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Challenge of pediatric oncology in Africa
Abstract
The care of children with malignant solid tumors in sub-Saharan Africa is compromised by resource deficiencies that range from inadequate healthcare budgets and a paucity of appropriately trained personnel, to scarce laboratory facilities and inconsistent drug supplies. Patients face difficulties accessing healthcare, affording investigational and treatment protocols, and attending follow-up. Children routinely present with advanced local and metastatic disease and many children cannot be offered any effective treatment. Additionally, multiple comorbidities, including malaria, tuberculosis, and HIV when added to acute on chronic malnutrition, compound treatment-related toxicities. Survival rates are poor. Pediatric surgical oncology is not yet regarded as a health care priority by governments struggling to achieve their millennium goals. The patterns of childhood solid malignant tumors in Africa are discussed, and the difficulties encountered in their management are highlighted. Three pediatric surgeons from different regions of Africa reflect on their experiences and review the available literature. The overall incidence of pediatric solid malignant tumor is difficult to estimate in Africa because of lack of vital hospital statistics and national cancer registries in most of countries. The reported incidences vary between 5% and 15.5% of all malignant tumors. Throughout the continent, patterns of malignant disease vary with an obvious increase in the prevalence of Burkitt lymphoma (BL) and Kaposi sarcoma in response-increased prevalence of HIV disease. In northern Africa, the most common malignant tumor is leukemia, followed by brain tumors and nephroblastoma or neuroblastoma. In sub-Saharan countries, BL is the commonest tumor followed by nephroblastoma, non-Hodgkin lymphoma, and rhabdomyosarcoma. The overall 5-years survival varied between 5% (in Côte d'Ivoire before 2001) to 34% in Egypt and up to 70% in South Africa. In many reports, the survival rate of patients is not mentioned but is clearly very low in many sub-Saharan Africa countries (Sudan, Nigeria). Late presentation was observed for many tumors like nephroblastoma in Nigeria, 72% were stages III and IV or BL stages III and IV were observed in 40% and 30%, respectively. Africa bears a great burden of childhood cancer. Cancer is now curable in developed countries as survival rates approach 80%, but in Africa, >80% of children still die without access to adequate treatment. Sharpening the needlepoint of surgical expertise will, of itself, not compensate for the major infrastructural deficiencies, but must proceed in tandem with resource development and allow heath planners to realize that pediatric surgical oncology is a cost-effective service that can uplift regional services.
... The lack of specialized equipment often resulted in delayed diagnosis, misdiagnosis, and suboptimal treatment options. 2,6,7,15,16,20,24,25,27,30,37,38,41,42 For example, Mezue et al. 31 noted that while computed tomography and MRI are available in some healthcare facilities in Sub-Saharan Africa, their accessibility can be restricted in rural areas, leading to delayed diagnosis and treatment of intracranial tumors. The studies identified several opportunities for improving access to diagnostic tools in neuro-oncology care in Sub-Saharan Africa. ...
... The studies also emphasized the importance of investing in education and training programs to build a skilled workforce capable of utilizing and interpreting diagnostic tools effectively. 38,42 Forty-one studies 2,7,8,10,11,13,[15][16][17][18][19][20][21][22][24][25][26][28][29][30][31][32][33]35,36,[38][39][40][41][42][43][44][45][46][47][48][49][50] discussed the availability of treatment modalities. Challenges included limited access to equipment, lack of trained personnel, inadequate funding, and poor infrastructure. ...
... Challenges included limited access to equipment, lack of trained personnel, inadequate funding, and poor infrastructure. 2,7,16,[18][19][20]24,30,32,35,38,41,42,45 For example, Thiam et al. 40 highlighted the challenges related to the availability of treatment modalities, including limited access to radiotherapy and chemotherapy. ...
Background
Ensuring equitable access to treatments and therapies in the constantly evolving field of neuro-oncology is an imperative global health issue. With its unique demographic, cultural, socioeconomic, and infrastructure characteristics, Sub-Saharan Africa faces distinct challenges. This literature review highlights specific barriers to neuro-oncology care in the region and explores potential opportunities for enhancing access.
Methods
Predetermined keyword searches were employed to screen titles and abstracts using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Inclusion criteria were studies published between January 1, 2003, and June 20, 2023, specifically addressing the capacity and challenges of neuro-oncology in the Sub-Saharan African region. The data sources queried were PubMed and Google Scholar. Systematic reviews and meta-analyses were deliberately excluded. All authors conducted independent screening and structured data extraction meticulously.
Results
Our paper identified multiple challenges that impede access to quality treatment for brain tumors. These include constrained resources, insufficient training of healthcare professionals, certain cultural beliefs, and a general lack of awareness about brain tumors, all contributing to delayed diagnosis and treatment. Furthermore, the lack of detailed data on the incidence and prevalence of primary central nervous system tumors impairs the accurate assessment of disease burden and precise identification of areas requiring improvement. However, we discovered that ongoing research, advocacy, enhanced training, mentorship, and collaborative efforts present valuable opportunities for substantial progress in neuro-oncology access.
Conclusions
While we provide a glimpse of the current state, we hope these results will help stimulate dialogue and catalyze initiatives to surmount highlighted obstacles and improve neuro-oncology outcomes across Sub-Saharan Africa.
... It is also crippled by scarce laboratory facilities and inconsistent drug supplies making the outcome of this tumor in this setting still poor. All these factors contribute to less than 50% survival at 5 years as most studies report [5]. ...
... Multiple comorbidities, such as malaria, tuberculosis, and HIV in malnourished patients raise the chance of treatment-related toxicities. Survival rates are invariably poor [5] [6]. ...
... Childhood solid tumors are becoming responsible for most deaths occurring in the first fifteen years of life [7]. Additionally, comorbidities that coexist along with the malignancy will compound treatment-related toxicities which directly impairs their adherence and effectiveness of the regimen provided with its attending risk of poor survival [5] [9]. ...
... Childhood and adolescent cancers are fast becoming an important public health problem globally, more so in parts of Africa, where there is a progressive decline in infectious and nutritional related morbidities and mortalities. [1][2][3][4][5] Cancer contributes significantly to the high morbidity and mortality rates in these age groups in both the developed and developing countries. 1,3,4 These cancers are fundamentally different from the adult forms in terms of the tumour type, aetiology, biology, management protocols, the therapeutic responses and prognostic outcomes. ...
... [1][2][3][4][5] Cancer contributes significantly to the high morbidity and mortality rates in these age groups in both the developed and developing countries. 1,3,4 These cancers are fundamentally different from the adult forms in terms of the tumour type, aetiology, biology, management protocols, the therapeutic responses and prognostic outcomes. [2][3][4][5] The spectrum, relative proportions presented histological subtypes of childhood and adolescent cancers and prognosis of such cancers vary across the globe, reflecting the environmental, genetics, immune status, and the availability of modern health infrastructures with the requisite specialists; pediatric surgeons, oncologist, haematologist and pathologist, in a given country. ...
... 1,3,4 These cancers are fundamentally different from the adult forms in terms of the tumour type, aetiology, biology, management protocols, the therapeutic responses and prognostic outcomes. [2][3][4][5] The spectrum, relative proportions presented histological subtypes of childhood and adolescent cancers and prognosis of such cancers vary across the globe, reflecting the environmental, genetics, immune status, and the availability of modern health infrastructures with the requisite specialists; pediatric surgeons, oncologist, haematologist and pathologist, in a given country. [3][4][5] Many researchers have reported higher proportions of these cancers in the age group 0-14 years, and more in males than females. 2 The epidemiology of various cancers has been studied in children and older adult populations for nearly half a century. ...
Background:
Published data on childhood and adolescent cancers in northern Ghana is scanty. The aim of this retrospective histopathological study was to identify and describe the relative proportions of childhood and adolescent cancers and the associated clinico-pathological features at the Tamale Teaching Hospital.
Materials and methods:
The cancers were classified according to the International Classification for Cancer in Children. Data was collected on the demographics and the clinico-pathological characteristics of the various types of cancers, from 1st January 2012 to 31st December, 2021, a 10-year period. The data was analysed using SPSS software (Version 26, Chicago).
Results:
A total of 196 childhood and adolescent cancers were reviewed, with a mean age of 9.5± 5.5 years. Approximately, 51.5% were female, with a younger mean age (years) of 8.4±5.3, compared to 10.6±5.6 for males. Majority (74.0%), were within the 0-14 years age group, (P<0.0001). All the patients presented with swellings and mostly after 6 months of disease onset. The common cancers for the study population were: soft tissue sarcoma (24.2%), primary bone cancer (21.1%), retinoblastoma (17.5%), lymphoma (13.3%), and germ cell tumours (6.7%). For females these were: soft tissue sarcoma (21.0%), retinoblastoma (20.0%), primary bone cancer (19.0%), nephroblastoma (13.0%), and ovarian tumours (12.0%). For males, these were: soft tissue sarcoma (27.7%), bone cancer (23.4%), lymphoma (19.1%), retinoblastoma (14.9%) and head and neck cancer (6.4%). The common soft tissue cancers were: rhabdomyosarcoma (46.8%), and spindle cell sarcoma (NOS) (17.0%). Osteosarcoma (70.7%), and Ewing's sarcoma 6 (14.6%) were the common primary bone cancers. Many (46.4%) of the retinoblastomas were of a high pathological TNM stage III. The optic nerve was involved in 70.6%, with 26.5% margin involvements.
Conclusion:
Childhood and adolescent cancers were common in pediatric age group with late stage at presentation. The common histological subtypes were: soft tissue sarcoma, primary bone cancer and retinoblastoma. There is the need for detection, diagnosis, and prompt oncology care.
... 5 In Africa, over 58,000 childhood cancers and over 18,000 deaths were recorded in 2018, 1 and >80% of these children still die without access to adequate treatment; in many reports, the five-year survival rates vary from as low as 5% to 70%. 6 The disparity in survival rates is compounded by barriers in all steps of cancer care from late presentation, co-morbidity (especially malnutrition), lack of affordability and restricted access to both supportive and empirical anti-cancer treatments. 6 Despite the widespread use of anti-retroviral therapy, human immunodeficiency virus (HIV)associated cancers such as Burkitt's lymphoma (BL) and other non-Hodgkin's lymphoma (NHL), Kaposi's sarcoma are common among children living with HIV in sub-Saharan Africa (SSA). ...
... 5 In Africa, over 58,000 childhood cancers and over 18,000 deaths were recorded in 2018, 1 and >80% of these children still die without access to adequate treatment; in many reports, the five-year survival rates vary from as low as 5% to 70%. 6 The disparity in survival rates is compounded by barriers in all steps of cancer care from late presentation, co-morbidity (especially malnutrition), lack of affordability and restricted access to both supportive and empirical anti-cancer treatments. 6 Despite the widespread use of anti-retroviral therapy, human immunodeficiency virus (HIV)associated cancers such as Burkitt's lymphoma (BL) and other non-Hodgkin's lymphoma (NHL), Kaposi's sarcoma are common among children living with HIV in sub-Saharan Africa (SSA). 6,7 Spontaneous tumour lysis syndrome (STLS), a rare but life-threatening metabolic oncological emergency, is known to complicate high-grade tumours such as BL, NHL and the acute leukaemias. ...
... 6 Despite the widespread use of anti-retroviral therapy, human immunodeficiency virus (HIV)associated cancers such as Burkitt's lymphoma (BL) and other non-Hodgkin's lymphoma (NHL), Kaposi's sarcoma are common among children living with HIV in sub-Saharan Africa (SSA). 6,7 Spontaneous tumour lysis syndrome (STLS), a rare but life-threatening metabolic oncological emergency, is known to complicate high-grade tumours such as BL, NHL and the acute leukaemias. [8][9][10] This is noted to occur, however, in Malawi, Zimbabwe and Uganda, in >50% of these high-grade malignancies among African children. ...
High-grade malignancy is endemic in sub-Saharan Africa and is prone to the spontaneous tumour lysis syndrome. However, data on spontaneous tumour lysis syndrome remain scanty in our setting. We sought to determine the prevalence and factors associated with laboratory spontaneous tumour lysis syndrome in children in Uganda. We conducted a cross-sectional study among children <18 years old with histologically confirmed high-grade malignancy between October 2013 and April 2014. Laboratory spontaneous tumour lysis syndrome was defined as the presence of 2 of each of hyperkalaemia, hypocalcaemia, hyperuricaemia and hyperphosphatemia prior to administration of chemo-therapy when alternative diagnoses had been excluded. A p < 0.05 was considered statistically significant. Of 108 children , of median age 7.7 years, where boys outnumbered girls 2:1, high-grade, malignancy included Burkitt's lymphoma, acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, acute myeloid leukaemia and Burkitt's leukaemia, with 14 suffering with laboratory spontaneous tumour lysis syndrome. Hypocalcaemia was its most common electrolyte imbalance ; and four children died prior to commencement of chemotherapy. Bulky disease, lactate dehydrogenase levels 500 iu/l and serum creatinine levels >1.2 mg/dl were associated with laboratory spontaneous tumour lysis syndrome. However, only bulky disease was significantly predictive of laboratory spontaneous tumour lysis syndrome. Such children would benefit from routine screening.
... The formation of collaborative study groups and multimodal therapy has led to significant progress in the management of WT [29]. However, in developing countries, late presentation, malnutrition, poverty, and lack of multidisciplinary cooperation affect treatment outcomes for children with WT [30,31]. The two comprehensive collaborating groups that studied WT were the Pediatric Oncology Group (COG) and the International Society of Pediatric Oncology (SIOP). ...
... The predominance of females recorded in this study is in agreement with the reports of Breslow et al. [32] and Kaste et al. [33] where female children were more prevalent in Wilm's tumors than male patients. However, Hadley et al. [31] and Davidson et al. [34] studies in Africa did not agree with current findings indicating a nearly identical incidence of Wilm's tumor in both sexes. Male/female predominance may depend on the geographical area of study. ...
