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Wismayer R, Kiwanuka J, Wabinga H, Odida M. Dietary risk factors for colorectal cancer in Uganda: a case-control study. BMC Nutr 2024; 10:88. [PMID: 38898481 PMCID: PMC11186163 DOI: 10.1186/s40795-024-00894-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 06/05/2024] [Indexed: 06/21/2024] Open
Abstract
INTRODUCTION Low-income countries in East Africa have a lower incidence of colorectal cancer (CRC) than high-income countries; however, the incidence has steadily increased in the last few decades. In Uganda, the extent to which genetic and environmental factors, particularly dietary factors, contribute to the aetiology of CRC is unclear. Therefore, the objective of our study was to determine the relationship between dietary factors and CRC in Uganda. METHODS We conducted a case-control study and recruited 128 cases and 256 controls, matched for age (± 5 years) and sex. Data regarding the frequency of consumption of the dietary factors were obtained from all the participants using an interview-based questionnaire. The potential dietary risk factors and protective factors evaluated included the type and frequency of meat consumed and the type and frequency of high-fibre foods consumed. The frequency was either 4 or more times/week, 2-3 times/week, once/week or never. Conditional logistic regression analyses were used to determine the odds ratios associated with the different risk and protective factors. RESULTS The median age (IQR) for the case participants was 55.5 (43-67.5) years, and that of the control participants was 54 (42-65) years. The male-to-female ratio was 1:1 for all the participants. Factors significantly associated with CRC cases included:- the consumption of boiled beef 2-3 times/week (aOR:3.24; 95% CI: 1.08-9.69; p < 0.035). Consumption of high-fibre foods, including:- millet for ≥ 4 times/week (aOR: 0.23; 95% CI: 0.09-0.62; p = 0.003)), spinach for ≥ 4 times/week (aOR:0.32; 95% CI: 0.11-0.97; p = 0.043), and potatoes 2-3 times/week (aOR: 0.30; 95% CI: 0.09-0.97; p = 0.044), were protective against CRC. Boiled cassava showed a tendency to reduce the likelihood of CRC when consumed ≥ 4 times/week (aOR:0.38; 95% CI: 0.12-1.18) however this did not reach statistical significance (p = 0.093). CONCLUSIONS The consumption of boiled beef increases the risk of CRC, while the intake of high-fibre foods may reduce the risk of CRC among Ugandans. We recommend nutritional educational programmes to increase public awareness regarding the protective role of a high-fibre diet and to limit the intake of cooked meat in our Ugandan population.
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Affiliation(s)
- Richard Wismayer
- Department of Surgery, Masaka Regional Referral Hospital, Masaka, Uganda.
- Department of Surgery, Faculty of Health Sciences, Equator University for Science and Technology, Masaka, Uganda.
- Department of Surgery, Faculty of Health Sciences, Habib Medical School, IUIU University, Kampala, Uganda.
- Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Julius Kiwanuka
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Henry Wabinga
- Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Michael Odida
- Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Pathology, Faculty of Medicine, Gulu University, Gulu, Uganda
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Selemane C, Ferro J, Lorenzoni C, Carrilho C, Ismail MR, Parkin M, Santos LL. Is the incidence rate of colorectal cancer increasing in Mozambique? Ecancermedicalscience 2024; 18:1693. [PMID: 38774567 PMCID: PMC11108046 DOI: 10.3332/ecancer.2024.1693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Indexed: 05/24/2024] Open
Abstract
Background Colorectal cancer (CRC) is a significant global health concern, ranking as the third most common cancer and the second leading cause of cancer-related deaths. However, in Africa, CRC is the fifth most common invasive malignancy. Limited data hinder our understanding of the evolving burden of CRC in sub-Saharan Africa. This study explores CRC trends in Mozambique, utilising data from population-based oncological registries. Methods CRC data were gathered from Beira and Maputo population-based cancer registries, along with supplementary information from pathology-based and hospital-based registries. Comparative analyses were performed across different time periods, focusing on trends and epidemiological characteristics. Results Incidence rates of CRC in Maputo and Beira were relatively low historically. However, data from recent years showed an increase, especially in age groups above 50. Analyses from pathology-based and hospital-based registries affirmed the rising trend. The age-standardised incidence rate in Maputo (2015-2017) was 3.17 for males and 2.55 for females. Beira exhibited increasing rates between 2009 and 2020, particularly in individuals aged 50 and above. Conclusion The study reveals an emerging burden of CRC in Mozambique, challenging the perception of low incidence. The rising trend underscores the necessity for tailored interventions, emphasizing early diagnosis, preventive strategies, and investments in healthcare infrastructure to address the increasing CRC burden in the region.
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Affiliation(s)
- Carlos Selemane
- Department of Surgery, Maputo Central Hospital, Av Agostinho Neto n° 164, Maputo 1164, Mozambique
| | - Josefo Ferro
- Department of Pathology, Beira Central Hospital, Av Mártires da Revolução nº 727, Beira, Mozambique
| | - Cesaltina Lorenzoni
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, and Maputo Central Hospital, Av Agostinho Neto n° 164, Maputo 1164, Mozambique
| | - Carla Carrilho
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, and Maputo Central Hospital, Av Agostinho Neto n° 164, Maputo 1164, Mozambique
| | - Mamudo Rafik Ismail
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, and Maputo Central Hospital, Av Agostinho Neto n° 164, Maputo 1164, Mozambique
| | - Max Parkin
- African Cancer Registry Network, Prama House, 267 Banbury Road, Oxford OX2 7HT, UK
| | - Lúcio Lara Santos
- Experimental Pathology and Therapeutics Research Group and Surgical Oncology Department, Portuguese Institute of Oncology, Dr António Bernardino de Almeida Street, Porto 4200-072, Portugal
- School of Medicine and Biomedical Sciences, Fernando Pessoa University, Av Fernando Pessoa 150, S. Gondomar 4420-096, Portugal
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Schmit N, Kaur J, Aglago EK. Mosquito Bed Net Use and Burkitt Lymphoma Incidence in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e247351. [PMID: 38635267 DOI: 10.1001/jamanetworkopen.2024.7351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Importance Burkitt lymphoma (BL) is one of the most common childhood cancers in sub-Saharan Africa and is etiologically linked to malaria. However, evidence for an effect of malaria interventions on BL is limited. Objective To investigate the potential population-level association between large-scale rollout of insecticide-treated bed nets (ITNs) in sub-Saharan Africa in the 2000s and BL incidence. Data Sources In this systematic review and meta-analysis, a search was conducted in the Embase, Global Health, and Medline databases and in cancer registry publications between January 1, 1990, and February 27, 2023. Study Selection All epidemiologic studies on BL incidence rates in children and adolescents aged 0 to 15 years in sub-Saharan African countries where malaria is endemic were identified by 2 reviewers blinded to each other's decision. Data Extraction and Synthesis The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. Data were extracted independently by 2 reviewers, and quality was scored based on 3 predefined criteria: data collection, case ascertainment, and calculation of person-time at risk. Main Outcomes and Measures Incidence rates of BL during childhood and mean ITN use in the population. Data were analyzed using a random-effects negative binomial regression model. Results Of 2333 studies meeting selection criteria, 23 comprising 66 data points on BL incidence were included based on 5226 BL cases from locations with large-scale ITN use in 17 countries. Rates of BL were 44% (95% CI, 12%-64%) lower in the period after ITN introduction compared with before. The adjusted pooled incidence rates of BL were 1.36 (95% CI, 0.88-2.10) and 0.76 (95% CI, 0.50-1.16) per 100 000 person-years before and after introduction of ITNs, respectively. After adjusting for potential confounders, a 1-percentage point increase in mean ITN use in the population in the 10 years before BL data collection was associated with a 2% (95% CI, 1%-4%) reduction in BL incidence. Conclusions and Relevance In this systematic review and meta-analysis, large-scale rollout of ITNs in the 2000s was associated with a reduction in BL burden among children in sub-Saharan Africa. Although published data may not be representative of all incidence rates across sub-Saharan Africa, this study highlights a potential additional benefit of malaria control programs.
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Affiliation(s)
- Nora Schmit
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, United Kingdom
| | - Jeevan Kaur
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Elom K Aglago
- Department of Epidemiology and Biostatistics, Imperial College London, School of Public Health, London, United Kingdom
- Faculty of Science and Technology, University of Kara, Kara, Togo
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Tulsidás S, Fontes F, Brandão M, Lunet N, Carrilho C. Oncology in Mozambique: Overview of the Diagnostic, Treatment, and Research Capacity. Cancers (Basel) 2023; 15:cancers15041163. [PMID: 36831505 PMCID: PMC9953997 DOI: 10.3390/cancers15041163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/30/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023] Open
Abstract
Mozambique is one of the poorest countries worldwide, with nearly two thirds of the population living below the poverty line. Similarly to other less developed countries, there is a weak provision of health care for non-communicable diseases due to competing priorities with infectious diseases. Although the leading causes of death in Mozambique in 2019 were Acquired Immune Deficiency Syndrome/Human Immunodeficiency Virus and other sexually transmitted diseases and respiratory infections and tuberculosis, with increasing urbanization and westernization of lifestyles, deaths attributed to cancer are also on the rise. This review summarizes cancer burden, cancer prevention and screening, cancer care resources, and trends in cancer training and research in Mozambique, providing a background for the development of cancer care policies in the country.
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Affiliation(s)
- Satish Tulsidás
- Serviço de Oncologia Médica, Hospital Central de Maputo, nº 1653 Avenida Eduardo Mondlane, Maputo 1101, Mozambique
- EPIUnit–Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal
| | - Filipa Fontes
- EPIUnit–Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
- Unidade de Investigação em Enfermagem Oncológica, Centro de Investigação do Instituto Português de Oncologia do Porto, Rua Dr António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - Mariana Brandão
- EPIUnit–Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Rue Meylemeersch 90, 1070 Anderlecht, Belgium
| | - Nuno Lunet
- EPIUnit–Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
| | - Carla Carrilho
- Departamento de Patologia, Faculdade de Medicina, Universidade Eduardo Mondlane, Avenida Salvador Allende, nº 702, Maputo 1101, Mozambique
- Serviço de Anatomia Patológica, Hospital Central de Maputo, Avenida Eduardo Mondlane, nº 1653, Maputo 1101, Mozambique
- Correspondence: ; Tel.: +258-823055650
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Rakislova N, Carreras‐Dieguez N, Manzotti C, Saúde O, del Pino M, Chulo L, Rangeiro R, Lovane L, Lorenzoni C, Fernandes F, Rodrigo‐Calvo MT, Diaz‐Mercedes S, Ribera‐Cortada I, Sanfeliu E, del Campo RL, Marimon L, Alós S, Vega N, Pérez FM, Trias I, Carrilho C, Ordi J. Differential etiopathogenic features of vulvar squamous cell carcinomas in sub-Saharan Africa and Europe. Int J Cancer 2023; 152:496-503. [PMID: 36214794 PMCID: PMC10092339 DOI: 10.1002/ijc.34314] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/15/2022] [Accepted: 09/22/2022] [Indexed: 02/01/2023]
Abstract
Two pathways have been described for vulvar squamous cell carcinomas (VSCC), one associated with human papillomavirus (HPV), and the other HPV-independent. We compared the etiopathogenic features of a series of VSCC from Mozambique, a sub-Saharan country with high prevalence of HPV and HIV, with those of Spain, a European country with low prevalence of HPV and HIV. All VSCC diagnosed at the two institutions from January 2018 to December 2020 were included (n = 35 and n = 41, respectively). HPV DNA detection and genotyping, and immunohistochemistry for p16 and p53 were performed. Tumors showing p16 positive staining and/or HPV DNA positivity were considered HPV-associated. 34/35 tumors (97%) from Mozambique and 8/41 (19%) from Spain were HPV-associated (P < .001). Mean age of the patients from Mozambique and Spain was 45 ± 12 and 72 ± 14, respectively (P < .001). No differences were found in terms of HPV genotypes or multiple HPV infection rates. 1/35 tumors (3%) from Mozambique and 29/41 (70%) from Spain showed abnormal p53 immunostaining (P < .001). In contrast with the predominance of HPV-independent VSCC affecting old women in Europe, most VSCC in sub-Saharan Africa are HPV-associated and arise in young women. This data may have important consequences for primary prevention of VSCC worldwide.
