Poisson regression was used to identify independent factors associated with breast cancer screening.SettingFour countries participating in the DHS from 2010 to 2014 with data on breast cancer screening.ParticipantsWomen of reproductive age 15–49 years (N=39 646).ResultsThe overall prevalence of breast cancer screening was only 12.9% during the study period, ranging from 5.2% in Ivory Coast to 23.1% in Namibia. Factors associated with breast cancer screening were secondary/higher education with adjusted prevalence ratio (adjusted PR)=2.33 (95% CI: 2.05 to 2.66) compared with no education; older participants, 35–49 years (adjusted PR=1.73, 95% CI : 1.56 to 1.91) compared with younger participants 15–24 years; health insurance coverage (adjusted PR=1.57, 95% CI: 1.47 to 1.68) compared with those with no health insurance and highest socioeconomic status (adjusted PR=1.33, 95% CI : 1.19 to 1.49) compared with lowest socioeconomic status.ConclusionDespite high breast cancer mortality rates in sub-Saharan Africa, the prevalence of breast cancer screening is substantially low and varies gradually across countries and in relation to factors such as education, age, health insurance coverage and household wealth index level. These results highlight the need for increased efforts to improve the uptake of breast cancer screening in sub-Saharan Africa.

scholarly journals Incidence of male breast carcinoma in North Uganda A survey at Lacor Hospital, Gulu, during 2009–2016

2021 ◽  
pp. 1-6
Author(s):  
Irene Pecorella ◽  
Tom Richard Okello ◽  
Martin David Okwang
Keyword(s):  
Breast Cancer ◽  
Breast Carcinoma ◽  
Early Recognition ◽  
Tumour Size ◽  
Male Breast ◽  
Sub Saharan Africa ◽  
High Rate ◽  
Symptom Duration ◽  
African Countries ◽  
Study Results

BACKGROUND: Little information is available on male breast cancer (MBC) incidence from sub-Saharan Africa. OBJECTIVE: This is a retrospective study on MBC in rural North Uganda, based on the pathology records of a private, non-profit, missionary hospital. METHODS: All male patients that had histological diagnosis of breast carcinoma from January 2009 to December 2016 were included in this study. RESULTS: In time span of 8 years, there were 337 consecutive breast cancer presentations, including 21 MBC (6.2%). The latter patients showed advanced disease (mean symptom duration: 20.3 months; mean tumour size: 5 cm;) skin ulceration and ipsilateral lymph node metastasis: 60%). The mean age was 60.52 years (from 30 to 85 yrs). Ductal infiltrating carcinoma was the prevalent histological type in our series (65%), followed by an unusually high rate of papillary carcinomas (15%). There appeared to be a prevalence for left breasts (11 LT versus 6 RT; 64.7%), a finding also observed in the majority of MBC. CONCLUSIONS: This study is representative of the scenario in Northern Uganda, where MBC accounts for 6.2% of breast cancers, More information on the occurrence and risk factors of this unusual neoplasm in African countries may prompt prevention of chronic liver disease and early recognition and treatment of MBC.

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