Wilms' tumor is a malignant tumor that contains metanephric blastema, stromal and epithelial derivatives. The characteristic is the presence of abortive tubules and glomeruli surrounded by the stroma of a spindle cell. The stroma may include striated muscle, cartilage, bone, adipose tissue, and fibrous tissue. The study aimed to describe the age, sex, and histology distribution of Wilms' tumor and its association with age groups, sex, and the side affected by the kidneys. A retrospective observational study was performed on renal masses patients who were consequently diagnosed selectively by histopathological study in the National Center for Public Health Laboratories (NCPHL) at the Department of Pathology, and the Department of Pathology in Al-Thorah university hospital, Sana'a, Yemen, over a period of 18 years from January 1, 2004, to December 31, 2021. Data were collected from hospital records. The study variables were lesions histological types, benign, malignancy, non-neoplastic lesions, sex, grades, and age. The whole data were analyzed by IBM SPSS Statistics 22. Ink. The outcomes for variables were given in the form of rates (%). Chi-Square was used for categorical variables that measured association among categorical variables. P-values less than 0.05 were considered significant. Wilms tumors count 47/282 (16.7%) of total diagnostic malignant tumors. The female cases were 29/47 (61.7%) more than male cases 18/47 (38.3%) with M: F ratio equal to 1.0: 1.6. The mean age of the Wilms' patients was 5.3 years with SD equal to 3.6 years and ages ranged from 9 months to 15 years. Most of the Wilms patients were in the age group 1-5 years 31/47(66%) followed by 6-10 years (25.5%). Favorable histology (FVH) Wilms' tumors with better prognosis counting 42/47 (89.4%) while unfavorable histology (UFVH) with poor prognosis only counting 5/47 (10.6%). There was no significant association between Wilms' tumor and gender while there was a highly significant association of Wilms' tumor in the 1-5 years group (rate = 77.5%, OR=48.6, CI =19.8-119, p <0.001) and with 6-10 years group (rate= 80%, OR=26.6, CI=7.1-98.7, p <0.001). There was no significant association between Wilms' tumors with the kidney side in which roughly equal rates were present in both sides. Wilms' tumors in Yemeni children appear at an early age and peak in the first 5 years of life with an increased incidence among females with predominantly FVH. The current study provided much-needed information about the burden of Wilms' cancer in Yemen, to enable Yemen to better plan to address the burden. Further studies are necessary to determine the exact incidence and trend of Wilms' cancer and risk factors in Yemen.
... [2,4] This starkly contrasts with sub-Saharan African figures, ranging from 11% in Sudan to 66% in SA. [10,11] These variations result from multifaceted factors, including late-stage disease presentation in lower-income countries, compromised health indicators and treatment abandonment due to socioeconomic challenges. [9,11,12] Recognising these intricacies becomes pivotal for tailoring interventions and improving outcomes. ...
... Incomplete patient information, specifically regarding symptom history and reasons for delayed presentation, might have introduced bias when categorising patients who had a delayed diagnosis. Additionally, confounding factors such as HIV/ AIDS [12] and nutritional deficiencies [43] were not investigated in this study, emphasising the need for future research to analyse these aspects thoroughly. The authors propose the following recommendations: (i) implement community health education, increase access to primary care and streamline referrals to improve early detection and reduce delays; (ii) address socioeconomic barriers with financial support, train care providers to recognise early symptoms, promote screening for high-risk groups and enhance diagnostic infrastructure; and (iii) collaboration among healthcare providers, government and non-governmental organisations, along with continuous evaluation, is key to refining strategies and improving outcomes. ...
Background. Nephroblastoma (Wilms tumour) is one of the most common solid tumours of all paediatric cancers (prevalence of 5%
globally and 13.5% in South Africa (SA)), with suboptimal survival outcomes, impacting children’s lives. Consequently, there is an urgent
need for enhanced early detection strategies, addressing survival rate disparities and late-stage presentations to improve outcomes.
Objectives. To assess profiles, disease presentations, management and outcomes of patients with nephroblastoma at Universitas Academic
Hospital Complex (UAHC), and to compare patients from SA and Lesotho, including differences between early and late presenters and
reasons for delayed presentation.
Methods. This retrospective cross-sectional study included 207 paediatric oncology patients treated for nephroblastoma at the Paediatric
Haematology and Oncology Unit at UAHC, Bloemfontein, SA, from January 2000 to December 2020.
Results. The median age of the study population was 38 months, with a marginal male predominance (50.7%). A 1-month delay occurred
between symptom onset and diagnosis, commonly attributed to delayed care-seeking, impacting survival rates. Compared with similar SA
studies, a higher stage IV disease rate (29.5%) was observed, and encouraging survival rates (59.4%) correlated with favourable preoperative
histology and no relapse. In comparison, Lesotho patients experienced longer delays and presented with more severe disease.
Conclusion. This study highlights the need for collaboration between SA and Lesotho healthcare providers to improve outcomes by
addressing diagnostic delays, treatment defaults and response variations in resource-limited settings through community health education,
improving access to primary care, offering care-provider training, improving diagnostic resources and addressing socioeconomic barriers.
... Soft tissue sarcomas (mainly rhabdomyosarcomas) were a significant contributor to childhood cancer burden in this study and was the 2 nd only to lymphoma as the most common cancer in people aged 0-19 years. This finding is in agreement with data from the cancer registry of Ibadan, Nigeria (2003-2012 where soft tissue sarcoma (predominantly rhabdomyosarcoma) was the 2 nd commonest cancer after lymphoma (14). The data from other parts of Africa show varied results that range from being the 3 rd commonest childhood cancer in Ethiopia and Kenya to not being among the top 5 paediatric cancers in most other countries (14,17). ...
... A striking observation in this study is the paucity of cases of CNS neoplasms, which is one of the major neoplasms occurring in children in high-income countries (2). As has been previously observed, the lower incident cases of CNS neoplasms in children of low and middle income countries (LMICs) likely reflect the paucity of paediatric neurosurgical and neuro-imaging facilities and personnel (2,30). ...
Introduction
Cancers are a major cause of childhood mortality worldwide especially in LMICs where underdiagnoses and lack of quality cancer data hampers effective cancer control efforts. This study aimed to document and describe the patterns and characteristics of childhood cancers in the North East geopolitical zone of Nigeria.
Methods
This was a retrospective cross-sectional study that collected cancer data from 4 out of the 6 states in the North East of Nigeria. The data included all malignancies diagnosed in children aged 0-19 years between 2019 and 2022. The age-specific incidence rates were also calculated for the individual 5-year age groups (0–4 years, 5–9 years, 10–14 years, and 15–19 years). The crude incidence rates (CIR) were calculated as the weighted averages of the respective ASRs in each age range within 0-14 years and 0-19 years respectively. The cancers were grouped according to the International Incidence of Childhood Cancers, volume 3 (IICC3).
Results
Cancers in people <20 years accounted for 7.3% of all cancers diagnosed over the same period. The crude incidence rates (CIR) for cancers in children and adolescents were 20.9 per million children aged 0-19 years and 18.8 per million children aged 0-14 years respectively, while the age-standardized rates (ASR) were 1.80 and 1.63 per million person-years respectively. There was a variation in the most commonly diagnosed cancers across all age groups. However, lymphomas were the most commonly diagnosed cancers overall, while CNS tumors were overwhelmingly rare.
Conclusion
Despite data limitations, this study provides useful insights into patterns of cancers in the region and will hopefully provide a basis for the strengthening of pediatric oncology care, childhood cancer control programs and population-based cancer registries.
... The incidence of CNS tumors was 1.41 and 0.66 cases per 100 000 children and young adults in Asia and Africa, respectively [6]. These significant differences in incidence can be attributed to the low availability of diagnostic modalities and neurosurgical services in developing countries, which often leads to the misdiagnosis of children with signs and symptoms typical of CNS malignancies [7,8]. Furthermore, most national registries of pediatric CNS tumors are from Europe and North America, with limited data from Asia or developing countries [9]. ...
... Epidemiological data and survival rates for brain and other CNS tumors are well understood in high-income countries [1,12]. Although most current studies in high-income countries are aimed at better identifying molecular genetic features of various tumor types, the paucity of data limits even the actual assessment of the incidence and survival of CNS tumors in children and young adults in LMICs [7,8]. Here, we provide needed data on the epidemiology, clinical characteristics, treatment, and outcomes of CNS tumors in pediatric and young adult patients from Armenia. ...
Central nervous system (CNS) tumors are the most common solid malignancies in children worldwide, including in Armenia. The current study aims to analyze epidemiological data, treatment, and outcomes of children and young adults (≤25 years) with CNS tumors in Armenia during the last 26 years.
We collected data from pediatric and young adult patients treated in selected sites in Armenia from 1st January 1995 to 31st December 2020. Incidence by sex, age at diagnosis, time from first complaints to diagnosis, histopathology results, treatment strategies, complications, and overall survival (OS) rates were calculated.
The multicenter data analysis revealed 149 patients with diagnosed primary CNS tumors over 26 years. Among them, 84 (56.4%) were male. The median age at diagnosis was 7 years (range, 3 months to 25 years), and the median time from the first complaints to diagnosis was 2 months (range, 1 week to 70 months). Medulloblastomas and other embryonal tumors (47), low-grade gliomas (32), and high-grade gliomas (22) were the most commonly diagnosed malignancies. Ependymomas, craniopharyngiomas, germ cell tumors, and other malignancies were observed in 22 patients. For 26 patients, no histopathological or radiological diagnosis was available. Follow-up information was available for 98 (65.8%) patients. The 5-year OS rate for the whole study group was 67.7%.
Consistent with international data, embryonal tumors, and gliomas were the most commonly diagnosed CNS malignancies in Armenia. Multimodal treatment was often not available in Armenia during the study period, especially for early cases.
... The formation of collaborative study groups and multimodal therapy has led to significant progress in the management of WT [29]. However, in developing countries, late presentation, malnutrition, poverty, and lack of multidisciplinary cooperation affect treatment outcomes for children with WT [30,31]. The two comprehensive collaborating groups that studied WT were the Pediatric Oncology Group (COG) and the International Society of Pediatric Oncology (SIOP). ...
... The predominance of females recorded in this study is in agreement with the reports of Breslow et al. [32] and Kaste et al. [33] where female children were more prevalent in Wilm's tumors than male patients. However, Hadley et al. [31] and Davidson et al. [34] studies in Africa did not agree with current findings indicating a nearly identical incidence of Wilm's tumor in both sexes. Male/female predominance may depend on the geographical area of study. ...
Background: Wilms' tumor is a malignant tumor that contains metanephric blastema, stromal and epithelial derivatives. The characteristic is the presence of abortive tubules and glomeruli surrounded by the stroma of a spindle cell. The stroma may include striated muscle, cartilage, bone, adipose tissue, and fibrous tissue. Aims: The study aimed to describe the age, sex and histology distribution of Wilms’ tumor and its association with age groups, sex and the side affected by the kidneys. Subjects and methods: A retrospective observational study was performed on renal masses patients who were consequently diagnosed selectively by histopathological study in the National Center for Public Health Laboratories (NCPHL) at the Department of Pathology, and the Department of Pathology in Al-Thorah university hospital, Sana'a, Yemen, over a period of 18 years from January 1, 2004 to December 31, 2021. Data were collected from hospital records. The study variables were lesions histological types, benign, malignancy, non-neoplastic lesions, sex, grades and age. The whole data were analyzed by IBM SPSS Statistics 22. Ink. The outcomes for variables were given in the form of rates (%). Chi Square was used for categorical variables that measured association among categorical variables. P-values less than 0.05 were considered significant. Results: Wilms tumors counting 47/282 (16.7%) of total diagnostic malignant tumors. The female cases were 29/47 (61.7%) more than male cases 18/47 (38.3%) with M:F ratio equal to 1.0: 1.6. The mean age of the Wilms’ patients was 5.3 years with SD equal to 3.6 years and ages ranged from 9 months to 15 years. Most of the Wilms’ patients were in age group 1-5 years 31/47(66%) followed by 6-10 years (25.5%). Favorable histology (FVH) Wilms’ tumors with better prognosis counting 42/47 (89.4%) while unfavorable histology (UFVH) with poor prognosis only counting 5/47 (10.6%). There was no significant association between Wilms’ tumor and gender while there was a highly significant association of Wilms’ tumor with 1-5 years group (rate = 77.5%, OR=48.6, CI =19.8-119, p <0.001) and with 6-10 years group (rate= 80%, OR=26.6, CI=7.1 – 98.7, p <0.001). There was no significant association between Wilms’ tumors with kidney side in which roughly equal rates were present in both sides. Conclusion: Wilms' tumors in Yemeni children appear at an early age and peak in the first 5 years of life with an increased incidence among females with predominantly FVH. The current study provided much needed information about the burden of Wilms' cancer in Yemen, to enable Yemen to better plan to address the burden. Further studies are necessary to determine the exact incidence and trend of Wilms' cancer and risk factors in Yemen.
... The formation of collaborative study groups and multimodal therapy has led to significant progress in the management of WT [29]. However, in developing countries, late presentation, malnutrition, poverty and lack of multidisciplinary cooperation affect treatment outcomes for children with WT [30,31]. The two comprehensive collaborating groups that studied WT were the Pediatric Oncology Group (COG) and the International Society of Pediatric Oncology (SIOP). ...
... The predominance of females recorded in this study is in agreement with the reports of Breslow et al. [32] and Kaste et al. [33] where female children were more prevalent in Wilm's tumors than male patients. However, Hadley et al. [31] Davidson et al. [34] studies in Africa did not agree with current findings indicating a nearly identical incidence of Wilm's tumor in both sexes. Male/female predominance may depend on the geographical area of study. ...
ABSTRACT
Background: Wilms' tumor is a malignant tumor that contains metanephric blastema, stromal and epithelial derivatives. The characteristic is the presence of abortive tubules and glomeruli surrounded by the stroma of a spindle cell. The stroma may include striated muscle, cartilage, bone, adipose tissue, and fibrous tissue.
Aims: The study aimed to describe the age, sex and histology distribution of Wilms’ tumor and its association with age groups, sex and the side affected by the kidneys.
Subjects and methods: A retrospective observational study was performed on renal masses patients who were consequently diagnosed selectively by histopathological study in the National Center for Public Health Laboratories (NCPHL) at the Department of Pathology, and the Department of Pathology in Al-Thorah university hospital, Sana'a, Yemen, over a period of 18 years from January 1, 2004 to December 31, 2021. Data were collected from hospital records. The study variables were lesions histological types, benign, malignancy, non-neoplastic lesions, sex, grades and age. The whole data were analyzed by IBM SPSS Statistics 22.Ink. The outcomes for variables were given in the form of rates (%). Chi Square was used for categorical variables that measured association among categorical variables. P-values less than 0.05 were considered significant.