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Affiliation(s)
- Natalia Rakislova
- Facultat de Medicina i Ciències de la Salut, c. CasanovaUniversitat de Barcelona (UB)BarcelonaSpain
- Department of Pathology, Hospital Clínic of BarcelonaUniversity of BarcelonaBarcelonaSpain
- Department of Pathology, Barcelona Institute of Global Health (ISGlobal)Hospital Clínic—Universitat de BarcelonaBarcelonaSpain
| | - Nuria Carreras‐Dieguez
- Department of Obstetrics and GynecologyHospital Clínic—Universitat de BarcelonaBarcelonaSpain
| | - Carolina Manzotti
- Department of Pathology, Hospital Clínic of BarcelonaUniversity of BarcelonaBarcelonaSpain
- Department of Pathology, Barcelona Institute of Global Health (ISGlobal)Hospital Clínic—Universitat de BarcelonaBarcelonaSpain
| | - Ofelia Saúde
- Department of PathologyHospital Central de MaputoMaputoMozambique
| | - Marta del Pino
- Department of Obstetrics and GynecologyHospital Clínic—Universitat de BarcelonaBarcelonaSpain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
| | - Laurina Chulo
- Department of PathologyHospital Central de MaputoMaputoMozambique
| | - Ricardina Rangeiro
- Department of Obstetrics and GynecologyHospital Central de MaputoMaputoMozambique
| | - Lucilia Lovane
- Department of PathologyHospital Central de MaputoMaputoMozambique
| | - Cesaltina Lorenzoni
- Department of PathologyHospital Central de MaputoMaputoMozambique
- Department of PathologyUniversidade Eduardo MondlaneMaputoMozambique
| | - Fabiola Fernandes
- Department of PathologyHospital Central de MaputoMaputoMozambique
- Department of PathologyUniversidade Eduardo MondlaneMaputoMozambique
| | | | - Sherley Diaz‐Mercedes
- Department of Pathology, Hospital Clínic of BarcelonaUniversity of BarcelonaBarcelonaSpain
| | | | - Esther Sanfeliu
- Department of Pathology, Hospital Clínic of BarcelonaUniversity of BarcelonaBarcelonaSpain
| | | | - Lorena Marimon
- Department of Pathology, Barcelona Institute of Global Health (ISGlobal)Hospital Clínic—Universitat de BarcelonaBarcelonaSpain
| | - Silvia Alós
- Department of Pathology, Hospital Clínic of BarcelonaUniversity of BarcelonaBarcelonaSpain
| | - Naiara Vega
- Department of Pathology, Hospital Clínic of BarcelonaUniversity of BarcelonaBarcelonaSpain
| | - Francisco M. Pérez
- Department of Pathology, Hospital Clínic of BarcelonaUniversity of BarcelonaBarcelonaSpain
| | - Isabel Trias
- Department of Pathology, Hospital Clínic of BarcelonaUniversity of BarcelonaBarcelonaSpain
| | - Carla Carrilho
- Department of PathologyHospital Central de MaputoMaputoMozambique
- Department of PathologyUniversidade Eduardo MondlaneMaputoMozambique
| | - Jaume Ordi
- Department of Pathology, Hospital Clínic of BarcelonaUniversity of BarcelonaBarcelonaSpain
- Department of Pathology, Barcelona Institute of Global Health (ISGlobal)Hospital Clínic—Universitat de BarcelonaBarcelonaSpain
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Penile Squamous Cell Carcinomas in Sub-Saharan Africa and Europe: Differential Etiopathogenesis. Cancers (Basel) 2022; 14:cancers14215284. [PMID: 36358704 PMCID: PMC9654935 DOI: 10.3390/cancers14215284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 11/27/2022] Open
Abstract
Penile squamous cell carcinomas (PSCC) are classified by the World Health Organization into two categories based on their relationship with the human papillomavirus (HPV): HPV-associated and HPV-independent. We compared a cohort of PSCC from Mozambique, a sub-Saharan country in southeast Africa with a high prevalence of HPV and HIV infection, and Spain, a country in southwestern Europe with a low prevalence of HPV and HIV, to study the distribution of the etiopathogenic categories of these tumors in both sites. A total of 79 PSCC were included in the study (28 from Mozambique and 51 from Spain). All cases underwent HPV-DNA polymerase chain reaction (PCR) testing, genotyping, and immunohistochemistry for p16 and p53. Any PSCC showing either p16 overexpression or HPV-DNA in PCR analysis was considered HPV-associated. Overall, 40/79 (50.6%) tumors were classified as HPV-associated and 39 (49.4%) as HPV-independent. The two sites showed marked differences: 25/28 (89.3%) tumors from Mozambique and only 15/51 (29.4%) from Spain were HPV-associated (p < 0.001). HPV16 was the most frequent HPV type identified in 64.0% (16/25) of the HPV-associated tumors from Mozambique, and 60.0% (9/15) from Spain (p = 0.8). On average, patients from Mozambique were almost two decades younger than those from Spain (mean age 50.9 ± 14.9 and 69.2 ± 13.3, respectively [p < 0.001]). In conclusion, significant etiopathogenic differences between PSCC in Mozambique and Spain were observed, with a remarkably high prevalence of HPV-associated tumors in Mozambique and a relatively low prevalence in Spain. These data may have important consequences for primary prevention of PSCC worldwide.
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Mabunda N, Vieira L, Chelene I, Maueia C, Zicai AF, Duajá A, Chale F, Chambal L, Vubil A, Augusto O. Prevalence of hepatitis B virus and immunity status among healthcare workers in Beira City, Mozambique. PLoS One 2022; 17:e0276283. [PMID: 36240262 PMCID: PMC9565706 DOI: 10.1371/journal.pone.0276283] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 10/03/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) infection can be prevented by vaccination. Exposure to blood or body fluids poses a high risk of transmission of HBV in health care workers (HCWs). This study aimed to determine the prevalence of markers of exposure, susceptibility, and protection to HBV infection in HCWs in Beira, Mozambique. METHODS A cross-sectional study was conducted between June and August 2020 in Beira City, Mozambique, in HCWs based on self-administered questionnaires and blood samples. Plasma samples were tested for HBV surface antigen (HBsAg), antibodies to HBV core antigen (anti-HBc), antibodies to HBsAg (anti-HBs) and HBV viral load (HBV DNA). RESULTS Most of the 315 HCWs in the study were nurses (125; 39.7%). Of the HCWs, 5.1% (16; 95% Confidence Interval (CI): 2.9 to 8.1%) were infected by HBV (HBsAg and/or HBV DNA positive). Occult HBV infection (OBI) (HBV DNA positive and HBsAg negative) was found in 0.3% (1; 95% CI: 0.0 to 1.8%) of participants; 27.9% (88; 95% CI: 23.1 to 33.2%) were susceptible (negative for all markers), 6.3% (20; 95% CI: 3.9 to 9.6) were immune due to natural infection (anti-HBs and anti-HBc positive only), while 60% (189; 95% CI: 54.4 to 65.5) were immune due to vaccination (anti-HBs positive only). CONCLUSION This study showed a high intermediate prevalence of chronic hepatitis B among healthcare workers in Beira City, Central Mozambique, and one-third of healthcare workers were susceptible to HBV infection. There is a need to implement a national hepatitis B screening and vaccination strategy among healthcare workers in Mozambique.
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Affiliation(s)
| | - Lúcia Vieira
- Instituto Nacional de Saúde, Delegação Provincial de Sofala, Beira, Mozambique
- Universidade Católica de Moçambique, Beira, Mozambique
| | | | - Cremildo Maueia
- Instituto Nacional de Saúde, Marracuene, Mozambique
- Division of Medical Virology, Departament of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique
| | | | - Ana Duajá
- Instituto Nacional de Saúde, Delegação Provincial de Sofala, Beira, Mozambique
| | - Falume Chale
- Instituto Nacional de Saúde, Delegação Provincial de Sofala, Beira, Mozambique
| | - Lúcia Chambal
- Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique
- Hospital Central de Maputo, Maputo, Mozambique
| | - Adolfo Vubil
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Orvalho Augusto
- Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique
- Department of Global Health, University of Washington, Seattle, Washington, DC, United States of America
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Musekiwa A, Moyo M, Mohammed M, Matsena-Zingoni Z, Twabi HS, Batidzirai JM, Singini GC, Kgarosi K, Mchunu N, Nevhungoni P, Silinda P, Ekwomadu T, Maposa I. Mapping Evidence on the Burden of Breast, Cervical, and Prostate Cancers in Sub-Saharan Africa: A Scoping Review. Front Public Health 2022; 10:908302. [PMID: 35784211 PMCID: PMC9246362 DOI: 10.3389/fpubh.2022.908302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCancer remains a major public health problem, especially in Sub-Saharan Africa (SSA) where the provision of health care is poor. This scoping review mapped evidence in the literature regarding the burden of cervical, breast and prostate cancers in SSA.MethodsWe conducted this scoping review using the Arksey and O'Malley framework, with five steps: identifying the research question; searching for relevant studies; selecting studies; charting the data; and collating, summarizing, and reporting the data. We performed all the steps independently and resolved disagreements through discussion. We used Endnote software to manage references and the Rayyan software to screen studies.ResultsWe found 138 studies that met our inclusion criteria from 2,751 studies identified through the electronic databases. The majority were retrospective studies of mostly registries and patient files (n = 77, 55.8%), followed by cross-sectional studies (n = 51, 36.9%). We included studies published from 1990 to 2021, with a sharp increase from 2010 to 2021. The quality of studies was overall satisfactory. Most studies were done in South Africa (n = 20) and Nigeria (n = 17). The majority were on cervical cancer (n = 93, 67.4%), followed by breast cancer (67, 48.6%) and the least were on prostate cancer (48, 34.8%). Concerning the burden of cancer, most reported prevalence and incidence. We also found a few studies investigating mortality, disability-adjusted life years (DALYs), and years of life lost (YLL).ConclusionsWe found many retrospective record review cross-sectional studies, mainly in South Africa and Nigeria, reporting the prevalence and incidence of cervical, breast and prostate cancer in SSA. There were a few systematic and scoping reviews. There is a scarcity of cervical, breast and prostate cancer burden studies in several SSA countries. The findings in this study can inform policy on improving the public health systems and therefore reduce cancer incidence and mortality in SSA.
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Affiliation(s)
- Alfred Musekiwa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- *Correspondence: Alfred Musekiwa
| | - Maureen Moyo
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Mohanad Mohammed
- School of Mathematics, Statistics, and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Zvifadzo Matsena-Zingoni
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Jesca Mercy Batidzirai
- School of Mathematics, Statistics, and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | | | - Kabelo Kgarosi
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Nobuhle Mchunu
- School of Mathematics, Statistics, and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | - Portia Nevhungoni
- School of Mathematics, Statistics, and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
- Biostatistics Unit, South African Medical Research Council, Pretoria, South Africa
| | - Patricia Silinda
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Theodora Ekwomadu
- Department of Biological Sciences, Faculty of Natural and Agricultural Sciences, North-West University, Mmabatho, South Africa
| | - Innocent Maposa
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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The Main Patterns in the Trend Change of Stomach Cancer Incidence amongst Selected African Countries. Glob Health Epidemiol Genom 2021; 2021:5065707. [PMID: 35024155 PMCID: PMC8718290 DOI: 10.1155/2021/5065707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/24/2021] [Accepted: 12/15/2021] [Indexed: 11/18/2022] Open
Abstract
Aim. The current study aimed to investigate the trend changes of stomach cancer incidence amongst African countries and identify the main patterns. Methods. The annual reports of stomach cancer incidence rate (per 100,000 people) for males and females in 53 African countries from 1990 to 2016 were maintained from the World Health Organization archive. The growth mixture model was used for fitting the models in Mplus 7.4. The estimated linear trend in each pattern was characterized by intercept (the rate at 1990) and slope (the observed biennial trend changes), and finally, each country was grouped into a cluster with the most similar pattern. Results. Three main patterns for males and two main patterns for females were determined. For males, the first cluster, containing Cape Verde, Central African Republic, and Mauritius, showed a sharp fall, while countries in the second pattern including Algeria, Côte d’Ivoire, Egypt, Gambia, Libya, Malawi, Morocco, Namibia, Nigeria, and Tunisia were categorized in a pattern with a slight decrease, and other 43 countries were in the third pattern with a moderate falling trend. For females, 19 countries including Angola, Botswana, Burundi, Cape Verde, Central African Republic, Congo Republic, Equatorial Guinea, Ethiopia, Gabon, Kenya, Mali, Mauritius, Rwanda, Sao Tome and Principe, Sudan, Swaziland, Uganda, Zambia, and Zimbabwe were categorized in the moderate-to-high falling pattern, but the other 34 countries had a gentle downward pattern. Conclusion. Although most of the observed trends of stomach cancer were falling, only a few countries had experienced a favorable decreasing trend (three countries in male incidence and nineteen countries in female incidence). Therefore, taking effective actions to accelerate the observed falling trends seems necessary.
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10
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Letang E, Rakislova N, Martinez MJ, Carlos Hurtado J, Carrilho C, Bene R, Mandomando I, Quintó L, Nhampossa T, Chicamba V, Luis E, Ismail MR, Fernandes F, Lorenzoni C, Ferreira L, Freire M, Teresa Rodrigo-Calvo M, Guerrero J, Munguambe K, Maixenchs M, Navarro M, Casas I, Marimon L, Ferrando M, Macete E, Lacerda M, Bassat Q, Menéndez C, Ordi J. Minimally Invasive Tissue Sampling: A Tool to Guide Efforts to Reduce AIDS-Related Mortality in Resource-Limited Settings. Clin Infect Dis 2021; 73:S343-S350. [PMID: 34910173 PMCID: PMC8672756 DOI: 10.1093/cid/ciab789] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Available information on the causes of death among people living with human immunodeficiency virus (PLHIV) in low- and middle-income countries (LMICs) remains scarce. We aimed to provide data on causes of death in PLHIV from two LMICs, Brazil and Mozambique, to assess the impact of clinical misdiagnosis on mortality rates and to evaluate the accuracy of minimally invasive tissue sampling (MITS) in determining the cause of death in PLHIV. METHODS We performed coupled MITS and complete autopsy on 164 deceased PLHIV (18 children, 36 maternal deaths, and 110 adults). HIV antibody levels and HIV RNA viral loads were determined from postmortem serum samples. RESULTS Tuberculosis (22.7%), toxoplasmosis (13.9%), bacterial infections (13.9%), and cryptococcosis (10.9%) were the leading causes of death in adults. In maternal deaths, tuberculosis (13.9%), bacterial infections (13.9%), cryptococcosis (11.1%), and cerebral malaria (8.3%) were the most frequent infections, whereas viral infections, particularly cytomegalovirus (38.9%), bacterial infections (27.8%), pneumocystosis (11.1%), and HIV-associated malignant neoplasms (11.1%) were the leading cause among children. Agreement between the MITS and the complete autopsy was 100% in children, 91% in adults, and 78% in maternal deaths. The MITS correctly identified the microorganism causing death in 89% of cases. CONCLUSIONS Postmortem studies provide highly granular data on the causes of death in PLHIV. The inaccuracy of clinical diagnosis may play a significant role in the high mortality rates observed among PLHIV in LMICs. MITS might be helpful in monitoring the causes of death in PLHIV and in highlighting the gaps in the management of the infections.
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Affiliation(s)
- Emilio Letang
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Department of Infectious Diseases, Hospital del Mar, Hospital del Mar Research Institute, Barcelona, Spain
| | - Natalia Rakislova
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, Spain
| | - Miguel J Martinez
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Department of Microbiology, Hospital Clínic, Universitat de Barcelona, Spain
| | - Juan Carlos Hurtado
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Department of Microbiology, Hospital Clínic, Universitat de Barcelona, Spain
| | - Carla Carrilho
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Rosa Bene
- Department of Medicine, Maputo Central Hospital, Maputo, Mozambique
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Llorenç Quintó
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Tacilta Nhampossa
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- Department of Pediatrics, Maputo Central Hospital, Maputo, Mozambique
| | - Valéria Chicamba
- Department of Pediatrics, Maputo Central Hospital, Maputo, Mozambique
| | - Elvira Luis
- Department of Obstetrics and Gynecology, Maputo Central Hospital, Maputo, Mozambique
| | - Mamudo R Ismail
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Fabiola Fernandes
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Cesaltina Lorenzoni
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Luiz Ferreira
- Fundação de Medicina Tropical Dr. Heitor Viera Dourado, Manaus, Amazonas, Brazil
| | - Monique Freire
- Fundação de Medicina Tropical Dr. Heitor Viera Dourado, Manaus, Amazonas, Brazil
- Fundação Centro de Controle de Oncologia do Amazonas, Manaus, Amazonas, Brazil
| | | | - José Guerrero
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, Spain
| | - Khátia Munguambe
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Maria Maixenchs
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Mireia Navarro
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Department of Microbiology, Hospital Clínic, Universitat de Barcelona, Spain
| | - Isaac Casas
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Department of Microbiology, Hospital Clínic, Universitat de Barcelona, Spain
| | - Lorena Marimon
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Melania Ferrando
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Eusebio Macete
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Marcus Lacerda
- Fundação de Medicina Tropical Dr. Heitor Viera Dourado, Manaus, Amazonas, Brazil
| | - Quique Bassat
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Clara Menéndez
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Jaume Ordi
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, Spain
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11
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Ismail MR, Noormahomed EV, Lawicki S, Eichbaum Q. Survey of Clinical and Anatomic Pathology Laboratory Infrastructure in Mozambique. Am J Clin Pathol 2021; 156:810-817. [PMID: 33940599 DOI: 10.1093/ajcp/aqab026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Pathology services are limited in most areas of sub-Saharan Africa. This study's aim was to survey anatomic and clinical pathology services and laboratory infrastructure in Mozambique. METHODS A survey was conducted from October-December 2018 across the four central hospitals of Mozambique to determine infrastructure and pathology services available. RESULTS Most laboratory/pathology services in Mozambique are limited to the four central hospitals. Only 14 pathologists practice in the country despite a population of 29.5 million for the world's fifth worst workforce/population ratio. Approximately 35,000 anatomic pathology specimens are evaluated annually. Standard services across chemistry, hematology, microbiology, and blood bank are available at the four central hospitals. Esoteric laboratory testing and immunohistochemistry are generally only available in Maputo. CONCLUSIONS While most pathology services are available in Mozambique, many are available only at the Maputo laboratory. Expansion of pathology services and infrastructure will improve provision of effective and efficient health care as access to timely and accurate clinical diagnoses increases in Mozambique.