Results: Wilms tumors counting 47/282 (16.7%) of total diagnostic malignant tumors. The female cases were 29/47 (61.7%) more than male cases 18/47 (38.3%) with M:F ratio equal to 1.0: 1.6. The mean age of the Wilms’ patients was 5.3 years with SD equal to 3.6 years and ages ranged from 9 months to 15 years. Most of the Wilms’ patients were in age group 1-5 years 31/47(66%) followed by 6-10 years (25.5%). Favorable histology (FVH) Wilms’ tumors with better prognosis counting 42/47 (89.4%) while unfavorable histology (UFVH) with poor prognosis only counting 5/47 (10.6%).
There was no significant association between Wilms’ tumor and gender while there was a highly significant association of Wilms’ tumor with 1-5 years group (rate = 77.5%, OR=48.6, CI =19.8-119, p <0.001) and with 6-10 years group (rate= 80%, OR=26.6, CI=7.1 – 98.7, p <0.001). There was no significant association between Wilms’ tumors with kidney side in which roughly equal rates were present in both side.
Conclusion: Wilms' tumors in Yemeni children appear at an early age and peak in the first 5 years of life with an increased incidence among females with predominantly FVH. The current study provided much needed information about the burden of Wilms' cancer in Yemen, to enable Yemen to better plan to address the burden. Further studies are necessary to determine the exact incidence and trend of Wilms' cancer and risk factors in Yemen.
Keywords: children cancers, kidney cancers, Sana’a city, Wilms' tumor (WT), degree of anaplasia, Yemen
... Formation of collaborative study groups and multimodal therapy has made dramatic advances in the management of WT [8]. However, in developing countries, late presentation, malnutrition, poverty and lack of multidisciplinary collaboration aff ect the treatment outcome of children that have WT [9,10]. Th e two comprehensive collaborative groups that have studied WT are the Children's Oncology Group (COG) and International Society of Paediatric Oncology (SIOP). ...
... Female predominance recorded in the present study is consistent with the report of other studies [11,12]. However, other studies are not in agreement with this fi nding [10,13]. Th e male/female predominance may depend on geographical area of study. ...
Objective: The objective of this study was to evaluate the profi le and management outcome of children treated for Wilms' Tumor (WT) in a developing country. Methodology: This was a retrospective study of children that were treated for WT at the pediatric surgery unit of Enugu State University Teaching Hospital (ESUTH), Enugu, Nigeria. Medical records of children who underwent treatment for WT over a 5-year period were evaluated. Results: Twenty one cases of WT were treated during the study period with an age range of 3-12 years (median 4.5 years) and male to female ratio of 1:1.3. The median duration of symptoms prior to presentation was 6 months and the mean duration of hospital stay was 24.2 days. All the patients presented with abdominal mass and they all had abdominal ultrasound and chest x-ray. Five (23.8%) patients had metastasis at presentation and majority of the patients were in stage 3. Surgery with adjuvant chemotherapy plus radiotherapy was received by most of the patients. Survival rate as at 5 years follow up period was 66.7%. Conclusion: There is still signifi cant morbidity and mortality associated with the management of WT in resource-constrained environment.
... Neuf leucémies ont été observées, soit 3 % des cancers de l'enfant. Cette fréquence est légèrement supérieure à celle rapportée par Margaron (1,8 %) au Kenya, mais nettement inférieure à celle des auteurs occidentaux (40 %) [5,9]. Cette différence pourrait s'expliquer par une insuffisance de moyens de diagnostic précoce dans les pays africains [9]. ...
... Cette fréquence est légèrement supérieure à celle rapportée par Margaron (1,8 %) au Kenya, mais nettement inférieure à celle des auteurs occidentaux (40 %) [5,9]. Cette différence pourrait s'expliquer par une insuffisance de moyens de diagnostic précoce dans les pays africains [9]. ...
... It accounts for approximately 60% of all malignant bone tumours diagnosed before young adulthood with the peak incidence in puberty [2]. In low-and middle-income countries (LMICs) and Africa in particular, current literature on osteosarcoma and other bone tumours is scarce, occasioned by the lack of cancer registries in these settings and the low priority given to surgical oncology in Africa [3]. In Uganda, an early analysis of data from the 1960s is limited to epidemiological data confirming osteosarcoma as the most common primary malignant bone tumour [4]. ...
Background
The survival rates for children and adolescents with osteosarcoma in low-income countries are poor. Insufficient data regarding the challenges of managing osteosarcoma in resource-limited settings has been published. We evaluated the treatment of osteosarcoma in children and adolescents with the aim of improving the health system and management outcomes.
Methods
We sourced data on children under 18 years treated for osteosarcoma at the Uganda Cancer Institute between January 2016 and December 2020. Descriptive statistics and Kaplan-Meier survival analysis were used.
Results
Seventy-four osteosarcoma cases were identified, with a median age of 13 years (IQR 9.8–15). Referrals were made after a median of 28 days (range 1-147). Before appropriate referral, more than a quarter (26%) had undergone invasive procedures that could compromise tumour integrity and outcome. Half (50%) of the patients had metastatic disease at diagnosis, primarily to the lungs (n = 43; 92%). Only 14 (33%) patients received neoadjuvant chemotherapy. Forty-three (58.1%) patients underwent limb amputation surgery, including 25 localized tumours and 18 patients with distant metastatic disease. No metastatectomies were performed. Adjuvant chemotherapy was delayed for longer than 21 days in 26 (61%) patients. No pathology reports described the status of resection margins or the degree of chemotherapy-induced necrosis. Twenty-six (35%) patients abandoned treatment, mainly due to pending radical surgery (n = 18/26; 69%). Only 18% (n = 13) were still alive; 46% (n = 34) had died; and 37% (n = 27) had an unknown status. The median overall survival was 1.1 years, and was significantly negatively affected by disease metastasis, timing of adjuvant therapy, and treatment abandonment.
Conclusions
Osteosarcoma outcomes for children and adolescents at the Uganda Cancer Institute are extremely poor. The quality of care can be improved by addressing delayed referrals, high rates of prior manipulative therapy, metastatic disease, treatment abandonment, surgical challenges, and delayed resumption of adjuvant chemotherapy.
... Studies suggest timely diagnosis of childhood cancer is basic in order to provide timely treatment before the disease prognoses and disseminate to other body parts, complicating the treatment needed and increase the time needed to heal (5). Accordingly, late presentation has been linked to an increased risk of death in children with cancer (5,6). ...
Background: Thus, the path of mothers with cancer children is intricate and severe. Several studies have addressed this topic. Most have considered the long-term effects of the children cancer diagnosis on the mother from a mental health perspective. The experience of living with cancer children as mothers reveals the urgent need to pay attention to the mother emotional, psychological, and social factors shaping caregiving.
Objective: This study aimed to look further into the lived experiences of Ethiopian mothers with children suffering from childhood cancer.
Method: Interpretive phenomenological approach of qualitative study conducted at the pediatric oncology unit of Tikur Anbessa Specialized Hospital and Tesfa Addis Parents Childhood Organization. Study participants were selected using the snowball purposive sampling technique. Data were collected using semi-structured interviews. A total of 12 mothers were interviewed. Interpretative phenomenological analysis was employed and Open Code 4.3 software was used for data management and used thematic analysis.
Result: When raising a child with childhood cancer, mothers encounter a wide range of issues in the context of childhood cancer care, including fatigue, poor access to high-quality medical care, divorce, parenting withdrawal, excessive medical expenses, lack of sufficient and accurate information, anxiety, impatience, forgetfulness, regret, and spiritual struggles. To overcome such difficulties, mothers employ loans, financial aid, and the sale of their homes and other assets to reduce their financial burden. Mothers' other coping method was to accept many sorts of support from family, friends, strangers, and organizations. The assistance received helped mothers gain resilience.
Conclusion: The study provides crucial insights into the experiences of mothers of children with childhood cancer. The diagnosis of childhood cancer has a profound impact on mothers, and it elicits various reactions from them. Investigate the emotional, mental, and social drivers of caregiving, emphasizing important factors such as financial pressure, insufficient quality medical treatment, emotional disturbances, and strategies of coping with their children by the mothers. Establish counseling and support schemes for mothers to cope with cancer therapy for their child. Organize community awareness campaigns to increase understanding, reduce stigma, and promote early treatment.
Keywords: Interpretive phenomenological analysis, childhood cancer, Ethiopia
... Looking ahead, pediatric surgical oncology faces several challenges that need to be addressed to continue advancing the field. First, the disparities in the availability of advanced surgical techniques and technologies between high-income countries and LMICs present a major challenge 5,6,7,22 . Addressing these disparities requires a concerted effort to improve educational infrastructure, training programs, and access to essential resources globally. ...
... Bladder Rhabdomyosarcoma is the most common bladder tumor in children [12] In our facility , it is the fourth most common childhood cancer [13] Both African based literature as well as in the SEER program, male predominance is reported and the commonest histological type is embryonal [14 -19] The mean age at diagnosis is at 5 years as reported in the SEER program [20] while in Low and Middle Income Countries ( LMICs) in Africa its at 6 years [16,17] In LMICs , patients present at an advanced stage as highlighted in our case report [21] This is attributed to limited health access to health care facilities, missed diagnosis , poor diagnostic facilities and unaffordability of medical insurance [22]The accurate prevalence of childhood cancers is challenging to determine due to underreporting. [23 -25] Additionally, It's challenging to determine how many children in Africa are diagnosed with cancer because there's a shortage of important medical data from hospitals and cancer tracking systems at the national level in many countries [26] SEER program reports of an incidence of 4.5 per million children, data as per Africa Cancer Registry Network (AFRCRN) is shows variable incidence rate:Western Africa 0.6-8.6 , Southern Africa 2.4-2.5 and Eastern Africa 2.6-16.3 per million children [27] Kenya as per the Eldoret and Nairobi Cancer registry 2007-2011/2012 is at 8.8-10.8 per million children [28] Population-based cancer registries (PBCRs) in HICs such as Surveillance, Epidemiology and End Results Program (SEER ) [15] and the National Program of Cancer Registries (NPCR) [29] are annually updated and raw data for statistical analysis is available for public access [4,15] Kenya does not have a national cancer registry . It heavily relies on three main PBCRs located in Nairobi, Eldoret, and Kisumu counties which only account for regional cancer statistics . ...
Background : Rhabdomyosarcoma is the most prevalent soft tissue tumor among children. The genitourinary system is the second most common primary site of tumor origin. Its management is highly reliant on resource availability. The purpose of this study is to provide a report on a rare case of advanced pleomorphic bladder rhabdomyosarcoma in a female child with an aggressive clinical course and briefly describe a comparative literature review on the clinical presentation and management of bladder rhabdomyosarcoma between High income countries and Low and middle income countries.
... Rhabdomyosarcoma (RMS) is the most frequent soft tissue sarcoma diagnosed in children. 1 An overall cure rate of 70−80% is observed with current treatment regimens in high-income countries (HICs), with significant variability among various risk groups. 2 In contrast, low-and middle-income countries (LMICs) report suboptimal overall survival (OS) of less than 50%. 3,4 The multimodality management and importance of local control pose a conundrum for the pediatric oncology teams in LMICs, where resources for diagnosis and supportive care are limited. Additionally, delayed presentation with advanced disease, treatment abandonment, and treatment-related mortality (TRM) contribute to suboptimal survival. ...
Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma among children and adolescents. The management of RMS involves risk stratification of the patients based on various clinicopathological characteristics. The multimodality treatment approach requires chemotherapy, surgery, and/or radiation. The treatment of RMS necessitates the involvement of multiple disciplines, such as pathology, pediatric oncology, surgery, and radiation oncology. The disease heterogeneity, molecular testing, evolving treatment regimens, and limited resources are some of the challenges faced by clinicians while treating a patient with RMS in low- and middle-income countries (LMICs). In this review, we endeavor to bring experts from varying fields to address clinicians' common questions while managing a child or adolescent with RMS in LMICs. This review is most applicable to level 2 centers in LMICs as per the levels of services described by the Adapted Treatment Regimens Working Group of the Pediatric Oncology in Developing Countries committee of the International Society of Pediatric Oncology.
... Similar trends have been reported in other studies from Africa. 30,31 These patterns in LMICs have been explained by complex referral systems, in which children with cancers are first seen at local health clinics and cannot be evaluated at district or national centers without a clinician referral. By the time these patients are referred to a higher-level hospital, they are often already in an advanced stages of disease. ...
Purpose:
Over 400,000 children are diagnosed with cancer around the world each year, with over 80% of these children residing in low- and middle-income countries. This study aims to summarize the epidemiology and care patterns of newly diagnosed childhood cancer patients in Northern Tanzania.
Methods:
Data from all children and adolescents (age 0-19 years) with newly diagnosed cancers were collected from the Kilimanjaro Cancer Registry located at the Kilimanjaro Christian Medical Centre. Descriptive and inferential analyses were used to compare the demographic and clinical characteristics of the participants over time, stage, and status at last contact. Statistical significance was set at P < .05. Secondary descriptive analysis was conducted on a subset sample with available staging data.
Results:
A total of 417 patients were diagnosed with cancer between 2016 and 2021. There was an increase in the rate of patients with newly diagnosed pediatric cancer each year, particularly among children under age 5 years and 10 years. Leukemias and lymphomas were the leading diagnoses and accounted for 183 (43.8%) of all patients. Over 75% of patients were diagnosed at stage III or above. From a subset analysis of patients with available staging data (n = 101), chemotherapy was the most common treatment (87.1%), compared with radiotherapy and surgery.
Conclusion:
There is a significant burden of children with cancer in Tanzania. Our study fills crucial gaps in the literature related to the large burden of disease and survival for children with cancer in the Kilimanjaro region. Furthermore, our results can be used to understand the regional needs and guide research and strategic interventions to improve childhood cancer survival in Northern Tanzania.
... This achievement is mainly related to the tremendous progress made in improving access to care, timely detection, and prompt treatment; an improvement in the safety of treatment and supportive care; and a large reduction in the treatment abandonment rate [3,6,7]. On the contrary, the survival rate in low-income countries (LICs), where more than 90% of the childhood cancer burden occurs [3], is around 20-30% [3,6,[8][9][10]. In LICs, only a small portion of children with cancer are diagnosed and treated [11]. ...
Background
Despite the recent interest in expanding pediatric oncology units in Ethiopia, reflected in the National Childhood and Adolescent Cancer Control Plan (NCACCP), little is known about the cost of running a pediatric oncology unit and treating childhood cancers.
Methods
We collected historical cost data and quantity of services provided for the pediatric oncology unit and all other departments in Tikur Anbessa Specialized Hospital (TASH) from 8 July 2018 to 7 July 2019, using a provider perspective and mixed (top-down and bottom-up) costing approaches. Direct costs (human resources, drugs, supplies, medical equipment) of the pediatric oncology unit, costs at other relevant clinical departments, and overhead cost share are summed up to estimate the total annual cost of running the unit. Further, unit costs were estimated at specific childhood cancer levels.
Results
The estimated annual total cost of running a pediatric oncology unit was USD 776,060 (equivalent to USD 577 per treated child). The cost of running a pediatric oncology unit per treated child ranged from USD 469 to USD 1,085, on the scenario-based sensitivity analysis. Drugs and supplies, and human resources accounted for 33% and 27% of the total cost, respectively. Outpatient department and inpatient department shared 37% and 63% of the cost, respectively. For the pediatric oncology unit, the cost per OPD visit, cost per bed day, and cost per episode of hospital admission were USD 36.9, 39.9, and 373.3, respectively. The annual cost per treated child ranged from USD 322 to USD 1,313 for the specific childhood cancers.
Conclusion
Running a pediatric oncology unit in Ethiopia is likely to be affordable. Further analysis of cost effectiveness, equity, and financial risk protection impacts of investing in childhood cancer programs could better inform the prioritization of childhood cancer control interventions in the Ethiopia Essential Health Service Package.
... 19 20 Sadly, as in other low-income countries (LICs), most childhood cancers in Ethiopia are not successfully treated. One Ethiopian study examined all children below 15 Open access 2010-2013 21 and found that only 20% improved, while 65% were discharged without improvement and 7% died in the hospital. The main reason for discharge was the unavailability and unaffordability of chemotherapeutic drugs. ...
Objective:
To estimate the cost-effectiveness of running a paediatric oncology unit in Ethiopia to inform the revision of the Ethiopia Essential Health Service Package (EEHSP), which ranks the treatment of childhood cancers at a low and medium priority.
Methods:
We built a decision analytical model-a decision tree-to estimate the cost-effectiveness of running a paediatric oncology unit compared with a do-nothing scenario (no paediatric oncology care) from a healthcare provider perspective. We used the recently (2018-2019) conducted costing estimate for running the paediatric oncology unit at Tikur Anbessa Specialized Hospital (TASH) and employed a mixed costing approach (top-down and bottom-up). We used data on health outcomes from other studies in similar settings to estimate the disability-adjusted life years (DALYs) averted of running a paediatric oncology unit compared with a do-nothing scenario over a lifetime horizon. Both costs and effects were discounted (3%) to the present value. The primary outcome was incremental cost in US dollars (USDs) per DALY averted, and we used a willingness-to-pay (WTP) threshold of 50% of the Ethiopian gross domestic product per capita (USD 477 in 2019). Uncertainty was tested using one-way and probabilistic sensitivity analyses.
Results:
The incremental cost and DALYs averted per child treated in the paediatric oncology unit at TASH were USD 876 and 2.4, respectively, compared with no paediatric oncology care. The incremental cost-effectiveness ratio of running a paediatric oncology unit was USD 361 per DALY averted, and it was cost-effective in 90% of 100 000 Monte Carlo iterations at a USD 477 WTP threshold.
Conclusions:
The provision of paediatric cancer services using a specialised oncology unit is most likely cost-effective in Ethiopia, at least for easily treatable cancer types in centres with minimal to moderate capability. We recommend reassessing the priority-level decision of childhood cancer treatment in the current EEHSP.
... The most effective strategy to reduce the burden of cancer in children and improve outcomes is to focus on a prompt, timely diagnosis followed by effective, evidencebased therapy with simple supportive care [9]. Even though national attempts have been tried on early diagnosis of childhood cancer to improve the quality of life and survival rate, there is still a big problem of delay in diagnosis due to different factors and the mortality rate is greater than 80% in Ethiopia [14]. ...
Background
Delay in the diagnosis of childhood cancer is one of the major health problem that contribute to decreased survival rates of children particularly in developing nations. Despite advances in the field of pediatric oncology, cancer remains a leading cause of death in children. Diagnosis of childhood cancer as early as possible is crucial to reduce mortality. Therefore, the aim of this study was to assess delay in diagnosis and associated factors among children with cancer admitted to pediatric oncology ward, University of Gondar comprehensive specialized hospital, Ethiopia 2022.
Method
Institutional-based retrospective cross-sectional study design was conducted from January1, 2019 to December 31, 2021 at University of Gondar comprehensive specialized hospital. All 200 children were included in the study and Data were extracted through structured check-list. The data were entered using EPI DATA version 4.6 and exported to STATA version 14.0 for data analysis.
Results
From the total of two hundred pediatric patients 44% had delayed diagnosis and the median delay diagnosis was 68 days. Rural residence (AOR = 1.96; 95%CI = 1.08–3.58), absence of health insurance (AOR = 2.21; 95%CI = 1.21–4.04), Hodgkin lymphoma (AOR = 9.36; 95%CI = 2.1-41.72), Retinoblastoma (AOR = 4.09; 95%CI = 1.29–13.02), no referral (AOR = 6.3; 95%CI = 2.15–18.55) and absence of comorbid disease (AOR = 2.14; 95%CI = 1.17–3.94) were significant factors associated with delay in diagnosis.
Conclusion and recommendation
Delayed in diagnosis of childhood cancer was relatively lower than previous studies and most influenced by the child’s residency, health insurance, type of cancer and comorbid disease. Thus; every effort should be made to promote public and parental understanding of childhood cancer, promote health insurance and referral.
... 19 20 Sadly, as in other low-income countries (LICs), most childhood cancers in Ethiopia are not successfully treated. One Ethiopian study examined all children below 15 Open access 2010-2013 21 and found that only 20% improved, while 65% were discharged without improvement and 7% died in the hospital. The main reason for discharge was the unavailability and unaffordability of chemotherapeutic drugs. ...
In low- and middle-income countries (LMICs), malignancies remain underreported due to lack of quality data. This study outlines the histopathological pattern of pediatric solid malignancies in children aged 0-15 years at the largest referral hospital in Ethiopia. A total of 432 solid malignancies were evaluated. The most common malignancies were lymphoma (21.8%), retinoblastoma (19.4%), and Wilms tumor (13.9%). Burkitt lymphoma accounted for 2.1%, despite being the most reported pediatric malignancy in sub-Saharan Africa in published literature. Definitive diagnosis could not be made in 7% of cases, related to the lack of confirmatory testing. The study highlights the need for improvement in diagnostic capabilities in LMICs.
... Endocrine disorders are the most frequently reported complications among childhood cancer survivors (CCS) that appear late within years after cancer survival [2]. The literature has shown that a lack of adequate follow-up of childhood brain tumor survivors may result in delayed management of these endocrine abnormalities that affect health and quality of life [2,3]. The purpose of this retrospective observational study was to evaluate the prevalence of different endocrine abnormalities focusing on hypothalamic-pituitary (HP) disorders and to evaluate the risk factors for these disorders in CCS of brain and neck cancer. ...
... 16 However, children often face long delays in cancer diagnosis, with as low as 30% of children in LMICs receiving timely diagnosis and treatment. [17][18][19] The Three-Delay Model has been widely used in many areas of global health to evaluate delays in care, with delays described across three domains, including (a) deciding to seek health care; (b) reaching an appropriate health facility; ...
Early access to care is essential to improve survival rates for childhood cancer. This study evaluates the determinants of delays in childhood cancer care in low‐ and middle‐income countries (LMICs) through a systematic review of the literature. We proposed a novel Three‐Delay framework specific to childhood cancer in LMICs by summarizing 43 determinants and 24 risk factors of delayed cancer care from 95 studies. Traditional medicine, household income, lack of transportation, rural population, parental education, and travel distance influenced most domains of our framework. Our novel framework can be used as a policy tool toward improving cancer care and outcomes for children in LMICs.
... As for germ cell tumors, it would be mixed in the suspected 32.71% because the assay of Alpha-feto-protein (AFP) and Betha HCG in two patients was negative. This distribution of histogenesis is different in Western countries demonstrated by Hadley L.G, et al. [17]. This difference can be explained by the presence of sufficient technical facilities in the West to make early diagnosis of certain tumors that are difficult to detect. ...
... Ja et al(2013) however found that seventy ve cases (23.1%) were seen in the 0-4 year age group, 118 cases (36.4%) in the[5][6][7][8][9] year age group while 131 cases (40.4%) were seen in the[10][11][12][13][14][15] year age group. Contrary to present study ndings Rajpal Singh15 Punia et al (2014) observed that highest number of cases were in the16 age group of 10-14 year. ...
... Many children with cancers in low-income countries still die without access to proper therapy, and the overall 5-year survival is considerably poor in most sub-Saharan African countries [3][4][5]. ...
Introduction: The burden of childhood cancer is an important child health concern globally. Several million new cases are diagnosed annually, but the greatest burden is borne by developing countries. The management of paediatric cancer patients in these settings is fraught with several challenges, which can significantly affect outcome. Aim: To identify the various challenges in management of children with cancers in the University of Uyo Teaching Hospital Uyo, Nigeria and proffer interventions which may impact positively on their long term survival and quality of life. Methods: A three year retrospective study of children admitted with cancers was carried out at the Haemato-Oncology unit of the department of Paediatrics, University of Uyo Teaching Hospital, Uyo Nigeria, from January 2019 and December 2021. The available records of their admission, treatment process, progress and outcome were reviewed. Results: Of the thirty-eight (38) patients seen, all presented at a late stage of disease. The socio-economic class of parents were mostly low (81.6%) and all treatments were self-sponsored, with 44.7% discharging against medical advice due to financial constraints. Conclusion: The challenges in the management of paediatric cancer patients included late presentation, late diagnosis, financial constraints/poverty, burn-out of caregivers, with a resultant high frequency of discharge against medical advice. Greater awareness about childhood cancers, increased advocacy for governmental input by way of resources, infrastructure and health insurance policies would improve outcome.
... Consequently, non-resectability is a major challenge with up to a quarter of patients receiving no treatment when chemotherapy is limited by availability or cost [45]. The 'Their Lives Matter' (TLM) charity in Tanzania, or the Groupe Franco-Africain d'Oncologie P ediatrique in Francophone West Africa, facilitate access to chemotherapy such that outcomes in the management of Wilms' tumour have improved in those areas in which they operate [46,47]. ...
The need for paediatric urological care in low‐ and middle‐income countries in sub‐Saharan Africa (SSA) is enormous due to a burgeoning paediatric‐aged population and a disproportionate burden of congenital malformations. There are formidable challenges in the provision of a skilled workforce and appropriate infrastructure, resulting in a huge unmet need with consequent effects on the long‐term health and prosperity of the population. Constraints of funding, geography, culture, surgical and anaesthetic skills, and instrumentation means that many conditions present late and with complications that could have been avoided by an earlier attendance. It also means that the management of congenital malformations, e.g., bladder exstrophy and congenital obstructive posterior urethral membrane, differ substantially from that seen in the developed world, with the outlook for children with renal failure being particularly bleak. Collaborations between paediatric urologists from high‐ and low‐income countries are beginning to help with the development of a surgical infrastructure customised to paediatric care, and with the training of specific paediatric urological knowledge and skills. These collaborations, whilst welcome, still require substantial expansion to achieve more equitable access to appropriate paediatric urological care for children in SSA. Future efforts have to focus on the creation of sustainable and equal partnerships between urologists from low‐ and high‐income healthcare environments, with an emphasis on providing sustainable management, appropriate to local need and available resources. The provision of shared learning, utilising the benefits of global digital communication, will improve mutual understanding of needs in a resource‐poor environment and the involvement of trainees from both income settings can help perpetuate long‐term collaborations.
... Neuroblastoma, arising from neural crest cells [3], accounts for 15% paediatric tumour-related deaths worldwide [4][5][6]. Factors including late presentation of disease and abandonment of treatment have been outlined as impeding good outcomes [7][8][9]. ...
Background
Cancer is a major global health concern and a leading cause of death in paediatric populations worldwide. Malnutrition contributes to a poor prognosis and remains the most common comorbidity leading to death in children with cancer. This retrospective study was developed through Oxford Paediatrics Linking Oncology Research with Electives (OxPLORE)—a medical student-led collaboration of paediatric surgeons and oncologists from low- and middle-income (LMIC) and high-income (HIC) countries. The aim of this study was twofold; firstly, to investigate the nutritional status and outcomes of neuroblastoma paediatric patients in two OxPLORE centres. Secondly, to facilitate the development of research skills of medical students as part of the OxPLORE initiative.
Results
Nine neuroblastoma patients were identified (YY, n = 4, XX, n = 5) over the study period. Nutritional status was poorer in YY patients (median z -score − 1.57 cf. − 0.7, t = 1.16, p = 0.28), which correlated with poorer survival in the YY cohort (75%), as compared to the XX cohort (100%). YY patients were older at presentation than the XX cohort (57 cf. 13 months, t = 1.959 p = 0.09). Further, tumour presentation was at a later stage in the YY group (75% stage IV).
Conclusion
This collaboration has shown a correlation in disparities in nutritional status and outcome of neuroblastoma in paediatric populations in YY and XX. These findings can inform institutional quality improvement. Further, this pilot study has highlighted the potential for medical students to undertake international research collaborations.
... poor settings, with as few as 30% of children in LMICs receiving early cancer diagnosis and treatment. [18][19][20] Therefore, identifying the factors contributing to delayed cancer care is an essential step in guiding strategic interventions to improve the care of childhood cancer along the entire continuum of care in low-resource settings. ...
Background:
Significant disparities exist for timely access to cancer care for children, with the highest disparities in low- and middle-income countries (LMICs). This study aims to conduct a systematic review that identifies the factors contributing to delayed care of childhood cancers in LMICs.