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Affiliation(s)
- Mamudo R Ismail
- Pathology Department, Faculty of Medicine, Eduardo Mondlane University, Central Hospital of Maputo, Maputo, Mozambique
| | - Emília V Noormahomed
- Department of Microbiology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Department of Medicine, Infectious Disease Division, University of California, San Diego, CA, USA
- Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
| | - Shaun Lawicki
- Department of Pathology, Louisiana State University School of Medicine, Baton Rouge, LA, USA
- Department of Pathology, University Medical Center New Orleans, New Orleans, LA, USA
| | - Quentin Eichbaum
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN, USA
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12
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Lyimo EP, Rumisha SF, Mremi IR, Mangu CD, Kishamawe C, Chiduo MG, Matemba LE, Bwana VM, Massawe IS, Mboera LEG. Cancer Mortality Patterns in Tanzania: A Retrospective Hospital-Based Study, 2006-2015. JCO Glob Oncol 2021; 6:224-232. [PMID: 32073912 PMCID: PMC7051795 DOI: 10.1200/jgo.19.00270] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE This retrospective study sought to determine the type, burden, and pattern of cancer deaths in public hospitals in Tanzania from 2006 to 2015. METHODS This study analyzed data on cancer mortality in 39 hospitals in Tanzania. Data on the age and sex of the deceased and type of cancer were extracted from hospital death registers and report forms. Cancer types were grouped according to the 10th revision of the International Classification of Diseases. Age-standardized mortality rates and cancer mortality patterns were analyzed. A χ2 test was used to examine the association between common cancers and selected covariates. RESULTS A total of 12,621 cancer-related deaths occurred during the 10-year period, which translates to an age-standardized hospital-based mortality rate of 47.8 per 100,000 population. Overall, the number of deaths was notably higher (56.5%) among individuals in the 15- to 59-year-old age category and disproportionately higher among females than males (P = .0017). Cancers of the cervix, esophagus, and liver were the 3 major causes of death across all study hospitals in Tanzania. Cancers of the cervix, esophagus, and liver were the largest contributors to mortality burden among females. Among males, cancers of the esophagus, liver, and prostate were the leading cause of mortality. CONCLUSION There is an increasing trend in cancer mortality over recent years in Tanzania, which differs with respect to age, sex, and geographic zones. These findings provide a basis for additional studies to ascertain incidence rates and survival probabilities, and highlight the need to strengthen awareness campaigns for early detection, access to care, and improved diagnostic capabilities.
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Affiliation(s)
- Emanuel P Lyimo
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania
| | - Susan F Rumisha
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania.,Southern African Centre for Infectious Disease Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Irene R Mremi
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania.,Southern African Centre for Infectious Disease Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Chacha D Mangu
- National Institute for Medical Research, Mbeya Research Centre, Mbeya, Tanzania
| | - Coleman Kishamawe
- National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania
| | - Mercy G Chiduo
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania
| | - Lucas E Matemba
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania.,Malaria Atlas Project, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Veneranda M Bwana
- National Institute for Medical Research, Amani Research Centre, Muheza, Tanzania
| | - Isolide S Massawe
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania
| | - Leonard E G Mboera
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania.,Southern African Centre for Infectious Disease Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
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13
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Lorenzoni CF, Ferro J, Carrilho C, Colombet M, Parkin DM. Cancer in Mozambique: Results from two population-based cancer registries. Int J Cancer 2020; 147:1629-1637. [PMID: 32142162 DOI: 10.1002/ijc.32953] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/06/2020] [Accepted: 02/14/2020] [Indexed: 01/24/2023]
Abstract
Results from two recently established population-based registries in Mozambique are reported: Beira in the central region (2014-2017) and Maputo, the capital city, in the South (2015-2017). The results are compared to those from Maputo (Lourenço Marques at the time) in 1956-1960 (appearing Cancer Incidence in Five Continents Vol 1), and with estimated incidence rates from other regions of Africa. The elevated prevalence of HIV infection (12.6% of adults in 2018) results in high rates for HIV-related cancers, and the greater prevalence in central Mozambique, compared to the south, largely explains the rather higher rates of Kaposi sarcoma (males), non-Hodgkin lymphoma, squamous cell carcinoma of conjunctiva and cervical cancer in Beira than in Maputo. Burkitt lymphoma is the commonest childhood cancer in Beira, with high rates typical of East Africa, while the low rates in Maputo are more typical of Southern Africa. Overall, 44% of cancers in Maputo and 52% in Beira are estimated to be caused by infectious agents. In the last 60 years, cancers more frequent in developed countries, such as breast and prostate, are emerging in Mozambique. The incidence of the former in Maputo has increased fivefold since 1956-1960, that of prostate cancer 2.5-fold, and that of large bowel cancer doubled. The results reported here were used to make national estimates of incidence, mortality and prevalence in Globocan 2018. The two registries were important in providing data to establish priority actions in the National Cancer Control Plan, and are a valuable resource to monitor progress toward its goals.
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Affiliation(s)
- Cesaltina F Lorenzoni
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo Central Hospital, Maputo, Mozambique
| | - Josefo Ferro
- Department of Pathology, Hospital Central da Beira, Beira, Mozambique
| | - Carla Carrilho
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo Central Hospital, Maputo, Mozambique
| | - Murielle Colombet
- Section of Cancer Information, International Agency for Research on Cancer, Lyon, France
| | - Donald M Parkin
- Section of Cancer Information, International Agency for Research on Cancer, Lyon, France
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- African Cancer Registry Network, Oxford, United Kingdom
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14
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Menendez YA, Cambaco O, Mindú C, Nhantumbo H, Uamusse T, Matsinhe G, Matsinhe B, Manjate RM, Bardají A, Menendez C, Sevene E, Munguambe K. Lay knowledge of cervical cancer in Manhiça district, Mozambique: a qualitative study. Reprod Health 2020; 17:130. [PMID: 32831101 PMCID: PMC7444028 DOI: 10.1186/s12978-020-00980-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 08/10/2020] [Indexed: 11/16/2022] Open
Abstract
Background Mozambique has one of the highest cervical cancer incidence rates in the world. Health interventions are still being conceived solely from a non-communicable disease standpoint despite that it is also a sexual and reproductive health problem. The objective of this study was to assess the extent to which lay perceptions of cervical cancer align with biomedical knowledge from the standpoint of sexual and reproductive health. Methods 10 focus group discussions were carried out with 10 target groups in Manhiça. The target groups were diverse in terms of age, sex, educational level and occupation. There were a total of 116 participants. The focus groups discussions were applied to obtain verbal information and trigger debates around beliefs and attitudes about cervical cancer as well as to explore notions of transmission and aetiology of the disease. The discussions were recorded for later transcription and analysis, following a combination of content and thematic analysis. Results Participants were familiar with the biomedical term ‘cervical cancer’ but knowledge of its aetiology and transmission was limited. Cervical cancer was readily associated to sexual transmission and sexually transmitted infections, and conceived as a ‘wound that does not heal’. The term ‘cancer’ caused confusion, as it was perceived to happen only in limbs, understood as hereditary, not transmissible and as an illness of the West. Conclusions Lay perceptions of cervical cancer do, to a large extent, align with biomedical ones, thus, there is common ground to frame future health interventions from a sexual and reproductive health standpoint. Some misperceptions were identified which could be reduced through social behaviour change communication initiatives.
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Affiliation(s)
| | - Olga Cambaco
- Manhiça Health Research Centre (CISM), Rua 12 - Cambeve, Manhiça, Mozambique
| | - Carolina Mindú
- Manhiça Health Research Centre (CISM), Rua 12 - Cambeve, Manhiça, Mozambique
| | - Hoticha Nhantumbo
- Manhiça Health Research Centre (CISM), Rua 12 - Cambeve, Manhiça, Mozambique
| | - Titos Uamusse
- Manhiça Health Research Centre (CISM), Rua 12 - Cambeve, Manhiça, Mozambique
| | - Graça Matsinhe
- Extended Program on Immunization (PAV), Ministry of Health (MISAU), Maputo, Mozambique
| | - Benigna Matsinhe
- National Directorate for Public Health (DNSP), Ministry of Health (MISAU), Maputo, Mozambique
| | - Rosa Marlene Manjate
- National Directorate for Public Health (DNSP), Ministry of Health (MISAU), Maputo, Mozambique
| | - Azucena Bardají
- Manhiça Health Research Centre (CISM), Rua 12 - Cambeve, Manhiça, Mozambique
| | - Clara Menendez
- Manhiça Health Research Centre (CISM), Rua 12 - Cambeve, Manhiça, Mozambique.,Barcelona Institute for Global Health (ISGLOBAL)/Hospital Clinic-Universitat de Barcelona, Barcelona, Spain
| | - Esperança Sevene
- Manhiça Health Research Centre (CISM), Rua 12 - Cambeve, Manhiça, Mozambique.,Faculty of Medicine, Eduardo Mondlane University (UEM), Maputo, Mozambique
| | - Khátia Munguambe
- Manhiça Health Research Centre (CISM), Rua 12 - Cambeve, Manhiça, Mozambique. .,Faculty of Medicine, Eduardo Mondlane University (UEM), Maputo, Mozambique.
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15
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Bule YP, Silva J, Carrilho C, Campos C, Sousa H, Tavares A, Medeiros R. Human papillomavirus prevalence and distribution in self-collected samples from female university students in Maputo. Int J Gynaecol Obstet 2020; 149:237-246. [PMID: 32086940 DOI: 10.1002/ijgo.13126] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/18/2019] [Accepted: 02/19/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To characterize human papillomavirus (HPV) prevalence and distribution among female university students in Maputo, Mozambique, and evaluate the determinants of HPV infection. METHODS A cross-sectional study among 504 female university students between February and April 2017. Cervicovaginal self-collected samples were analyzed for HPV genotypes by polymerase chain reaction-restriction fragment length polymorphism and AnyplexTM II HPV28 Detection kit (Seegene® ). RESULTS The prevalence of any HPV genotype was 28.6% (144/504). Single and multiple HPV infections were detected in 76 (15.1%) and 68 (13.5%) participants, respectively. Prevalence of high-risk HPV was significantly higher than that of low-risk HPV (P<0.001). HPV16 was the most frequent genotype, followed by HPV58, HPV66, HPV52, HPV18, HPV56, HPV61, and HPV70. The prevalence of genotypes covered by the bivalent, quadrivalent, and nonavalent vaccine was 14.3%, 15.9%, and 23.4%, respectively. Number of sexual partners over lifetime and in the past 12 months was associated with HPV infection (P<0.001 and P=0.039, respectively). CONCLUSIONS Knowledge of HPV genotype-specific prevalence among young women is important to set up strategies for HPV vaccination. The findings suggest that introduction of the nonavalent HPV vaccine might be the way forward in the present low-resource setting. In addition, self-sampling was useful for HPV detection and genotyping.
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Affiliation(s)
- Yara Priscilla Bule
- Molecular Oncology & Viral Pathology Group, IPO-Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Jani Silva
- Molecular Oncology & Viral Pathology Group, IPO-Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Carla Carrilho
- Pathology Department, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.,Pathology Service, Maputo Central Hospital, Maputo, Mozambique
| | - Carla Campos
- Virology Service, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Hugo Sousa
- Molecular Oncology & Viral Pathology Group, IPO-Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto, Porto, Portugal.,Virology Service, Portuguese Oncology Institute of Porto, Porto, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Ana Tavares
- Virology Service, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Rui Medeiros
- Molecular Oncology & Viral Pathology Group, IPO-Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto, Porto, Portugal.,Virology Service, Portuguese Oncology Institute of Porto, Porto, Portugal.,FP-ENAS Research Unit, UFP Energy, Environment and Health Research Unit, CEBIMED, Biomedical Research Centre, University Fernando Pessoa, Porto, Portugal.,LPCC, Research Department - Portuguese League Against Cancer (LPPC - NRN), Porto, Portugal
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16
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Dasgupta P, Henshaw C, Youlden DR, Clark PJ, Aitken JF, Baade PD. Global Trends in Incidence Rates of Primary Adult Liver Cancers: A Systematic Review and Meta-Analysis. Front Oncol 2020; 10:171. [PMID: 32185125 PMCID: PMC7058661 DOI: 10.3389/fonc.2020.00171] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/31/2020] [Indexed: 12/24/2022] Open
Abstract
Background: Primary liver cancer is a leading cause of cancer deaths worldwide. Global burden varies, reflecting geographical distribution of viral hepatitis. Our objective was to perform a systematic review and meta-analysis of published current trends in incidence of adult liver cancers and histological types worldwide. Methods: This study used systematic searches of PubMed, Embase, CINAHL, and Web of Science databases for English-language peer-reviewed articles published from 1 January 2008 to 01 September 2019. Inclusion criteria were population-based studies of adult liver cancer patients with quantitative estimates of temporal trends in incidence for liver cancers and/or histological types. For multiple studies from the same geographical area, only the publication that reported the most recent trends for the same cancer type and population subgroup was included. Review was conducted per PRISMA guidelines. Two authors independently extracted data and critically assessed studies. Proposed contributors to observed trends were extracted from included articles. Study-specific estimates of the annual percentage change (APC) in incidence rates with 95% confidence intervals (CIs) were pooled using random-effects meta-analysis models. Heterogeneity was measured using the I2 statistics and publication bias evaluated using funnel plots and Egger's tests. Results: Overall, 53 studies met the inclusion criteria, of which 31 were included in the meta-analysis. Overall, pooled APC estimates were +0.8 (95% CI −0.3, +2.0) for liver cancers combined, +2.6 (95% CI +1.2, +4.0) for hepatocellular carcinoma (HCC), and +4.3 (95% CI +2.5, +6.1) for intrahepatic cholangiocarcinoma. Subgroup analyses indicated increasing trends for liver cancers (APC +3.2, 95% CI +2.5, +3.9) and HCC (APC +3.6, 95% CI +2.9, +4.4) in the region of North America/Europe/Australia, whereas corresponding trends were decreasing (APC −1.7, 95% CI −2.2, −1.1) and stable (APC −0.7, 95% CI −1.9, +0.5) in Asia, respectively. Conclusions: Incidence is increasing for adult liver cancers and HCC in Western countries, whereas trends are decreasing in the Asian region, although still remaining high. Our findings highlight the importance of viral hepatitis control and lifestyle interventions to reduce global liver cancer burden. Ongoing surveillance is also vital to detect early shifts in incidence trends.