Methods:
We will conduct a systematic review with search strings compliant with the PICO framework: (1) the Population-children (aged 0-18 years) from LMICs; (2) the Exposure-factors contributing to timely childhood cancer care; (3) the Outcome-delays in childhood cancer care.
Discussion:
Our study is an essential step to guide strategic interventions to assess the myriad of factors that prevent children from accessing timely cancer care in LMICs. The results will be submitted for publication in a peer-reviewed journal and shared with institutions related to the field.
... Poor health-seeking behavior, geographic inaccessibility, financial unaffordability of care, infrastructural deficiencies, deficient diagnostic capability and equipping of health workers, and specialist care unavailability have been documented as some of the causes. [6,7] Several studies have also reported the role of delayed presentation in impacting survival rates. [8] Often, these studies have quite accurately blamed delayed presentation on factors such as lack of awareness, poor health-seeking behavior, [9] stigma, and sociocultural/religious beliefs of patients, [10] or in the case of paediatric patients, the parents, or caregivers. ...
Background
Paediatric cancer patients in Nigeria continue to arrive at specialist centers with advanced-stage disease. The reasons for this are myriad, not least of which are delays in detection, diagnosis, and referral for treatment. While delayed presentation has often been reported from the perspective of delays from caregivers' decisions, institutional deficiencies in the health care system may account for an unmeasured portion of the factors leading to delayed presentation. This project centered around training of health-care professionals at community level to detect potential paediatric cancer signs and refer appropriately.
Aim
The aim of the study is to access the immediate impact of training on early detection and referral of possible paediatric cancer cases in the community and primary level health care workers and professionals in the Southwest Nigeria.
Materials and Methods
This was a retrospective review of the training impact in three South-Western states in Nigeria. Scores before and after the training were analyzed using the IBM SPSS statistics, version 23 (IBM, Armonk, NY, USA).
Results
A total of 732 primary health care workers were trained. In the pre assessment evaluations, 44.8% of participants reported that cancer did not occur in children, 47.2% did not know any referral pathway for a child suspected of cancer. The post training assessment indicated an improvement in participants' understanding of common paediatric cancers types and how to refer a suspected case for specialist diagnosis and attention. Mean scores before and after the training were 3.5/15 and 12.5/15, respectively.
Conclusion
Training health-care professionals working at the community level can have an immediate and measurable impact on early detection and referral for paediatric cancers, as seen by the difference in pre training and post training assessment scores. There remains a need for continuous training to ensure early referral and ultimately increase survival indices of children diagnosed with cancer in Nigeria.
... [26,27] In LMICs, the advanced disease stages seen in patients are likely due to late diagnosis and late referral. [28,29] In our series, 44% of patients were identified to be in stage IIIB, and the group with an unfavourable prognosis (G2) accounted for 85.8% of patients. In studies from Brazil and India, stages III and IV accounted for ~50% of patients. ...
... Menos de 20% das crianças/adolescentes têm acesso ao tratamento curativo. Consequentemente, a sobrevivência de crianças com câncer na África é significativamente menor do que nos países desenvolvidos, onde a sobrevida global em 5 anos é de 70 a 80% (Hadley, Rouma & Saad-Eldin, 2012). ...
Trata-se de uma revisão narrativa com objetivo de evidenciar repercussões psicossociais do câncer na vida de crianças/ adolescentes adoecidos e familiares/cuidadores. Os dados encontrados na literatura científica demonstram que o câncer é um evento complexo e amplo, marcado por determinantes subjetivos e sociais, sendo os aspectos psicológicos, financeiros, disparidades no acesso ao tratamento em contexto global e a escolarização, socialização as principais dimensões que sofrem interferência do processo de adoecimento/tratamento. A compreensão das implicações psicossociais torna-se essencial para a prestação de um cuidado integral em saúde, uma vez que esse evento afeta o modo de vida da pessoa adoecida e a dinâmica familiar.
Abstract: It is a narrative review with the objective of showing psychosocial repercussions of cancer in the lives of sick chil-dren/adolescents and family members/caregivers. The data found in the scientific literature demonstrate that cancer is a complex and broad event, marked by subjective and social determinants, with psychological, financial aspects, disparities in access to treatment in a global context and schooling, socialization the main dimensions that suffer interference of the illness/treatment process. Understanding the psychosocial implications becomes essential for the provision of comprehensive health care, since this event affects the sick person's way of life and family dynamics.
... African countries, whereas it ranks fifth in North America. 3 Moreover, survival rates of 25%-53% in low-income countries have been reported as opposed to 70%-97% in high-income countries. 2 In 2018, the WHO set a global survival target of 60% for children with cancer by 2030. ...
Background/objectives
Wilms tumor (WT) is a curable type of cancer with 5-year survival rates of over 90% in high-income countries, whereas this is less than 50% in low- and middle-income countries. We assessed treatment outcomes of children with WT treated at a large Kenyan teaching and referral hospital.
Design/methods
We conducted a retrospective record review of children diagnosed with WT between 2013 and 2016. Treatment protocol consisted of 6 weeks of preoperative chemotherapy and surgery, and 4–18 weeks of postoperative chemotherapy depending on disease stage. Probability of event-free survival (pEFS) and overall survival (pOS) was assessed using Kaplan–Meier method with Cox regression analysis. Competing events were analyzed with cumulative incidences and Fine–Gray regression analysis.
Results
Of the 92 diagnosed patients, 69% presented with high-stage disease. Two-year observed EFS and OS were, respectively, 43.5% and 67%. Twenty-seven percent of children died, 19% abandoned treatment, and 11% suffered from progressive or relapsed disease. Patients who were diagnosed in 2015–2016 compared to 2013–2014 showed higher pEFS. They less often had progressive or relapsed disease (p = .015) and borderline significant less often abandonment of treatment (p = .09). Twenty-nine children received radiotherapy, and 2-year pEFS in this group was 86%.
Conclusion
Outcome of children with WT improved over the years despite advanced stage at presentation. Survival probabilities of patients receiving comprehensive therapy including radiation are approaching those of patients in high-income countries. Additional improvement could be achieved by ensuring that patients receive all required treatment and working on earlier diagnosis strategies.
... 1,2 The incidence of WT is highest among African American children, followed by Caucasian children, and then Asian children. [3][4][5][6] Five-year survival is more than 90% for children with all stages of favorable histology WT (FHWT) who receive appropriate treatment. [7][8][9][10] However, survival remains poor for children with higherstage diffuse anaplastic WT. 11,12 Most children present with resectable disease in one kidney, and upfront unilateral nephrectomy is recommended for most children. ...
The NCCN Guidelines for Wilms Tumor focus on the screening, diagnosis, staging, treatment, and management of Wilms tumor (WT, also known as nephroblastoma). WT is the most common primary renal tumor in children. Five-year survival is more than 90% for children with all stages of favorable histology WT who receive appropriate treatment. All patients with WT should be managed by a multidisciplinary team with experience in managing renal tumors; consulting a pediatric oncologist is strongly encouraged. Treatment of WT includes surgery, neoadjuvant or adjuvant chemotherapy, and radiation therapy (RT) if needed. Careful use of available therapies is necessary to maximize cure and minimize long-term toxicities. This article discusses the NCCN Guidelines recommendations for favorable histology WT.
... For example, in Africa, the survival outcomes of children with brain tumors remain poor, and priority must be given to access to care before organizing an effective transitional care for AYA patients. [25][26][27] ...
Objective:
Transitional care in surgical neurooncology is poorly studied. However, this period is pivotal, since it allows the patient to be empowered in his or her disease management. Here, the authors describe the experience of the Necker-Enfants Malades and the Sainte-Anne Hospital collaboration.
Methods:
The mixed transitional consultations started in September 2019 in a dedicated space for transitional care, named the "La Suite" department, located in the Necker-Enfants Malades Hospital, Paris, France. The authors organized planned consultations to schedule the clinical and radiological follow-up in the adult neurosurgical department but also emergency consultations to manage tumor recurrence in young adult patients. Transitional care was performed jointly by pediatric and adult neurosurgeons who have developed clinical and research skills in the field of surgical neurooncology. Neuropathological analysis was performed by a neuropathologist who is specialized in pediatric and adult neurooncology.
Results:
Fourteen patients benefited from a mixed transitional consultation. All of them accepted to start their management in an adult neurosurgical environment. Eleven patients (78.6%) for whom the disease was controlled benefited from a planned consultation. Three patients (21.4%) required rapid neurosurgical management for a tumor recurrence (n = 2) or for a new primary CNS tumor (n = 1) and benefited from an emergency consultation.
Conclusions:
For adult patients harboring a brain tumor during childhood or adolescence, the authors suggest that neurosurgeons specialized in adult surgical neurooncology with a full knowledge in pediatric neurooncology will combine the required skills to optimize care management for these patients within a dedicated multidisciplinary organization framework.
... Cancer is now curable in developed countries as survival rates approach 80%, but in Africa,>80% of children still die without access to adequate treatment (2) .The costs of treatment, diagnostic investigations, meals and hospital stay are borne by patients and their families. Because no coordinated cancer registry exists in Ethiopia, few studies have explored the incidence of pediatric malignancies and to our knowledge none have reported outcomes from our region. ...
... All the authors recommend alternative solutions which do not involve ionizing radiation [13][14][15][16][17]. This is all the more valid in Africa, which contains 80% of the world's children and where cancer care is still a dilemma [18][19][20]. ...
Background
Abdominal trauma are a common cause of infant morbidity and mortality.
Aim
To assess the relevance of computed tomography scan for the management of abdominal trauma in children in countries with limited resources.
Patients and method
It was a retrospective and descriptive study over 5 years in patients aged 0 to 15 years.
Results
Twenty four cases of abdominal trauma were collected. There were 14 boys and 10 girls with a sex ratio of 1.4. The average age was 8.7 years with extremes of 18 months and 15 years. The causes found were: road accidents (14 cases), home accident (6 cases), gambling accidents (3 cases) and one aggression. Traumas were divided into 83.3% (20 cases) of abdominal blunt and 16.7% (4 cases) of abdominal wound. Polytrauma accounted for 41.7% (10 cases). No computed tomography scan was ordered. The spleen was the most injured organ (11 cases) followed by the intestines (6 cases). The average length of hospital stay was 12.3 days with extremes of 3 and 15 days. The treatment was non-operative in 13 patients (54.2%) and surgical in 11 ones (45.8%). No deaths were noted in our series.
Conclusion
Abdominal trauma in children are potentially serious injuries. The treatment depends on the damaged organ and the patient's hemodynamic status. Computed tomography scan does not appear to be indispensable in the management of traumatized children in countries with limited resources.
Burkitt lymphoma (BL) is a curable, aggressive pediatric cancer, yet in low- and middle-income countries like Nigeria, children with BL face poor survival outcomes. Identifying barriers to and facilitators of cancer care for.
Objective
The aim was to explore the prevalence and risk factors for pituitary and growth disorders in pediatric brain and neck tumor survivors.
Methods
203 children with brain or neck tumors that survived 2 years after tumors treatment were included. Demographic data, anthropometric assessments, characteristics of the tumors, tumor treatment modalities, and hormonal profile evaluation were reported.
Results
After a mean follow-up of 4.77 years, 62 (30.54%) survivors were diagnosed with at least one pituitary disorder. Growth hormone deficiency (GHD) was detected in 17.28% of survivors, moreover, thyroid-stimulating hormone deficiency (TSHD), luteinizing hormone and follicle-stimulating hormone deficiency (LH/FSHD), adrenocorticotropic hormone deficiency (ACTHD)/cortisol deficiency and central precocious puberty were detected in 10.4, 9.09, 8.06, and 1.69% of survivors, respectively. The prevalence of short stature and obesity was 9.1% and 17.05%, respectively among survivors who attended follow-up clinics during data collection. The risk of developing pituitary disorders was associated with craniopharyngioma histology (OR, 6.207; 95% CI, 1.025–37.581) and a history of hydrocephalus at cancer diagnosis (OR, 3.075; 95% CI, 1.402–6.746). Older age at the time of radiotherapy was associated with a lower risk of developing pituitary disorders (OR, 0.928; 95% CI, 0.864–0.997).
Conclusion
This study observed a high prevalence of pituitary disorders among survivors of pediatric brain and neck tumors. So proper screening of pituitary disorders in survivors of brain and neck tumors is warranted.
Introduction
The effectiveness of a health system in providing access to medicines is in part determined by the alignment of several core pharmaceutical processes. For South Africa’s public health sector, these include the registration of medicines, selection and subsequent procurement through national tenders. Registration, selection and reimbursement are key processes in the private sector. This study assessed the alignment of forementioned processes for essential paediatric oncology medicines in South Africa.
Methods
A selection of priority chemotherapeutics, antiemetics and analgesics in the treatment of five prevalent childhood cancers in South Africa was compared with those listed in 1) the WHO Essential Medicines List for Children (WHO EMLc) 2021, 2) the registered health products database of South Africa, 3) the relevant South African National Essential Medicines Lists (NEML), 4) bid packs and awarded tenders for oncology medicines for 2020 and 2022 and 5) oncology formularies from the leading Independent Clinical Oncology Network (ICON) and two private sector medical aid schemes. Consistency between these sources was assessed descriptively.
Results
There was full alignment for 25 priority chemotherapeutics for children between the NEML, the products registered in South Africa and those included on tender. Due to unsuccessful procurement, access to seven chemotherapeutics was potentially constrained. For antiemetics and analgesics, eight of nine active ingredients included on the WHO EMLc were also registered in South Africa and on its NEML. An exploratory assessment of private sector formularies showed many gaps in ICON’s formulary and two medical scheme formularies (listing 33% and 24% of the chemotherapeutics, respectively).
Conclusion
Despite good alignment in public sector pharmaceutical processes, access constraints to essential chemotherapeutics for children may stem from unsuccessful tenders. Private sector formularies show major gaps; however, it is unclear how this translates to access in clinical practice.
Purpose:
Studies from different countries show that caregivers of children with haematological cancer receiving chemotherapy encounter substantial distress when witnessing their children's suffering from the illness and chemotherapy side effects, alongside experiencing psychosocial problems and financial difficulties. However, no studies for this are available from Ethiopia in its specific cultural background and health care system. Thus, this study aimed to explore and bring into light the experiences of Ethiopian family caregivers of children with haematological malignancies receiving chemotherapy.
Methods:
A qualitative descriptive study was conducted using a maximum variation purposive sampling method among 20 caregivers. Semi-structured in-depth face-to-face interviews were conducted until no new themes discovered. The data were analysed through qualitative thematic analysis.
Results:
Participants believed cancer comes from different reasons and chemotherapy is ineffective in curing cancer. They identified various chemotherapy-related side effects, and psychosocial problems. The lack of health insurance, loss of job or income, and high cost of treatments were the major financial challenges. Adhering to treatments, acceptance and reassurance, religious and spiritual therapies, traditional medicine, and a support system were the major coping strategies. They had needs for improved support in information and education, psychosocial support, and in the availability of medications.
Conclusions:
Systematic health assessment, provision of targeted information and education, psychosocial support, nursing care respecting the caregivers' positive coping strategies, improvement in chemotherapy medication availability, and facilitating connections with supporting organisations would help improve child outcomes and address caregiver needs.
BACKGROUND
Research in Namibia has come a long way over the past two decades. Even so, research in the field of paediatric oncology is still lagging behind. Therefore, this study looked at the pattern of paediatric cancer patient over a ten-year period.
METHODS
A cross-sectional study was done to analyse the paediatric oncology cases that were admitted to the paediatric oncology unit (ward 8 west) at Windhoek Central Hospital (WCH) between 01 January 2011 and 31 December 2020. The study analysed the files of paediatric patients admitted with a paediatric cancer diagnosis from the age of 0 to 16 years.
RESULTS
A total of 174 paediatric cancer patient files met the inclusion criteria. Haematopoietic cancers were the most commonly occurring diagnosis of a paediatric cancer type in the study population (44.8%), of which leukaemias were the most common type of haematopoietic cancer. The other types of cancer apart from haematopoietic cancers consisted of embryonal cancers (37.9%), soft tissue and bone sarcomas (13.8%), and brain or CNS cancers (3.4%). The median age at diagnosis was 5.13 years with an age range of 0 to 15 years. HIV exposure had an incidence of 6.4%.
CONCLUSIONS
Haematopoietic cancers remains the number one most common type in Namibia. However, there has been a change in the ranking of the other childhood cancer subtypes over the last 3 decades. The recommendation is that there be better recordkeeping of cancer patient files to capture important information. For follow-up studies, prospective studies are recommended in the future.
Wilms’ tumor is the most common renal tumor of childhood, affecting seven to eight cases per million person years in children. It accounts for 95% of all pediatric renal cancers and 6% of all cancers below 15 years of age. The gender-specific incidence is almost similar with slight female preponderance. The mean age of diagnosis is 41.6 months in boys and 46.9 months in girls for unilateral disease. The patients with bilateral disease present approximately 1 year before those with unilateral disease. The recent data has revealed the difference in incidence between different geographic regions and ethnic groups within that geographic region. Various case control studies have been conducted to study the role of paternal occupational exposure and maternal occupational and hormonal exposure during pregnancy. There have been inconsistencies in the pattern of exposure, and it seems unlikely that environmental exposure has any significant role to play in the pathogenesis of Wilms’ tumor. This chapter discusses the epidemiology of Wilms’ tumor in particular relation to the incidence of the tumor, geographic and ethnic variations, causative hypothesis, role of environmental factors in causation, pertinent issues in low-income countries, and the role of tumor registries.KeywordsWilms tumorEpidemiologyIncidence
Background
The rarity and heterogeneity of pediatric cancers make it difficult to assess risk factors associated with the development of cancer in this group. This also determines the quantity and quality of evidence for etiological factors linked to pediatric cancers. Evidence on the risk factors associated with pediatric cancers is scarce; however, it has been accumulating slowly over the years. As the disease burden shifts from communicable to non-communicable diseases, most of these low- to middle-income countries (LMICs) find themselves overburdened with changing health care priorities and needs. In sub-Saharan Africa, it is of major importance to pay particular attention to risk factors associated with pediatric cancer.
Objective
To map evidence on risk factors associated with pediatric cancers in sub-Saharan Africa (SSA).
Methods
This review was guided by Arksey and O’Malley’s framework for conducting scoping reviews. Four electronic databases were searched in December 2018, and another manual search was conducted in February 2022 to include newly published eligible articles. The databases searched included PubMed and Health Source: Nursing/Academic Edition. We also searched articles from an academic search engine, Google scholar. This review included articles reporting the relevant outcomes of this study and articles reporting cancers in children in the 0–15 years age range. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews (PRISMA-ScR): checklist and explanation.
Results
We retrieved 7391 articles from the initial database. The final number of studies that were included for data extraction was 15. Evidence from the retrieved studies suggests that most childhood cancers in the SSA region are infection-induced. The type of cancer mostly reported is Burkitt Lymphoma and is diagnosed mostly in the tropical region of SSA. The type of risk factors was divided into three types: infection-induced, genetic, and demographic risk factors. Overall, based on the articles retrieved, there was limited evidence on the risk factors associated with pediatric cancers in SSA.
Conclusion
The limited evidence on the risk factors coupled with the lack of evidence on the true burden of these malignancies in the SSA hampers efforts to set priorities for childhood cancer control. Formulation of effective preventative (where possible) measures and treatment regimens will need proper assessment of risk factors.
Background: Unaffordable health-care costs are a critical factor in poor cancer care in low and middle-income countries. Net costs of treating childhood cancer in Nigeria are largely undocumented. This study sought to define the direct cost of pediatric cancer treatment in Lagos, Nigeria, to address this knowledge gap. Methods: This was a longitudinal study design targeting determination of cost of cancer-related care delivered to newly diagnosed childhood cancer patients at the Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria, from January 2017 to January 2020. Study participants included children with histologically confirmed diagnoses. All direct costs associated with care from the time of diagnosis until either remission or death were documented based on a parental survey at each patient encounter. Results: Among 46 enrolled participants (median age of 6 years), leukemia was the most common diagnosis. The median duration from diagnosis to last assessment was 11 months, and the average cost directly related from diagnosis to remission or death was NGN 5,064,700 (USD 13,876). The highest cost of care was associated with rhabdomyosarcoma, with an average cost of ₦6,798,635 ($18,678). These costs were juxtaposed to the average monthly family earning of NGN 115,228 (USD 316). Conclusion: This study revealed the direct cost of managing childhood cancer in Lagos, Nigeria, which proved unaffordable for most caregivers. Policies are needed to improve the affordability of health-care delivery for childhood cancer, including a focus on the adequacy of health insurance coverage and public health-related policies governing financial support targeting health-care delivery in the context of childhood cancer to improve outcomes.
Despite the high prevalence of infection by the Human Immunodeficiency Virus (HIV) in South Africa, information on its association with cancer is sparse. Our study was carried out to examine the relationship between HIV and a number of cancer types or sites that are common in South Africa. A total of 4,883 subjects, presenting with a cancer or cardiovascular disease at the 3 tertiary referral hospitals in Johannesburg, were interviewed and had blood tested for HIV. Odds ratios associated with HIV infection were calculated by using unconditional logistic regression models for 16 major cancer types where data was available for 50 or more patients. In the comparison group, the prevalence of HIV infection was 8.3% in males and 9.1% in females. Significant excess risks associated with HIV infection were found for Kaposi's sarcoma (OR=21.9, 95% CI=12.5–38.6), non‐Hodgkin lymphoma (OR=5.0, 95%CI=2.7–9.5), vulval cancer (OR=4.8, 95%CI=1.9–12.2) and cervical cancer (OR=1.6, 95%CI=1.1–2.3) but not for any of the other major cancer types examined, including Hodgkin disease, multiple myeloma and lung cancer. In Johannesburg, South Africa, HIV infection was associated with significantly increased risks of Kaposi's sarcoma, non‐Hodgkin lymphoma and cancers of the cervix and the vulva. The relative risks for Kaposi's sarcoma and non‐Hodgkin lymphoma associated with HIV infection were substantially lower than those found in the West. Int. J. Cancer 88:489–492, 2000. © 2000 Wiley‐Liss, Inc.
Background: Red blood cells and platelet concentrates are frequently used in paediatric oncology. There is little literature on the indications and costs of this adjuvant therapy. Aim: To retrospectively evaluate the indications, amounts and costs of transfusing blood products in 2008 in the Depart-ment of Paediatric Oncology at Tygerberg Children's Hospital, Cape Town. Material and Method: The patient records were analyzed for age, sex, disease and stage, indications for transfusion and type of blood product as well as amount. The costs were obtained from the Blood Bank for each item released for every patient. Results: Thirty-nine children with cancer were transfused, between one unit and 34 units of blood products per patient, during their treatment in 2008. The total cost of this therapy in 2008 was ZAR 941,966 = USD 125,595 = EUR 89,711. The maximum cost per patient amounted to ZAR 70,682 = USD 9,424 = EUR 6,731 and the minimum ZAR 914 = USD 121 = EUR 87. The average expenditure per patient was ZAR 24,125 = USD 3,216 = EUR 2,297. The management of leukemia required the highest usage of blood products per patient. Conclusion: The use of blood products is indispensable during the treatment of numerous haematology – oncology diseases. Their indications should be specified in internal protocols and their actual use should be audited frequently due to the considerable costs.
Background
Wilms tumour is one of the commonest childhood solid tumours which has an excellent outlook in the developed world with 5-year overall survival exceeding 90%. There is little information from Sudan regarding Wilms tumour.ProcedureRecords of patients with Wilms tumour diagnosed and treated at Institute of Nuclear Medicine, Molecular Biology and Oncology (INMO) in the University of Gezira from May 1999 to June 2007 were reviewed.ResultsThirty-seven children presented at a mean age of 4.1 years (range 2 months–13 years). The male to female ratio was 0.9–1. Abdominal swelling or mass was the commonest symptom. There was 1 child with Stage I (2.7%), 7 with stage II (18.9%), 25 with Stage III (67.6%) and 4 with Stage IV (10.8%). Following diagnosis 27% of children did not receive further treatment (5.4% died prior to treatment, 5.4% were not able to finance treatment and for the rest 16.2% no cause was identified). More than half of the children did not have a nephrectomy and only 4 (11%) completed treatment.Conclusions
The poor outlook is related to several factors. Delayed presentation, poor awareness of treatment options, lack of finances, no provision of food, lodging and transport, absence of paediatric trained staff are the obstacles to better outcomes. Empowering parents with information, giving chemotherapy prior to nephrectomy, training staff and establishing links with a tertiary cancer centre in the developed world are some of the options to improve survival. Pediatr Blood Cancer 2008;50:1135–1137. © 2008 Wiley-Liss, Inc.
Africa has one of the highest neonatal mortalities in the world, for which the commonest causes do not include surgical conditions such as some congenital anomalies that are amenable to surgery but are not often operated on because of a number of challenges. These challenges include cultural beliefs and practices, dearth of human resource capacity, inadequate laboratory and imaging support and lack of consumables and intensive or high dependency care facilities. Some of these challenges will be examined and highlighted using the acronym "ASKS" in this article.
Childhood cancer is fast becoming an important paediatric problem in Nigeria and several parts of Africa, with the progressive decline of infectious and nutritional diseases. The following study was a 5-year retrospective review of paediatric solid tumours as seen at the Jos University Teaching Hospital, Nigeria.
To determine the relative frequencies of childhood solid malignant tumours in Jos, Central Nigeria and compare with reports of previous studies both locally and abroad.
Cancer registers and medical records of patients were used to extract demographic data, specimen number and/or codes. Archival materials were retrieved from the histopathology laboratory and sections were made from paraffin embedded blocks of these specimens. Slides of these histological sections were reviewed and reclassified where necessary. The relative frequencies were then determined.
One hundred and eighty one solid tumours of children were diagnosed within the study period. Ninety-four (51%) were benign and 87 (49%) malignant. Male: Female ratio was 1.3:1. The commonest malignant tumour diagnosed was rhabdomyosarcoma which accounted for 27 (31%), comprising of 15 (55.6%), 11 (40.7%) and 1 (3.7%) embryonal, alveolar and pleomorphic rhabdomyosarcomas, respectively. Non Hodgkin lymphoma and Burkitt lymphoma accounted for 17 (19.5%) and 12 (13.8%), respectively.
Based on the result of our study, we conclude that the commonest solid malignancy of childhood in Jos, Nigeria is rhabdomyosarcoma. This has implications for diagnosis, management and prognosis of theses soft tissue sarcomas in our paediatric population.
Advances in paediatric oncology has tremendously improved the outcome in children with nephroblastoma. In most developing countries, however, the survival rate is still very low. Objective: To study the outcome and the impediments to the management of nephroblastoma in Southeast Nigeria.
Analysis of 42 children managed for nephroblastoma over a 10-year period (January 1995-December 2004) at the University of Nigeria Teaching Hospital, Enugu, Nigeria is made. Diagnosis was based on clinical, radiologic and histologic evaluation.
The peak age incidence was 2-5 years with a male:female ratio of 1.1:1. Abdominal mass was the main presentation in all the children. Treatment consisted of nephroureterectomy followed by adjuvant chemotherapy with Vincristine, Actinomycin D and Cyclophosphamide. Adriamycin was added for metastatic disease. Twenty-two children (52.3%) had stage III disease, 13 (31.0%) had stage IV, while the remaining seven (16.7%) children had stage II. Stage I disease was not encountered. Seven children had inoperable tumor requiring pre-operative chemotherapy. While 25 children were available for evaluation, 17 were lost to follow up. Four children died of complications of treatment, while 11 relapsed with poor outcome. With a mean follow up of 21 months, the 5-year survival rate is 40%.
Morbidity and mortality with nephroblastoma is high in our environment. Late presentation, poverty, ignorance and poor compliance to treatment constitute a great challenge to the paediatric oncologist in a developing country. Solutions may lie in improving health funding and health information in the health care delivery system. Free health care for children with malignancy is advocated. Collaboration with institutions in the privileged parts of the world may help.
Context.—Histopathology, like other branches of medicine in West Africa, has suffered largely from economic, political, social, and infrastructural problems, becoming a shadow of the top quality that had been obtained in the past. To address the prevailing problems, one needs to attempt defining them.
Objective.—The existing structure of training and practice are discussed, highlighting the author's perception of the problems and suggesting practical ways to address these while identifying potential roles for North American pathology organizations.
Design.—The author's past and ongoing association with pathology practice in Nigeria forms the basis for this review.