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Affiliation(s)
- Paramita Dasgupta
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia
| | - Chloe Henshaw
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia
| | - Danny R Youlden
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Paul J Clark
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Mater Research Institute, Brisbane, QLD, Australia.,Princess Alexandra Hospital & Mater Hospital, Brisbane, QLD, Australia
| | - Joanne F Aitken
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD, Australia.,School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Peter D Baade
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,School of Mathematical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
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Koon Sun Pat M, Manraj M, Fauzee J, Sewsurn S, Parkin DM, Manraj S. Trends in cancer incidence in the Republic of Mauritius, 1991-2015. Cancer Epidemiol 2019; 63:101616. [PMID: 31590038 DOI: 10.1016/j.canep.2019.101616] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/13/2019] [Accepted: 09/22/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Mauritius, a small state, is among the few African countries where cancer registration is population based and nationwide. We reported trends in cancer incidence for twenty five years as well as the mortality to incidence ratio (MIR) as main quality indicator of the Mauritius National Cancer Registry (MNCR). MATERIALS AND METHODS We calculated age standardised incidence rates (ASRs) of cancers by sex and by 5 year age group for five successive year periods from 1991 to 2015. The average annual percentage change (AAPC) were determined by sex and cancer sites. MIRs were compared for the period 2001-2004 and 2012-2015. RESULTS In males, the most common cancer sites (in terms of ASRs per 100,000) were those of the colon-rectum (17.0), prostate (16.5), trachea-bronchus-lung (13.0), stomach (8.4) and lip-oral cavity-pharynx (7.7). The AAPC were +3.9%, +4.2%, +0.5%, -0.1% and -1.3% respectively. In females, the most frequent sites were breast (53.7), colon-rectum (13.2), cervix uteri (11.2), corpus uteri (7.7) and ovary (5.7). The AAPC were +3.4%, +4.4%, -2%, +5.2% and -0.1% respectively. The most significant decrease in MIRs among males were liver (1.9 to 1.0), stomach (1.3 to 0.8) and lung (1.7 to 1.2) cancers while among females, they were pancreas (3.4 to 1.3), liver (1.8 to 1.2) and stomach (1.5 to 0.8) cancers. CONCLUSION The most common cancers were those associated with 'westernisation' of lifestyle. Our figures contrast with other Sub-Saharan Africa countries where infection related cancers are most predominant. The MNCR has also improved its data quality over time.
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Affiliation(s)
- Marvin Koon Sun Pat
- Medical Health Officer, SSRN Hospital, Pamplemousses, Mauritius; Faculty of Science, University of Mauritius, Reduit, Mauritius.
| | - Meera Manraj
- Faculty of Science, University of Mauritius, Reduit, Mauritius.
| | | | | | | | - Shyam Manraj
- Central Laboratory, Candos, Victoria Hospital, Mauritius.
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18
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Alonso S, Cambaco O, Maússe Y, Matsinhe G, Macete E, Menéndez C, Sicuri E, Sevene E, Munguambe K. Costs associated with delivering HPV vaccination in the context of the first year demonstration programme in southern Mozambique. BMC Public Health 2019; 19:1031. [PMID: 31370810 PMCID: PMC6676560 DOI: 10.1186/s12889-019-7338-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 07/18/2019] [Indexed: 12/24/2022] Open
Abstract
Background In Mozambique cervical cancer is a public health threat, due to its high incidence and limited access to early diagnosis of precancerous lesions. International organisations are supporting the introduction of human papillomavirus (HPV) vaccines in low- and middle-income countries. Some of these countries recently conducted demonstration programmes, which included evaluation of acceptability, coverage, and practicality of implementation and of integration in existing programmes. Information on costs of delivering the vaccine is needed to overcome the challenges of reaching vaccine potential recipients in rural and remote areas. Methods We estimated the financial and economic costs of delivering HPV vaccination to ten-year-old girls at schools for the first vaccination cycle of the demonstration programme in the Manhiça district (southern Mozambique), delivered throughout 2014. We also estimated costs of an alternative scenario with a reduced number of doses and personnel, which was analogous to the second vaccination cycle delivered throughout 2015. Cost estimates followed a micro-costing approach and included interviews with key informants at different administrative levels through the administration of standard questionnaires developed by the World Health Organisation. Results Considering only data from the first vaccination cycle (2014), which consisted in the administration of three doses, the average economic cost was US$17.59 per dose and US$52.29 per fully-immunised girl (FIG). Financial cost per dose (US$6.07) and per FIG (US$17.95) were substantially lower. The economic cost was US$15.53 per dose and US$31.14 per FIG when estimating an alternative cost scenario with reduced number of doses and personnel. Conclusions The average economic cost per dose was lower than the ones recently reported for low- and middle-income countries. However, our estimation of the financial cost per FIG was higher than the ones observed elsewhere (ranging from US$2.49 in India to US$20.36 in Vietnam) due to the high percentage of out-of-school girls which, reduced vaccine coverage and, therefore, reduced the denominator. Due to budget constraints, if Mozambique is to implement nation-wide HPV vaccination targeted to ten-year-old girls at schools, a reduction in personnel costs should be operated either by restricting the outreach vaccinator team or the number of supervision visits. Electronic supplementary material The online version of this article (10.1186/s12889-019-7338-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sergi Alonso
- CISM (Centro de Investigação em Saúde de Manhiça), Bairro Cambeve, Rua 12, Distrito da Manhiça, Maputo, CP 1929, Mozambique. .,ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain. .,Centre for Primary Care and Public Health, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK.
| | - Olga Cambaco
- CISM (Centro de Investigação em Saúde de Manhiça), Bairro Cambeve, Rua 12, Distrito da Manhiça, Maputo, CP 1929, Mozambique
| | - Yolanda Maússe
- CISM (Centro de Investigação em Saúde de Manhiça), Bairro Cambeve, Rua 12, Distrito da Manhiça, Maputo, CP 1929, Mozambique
| | - Graça Matsinhe
- Expanded Program on Immunisation (EPI), Ministry of Health, Maputo, Mozambique
| | - Eusébio Macete
- CISM (Centro de Investigação em Saúde de Manhiça), Bairro Cambeve, Rua 12, Distrito da Manhiça, Maputo, CP 1929, Mozambique
| | - Clara Menéndez
- CISM (Centro de Investigação em Saúde de Manhiça), Bairro Cambeve, Rua 12, Distrito da Manhiça, Maputo, CP 1929, Mozambique.,ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Elisa Sicuri
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Health Economics group, School of Public Health, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Esperança Sevene
- CISM (Centro de Investigação em Saúde de Manhiça), Bairro Cambeve, Rua 12, Distrito da Manhiça, Maputo, CP 1929, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Khátia Munguambe
- CISM (Centro de Investigação em Saúde de Manhiça), Bairro Cambeve, Rua 12, Distrito da Manhiça, Maputo, CP 1929, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
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19
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Cunha L, Carrilho C, Bhatt N, Loforte M, Maueia C, Fernandes F, Guisseve A, Mbofana F, Maibaze F, Mondlane L, Ismail M, Dimande L, Machatine S, Lunet N, Liu YT, Gudo ES, Pineau P. Hepatocellular carcinoma: Clinical-pathological features and HIV infection in Mozambican patients<sup/>. Cancer Treat Res Commun 2019; 19:100129. [PMID: 30903933 PMCID: PMC6504939 DOI: 10.1016/j.ctarc.2019.100129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 02/28/2019] [Accepted: 03/13/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Mozambique had been ranked among the countries with the highest global incidence of HCC with chronic hepatitis B infection and high exposure to aflatoxin-B1 (AFB1) being major risk factors. Indeed, HCC remains one of the most frequent cancer in Maputo. On the other hand, Mozambique has a high prevalence of infection with Human Immunodeficiency virus (HIV). Our study aims to describe the epidemiology, clinicopathological and serological features of patients with HCC in Maputo Central Hospital and its relationship with HIV. METHODS A series of 206 patients, diagnosed with HCC via fine needle aspiration, were consecutively included in the study. Patient data was collected using a questionnaire and all patients were tested for HBV, HCV, HIV. RESULTS Median age was 49 years old and the M: F sex ratio was 2.4. A total of 114 (56.2%) of the patients were HBsAg positive. Hepatitis C antibodies were present in 8.9% of cases, and co-infection with HBV and HCV (HBsAg/anti-HCV) was observed in 4 (2.0%) cases. The remainder, 36.3%, were neither hepatitis B- nor C-related. HIV was detected in 34 cases (18.0%) cases. HIV-HBV or HIV-HCV co-infections were observed in 22 (68.8%) and 2 (6.2%) cases. Overall, positivity for HIV was associated with younger age, and especially in patients with HBsAg+/anti-HCV+. CONCLUSIONS Our data emphasize the need for a reinforcement of secondary prevention measures in Mozambique. Serological screening for HBV in people born before universal anti-hepatitis B immunization (2001), effective screening, and specific management in HIV(+) patients are urgently needed.
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Affiliation(s)
- Lina Cunha
- Gastroenterology Service, Maputo Private Hospital, Maputo, Rua do Rio Inhamiara-Sommerchield II-Maputo, Mozambique.
| | - Carla Carrilho
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique; Department of Pathology - Maputo Central Hospital, Maputo, Mozambique
| | - Nilesh Bhatt
- National Institute of Health, Maputo, Mozambique
| | - Michella Loforte
- Department of Medicine, Gastroenterology Service, Maputo Central Hospital, Maputo, Mozambique
| | | | - Fabíola Fernandes
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique; Department of Pathology - Maputo Central Hospital, Maputo, Mozambique
| | - Assucena Guisseve
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique; Department of Pathology - Maputo Central Hospital, Maputo, Mozambique
| | | | - Fatima Maibaze
- Department of Medicine, Gastroenterology Service, Maputo Central Hospital, Maputo, Mozambique
| | - Liana Mondlane
- Department of Medicine, Gastroenterology Service, Maputo Central Hospital, Maputo, Mozambique
| | - Muhammad Ismail
- Department of Medicine, Gastroenterology Service, Maputo Central Hospital, Maputo, Mozambique
| | - Luzmira Dimande
- Department of Medicine, Gastroenterology Service, Maputo Central Hospital, Maputo, Mozambique
| | - Sheila Machatine
- Department of Medicine, Gastroenterology Service, Maputo Central Hospital, Maputo, Mozambique
| | - Nuno Lunet
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Yu-Tsueng Liu
- University of California San Diego, La Jolla, CA, United States
| | | | - Pascal Pineau
- Unité « Organisation Nucléaire et Oncogenèse », INSERM U993, Institut Pasteur, Paris, France
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20
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Morais A, Come J, Selemane C, Pires G, Tivane A, Cossa M, Tulsidás S, Antunes L, Costa MJ, Sidat M, Martins MDR, Carrilho C, Santos LL. Understanding the bricks to build better surgical oncology unit at Maputo Central Hospital: prevalent surgical cancers and residents knowledge. Pan Afr Med J 2019; 32:83. [PMID: 31223374 PMCID: PMC6560991 DOI: 10.11604/pamj.2019.32.83.18126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 01/27/2019] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Cancer is a growing concern in Mozambique. However, the country has limited facilities and few oncologists. Surgical oncologists are an unmet need. The aim of this study was to assess residents' knowledge in prevalent cancer domains and to identify and characterize prevalent cancers treated by surgery at Maputo Central Hospital, the largest hospital in Mozambique. The expectations were that the findings shall inform the development of a comprehensive curriculum in surgical oncology fellowship fit for the Hospital. METHODS To identify and characterize prevalent cancers, we performed a retrospective analysis of individual cancer patient registries of Maputo Central Hospital (MCH), Mozambique. Information was recorded into data collection sheets and analyzed with SPSS® 21. To assess MCH residents oncologic knowledge, we invited Twenty-six junior residents (49% of all residents) of different specialties to take a 30 item multiple choice written test used elsewhere in previous studies. The test focused on the domains of Basis of oncology, Radiotherapy, Pathology, Chemotherapy, Pain management, Surgical oncology and Clinical Pathway. The test was administered anonymously and without prior notice. We analyzed the overall test and topic performance of residents. RESULTS The study covered a period of 3 years and 203 patients. The most prevalent malignant tumors treated by general and thoracic surgery in MCH cancer registry were esophageal (7%), female breast (6.5%) and colorectal cancer (2.8%). Globally these malignancies were diagnosed at an advanced stage of the disease and required a multimodal treatment. The mean percent correct score of residents was 37.3%. The dimension with the highest percent correct score were clinical management (46%) and surgical oncology (28%) showed the lowest correct score. CONCLUSION In Maputo, Mozambique esophageal, breast and colorectal cancer were the most prevalent malignancies treated, with surgery, by thoracic or general surgery in MCH. The test scores suggest that, among residents, the knowledge in oncology needs to be improved, rendering support to the need of a surgical oncology training tailored to suit the local needs. Specific training should take into account local cancer prevalence, resources, their quality and the support of surgical oncology services with volume and experience.
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Affiliation(s)
- Atílio Morais
- Surgical Department, Maputo Central Hospital, Maputo, Mozambique
- Department of Surgery of Faculty of Medicine, University of Eduardo Mondlane, Maputo, Mozambique
| | - Jotamo Come
- Surgical Department, Maputo Central Hospital, Maputo, Mozambique
| | - Carlos Selemane
- Surgical Department, Maputo Central Hospital, Maputo, Mozambique
| | - Germano Pires
- Surgical Department, Maputo Central Hospital, Maputo, Mozambique
| | - Adriano Tivane
- Surgical Department, Maputo Central Hospital, Maputo, Mozambique
| | - Matchecane Cossa
- Surgical Department, Maputo Central Hospital, Maputo, Mozambique
| | - Satish Tulsidás
- Medical Oncology Department, Maputo Central Hospital, Maputo, Mozambique
| | - Luís Antunes
- Epidemiology Service, Portuguese Institute of Oncology, Porto, Portugal
| | - Manuel João Costa
- Medical Education Unit, School of Medicine University of Minho, Portugal
| | - Moshin Sidat
- Department of Community Health, University of Eduardo Mondlane, Maputo, Mozambique
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Portugal
| | - Maria do Rosário Martins
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Portugal
| | - Carla Carrilho
- Pathology Department, Maputo Central Hospital, Maputo, Mozambique
| | - Lúcio Lara Santos
- Surgical Oncology Department, Portuguese Institute of Oncology, Porto, Portugal
- Experimental Pathology and Therapeutics Research Group, Portuguese Institute of Oncology, Porto, Portugal
- ONCOCIR- Education and Care in Oncology, Lusophone, Africa
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21
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Santos LL, Spencer HB, Miguel F, Tulsidás S, Rodrigues B, Lopes LV. Fight against cancer in Portuguese-speaking African countries: echoes from the last cancer meetings. Infect Agent Cancer 2019. [PMCID: PMC6377738 DOI: 10.1186/s13027-019-0222-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Portuguese-speaking countries in Africa include Angola, Mozambique, Guinea-Bissau, Cape Verde, São Tomé and Principe. These countries belong to an interstate organization known as PALOP. In June 2018, PALOP organized a cancer meeting in Praia, Cape Verde, entitled ‘Quality in cancer care, optimization of cancer units, cancer education and training.’ This meeting was supported by faculty from the African Organization for Research and Training in Cancer (AORTIC) and was dedicated to the improvement of cancer care in PALOP countries. The burden of non-communicable diseases, which includes cancer, is increasing rapidly in these countries.. During this meeting, a plan was developed to guide the future strategic actions in this community. The main points of action include to increase access to cancer care, boost HPV and hepatitis B vaccination, improve access to cancer treatment, including radiotherapy and palliative care, amongst others. Efforts will be made to ensure the participation of all of these countries at PALOP meetings, including Equatorial Guinea, a potential new member.
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Carrilho C, Ismail M, Lorenzoni C, Fernandes F, Alberto M, Akrami K, Funzamo C, Lunet N, Schmitt F. Fine needle aspiration cytology in Mozambique: Report of a 15-year experience. Diagn Cytopathol 2018; 47:166-171. [PMID: 30478961 DOI: 10.1002/dc.24062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/25/2018] [Accepted: 08/03/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Fine needle aspiration cytology (FNAC) is an important diagnostic tool in a range of medical settings. It is fast, quick and a highly accurate diagnostic method and can be used, in settings with minimal laboratory infrastructures. METHODS In this report, we describe the experience in the use of FNAC since it is introduction in 1996 in the Anatomical Pathology Service of the Maputo Central Hospital (MCH), along with more detailed data referring to 2009-2010. RESULTS The number of FNAC analyses increased gradually from 269 (4.1% of all pathologic tests of the Service) in 1996, when it was introduced in Mozambique, to 3234 (17% of all tests) in 2010. Lymph nodes were the organs most frequently biopsied, followed by breast and soft tissues. Inflammatory conditions, especially tuberculosis, were the most frequent diagnoses (22.2% of the cases), followed by hyperplastic conditions (20.6%), benign tumors (13.4%) and malignant tumors (12.3%). CONCLUSION Our results clearly demonstrate that even in an environment with poor laboratory resources, it is possible to establish a FNAC clinic that can provide a quick and precise diagnosis for clinicians to aid in early treatment interventions, especially in inflammatory diseases which were the majority of our cases.
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Affiliation(s)
- Carla Carrilho
- Departamento de Patologia, Hospital Central de Maputo, Maputo, Moçambique.,Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Moçambique
| | - Mamudo Ismail
- Departamento de Patologia, Hospital Central de Maputo, Maputo, Moçambique.,Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Moçambique
| | - Cesaltina Lorenzoni
- Departamento de Patologia, Hospital Central de Maputo, Maputo, Moçambique.,Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Moçambique.,National Cancer Control Program Ministry of Health, Maputo, Mozambique
| | - Fabíola Fernandes
- Departamento de Patologia, Hospital Central de Maputo, Maputo, Moçambique.,Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Moçambique
| | - Matos Alberto
- Departamento de Patologia, Hospital Central de Maputo, Maputo, Moçambique
| | - Kevan Akrami
- Department of Infectious Disease, University of California, San Diego, San Diego, California
| | - Carlos Funzamo
- National Cancer Control Program Ministry of Health, Maputo, Mozambique
| | - Nuno Lunet
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Fernando Schmitt
- Instituto de Patologia e Imunologia Molecular da Universidade do Porto, IPATIMUP, Porto, Portugal.,Departamento de Patologia da Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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23
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Come J, Castro C, Morais A, Cossa M, Modcoicar P, Tulsidâs S, Cunha L, Lobo V, Morais AG, Cotton S, Lunet N, Carrilho C, Santos LL. Clinical and Pathologic Profiles of Esophageal Cancer in Mozambique: A Study of Consecutive Patients Admitted to Maputo Central Hospital. J Glob Oncol 2018; 4:1-9. [PMID: 30398947 PMCID: PMC7010456 DOI: 10.1200/jgo.18.00147] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Eastern Africa was recently described as a high-incidence geographic area for esophageal cancer. Mozambique is included in this region. This study aimed to characterize this malignant disease at Maputo Central Hospital (MCH) to develop a global program for esophageal cancer management in Mozambique. METHODS MCH records from between 2012 and 2016 were used to assess the clinical, pathologic, and outcome profiles of esophageal tumors. A descriptive analysis of data collected was performed. Overall survival was evaluated using Kaplan-Meier curves. RESULTS In the study, 522 consecutive patient cases of esophageal cancer were recorded. The median patient age was 56.1 years (range, 27 to 97 years); 291 (55.7%) patients were women, and 230 (44.1%) were men. Regarding tumor site, 113 patients (21.6%) had a tumor in the lower third, 154 (29.5%) in the middle, and 50 (9.6%) in the upper third of the esophagus; in the remaining 196 (37.5%), tumor site was unknown. Squamous cell carcinoma comprised 94.4% of cases with documented histopathology (74.9% of the sample). Surgical treatment was possible in 32 patients (6.1%). Disease stage was documented only in these 32 surgical patients; 28.1%, 53.1%, and 18.8% had stage I, II, and III disease, respectively. The remaining patient cases seemed to involve clinically advanced tumors. The median follow-up time was of 1.6 months. The median survival time was of 3.5 months for all patients; for patients treated with curative intent, it was of 8.7 months. CONCLUSION Esophageal carcinoma is a common malignant tumor at MCH and is diagnosed in the advanced stages resulting in poor prognosis. Therefore, implementation of an Esophageal Cancer Program in Mozambique is essential.
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Affiliation(s)
- Jotamo Come
- Jotamo Come, Atílio Morais, Matchecane Cossa, Prassad Modcoicar, Satish Tulsidás, Lina Cunha, Vitória Lobo, Alberto Gudo Morais, and Carla Carrilho, Hospital Central de Maputo; Carla Carrilho, Universidade Eduardo Mondlane, Maputo, Moçambique; Clara Castro, Sofia Cotton, and Lúcio Lara Santos, Instituto Português de Oncologia; Clara Castro and Nuno Lunet, Universidade do Porto; Sofia Cotton, Project ESTIMA-01-0145-FEDER-000027; Sofia Cotton and Lúcio Lara Santos, Grupo de Patologia e Terapêutica Experimental; Lúcio Lara Santos Universidade Fernando Pessoa, Porto, Portugal
| | - Clara Castro
- Jotamo Come, Atílio Morais, Matchecane Cossa, Prassad Modcoicar, Satish Tulsidás, Lina Cunha, Vitória Lobo, Alberto Gudo Morais, and Carla Carrilho, Hospital Central de Maputo; Carla Carrilho, Universidade Eduardo Mondlane, Maputo, Moçambique; Clara Castro, Sofia Cotton, and Lúcio Lara Santos, Instituto Português de Oncologia; Clara Castro and Nuno Lunet, Universidade do Porto; Sofia Cotton, Project ESTIMA-01-0145-FEDER-000027; Sofia Cotton and Lúcio Lara Santos, Grupo de Patologia e Terapêutica Experimental; Lúcio Lara Santos Universidade Fernando Pessoa, Porto, Portugal
| | - Atílio Morais
- Jotamo Come, Atílio Morais, Matchecane Cossa, Prassad Modcoicar, Satish Tulsidás, Lina Cunha, Vitória Lobo, Alberto Gudo Morais, and Carla Carrilho, Hospital Central de Maputo; Carla Carrilho, Universidade Eduardo Mondlane, Maputo, Moçambique; Clara Castro, Sofia Cotton, and Lúcio Lara Santos, Instituto Português de Oncologia; Clara Castro and Nuno Lunet, Universidade do Porto; Sofia Cotton, Project ESTIMA-01-0145-FEDER-000027; Sofia Cotton and Lúcio Lara Santos, Grupo de Patologia e Terapêutica Experimental; Lúcio Lara Santos Universidade Fernando Pessoa, Porto, Portugal
| | - Matchecane Cossa
- Jotamo Come, Atílio Morais, Matchecane Cossa, Prassad Modcoicar, Satish Tulsidás, Lina Cunha, Vitória Lobo, Alberto Gudo Morais, and Carla Carrilho, Hospital Central de Maputo; Carla Carrilho, Universidade Eduardo Mondlane, Maputo, Moçambique; Clara Castro, Sofia Cotton, and Lúcio Lara Santos, Instituto Português de Oncologia; Clara Castro and Nuno Lunet, Universidade do Porto; Sofia Cotton, Project ESTIMA-01-0145-FEDER-000027; Sofia Cotton and Lúcio Lara Santos, Grupo de Patologia e Terapêutica Experimental; Lúcio Lara Santos Universidade Fernando Pessoa, Porto, Portugal
| | - Prassad Modcoicar
- Jotamo Come, Atílio Morais, Matchecane Cossa, Prassad Modcoicar, Satish Tulsidás, Lina Cunha, Vitória Lobo, Alberto Gudo Morais, and Carla Carrilho, Hospital Central de Maputo; Carla Carrilho, Universidade Eduardo Mondlane, Maputo, Moçambique; Clara Castro, Sofia Cotton, and Lúcio Lara Santos, Instituto Português de Oncologia; Clara Castro and Nuno Lunet, Universidade do Porto; Sofia Cotton, Project ESTIMA-01-0145-FEDER-000027; Sofia Cotton and Lúcio Lara Santos, Grupo de Patologia e Terapêutica Experimental; Lúcio Lara Santos Universidade Fernando Pessoa, Porto, Portugal
| | - Satish Tulsidâs
- Jotamo Come, Atílio Morais, Matchecane Cossa, Prassad Modcoicar, Satish Tulsidás, Lina Cunha, Vitória Lobo, Alberto Gudo Morais, and Carla Carrilho, Hospital Central de Maputo; Carla Carrilho, Universidade Eduardo Mondlane, Maputo, Moçambique; Clara Castro, Sofia Cotton, and Lúcio Lara Santos, Instituto Português de Oncologia; Clara Castro and Nuno Lunet, Universidade do Porto; Sofia Cotton, Project ESTIMA-01-0145-FEDER-000027; Sofia Cotton and Lúcio Lara Santos, Grupo de Patologia e Terapêutica Experimental; Lúcio Lara Santos Universidade Fernando Pessoa, Porto, Portugal
| | - Lina Cunha
- Jotamo Come, Atílio Morais, Matchecane Cossa, Prassad Modcoicar, Satish Tulsidás, Lina Cunha, Vitória Lobo, Alberto Gudo Morais, and Carla Carrilho, Hospital Central de Maputo; Carla Carrilho, Universidade Eduardo Mondlane, Maputo, Moçambique; Clara Castro, Sofia Cotton, and Lúcio Lara Santos, Instituto Português de Oncologia; Clara Castro and Nuno Lunet, Universidade do Porto; Sofia Cotton, Project ESTIMA-01-0145-FEDER-000027; Sofia Cotton and Lúcio Lara Santos, Grupo de Patologia e Terapêutica Experimental; Lúcio Lara Santos Universidade Fernando Pessoa, Porto, Portugal
| | - Vitória Lobo
- Jotamo Come, Atílio Morais, Matchecane Cossa, Prassad Modcoicar, Satish Tulsidás, Lina Cunha, Vitória Lobo, Alberto Gudo Morais, and Carla Carrilho, Hospital Central de Maputo; Carla Carrilho, Universidade Eduardo Mondlane, Maputo, Moçambique; Clara Castro, Sofia Cotton, and Lúcio Lara Santos, Instituto Português de Oncologia; Clara Castro and Nuno Lunet, Universidade do Porto; Sofia Cotton, Project ESTIMA-01-0145-FEDER-000027; Sofia Cotton and Lúcio Lara Santos, Grupo de Patologia e Terapêutica Experimental; Lúcio Lara Santos Universidade Fernando Pessoa, Porto, Portugal
| | - Alberto Gudo Morais
- Jotamo Come, Atílio Morais, Matchecane Cossa, Prassad Modcoicar, Satish Tulsidás, Lina Cunha, Vitória Lobo, Alberto Gudo Morais, and Carla Carrilho, Hospital Central de Maputo; Carla Carrilho, Universidade Eduardo Mondlane, Maputo, Moçambique; Clara Castro, Sofia Cotton, and Lúcio Lara Santos, Instituto Português de Oncologia; Clara Castro and Nuno Lunet, Universidade do Porto; Sofia Cotton, Project ESTIMA-01-0145-FEDER-000027; Sofia Cotton and Lúcio Lara Santos, Grupo de Patologia e Terapêutica Experimental; Lúcio Lara Santos Universidade Fernando Pessoa, Porto, Portugal
| | - Sofia Cotton
- Jotamo Come, Atílio Morais, Matchecane Cossa, Prassad Modcoicar, Satish Tulsidás, Lina Cunha, Vitória Lobo, Alberto Gudo Morais, and Carla Carrilho, Hospital Central de Maputo; Carla Carrilho, Universidade Eduardo Mondlane, Maputo, Moçambique; Clara Castro, Sofia Cotton, and Lúcio Lara Santos, Instituto Português de Oncologia; Clara Castro and Nuno Lunet, Universidade do Porto; Sofia Cotton, Project ESTIMA-01-0145-FEDER-000027; Sofia Cotton and Lúcio Lara Santos, Grupo de Patologia e Terapêutica Experimental; Lúcio Lara Santos Universidade Fernando Pessoa, Porto, Portugal
| | - Nuno Lunet
- Jotamo Come, Atílio Morais, Matchecane Cossa, Prassad Modcoicar, Satish Tulsidás, Lina Cunha, Vitória Lobo, Alberto Gudo Morais, and Carla Carrilho, Hospital Central de Maputo; Carla Carrilho, Universidade Eduardo Mondlane, Maputo, Moçambique; Clara Castro, Sofia Cotton, and Lúcio Lara Santos, Instituto Português de Oncologia; Clara Castro and Nuno Lunet, Universidade do Porto; Sofia Cotton, Project ESTIMA-01-0145-FEDER-000027; Sofia Cotton and Lúcio Lara Santos, Grupo de Patologia e Terapêutica Experimental; Lúcio Lara Santos Universidade Fernando Pessoa, Porto, Portugal
| | - Carla Carrilho
- Jotamo Come, Atílio Morais, Matchecane Cossa, Prassad Modcoicar, Satish Tulsidás, Lina Cunha, Vitória Lobo, Alberto Gudo Morais, and Carla Carrilho, Hospital Central de Maputo; Carla Carrilho, Universidade Eduardo Mondlane, Maputo, Moçambique; Clara Castro, Sofia Cotton, and Lúcio Lara Santos, Instituto Português de Oncologia; Clara Castro and Nuno Lunet, Universidade do Porto; Sofia Cotton, Project ESTIMA-01-0145-FEDER-000027; Sofia Cotton and Lúcio Lara Santos, Grupo de Patologia e Terapêutica Experimental; Lúcio Lara Santos Universidade Fernando Pessoa, Porto, Portugal
| | - Lúcio Lara Santos
- Jotamo Come, Atílio Morais, Matchecane Cossa, Prassad Modcoicar, Satish Tulsidás, Lina Cunha, Vitória Lobo, Alberto Gudo Morais, and Carla Carrilho, Hospital Central de Maputo; Carla Carrilho, Universidade Eduardo Mondlane, Maputo, Moçambique; Clara Castro, Sofia Cotton, and Lúcio Lara Santos, Instituto Português de Oncologia; Clara Castro and Nuno Lunet, Universidade do Porto; Sofia Cotton, Project ESTIMA-01-0145-FEDER-000027; Sofia Cotton and Lúcio Lara Santos, Grupo de Patologia e Terapêutica Experimental; Lúcio Lara Santos Universidade Fernando Pessoa, Porto, Portugal
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Morais A, Cossa M, Tivane A, Come J, Venetsky V, Torres F, Pacheco V, Reyes M, Pires G, Peyroteo M, Tulsidas S, Baker E, Sidat M, O Martins MDR, Santos LL. Identifying barriers and finding solutions to implement best practices for cancer surgery at Maputo Central Hospital, Mozambique. Ecancermedicalscience 2018; 12:878. [PMID: 30483358 PMCID: PMC6214672 DOI: 10.3332/ecancer.2018.878] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Indexed: 01/06/2023] Open
Abstract
Purpose The aim of this study was to assess the surgical resources and surgical oncology team skills at the Surgical Department of Maputo Central Hospital (MCH) in Mozambique in order to define an educational program to support surgical oncology practice. Methods From January 2017 to December 2017, a general evaluation of the resources of MCH was carried out, as well as its offerings in oncological care in different services. Data were obtained by reviewing documents, visiting surgical services and interviewing key-informants and others informally. In addition, a group of seven surgeons of the Surgical Department of MCH answered a questionnaire about the quality of the cancer units (The Cancer Units Assessment Checklist for low- or middle-income African countries). Subsequently, surgical, anaesthesiology and intensive care facilities were evaluated according to the Portuguese-speaking African Countries Assessment of Surgical Oncology Capacity Survey (PSAC-Surgery). All the data were triangulated in order to identify gaps, develop an action plan and define an educational program. Results Breast, oesophagus and colorectal cancers were the most commonly treated neoplasms in MCH. A range of technical and resource needs as well as the gaps in knowledge and skills were identified. All surgeons recognised the need to create a training program in oncology at the undergraduate level, specific training for residents and continuing oncological education for general surgeons to improve the practice of surgical oncology. It was evident that all these interventions needed to be formalised, appropriately certified and count for professional career progression. Based on the local epidemiological data and on these study findings, oncology education programs were developed for surgeons. Conclusions The findings of this study contributed to the development of an educational program in surgical oncology, considered essential to the training of surgeons at MCH. The cancer educational programs and the mobilisation of adequate resources will ensure the provision of adequate surgical oncology treatments for MCH. The training requirements should be tailored to suit the local needs based on the most prevalent malignancies diagnosed in the region. In our view, this methodology may apply to other countries with similar realities in the formation of surgical oncologists.