Results.—Pathology practice is largely restricted to academic medical centers. The largest of academic centers each accession around 4000 or fewer surgical specimens per year to train 9 to 12 residents. Histopathology largely uses hematoxylin-eosin routine stains, sometimes with histochemistry but rarely immunohistochemistry. Pathologists depend largely on their skills in morphology (with its limitations) to classify and subclassify tumors on routine stains, including soft tissue and hematolymphoid malignancies. Immunofluorescence, intraoperative frozen section diagnosis, electronic laboratory system, and gross and microscopic imaging facilities are generally not available for clinical use.
Conclusion.—The existing facilities and infrastructure can be augmented with provision of material and professional assistance from other pathology associations in more developed countries and should, among other things, focus on supplementing residency education. Virtual residency programs, short-visit observerships, development of simple but practical laboratory information systems, and closer ties with pathologists in these countries are some of the suggested steps in achieving this goal.
From 1961 to 1986, 29 patients with pelvic rhabdomyosarcoma (including pelvic retroperitoneal rhabdomyosarcoma) were admitted to the paediatric surgical service at the Red Cross Children's Hospital, Cape Town. During the period 1961–1970, the mainstay of treatment was radical surgery with or without subsquent chemotheraphy and radiotherapy. Of the 13 patients, only 2 have survived long-term (15%). From 1971 a new management policy of pre-treatment with chemotherapy and in some instances radiotherapy followed by conservative limited surgery was commenced. Twelve of the 16 patients have survived (75%). One patient with stage III prostatic tumour had treatment with only chemotherapy and radiotherapy and is surviving 8 years after diagnosis; another with a vaginal tumour, also stage III, whose parents refused surgery is alive tumour-free 4 years after similar treatment. Chemotherapy has not only significantly improved survival in pelvic rhabdomyosarcoma but has permitted limited surgery and in some instances has resulted in survival without surgical excision.
Background
Wilms tumor has a survival rate of 85–90% in well resourced countries but in low income countries survival is lower. Malawi is a country with very limited resources. We studied the feasibility, toxicity and efficacy of preoperative chemotherapy for Wilms tumor in Malawian children.Methods
All patients diagnosed with a Wilms tumor, admitted in Blantyre, Malawi, from 2006 to 2008, were included. These patients received SIOP-based preoperative chemotherapy followed by surgery and risk-stratified post-operative chemotherapy. Social support and counseling were provided to prevent abandonment of treatment.ResultsTwenty patients were included. Mean tumor volume at diagnosis was 2,500 ml and eight patients (40%) had metastases. Ninety-five percent of patients presented with hypertension, 80% with microscopic hematuria and 60% with a raised platelet count. Preoperative chemotherapy resulted in >50% tumor reduction in 55% of patients with localized disease and 75% of patients with metastatic disease. During preoperative chemotherapy, 11 of 18 patients experienced ≥ grade 3 anaemia, 7 patients experienced ≥ grade 3 neutropenia. In 12 patients the tumor was resected. Reasons of treatment failure were: abandonment of treatment (N = 3), death during anaesthesia induction (N = 1), inoperability (N = 5, due to metastatic disease in N = 4) and relapse (N = 2). One patient died of malaria 2 months after completion of chemotherapy. Eight patients (40%) are alive with a median follow up of 8 months (range 0–1.5 years).Conclusion
Preoperative chemotherapy for Wilms tumor is feasible, tolerated and efficacious in Malawi. Continued efforts are needed to encourage early presentation and to prevent abandonment. Pediatr Blood Cancer 2009;53:584–589. © 2009 Wiley-Liss, Inc.
Despite the high prevalence of infection by the Human Immunodeficiency Virus (HIV) in South Africa, information on its association with cancer is sparse. Our study was carried out to examine the relationship between HIV and a number of cancer types or sites that are common in South Africa. A total of 4,883 subjects, presenting with a cancer or cardiovascular disease at the 3 tertiary referral hospitals in Johannesburg, were interviewed and had blood tested for HIV. Odds ratios associated with HIV infection were calculated by using unconditional logistic regression models for 16 major cancer types where data was available for 50 or more patients. In the comparison group, the prevalence of HIV infection was 8.3% in males and 9.1% in females. Significant excess risks associated with HIV infection were found for Kaposi's sarcoma (OR=21.9, 95% CI=12.5–38.6), non-Hodgkin lymphoma (OR=5.0, 95%CI=2.7–9.5), vulval cancer (OR=4.8, 95%CI=1.9–12.2) and cervical cancer (OR=1.6, 95%CI=1.1–2.3) but not for any of the other major cancer types examined, including Hodgkin disease, multiple myeloma and lung cancer. In Johannesburg, South Africa, HIV infection was associated with significantly increased risks of Kaposi's sarcoma, non-Hodgkin lymphoma and cancers of the cervix and the vulva. The relative risks for Kaposi's sarcoma and non-Hodgkin lymphoma associated with HIV infection were substantially lower than those found in the West. Int. J. Cancer 88:489–492, 2000. © 2000 Wiley-Liss, Inc.
Thirty-eight cases of a sarcoma involving the jaws of African children are described. This is a syndrome which has not previously been fully recognized. It is by far the commonest malignant tumour of childhood seen at Mulago Hospital.
Histopathology, like other branches of medicine in West Africa, has suffered largely from economic, political, social, and infrastructural problems, becoming a shadow of the top quality that had been obtained in the past. To address the prevailing problems, one needs to attempt defining them.
The existing structure of training and practice are discussed, highlighting the author's perception of the problems and suggesting practical ways to address these while identifying potential roles for North American pathology organizations.
The author's past and ongoing association with pathology practice in Nigeria forms the basis for this review.
Pathology practice is largely restricted to academic medical centers. The largest of academic centers each accession around 4000 or fewer surgical specimens per year to train 9 to 12 residents. Histopathology largely uses hematoxylin-eosin routine stains, sometimes with histochemistry but rarely immunohistochemistry. Pathologists depend largely on their skills in morphology (with its limitations) to classify and subclassify tumors on routine stains, including soft tissue and hematolymphoid malignancies. Immunofluorescence, intraoperative frozen section diagnosis, electronic laboratory system, and gross and microscopic imaging facilities are generally not available for clinical use.
The existing facilities and infrastructure can be augmented with provision of material and professional assistance from other pathology associations in more developed countries and should, among other things, focus on supplementing residency education. Virtual residency programs, short-visit observerships, development of simple but practical laboratory information systems, and closer ties with pathologists in these countries are some of the suggested steps in achieving this goal.
This is a review of recently published literature on surgery in tropical Africa. It presents the current state of surgical need and surgical practice on the continent. We discuss the enormous burden of surgical pathology (as far as it is known) and the access to and acceptability of surgery. We also describe the available facilities in terms of equipment and manpower. The study looked at the effects of the human immunodeficiency virus, the role of traditional healers, anesthesia, and the economics of surgery. Medical training and research are discussed, as are medical migration out of Africa and the concept of task shifting, where surgical procedures are performed by others when surgeons are not available. It closes with recommendations for involvement and action in this area of great global need.
The French African Group of Pediatric Oncology was set-up to improve quality of care for children with cancer. Preliminary observations on the efficacy in Burkitt lymphoma (BL) of a cyclophosphamide monotherapy (CPM) have been published. We report the results of a multicentric prospective study combining first-line CPM and a multidrug second-line chemotherapy (SC) for refractory/relapsed patients.
Patients ≤ 18 years with Burkitt or Burkitt-like lymphoma, were included in six countries (Burkina-Faso, Cameroon, Ivory Coast, Madagascar, Mali, and Senegal). All patients received three weekly CPM courses (1.2 g/m(2) IV with intrathecal methotrexate and hydrocortisone), stage 3/4 patients received three further courses. SC added methotrexate, vincristine, cytarabine, and prednisone.
There were 178 patients included (42 stage 1/2, 134 stage 3/4, and 2 unknown). Isolated facial localization was found in 41 patients, diffuse abdominal involvement in 120 patients including 65 with both. Nine early deaths were reported, toxicity occurred in 136/743 courses (83 patients) and was predominantly hematological. After CPM, complete remission (CR) rate was 47% with a 33% EFS. Because of rapid progression 76/108 eligible patients (85 primary refractory and 23 relapses) received SC resulting in 35.7% CR but a 21% toxic death rate. The OS of the whole strategy was 50.5% and correlated to stage.
A prospective multicentric study on BL was feasible in very low-income countries. CPM can be recommended in stage 1-2 because of optimal cost/benefit ratio. However, more intensive strategies, still adapted to socio-economic conditions, are required for advanced stages 3 and 4.
Co-morbidities introduce confounding variables into investigational protocols and complicate both diagnosis and management of children with malignant solid tumours. Such patients who are coincidentally HIV infected and who also have pulmonary or abdominal tuberculosis pose a particular challenge.
The purpose of this report is to describe the diagnostic and management difficulties encountered in a small cadre of 18 HIV-infected children with solid tumours presenting to the Department of Paediatric Surgery.
A retrospective descriptive study of HIV-infected children with malignant solid tumours.
18 HIV-infected children were identified with a variety of primary tumours. 11 children had confirmed pulmonary or abdominal tuberculosis and in 4 the diagnosis was suspected. Neoadjuvant chemotherapy was used when possible to provide a window of opportunity to investigate co-morbidity and improve health status, inter alia, improving the patients' nutritional status. FDG-PET scanning proved unreliable in discriminating between malignant and inflammatory pathology. Overall survival was 33%.
The coincidence of malignancy, HIV infection and tuberculosis carries a high mortality independent of the primary tumour type.
Tumors arising from the soft tissues are uncommon in children, accounting for about 6% of all childhood malignancies. More than half (53%) of these originate from the striated muscles and are called rhabdomyosarcomas (RMS) the remaining are nonrhabdomyosarcoma soft tissue sarcomas (NRSTS). Almost two-thirds of RMS cases are diagnosed in children < 6 years of age. They can arise at varied locations like the head and neck region, genitourinary tract, extremities, trunk and retroperitoneum. Pathologically RMS is now classified as superior, intermediate and poor outcome histologies. For stratification of treatment and also comparison of results the RMS are now staged both by the clinical grouping and the TNM staging systems. The ultimate outcome depends on the site, extent of disease and histology. Currently, approximately 70% of the patients survive for 5 years or more and are probably cured. This is credited to the use of multi-modal, risk-adapted therapy, refinements in tumor grouping and better supportive care which has emerged out of cooperative studies like Intergroup Rhabdomyosarcoma Study (IRS) and the International Society of Pediatric Oncology studies (SIOP). The treatment involves chemotherapy, radiotherapy and organ/function preserving surgery. The gold standard chemotherapy is still vincristine, actinomycin D and cyclophosphamide (VAC) regime with high doses of intensity bone marrow rescue with colony stimulating factors. The NRSTS are rare and of heterogenous histologies and so it has been difficult to arrive at a treatment strategy for these. What is definitely understood is that these are usually immature and poorly differentiated tumors that respond poorly to chemotherapy and so surgical resection forms the mainstay of treatment with adjuvant radiotherapy and chemotherapy to prevent local recurrences. In all likelihood, the molecular analysis of RMS will further refine current classification schemes and knowledge of genetic features of the tumors will significantly improve the ability of investigators to identify patients at lower or higher risk of treatment failures, thus paving the way for advances in risk-based therapy.
Background:
Childhood-cancer survival is dismal in most low-income countries, but initiatives for treating paediatric cancer have substantially improved care in some of these countries. The My Child Matters programme was launched to fund projects aimed at controlling paediatric cancer in low-income and mid-income countries. We aimed to assess baseline status of paediatric cancer care in ten countries that were receiving support (Bangladesh, Egypt, Honduras, Morocco, the Philippines, Senegal, Tanzania, Ukraine, Venezuela, and Vietnam).
Methods:
Between Sept 5, 2005, and May 26, 2006, qualitative face-to-face interviews with clinicians, hospital managers, health officials, and other health-care professionals were done by a multidisciplinary public-health research company as a field survey. Estimates of expected numbers of patients with paediatric cancer from population-based data were used to project the number of current and future patients for comparison with survey-based data. 5-year survival was postulated on the basis of the findings of the interviews. Data from the field survey were statistically compared with demographic, health, and socioeconomic data from global health organisations. The main outcomes were to assess baseline status of paediatric cancer care in the countries and postulated 5-year survival.
Findings:
The baseline status of paediatric oncology care varied substantially between the surveyed countries. The number of patients reportedly receiving medical care (obtained from survey data) differed markedly from that predicted by population-based incidence data. Management of paediatric cancer and access to care were poor or deficient (ie, nonexistent, unavailable, or inconsistent access for most children with cancer) in seven of the ten countries surveyed, and accurate baseline data on incidence and outcome were very sparse. Postulated 5-year survival were: 5-10% in Bangladesh, the Philippines, Senegal, Tanzania, and Vietnam; 30% in Morocco; and 40-60% in Egypt, Honduras, Ukraine, and Venezuela. Postulated 5-year survival was directly proportional to several health indicators (per capita annual total health-care expenditure [Pearson's r(2)=0.760, p=0.001], per capita gross domestic product [r(2)=0.603, p=0.008], per capita gross national income [r(2)=0.572, p=0.011], number of physicians [r(2)=0.560, p=0.013] and nurses [r(2)=0.506, p=0.032] per 1000 population, and most significantly, annual government health-care expenditure per capita [r(2)=0.882, p<0.0001]).
Interpretation:
Detailed surveys can provide useful data for baseline assessment of the status of paediatric oncology, but cannot substitute for national cancer registration. Alliances between public, private, and international agencies might rapidly improve the outcome of children with cancer in these countries.
Malnutrition at diagnosis is found in 10-50% of children with cancer in industrialized countries. In developing countries a large proportion of the normal paediatric population is undernourished and children with cancer often present late with advanced disease. Therefore it would be expected that many children with cancer are malnourished at admission. Malnutrition is associated with more severe chemotherapy toxicity and infectious complications.
All new paediatric oncology patients admitted in the Queen Elizabeth Central Hospital, Blantyre, Malawi between 1, January 2007 and 1, January 2008 were included. We documented age, clinical diagnosis, HIV status, weight, height, mid-upper-arm-circumference (MUAC) and triceps skinfold (TSF), and calculated arm muscle area (AMA). Nutritional data were compared with the 1978 NCHS growth curves.