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Affiliation(s)
- Atílio Morais
- Thoracic Surgery, Surgical Department, Maputo Central Hospital, Av Agostinho Neto n° 164, Maputo 1164, Mozambique
| | - Matchecane Cossa
- Thoracic Surgery, Surgical Department, Maputo Central Hospital, Av Agostinho Neto n° 164, Maputo 1164, Mozambique
| | - Adriano Tivane
- Thoracic Surgery, Surgical Department, Maputo Central Hospital, Av Agostinho Neto n° 164, Maputo 1164, Mozambique
| | - Jotamo Come
- Breast Surgery, Surgical Department, Maputo Central Hospital, Av Agostinho Neto n° 164, Maputo 1164, Mozambique
| | - Volodimir Venetsky
- Breast Surgery, Surgical Department, Maputo Central Hospital, Av Agostinho Neto n° 164, Maputo 1164, Mozambique
| | - Fernando Torres
- Breast Surgery, Surgical Department, Maputo Central Hospital, Av Agostinho Neto n° 164, Maputo 1164, Mozambique
| | - Victor Pacheco
- Colorectal Surgery, Surgical Department, Maputo Central Hospital, Av Agostinho Neto n° 164, Maputo 1164, Mozambique
| | - Miguel Reyes
- Colorectal Surgery, Surgical Department, Maputo Central Hospital, Av Agostinho Neto n° 164, Maputo 1164, Mozambique
| | - Germano Pires
- Heath National Institute, Av Eduardo Mondlane, Maputo 264, Mozambique
| | - Mariana Peyroteo
- Surgical Oncology Department, Portuguese Institute of Oncology, Dr António Bernardino de Almeida Street, Porto 4200-072, Portugal
| | - Satish Tulsidas
- Medical Oncology Department, Maputo Central Hospital, Av Agostinho Neto n° 164, Maputo 1164, Mozambique
| | - Ellen Baker
- UT MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Moshin Sidat
- Department of Community Health, University Eduardo Mondlane, Av Julius Nyerere, Maputo 257, Mozambique.,Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, Universidade Nova de Lisboa, Junqueira Street 100, Lisboa 1349-008 Portugal
| | - Maria do Rosário O Martins
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, Universidade Nova de Lisboa, Junqueira Street 100, Lisboa 1349-008 Portugal
| | - Lúcio Lara Santos
- Surgical Oncology Department, Portuguese Institute of Oncology, Dr António Bernardino de Almeida Street, Porto 4200-072, Portugal.,Experimental Pathology and Therapeutics Research Group, Surgical Oncology Department, Portuguese Institute of Oncology, Dr António Bernardino de Almeida Street, Porto 4200-072, Portugal.,ONCOCIR-Education and Care in Oncology-Lusophone Africa, Quires Street 168, Moreira da Maia 4470-643, Portugal
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25
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Katsidzira L, Laubscher R, Gangaidzo IT, Swart R, Makunike-Mutasa R, Manyanga T, Thomson S, Ramesar R, Matenga JA, Rusakaniko S. Dietary patterns and colorectal cancer risk in Zimbabwe: A population based case-control study. Cancer Epidemiol 2018; 57:33-38. [PMID: 30286315 PMCID: PMC6291434 DOI: 10.1016/j.canep.2018.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 09/17/2018] [Accepted: 09/24/2018] [Indexed: 01/28/2023]
Abstract
Three main dietary patterns in Zimbabwe; traditional African, urban and processed foods. Traditional African diet associated with a reduced risk of colorectal cancer. No association between colorectal cancer and the urban or processed food patterns.
Background The rising incidence of colorectal cancer in sub-Saharan Africa may be partly caused by changing dietary patterns. We sought to establish the association between dietary patterns and colorectal cancer in Zimbabwe. Methods One hundred colorectal cancer cases and 200 community-based controls were recruited. Data were collected using a food frequency questionnaire, and dietary patterns derived by principal component analysis. Generalised linear and logistic regression models were used to assess the associations between dietary patterns, participant characteristics and colorectal cancer. Results Three main dietary patterns were identified: traditional African, urbanised and processed food. The traditional African diet appeared protective against colorectal cancer (Odds Ratio (OR) 0.35; 95% Confidence Interval (CI), 0.21 – 0.58), which had no association with the urban (OR 0.68; 95% CI, 0.43–1.08), or processed food (OR 0.91; 0.58–1.41) patterns. The traditional African diet was associated with rural domicile, (OR 1.26; 95% CI, 1.00–1.59), and a low income (OR1.48; 95% CI, 1.06–2.08). The urbanised diet was associated with urban domicile (OR 1.70; 95% CI, 1.38–2.10), secondary (OR 1.30; 95% CI, 1.07–1.59) or tertiary education (OR 1.48; 95% CI, 1.11–1.97), and monthly incomes of $201–500 (OR 1.30; 95% CI, 1.05–1.62), and the processed food pattern with tertiary education (OR 1.42; 95% CI, 1.05–1.92), and income >$1000/month (OR 1.48; 95% CI, 1.02–2.15). Conclusion A shift away from protective, traditional African dietary patterns may partly explain the rising incidence of colorectal cancer in sub-Saharan Africa.
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Affiliation(s)
- Leolin Katsidzira
- Department of Medicine, College of Health Sciences, University of Zimbabwe, PO Box A178, Avondale, Harare, Zimbabwe.
| | - Ria Laubscher
- Biostatistics Unit, South African Medical Research Council, PO Box 19070, Tygerberg, Cape Town, 7505, South Africa
| | - Innocent T Gangaidzo
- Department of Medicine, College of Health Sciences, University of Zimbabwe, PO Box A178, Avondale, Harare, Zimbabwe
| | - Rina Swart
- Department of Dietetics and Nutrition, University of Western Cape, Bellville, 7535, Western Cape, South Africa
| | - Rudo Makunike-Mutasa
- Department of Histopathology, College of Health Sciences, University of Zimbabwe, PO Box A178, Avondale, Harare, Zimbabwe
| | - Tadios Manyanga
- Department of Medicine, College of Health Sciences, University of Zimbabwe, PO Box A178, Avondale, Harare, Zimbabwe
| | - Sandie Thomson
- Division of Gastroenterology, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Observatory, 7925, Cape Town, South Africa
| | - Raj Ramesar
- MRC/UCT Research Unit for Genomic and Precision Medicine, Division of Human Genetics, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, 7925, South Africa
| | - Jonathan A Matenga
- Department of Medicine, College of Health Sciences, University of Zimbabwe, PO Box A178, Avondale, Harare, Zimbabwe
| | - Simbarashe Rusakaniko
- Department of Community Medicine, College of Health Sciences, University of Zimbabwe, PO Box A178, Avondale, Harare, Zimbabwe
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26
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Adeloye D, Sowunmi OY, Jacobs W, David RA, Adeosun AA, Amuta AO, Misra S, Gadanya M, Auta A, Harhay MO, Chan KY. Estimating the incidence of breast cancer in Africa: a systematic review and meta-analysis. J Glob Health 2018; 8:010419. [PMID: 29740502 PMCID: PMC5903682 DOI: 10.7189/jogh.08.010419] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background Breast cancer is estimated to be the most common cancer worldwide. We sought to assemble publicly available data from Africa to provide estimates of the incidence of breast cancer on the continent. Methods A systematic search of Medline, EMBASE, Global Health and African Journals Online (AJOL) was conducted. We included population- or hospital-based registry studies on breast cancer conducted in Africa, and providing estimates of the crude incidence of breast cancer among women. A random effects meta-analysis was employed to determine the pooled incidence of breast cancer across studies. Results The literature search returned 4648 records, with 41 studies conducted across 54 study sites in 22 African countries selected. We observed important variations in reported cancer incidence between population- and hospital-based cancer registries. The overall pooled crude incidence of breast cancer from population-based registries was 24.5 per 100 000 person years (95% confidence interval (CI) 20.1-28.9). The incidence in North Africa was higher at 29.3 per 100 000 (95% CI 20.0-38.7) than Sub-Saharan Africa (SSA) at 22.4 per 100 000 (95% CI 17.2-28.0). In hospital-based registries, the overall pooled crude incidence rate was estimated at 23.6 per 100 000 (95% CI 18.5-28.7). SSA and Northern Africa had relatively comparable rates at 24.0 per 100 000 (95% CI 17.5-30.4) and 23.2 per 100 000 (95% CI 6.6-39.7), respectively. Across both registries, incidence rates increased considerably between 2000 and 2015. Conclusions The available evidence suggests a growing incidence of breast cancer in Africa. The representativeness of these estimates is uncertain due to the paucity of data in several countries and calendar years, as well as inconsistency in data collation and quality across existing cancer registries.
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Affiliation(s)
- Davies Adeloye
- Nigerian Urban Reproductive Health Initiative, Abuja, Nigeria.,Johns Hopkins Centre for Communication Programs, Baltimore, Maryland, USA.,Centre for Global Health Research and the World Health Organization Collaborating Centre for Population Health Research and Training, Usher Institute, University of Edinburgh, Scontland, UK
| | - Olaperi Y Sowunmi
- Computer and Information Sciences, Covenant University, Ota, Ogun State, Nigeria
| | - Wura Jacobs
- Department of Health Science, California State University, Fullerton, California, USA
| | - Rotimi A David
- Department of Urology, Morriston Hospital, Abertawe Bro Morgannwg University Health Board, Swansea, UK
| | - Adeyemi A Adeosun
- Health Initiative Department, National Jewish Hospital, Denver, Colorado, USA
| | - Ann O Amuta
- Department of Health Studies, Texas Woman's University, Denton, Texas, USA
| | - Sanjay Misra
- Department of Computer Engineering, Atilim University, Turkey
| | - Muktar Gadanya
- Department of Community Medicine, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
| | - Asa Auta
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Fylde Road, Preston, UK
| | - Michael O Harhay
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kit Yee Chan
- Centre for Global Health Research and the World Health Organization Collaborating Centre for Population Health Research and Training, Usher Institute, University of Edinburgh, Scontland, UK
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27
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Awareness of cervical cancer and willingness to be vaccinated against human papillomavirus in Mozambican adolescent girls. PAPILLOMAVIRUS RESEARCH 2018; 5:156-162. [PMID: 29665430 PMCID: PMC6046684 DOI: 10.1016/j.pvr.2018.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 04/04/2018] [Accepted: 04/12/2018] [Indexed: 01/27/2023]
Abstract
Sub-Saharan Africa concentrates the largest burden of cervical cancer worldwide. The introduction of the HPV vaccination in this region is urgent and strategic to meet global health targets. This was a cross-sectional study conducted in Mozambique prior to the first round of the HPV vaccine demonstration programme. It targeted girls aged 10–19 years old identified from schools and households. Face-to-face structured interviews were conducted. A total of 1147 adolescents were enrolled in three selected districts of the country. Most girls [84% (967/1147)] had heard of cervical cancer, while 76% believed that cervical cancer could be prevented. However only 33% (373/1144) of girls recognized having ever heard of HPV. When girls were asked whether they would accept to be vaccinated if a vaccine was available in Mozambique, 91% (1025/1130) answered positively. Girls from the HPV demonstration districts showed higher awareness on HPV and cervical cancer, and willingness to be vaccinated. This study anticipates high acceptability of the HPV vaccine in Mozambique and high awareness about cervical cancer, despite low HPV knowledge. These results highlight that targeted health education programmes are critical for acceptance of new tools, and are encouraging for the reduction of cervical cancer related mortality and morbidity in Mozambique. Cervical cancer incidence rates in Mozambique are among the highest in the world. Introduction of HPV vaccination in Mozambique is an urgent and necessary strategy to meet global targets on women´s health. The awareness on cervical cancer, and anticipated acceptance of HPV vaccination was assessed in Mozambican adolescent girls. The study anticipates high acceptability of HPV vaccine and adequate awareness about cervical cancer. These results are timely in the context towards the implementation of the HPV vaccine at a national scale in Mozambique.
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28
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Lorenzoni C, Oliveras L, Vilajeliu A, Carrilho C, Ismail MR, Castillo P, Augusto O, Sidat M, Menéndez C, Garcia-Basteiro AL, Ordi J. Weak surveillance and policy attention to cancer in global health: the example of Mozambique. BMJ Glob Health 2018; 3:e000654. [PMID: 29607101 PMCID: PMC5873532 DOI: 10.1136/bmjgh-2017-000654] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/20/2018] [Accepted: 02/24/2018] [Indexed: 12/29/2022] Open
Abstract
Cancer is an emerging public health problem in sub-Saharan Africa due to population growth, ageing and westernisation of lifestyles. The increasing burden of cancer calls for urgent policy attention to develop cancer prevention and control programmes. Cancer surveillance is an essential prerequisite. Only one in five low-income and middle-income countries have the necessary data to drive policy and reduce the cancer burden. In this piece, we use data from Mozambique over a 50-year period to illustrate cancer epidemiological trends in low-income and middle-income countries to hypothesise potential circumstances and factors that could explain changes in cancer burden and to discuss surveillance weaknesses and potential improvements. Like many low-income and middle-income countries, Mozambique faces the dual challenge of a still high morbidity and mortality due to infectious diseases in rural areas and increased incidence of cancers associated with westernisation of lifestyles in urban areas, as well as a rise of cancers related to the HIV epidemic. An increase in cancer burden and changes in the cancer profile should be expected in coming years. The Mozambican healthcare and health-information systems, like in many other low-income and middle-income countries, are not prepared to face this epidemiological transition, which deserves increasing policy attention.
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Affiliation(s)
- Cesaltina Lorenzoni
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Laura Oliveras
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Department of Preventive Medicine and Epidemiology, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain
| | - Alba Vilajeliu
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Department of Preventive Medicine and Epidemiology, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain
| | - Carla Carrilho
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Mamudo R Ismail
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Paola Castillo
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Orvalho Augusto
- Community Health Department, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Mohsin Sidat
- Community Health Department, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Clara Menéndez
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Alberto L Garcia-Basteiro
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands
| | - Jaume Ordi
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
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29
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Edna Omar V, Orvalho A, Nália I, Kaliff M, Lillsunde-Larsson G, Ramqvist T, Nilsson C, Falk K, Nafissa O, Ilesh Vindorai J, Andersson S. Human papillomavirus prevalence and genotype distribution among young women and men in Maputo city, Mozambique. BMJ Open 2017; 7:e015653. [PMID: 28716790 PMCID: PMC5722086 DOI: 10.1136/bmjopen-2016-015653] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Human papillomavirus (HPV) is a well-known cause of cervical cancer, the second most frequent cancer in female African populations. This study aimed at determining the prevalence of HPV infections and the genotype distribution in young adults aged 18-24, in Maputo city, Mozambique, and to assess the suitability of commercially available HPV vaccines. METHODS This cross-sectional study was conducted between 2009 and 2011 at a youth clinic in Maputo Central Hospital. Cervical and urethral samples were obtained from 236 women and 176 men, respectively. Demographic and behavioural data were collected using structured questionnaires. HPV genotyping was performed for 35 different high, probably or possibly high-risk and low-risk HPV types using the CLART Human Papillomavirus 2. RESULTS HPV prevalence was 168/412 (40.8%; 95% CI 36.0 to 45.5) and was significantly higher in women than in men (63.6%vs10.2%). HPV52 was the most frequent type found in women, followed by HPV35, -16,-53, -58,-6 and -51. In men, HPV51 ranked the highest, followed by HPV6, -11,-52, -59 and -70. HIV infection and sexual debut before 18 years of age were associated with multiple HPV infections (OR 3.03; 95% CI 1.49 to 6.25 and OR 6.03; 95% CI 1.73 to 21.02, respectively). Women had a significantly higher HPV infection prevalence than men (p<0.001). The 9-valent HPV vaccine would cover 36.8% of the high-risk genotypes circulating in women in this study, compared with 26.3% and 15.8% coverage by the bivalent and quadrivalent vaccines, respectively. CONCLUSION This study confirmed the high burden of HPV infections in young women in Maputo city, Mozambique. The HPV prevalence was associated with high-risk sexual behaviour. Sex education and sexually transmitted infection prevention interventions should be intensified in Mozambique. Only a proportion of the high-risk HPV genotypes (37%) were covered by currently available vaccines.
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Affiliation(s)
- Viegas Edna Omar
- Instituto Nacional de Saúde, Maputo, Mozambique
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Huddinge, Sweden
- Eduardo Mondlane University, Maputo, Mozambique
| | | | | | - Malin Kaliff
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Torbjörn Ramqvist
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Charlotta Nilsson
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Huddinge, Sweden
- Department of Microbiology, Public Health Agency of Sweden, Stockholm, Sweden
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Kerstin Falk
- Department of Microbiology, Public Health Agency of Sweden, Stockholm, Sweden
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Osman Nafissa
- Eduardo Mondlane University, Maputo, Mozambique
- Hospital Central de Maputo, Maputo, Mozambique
| | | | - Sören Andersson
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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30
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Katsidzira L, Gangaidzo I, Thomson S, Rusakaniko S, Matenga J, Ramesar R. The shifting epidemiology of colorectal cancer in sub-Saharan Africa. Lancet Gastroenterol Hepatol 2017; 2:377-383. [PMID: 28397702 DOI: 10.1016/s2468-1253(16)30183-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/04/2016] [Accepted: 11/07/2016] [Indexed: 02/07/2023]
Abstract
The perception that colorectal cancer is rare in sub-Saharan Africa is widely held; however, it is unclear whether this is due to poor epidemiological data or to lower disease rates. The quality of epidemiological data has somewhat improved, and there is an ongoing transition to western dietary and lifestyle practices associated with colorectal cancer. The impact of these changes on the incidence of colorectal cancer is not as evident as it is with other non-communicable diseases such as diabetes. In this Viewpoint, we discuss the epidemiology of colorectal cancer in sub-Saharan Africa. Colorectal cancer in this region frequently occurs at an early age, often with distinctive histological characteristics. We detail the crucial need for hypothesis-driven research on the risk factors for colorectal cancer in this population and identify key research gaps. Should colorectal cancer occur more frequently than assumed, then commensurate allocation of resources will be needed for diagnosis and treatment.
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Affiliation(s)
- Leolin Katsidzira
- Division of Gastroenterology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Department of Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
| | - Innocent Gangaidzo
- Department of Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Sandie Thomson
- Division of Gastroenterology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Simbarashe Rusakaniko
- Department of Community Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Jonathan Matenga
- Department of Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Raj Ramesar
- MRC/UCT Human Genetics Research Unit, Division of Human Genetics, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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31
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Castillo P, Martínez MJ, Ussene E, Jordao D, Lovane L, Ismail MR, Carrilho C, Lorenzoni C, Fernandes F, Bene R, Palhares A, Ferreira L, Lacerda M, Mandomando I, Vila J, Hurtado JC, Munguambe K, Maixenchs M, Sanz A, Quintó L, Macete E, Alonso P, Bassat Q, Menéndez C, Ordi J. Validity of a Minimally Invasive Autopsy for Cause of Death Determination in Adults in Mozambique: An Observational Study. PLoS Med 2016; 13:e1002171. [PMID: 27875530 PMCID: PMC5119723 DOI: 10.1371/journal.pmed.1002171] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 10/11/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND There is an urgent need to identify tools able to provide reliable information on the cause of death in low-income regions, since current methods (verbal autopsy, clinical records, and complete autopsies) are either inaccurate, not feasible, or poorly accepted. We aimed to compare the performance of a standardized minimally invasive autopsy (MIA) approach with that of the gold standard, the complete diagnostic autopsy (CDA), in a series of adults who died at Maputo Central Hospital in Mozambique. METHODS AND FINDINGS In this observational study, coupled MIAs and CDAs were performed in 112 deceased patients. The MIA analyses were done blindly, without knowledge of the clinical data or the results of the CDA. We compared the MIA diagnosis with the CDA diagnosis of cause of death. CDA diagnoses comprised infectious diseases (80; 71.4%), malignant tumors (16; 14.3%), and other diseases, including non-infectious cardiovascular, gastrointestinal, kidney, and lung diseases (16; 14.3%). A MIA diagnosis was obtained in 100/112 (89.2%) cases. The overall concordance between the MIA diagnosis and CDA diagnosis was 75.9% (85/112). The concordance was higher for infectious diseases and malignant tumors (63/80 [78.8%] and 13/16 [81.3%], respectively) than for other diseases (9/16; 56.2%). The specific microorganisms causing death were identified in the MIA in 62/74 (83.8%) of the infectious disease deaths with a recognized cause. The main limitation of the analysis is that both the MIA and the CDA include some degree of expert subjective interpretation. CONCLUSIONS A simple MIA procedure can identify the cause of death in many adult deaths in Mozambique. This tool could have a major role in improving the understanding and surveillance of causes of death in areas where infectious diseases are a common cause of mortality.
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Affiliation(s)
- Paola Castillo
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Miguel J Martínez
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Esperança Ussene
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Dercio Jordao
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Lucilia Lovane
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Mamudo R Ismail
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Carla Carrilho
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Cesaltina Lorenzoni
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Fabiola Fernandes
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Rosa Bene
- Department of Medicine, Maputo Central Hospital, Maputo, Mozambique
| | - Antonio Palhares
- Fundação de Medicina Tropical Doutor Heitor Viera Dourado, Manaus, Amazonas, Brazil
| | - Luiz Ferreira
- Fundação de Medicina Tropical Doutor Heitor Viera Dourado, Manaus, Amazonas, Brazil
| | - Marcus Lacerda
- Fundação de Medicina Tropical Doutor Heitor Viera Dourado, Manaus, Amazonas, Brazil
| | | | - Jordi Vila
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Juan Carlos Hurtado
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | - Maria Maixenchs
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Ariadna Sanz
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Llorenç Quintó
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Eusebio Macete
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Pedro Alonso
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Quique Bassat
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Clara Menéndez
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Jaume Ordi
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
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32
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Lopez MS, Baker ES, Milbourne AM, Gowen RM, Rodriguez AM, Lorenzoni C, Mwaba C, Msadabwe SC, Tavares JH, Fontes-Cintra G, Zucca-Matthes G, Callegaro-Filho D, Ramos-Martin D, Thiago de Carvalho I, Coelho R, Marques RM, Chulam T, Pontremoli-Salcedo M, Nozar F, Fiol V, Maza M, Arora S, Hawk ET, Schmeler KM. Project ECHO: A Telementoring Program for Cervical Cancer Prevention and Treatment in Low-Resource Settings. J Glob Oncol 2016; 3:658-665. [PMID: 29094102 PMCID: PMC5646881 DOI: 10.1200/jgo.2016.005504] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Cervical cancer incidence and mortality rates are significantly higher in low- and middle-income countries compared with the United States and other developed countries. This disparity is caused by decreased access to screening, often coupled with low numbers of trained providers offering cancer prevention and treatment services. However, similar disparities are also found in underserved areas of the United States, such as the Texas-Mexico border, where cervical cancer mortality rates are 30% higher than in the rest of Texas. To address these issues, we have adopted the Project ECHO (Extension for Community Healthcare Outcomes) program, a low-cost telementoring model previously proven to be successful in increasing local capacity, improving patient management skills, and ultimately improving patient outcomes in rural and underserved areas. We use the Project ECHO model to educate local providers in the management of cervical dysplasia in a low-resource region of Texas and have adapted it to inform strategies for the management of advanced cervical and breast cancer in Latin America and sub-Saharan Africa. This innovative approach, using ECHO, is part of a larger strategy to enhance clinical skills and develop collaborative projects between academic centers and partners in low-resource regions.