Of 128 children, 70 (55.1%) had an AMA for age <5th percentile and 76 (59.3%) had a TSF and MUAC below the 5th percentile, both parameters indicating acute malnutrition. Fifty seven patients (44.5%) had a height for age <-2 SD (indicative of stunting), and 22 patients (17.2%) had a weight for height (WFH) <-2 SD.
Arm anthropometry shows that more than half of Malawian children with cancer are severely acutely malnourished at diagnosis. WFH, in children with large tumour masses, is less sensitive than arm anthropometry in detecting acute malnutrition. Forty-five percent of paediatric oncology patients in Malawi are stunted, making interpretation of weight for age (WFA) very difficult.
Childhood cancer is fast becoming an important pediatric problem in several parts of Africa, with the progressive decline of infectious and nutritional diseases. The present study analyzes 1325 Nigerian children with neoplasms diagnosed over a 13-year period (1960-1972). It accounted for 12.5% of all tumors registered in our Cancer Registery over the period of study. The commonest type of malignant tumor in the Nigerian child was solid lymphoma, of which Burkitt's tumor predominated. The overall pattern of tumors in these children was strikingly different in certain aspects from what obtains in the Caucasian child. When four main groups of tumors were considered, the ratio frequency pattern in Nigerian children was one of high lymphoma, high orbital, low leukemia, low glioma type. In the Caucasian child, the ratio frequency pattern is usually one of high leukemia, high glioma, low lymphoma, low orbital type. The observed differences in frequencies of childhood tumors between population groups require further studies.
The pattern of childhood malignancies in the developing countries of Africa is characterized by a high incidence of lymphoma and a low incidence of leukaemia. The converse is the case in the developed countries of Europe and North America. A high incidence of lymphoma with low incidence of leukaemia has been associated with poor living standards. The clinical records of 257 children admitted with malignant disease to the University of Nigeria Teaching Hospital, Enugu between January 1978 and December 1982 were studied retrospectively to determine the pattern of malignant diseases amongst these children. The lymphomas were the commonest tumours, constituting nearly 40% of the total, followed by Wilm's tumour (14.0%), leukaemia (12.9%) and CNS tumours (9.7%). However, the incidence of lymphoma was lower while the incidence of leukaemia was higher than in previous reports from other parts of Nigeria and Africa. The rarity of Ewing's tumour, histocytosis-X and testicular tumours in African children is confirmed in the present study.
Data from the cancer register in the Department of Child Health, Korle Bu Teaching Hospital Accra, Ghana was reviewed in order to document the pattern of malignancies seen in children. Out of a total of 15,200 admissions over a 40 month period there were 254 malignancies diagnosed constituting 1.67% of all admission. Lymphoma was the commonest tumour constituting 67% with Burkitt's Lymphoma being the commonest subtype. This was followed by Retinoblastoma (8.6%), Leukaemia (8.2%) and Wilms tumour (7.8%). This trend is similar to the picture seen in other developing countries in Africa where there is a high incidence of lymphoma and a low incidence of leukaemia, the converse being the case in Europe and North America.
Despite the high prevalence of infection by the Human Immunodeficiency Virus (HIV) in South Africa, information on its association with cancer is sparse. Our study was carried out to examine the relationship between HIV and a number of cancer types or sites that are common in South Africa. A total of 4,883 subjects, presenting with a cancer or cardiovascular disease at the 3 tertiary referral hospitals in Johannesburg, were interviewed and had blood tested for HIV. Odds ratios associated with HIV infection were calculated by using unconditional logistic regression models for 16 major cancer types where data was available for 50 or more patients. In the comparison group, the prevalence of HIV infection was 8.3% in males and 9.1% in females. Significant excess risks associated with HIV infection were found for Kaposi's sarcoma (OR=21.9, 95% CI=12.5-38.6), non-Hodgkin lymphoma (OR=5.0, 95%CI=2.7-9.5), vulval cancer (OR=4.8, 95%CI= 1.9-12.2) and cervical cancer (OR= 1.6, 95%CI= 1.1-2.3) but not for any of the other major cancer types examined, including Hodgkin disease, multiple myeloma and lung cancer. In Johannesburg, South Africa, HIV infection was associated with significantly increased risks of Kaposi's sarcoma, non-Hodgkin lymphoma and cancers of the cervix and the vulva. The relative risks for Kaposi's sarcoma and non-Hodgkin lymphoma associated with HIV infection were substantially lower than those found in the West.
With 90% of world children living in developing countries and a rising cancer incidence, the third world bears the greatest burden of pediatric cancer. Pediatric cancers today are highly treatable, but 80% of children with malignancies die because they live in the developing countries where access to medical care is inadequate. Pediatric cancer care is expensive and available at only a few centers, which deal with excessive patient numbers and are staffed by inadequate numbers of physicians and nurses. There are marked geographic variations in incidences and presentations observed in the spectrum of pediatric malignancies. Initiatives to improve cancer care include setting up worldwide pediatric care units; establishing standard guidelines for treating patients; undertaking research and lobbying international organizations like the World Health Organization, United Nations Children's Emergency Fund (UNICEF), International Union Against Cancer (UICC), and the International Society of Pediatric Oncology (SIOP); to make chemotherapy, supportive care drugs, and opioids for palliation uniformly available. New outreach training programs would alleviate manpower shortages by linking centers from the two world regions for training and facilitate collaboration with international organizations.
To review the clinical presentation and management of children with nephroplastoma and the factors influencing the outcome at Kenyatta National Referral and Teaching Hospital (KNH).
This was a retrospective case series study based on secondary data accumulated between 1990 and 1996.
The relevant data were extracted from records of all children aged 12 years and below, admitted for cancer at KNH, Nairobi.
Out of 803 children with cancer, 71 (8.8%) had histologically proven nephroblastoma. At presentation, 1.5% were in stage I, 13.2% stage II, 36.8% stage III, 41.2% stage IV and 7.4% stage V. Eighty five per cent presented with stage III-V disease. Ninety five per cent had nepherectomy and received chemotherapy. Radiotherapy was given to 50.7% of the patients. Nine patients died before commencement of chemotherapy, two of whom died in the immediate post-operative period. The median duration between admission and surgery was 41 days. Pre-operative chemotherapy was given to 42% of the patients. Approximately 25.5% of the patients received little or no induction chemotherapy due to unavailability of drugs while only 2.8% received the prescribed maintenance treatment with the remainder getting erratic or no treatment. Overall, only 34.7% remained disease free two years from time of diagnosis.
Late presentation, poor availability of cytotoxic drugs and frequent treatment interruptions for various reasons have contributed to the poor outcome of nephroblastoma in Kenya.
To determine the frequency distribution of malignant tumours of childhood aged 0-14 years.
A retrospective histopathological review of 541 cases of malignant tumours of childhood.
Cancer Registry, Department of Histopathology, Muhimbili Medical Centre, Dar es Salaam, Tanzania.
Malignant tumours of childhood accounted for 11.5% of all malignant tumours recorded in the cancer registry. Commonest malignant tumours were lymphomas (53%), of which 31.4% were Burkitt's lymphoma (BL), 14.9% Hodgkin's disease (HD), and 6.6% Non-Hodgkin's lymphoma (NHL). Others were retinoblastoma (12.9%), carcinoma (9%), nephroblastoma and soft tissue sarcoma each 6.7% and Kaposi's sarcoma (5.9%). Bone, germ cell and nervous system tumours were rare.
These findings may act as a basis for which further studies on malignant tumours of childhood in Tanzania could be carried out.
Child survival efforts can be effective only if they are based on accurate information about causes of deaths. Here, we report on a 4-year effort by WHO to improve the accuracy of this information.
WHO established the external Child Health Epidemiology Reference Group (CHERG) in 2001 to develop estimates of the proportion of deaths in children younger than age 5 years attributable to pneumonia, diarrhoea, malaria, measles, and the major causes of death in the first 28 days of life. Various methods, including single-cause and multi-cause proportionate mortality models, were used. The role of undernutrition as an underlying cause of death was estimated in collaboration with CHERG.
In 2000-03, six causes accounted for 73% of the 10.6 million yearly deaths in children younger than age 5 years: pneumonia (19%), diarrhoea (18%), malaria (8%), neonatal pneumonia or sepsis (10%), preterm delivery (10%), and asphyxia at birth (8%). The four communicable disease categories account for more than half (54%) of all child deaths. The greatest communicable disease killers are similar in all WHO regions with the exception of malaria; 94% of global deaths attributable to this disease occur in the Africa region. Undernutrition is an underlying cause of 53% of all deaths in children younger than age 5 years.
Achievement of the millennium development goal of reducing child mortality by two-thirds from the 1990 rate will depend on renewed efforts to prevent and control pneumonia, diarrhoea, and undernutrition in all WHO regions, and malaria in the Africa region. In all regions, deaths in the neonatal period, primarily due to preterm delivery, sepsis or pneumonia, and birth asphyxia should also be addressed. These estimates of the causes of child deaths should be used to guide public-health policies and programmes.
Juvenile rhabdomyosarcoma (JRMS) though rare, is the most common soft tissue malignancy of childhood that exhibits bimodal age distribution pattern.
Review the pattern of JRMS in Port Harcourt based on sex, age, tumor sites and histologic types.
A retrospective descriptive study.
The study was conducted in the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Nigeria over 12 years.
We studied 21 juvenile rhabdomyosarcomas during the period under review. The hematoxylin and eosin stained histological slides were retrieved and reviewed to confirm previous diagnosis and histologically typed for the study. The sex, age and tumor sites were retrieved from the histology consultation forms,
These tumors were diagnosed from patients aged 0 - 20 years with the highest frequencies (38.1% each) occurring at 0 - 5 and 16 - 20 years age group. Males are more affected with a ratio 3.2:1. The trunk is the most common site of occurrence (47.7%) of which the genitourinary system is the most affected (23.8%) in this study. The most common histologic type is the embryonal rhabdomyosarcoma (71.5%). Alveolar rhabdomyosarcoma accounted for (19%) and the sarcoma botryoides (9.5%).
The age of presentation and anatomic sites of the tumor are important in the diagnosis of these tumors. If a tumor histologically shows as small round blue cells, rhabdomyosarcoma should be considered as a differential diagnosis.
Soft tissue sarcomas are a complex heterogeneous group of tumours that often cause a diagnostic problem. Special stains are often employed for further differentiation of these tumours. As a group, soft tissue sarcomas are not uncommon as previously believed.
To undertake a ten year retrospective study of soft tissue sarcomas in a Nigerian Teaching Hospital and to also discuss the pathology of the disease.
The study consisted of all records of histologically confirmed cases of soft tissue sarcomas from 1994 2003, seen at JUTH. The slides were retrieved and read separately by two pathologists. Special stain such as Reticulin, PTAH, Oilred O, were used to demonstrate basement membrane, muscle striation and lipids respectively. These aided confirmation of the diagnosis. Information extracted from patients' records included age, site of lesion and sex.
A total number of 266 cases of soft tissue sarcomas were recorded out of 2353 histologically confirmed cancers. These accounted for 11.3% of all cancers. One hundred and eighty three occurred in males and 83 in females, with male, female ratio of 2:1. Kaposi sarcoma (KS), Rhabdomyosarcoma (RMS), Malignant Fibrous Histiocytoma (MFH), and Fibrosarcoma (FS) were the commonest histological subtypes accounting for 69 (25.9%), 63 (23.7%), 56 (21.1%) and 49 (18.4%) respectively; with Rhabdomyosarcoma occurring more in paediatric and adolescent age groups, while the rest subtypes were more prevalent in adults. The commonest sites affected were leg/foot 71 (26.7%), head/neck 68 (25.6%) and thigh 50 (19%).
Soft tissue sarcomas constituted a significant proportion of cancers in our centre and are not uncommon as previously reported in the literature.
Childhood Wilms' tumour or nephroblastoma represents one of the challenges for paediatric oncologists in developing countries.
To review the clinical characteristics and outcome of management of childhood nephroblastoma in North- Central Nigeria.
The clinical, operative and histological records of children aged 15 years and below, that were managed for Wilms' tumour at the Jos University Teaching Hospital between 1998 and 2005 were retrospectively reviewed.
There were 32 children (M:F=1.9:1) with histologically confirmed nephroblastoma seen over the 7-year period. Their median(range) age was 4 (3-15) years. The patients invariably presented with a palpable abdominal mass, but haematuria was exceptional. The neoplasm tended to be larger on average than those reported previously among Caucasian children. At presentation, 1 (3.1%) patient was in stage I, 8 (25%) stage II, 11 (34.4%) stage III and 12 (37.5%) stage IV. About 72% of the patients presented with stage III-IV disease. Poorly differentiated neoplasm was more common in male than in female patients. Nephrectomy and chemotherapy were the modality of treatment. Fifteen (46.9%) of the patients received little or no induction chemotherapy due to unavailability of drugs while only 12 (37.5%) received the prescribed maintenance treatment with the remainder getting erratic or no treatment. Overall, only 43.8% were alive between 1 and 9 months (median: 6 months) of follow-up period, but there was no survivor at two years after treatment.
Childhood nephroblastoma has a high mortality rate in north central Nigeria because of late clinical presentation with advanced disease, poor availability of cytotoxic drugs and frequent interruptions in treatment and inadequate follow-up.
Five years activity in pediatric oncology unit at Treichville teaching hospital in Abidjan, Cote d'Ivoire [in French]
- Couitchéré L M Orega
- Oulai
- Sm
Couitchéré L, Orega M, Oulai SM, et al. Five years activity in pediatric oncology unit at Treichville teaching hospital in Abidjan, Cote d'Ivoire [in French]. Archives de Pediatrie 2004;11:257-60.
Rhabdomyosarcoma of little girl Urogénital sinus: A 4 cases report
- R Bankole
- I Adoubi
- Konenandiolo
Bankole R, Adoubi I, KoneNandiolo, et al. Rhabdomyosarcoma of little girl Urogénital sinus: A 4 cases report. Oncol Clin Afr 2007;3: 25-7.
Alexandria Regional Cancer Registry
- R N Bedwani
- A Zaki
- H H Abuseif
Rhabdomyosarcoma of little girl Urogénital sinus: A 4 cases report
- Bankole
20) voir livre: Soft tissue sarcoma
- Kaposi