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Affiliation(s)
- Melissa S Lopez
- , , , , and , The University of Texas MD Anderson Cancer Center, Houston; , Su Clinica Familiar, Brownsville; , The University of Texas Medical Branch, Galveston, TX; , Hospital Central de Maputo, Maputo, Mozambique; , , Cancer Diseases Hospital, Lusaka, Zambia; , , , and , Hospital de Cancer de Barretos, Barretos; , , , and , Hospital Israelita Albert Einstein; , A.C. Camargo Cancer Center, Sao Paulo; , Federal University of Health Sciences/Santa Casa de Misericordia, Porto Alegre, Brazil; and , Universidad de la Republica, Montevideo, Uruguay; , Basic Health International, San Salvador, El Salvador; and , University of New Mexico, Albuquerque, NM
| | - Ellen S Baker
- , , , , and , The University of Texas MD Anderson Cancer Center, Houston; , Su Clinica Familiar, Brownsville; , The University of Texas Medical Branch, Galveston, TX; , Hospital Central de Maputo, Maputo, Mozambique; , , Cancer Diseases Hospital, Lusaka, Zambia; , , , and , Hospital de Cancer de Barretos, Barretos; , , , and , Hospital Israelita Albert Einstein; , A.C. Camargo Cancer Center, Sao Paulo; , Federal University of Health Sciences/Santa Casa de Misericordia, Porto Alegre, Brazil; and , Universidad de la Republica, Montevideo, Uruguay; , Basic Health International, San Salvador, El Salvador; and , University of New Mexico, Albuquerque, NM
| | - Andrea M Milbourne
- , , , , and , The University of Texas MD Anderson Cancer Center, Houston; , Su Clinica Familiar, Brownsville; , The University of Texas Medical Branch, Galveston, TX; , Hospital Central de Maputo, Maputo, Mozambique; , , Cancer Diseases Hospital, Lusaka, Zambia; , , , and , Hospital de Cancer de Barretos, Barretos; , , , and , Hospital Israelita Albert Einstein; , A.C. Camargo Cancer Center, Sao Paulo; , Federal University of Health Sciences/Santa Casa de Misericordia, Porto Alegre, Brazil; and , Universidad de la Republica, Montevideo, Uruguay; , Basic Health International, San Salvador, El Salvador; and , University of New Mexico, Albuquerque, NM
| | - Rose M Gowen
- , , , , and , The University of Texas MD Anderson Cancer Center, Houston; , Su Clinica Familiar, Brownsville; , The University of Texas Medical Branch, Galveston, TX; , Hospital Central de Maputo, Maputo, Mozambique; , , Cancer Diseases Hospital, Lusaka, Zambia; , , , and , Hospital de Cancer de Barretos, Barretos; , , , and , Hospital Israelita Albert Einstein; , A.C. Camargo Cancer Center, Sao Paulo; , Federal University of Health Sciences/Santa Casa de Misericordia, Porto Alegre, Brazil; and , Universidad de la Republica, Montevideo, Uruguay; , Basic Health International, San Salvador, El Salvador; and , University of New Mexico, Albuquerque, NM
| | - Ana M Rodriguez
- , , , , and , The University of Texas MD Anderson Cancer Center, Houston; , Su Clinica Familiar, Brownsville; , The University of Texas Medical Branch, Galveston, TX; , Hospital Central de Maputo, Maputo, Mozambique; , , Cancer Diseases Hospital, Lusaka, Zambia; , , , and , Hospital de Cancer de Barretos, Barretos; , , , and , Hospital Israelita Albert Einstein; , A.C. Camargo Cancer Center, Sao Paulo; , Federal University of Health Sciences/Santa Casa de Misericordia, Porto Alegre, Brazil; and , Universidad de la Republica, Montevideo, Uruguay; , Basic Health International, San Salvador, El Salvador; and , University of New Mexico, Albuquerque, NM
| | - Cesaltina Lorenzoni
- , , , , and , The University of Texas MD Anderson Cancer Center, Houston; , Su Clinica Familiar, Brownsville; , The University of Texas Medical Branch, Galveston, TX; , Hospital Central de Maputo, Maputo, Mozambique; , , Cancer Diseases Hospital, Lusaka, Zambia; , , , and , Hospital de Cancer de Barretos, Barretos; , , , and , Hospital Israelita Albert Einstein; , A.C. Camargo Cancer Center, Sao Paulo; , Federal University of Health Sciences/Santa Casa de Misericordia, Porto Alegre, Brazil; and , Universidad de la Republica, Montevideo, Uruguay; , Basic Health International, San Salvador, El Salvador; and , University of New Mexico, Albuquerque, NM
| | - Catherine Mwaba
- , , , , and , The University of Texas MD Anderson Cancer Center, Houston; , Su Clinica Familiar, Brownsville; , The University of Texas Medical Branch, Galveston, TX; , Hospital Central de Maputo, Maputo, Mozambique; , , Cancer Diseases Hospital, Lusaka, Zambia; , , , and , Hospital de Cancer de Barretos, Barretos; , , , and , Hospital Israelita Albert Einstein; , A.C. Camargo Cancer Center, Sao Paulo; , Federal University of Health Sciences/Santa Casa de Misericordia, Porto Alegre, Brazil; and , Universidad de la Republica, Montevideo, Uruguay; , Basic Health International, San Salvador, El Salvador; and , University of New Mexico, Albuquerque, NM
| | - Susan Citonje Msadabwe
- , , , , and , The University of Texas MD Anderson Cancer Center, Houston; , Su Clinica Familiar, Brownsville; , The University of Texas Medical Branch, Galveston, TX; , Hospital Central de Maputo, Maputo, Mozambique; , , Cancer Diseases Hospital, Lusaka, Zambia; , , , and , Hospital de Cancer de Barretos, Barretos; , , , and , Hospital Israelita Albert Einstein; , A.C. Camargo Cancer Center, Sao Paulo; , Federal University of Health Sciences/Santa Casa de Misericordia, Porto Alegre, Brazil; and , Universidad de la Republica, Montevideo, Uruguay; , Basic Health International, San Salvador, El Salvador; and , University of New Mexico, Albuquerque, NM
| | - José Humberto Tavares
- , , , , and , The University of Texas MD Anderson Cancer Center, Houston; , Su Clinica Familiar, Brownsville; , The University of Texas Medical Branch, Galveston, TX; , Hospital Central de Maputo, Maputo, Mozambique; , , Cancer Diseases Hospital, Lusaka, Zambia; , , , and , Hospital de Cancer de Barretos, Barretos; , , , and , Hospital Israelita Albert Einstein; , A.C. Camargo Cancer Center, Sao Paulo; , Federal University of Health Sciences/Santa Casa de Misericordia, Porto Alegre, Brazil; and , Universidad de la Republica, Montevideo, Uruguay; , Basic Health International, San Salvador, El Salvador; and , University of New Mexico, Albuquerque, NM
| | - Georgia Fontes-Cintra
- , , , , and , The University of Texas MD Anderson Cancer Center, Houston; , Su Clinica Familiar, Brownsville; , The University of Texas Medical Branch, Galveston, TX; , Hospital Central de Maputo, Maputo, Mozambique; , , Cancer Diseases Hospital, Lusaka, Zambia; , , , and , Hospital de Cancer de Barretos, Barretos; , , , and , Hospital Israelita Albert Einstein; , A.C. Camargo Cancer Center, Sao Paulo; , Federal University of Health Sciences/Santa Casa de Misericordia, Porto Alegre, Brazil; and , Universidad de la Republica, Montevideo, Uruguay; , Basic Health International, San Salvador, El Salvador; and , University of New Mexico, Albuquerque, NM
| | - Gustavo Zucca-Matthes
- , , , , and , The University of Texas MD Anderson Cancer Center, Houston; , Su Clinica Familiar, Brownsville; , The University of Texas Medical Branch, Galveston, TX; , Hospital Central de Maputo, Maputo, Mozambique; , , Cancer Diseases Hospital, Lusaka, Zambia; , , , and , Hospital de Cancer de Barretos, Barretos; , , , and , Hospital Israelita Albert Einstein; , A.C. Camargo Cancer Center, Sao Paulo; , Federal University of Health Sciences/Santa Casa de Misericordia, Porto Alegre, Brazil; and , Universidad de la Republica, Montevideo, Uruguay; , Basic Health International, San Salvador, El Salvador; and , University of New Mexico, Albuquerque, NM
| | - Donato Callegaro-Filho
- , , , , and , The University of Texas MD Anderson Cancer Center, Houston; , Su Clinica Familiar, Brownsville; , The University of Texas Medical Branch, Galveston, TX; , Hospital Central de Maputo, Maputo, Mozambique; , , Cancer Diseases Hospital, Lusaka, Zambia; , , , and , Hospital de Cancer de Barretos, Barretos; , , , and , Hospital Israelita Albert Einstein; , A.C. Camargo Cancer Center, Sao Paulo; , Federal University of Health Sciences/Santa Casa de Misericordia, Porto Alegre, Brazil; and , Universidad de la Republica, Montevideo, Uruguay; , Basic Health International, San Salvador, El Salvador; and , University of New Mexico, Albuquerque, NM
| | - Danielle Ramos-Martin
- , , , , and , The University of Texas MD Anderson Cancer Center, Houston; , Su Clinica Familiar, Brownsville; , The University of Texas Medical Branch, Galveston, TX; , Hospital Central de Maputo, Maputo, Mozambique; , , Cancer Diseases Hospital, Lusaka, Zambia; , , , and , Hospital de Cancer de Barretos, Barretos; , , , and , Hospital Israelita Albert Einstein; , A.C. Camargo Cancer Center, Sao Paulo; , Federal University of Health Sciences/Santa Casa de Misericordia, Porto Alegre, Brazil; and , Universidad de la Republica, Montevideo, Uruguay; , Basic Health International, San Salvador, El Salvador; and , University of New Mexico, Albuquerque, NM
| | - Icaro Thiago de Carvalho
- , , , , and , The University of Texas MD Anderson Cancer Center, Houston; , Su Clinica Familiar, Brownsville; , The University of Texas Medical Branch, Galveston, TX; , Hospital Central de Maputo, Maputo, Mozambique; , , Cancer Diseases Hospital, Lusaka, Zambia; , , , and , Hospital de Cancer de Barretos, Barretos; , , , and , Hospital Israelita Albert Einstein; , A.C. Camargo Cancer Center, Sao Paulo; , Federal University of Health Sciences/Santa Casa de Misericordia, Porto Alegre, Brazil; and , Universidad de la Republica, Montevideo, Uruguay; , Basic Health International, San Salvador, El Salvador; and , University of New Mexico, Albuquerque, NM
| | - Robson Coelho
- , , , , and , The University of Texas MD Anderson Cancer Center, Houston; , Su Clinica Familiar, Brownsville; , The University of Texas Medical Branch, Galveston, TX; , Hospital Central de Maputo, Maputo, Mozambique; , , Cancer Diseases Hospital, Lusaka, Zambia; , , , and , Hospital de Cancer de Barretos, Barretos; , , , and , Hospital Israelita Albert Einstein; , A.C. Camargo Cancer Center, Sao Paulo; , Federal University of Health Sciences/Santa Casa de Misericordia, Porto Alegre, Brazil; and , Universidad de la Republica, Montevideo, Uruguay; , Basic Health International, San Salvador, El Salvador; and , University of New Mexico, Albuquerque, NM
| | - Renato Moretti Marques
- , , , , and , The University of Texas MD Anderson Cancer Center, Houston; , Su Clinica Familiar, Brownsville; , The University of Texas Medical Branch, Galveston, TX; , Hospital Central de Maputo, Maputo, Mozambique; , , Cancer Diseases Hospital, Lusaka, Zambia; , , , and , Hospital de Cancer de Barretos, Barretos; , , , and , Hospital Israelita Albert Einstein; , A.C. Camargo Cancer Center, Sao Paulo; , Federal University of Health Sciences/Santa Casa de Misericordia, Porto Alegre, Brazil; and , Universidad de la Republica, Montevideo, Uruguay; , Basic Health International, San Salvador, El Salvador; and , University of New Mexico, Albuquerque, NM
| | - Thiago Chulam
- , , , , and , The University of Texas MD Anderson Cancer Center, Houston; , Su Clinica Familiar, Brownsville; , The University of Texas Medical Branch, Galveston, TX; , Hospital Central de Maputo, Maputo, Mozambique; , , Cancer Diseases Hospital, Lusaka, Zambia; , , , and , Hospital de Cancer de Barretos, Barretos; , , , and , Hospital Israelita Albert Einstein; , A.C. Camargo Cancer Center, Sao Paulo; , Federal University of Health Sciences/Santa Casa de Misericordia, Porto Alegre, Brazil; and , Universidad de la Republica, Montevideo, Uruguay; , Basic Health International, San Salvador, El Salvador; and , University of New Mexico, Albuquerque, NM
| | - Mila Pontremoli-Salcedo
- , , , , and , The University of Texas MD Anderson Cancer Center, Houston; , Su Clinica Familiar, Brownsville; , The University of Texas Medical Branch, Galveston, TX; , Hospital Central de Maputo, Maputo, Mozambique; , , Cancer Diseases Hospital, Lusaka, Zambia; , , , and , Hospital de Cancer de Barretos, Barretos; , , , and , Hospital Israelita Albert Einstein; , A.C. Camargo Cancer Center, Sao Paulo; , Federal University of Health Sciences/Santa Casa de Misericordia, Porto Alegre, Brazil; and , Universidad de la Republica, Montevideo, Uruguay; , Basic Health International, San Salvador, El Salvador; and , University of New Mexico, Albuquerque, NM
| | - Fernanda Nozar
- , , , , and , The University of Texas MD Anderson Cancer Center, Houston; , Su Clinica Familiar, Brownsville; , The University of Texas Medical Branch, Galveston, TX; , Hospital Central de Maputo, Maputo, Mozambique; , , Cancer Diseases Hospital, Lusaka, Zambia; , , , and , Hospital de Cancer de Barretos, Barretos; , , , and , Hospital Israelita Albert Einstein; , A.C. Camargo Cancer Center, Sao Paulo; , Federal University of Health Sciences/Santa Casa de Misericordia, Porto Alegre, Brazil; and , Universidad de la Republica, Montevideo, Uruguay; , Basic Health International, San Salvador, El Salvador; and , University of New Mexico, Albuquerque, NM
| | - Veronica Fiol
- , , , , and , The University of Texas MD Anderson Cancer Center, Houston; , Su Clinica Familiar, Brownsville; , The University of Texas Medical Branch, Galveston, TX; , Hospital Central de Maputo, Maputo, Mozambique; , , Cancer Diseases Hospital, Lusaka, Zambia; , , , and , Hospital de Cancer de Barretos, Barretos; , , , and , Hospital Israelita Albert Einstein; , A.C. Camargo Cancer Center, Sao Paulo; , Federal University of Health Sciences/Santa Casa de Misericordia, Porto Alegre, Brazil; and , Universidad de la Republica, Montevideo, Uruguay; , Basic Health International, San Salvador, El Salvador; and , University of New Mexico, Albuquerque, NM
| | - Mauricio Maza
- , , , , and , The University of Texas MD Anderson Cancer Center, Houston; , Su Clinica Familiar, Brownsville; , The University of Texas Medical Branch, Galveston, TX; , Hospital Central de Maputo, Maputo, Mozambique; , , Cancer Diseases Hospital, Lusaka, Zambia; , , , and , Hospital de Cancer de Barretos, Barretos; , , , and , Hospital Israelita Albert Einstein; , A.C. Camargo Cancer Center, Sao Paulo; , Federal University of Health Sciences/Santa Casa de Misericordia, Porto Alegre, Brazil; and , Universidad de la Republica, Montevideo, Uruguay; , Basic Health International, San Salvador, El Salvador; and , University of New Mexico, Albuquerque, NM
| | - Sanjeev Arora
- , , , , and , The University of Texas MD Anderson Cancer Center, Houston; , Su Clinica Familiar, Brownsville; , The University of Texas Medical Branch, Galveston, TX; , Hospital Central de Maputo, Maputo, Mozambique; , , Cancer Diseases Hospital, Lusaka, Zambia; , , , and , Hospital de Cancer de Barretos, Barretos; , , , and , Hospital Israelita Albert Einstein; , A.C. Camargo Cancer Center, Sao Paulo; , Federal University of Health Sciences/Santa Casa de Misericordia, Porto Alegre, Brazil; and , Universidad de la Republica, Montevideo, Uruguay; , Basic Health International, San Salvador, El Salvador; and , University of New Mexico, Albuquerque, NM
| | - Ernest T Hawk
- , , , , and , The University of Texas MD Anderson Cancer Center, Houston; , Su Clinica Familiar, Brownsville; , The University of Texas Medical Branch, Galveston, TX; , Hospital Central de Maputo, Maputo, Mozambique; , , Cancer Diseases Hospital, Lusaka, Zambia; , , , and , Hospital de Cancer de Barretos, Barretos; , , , and , Hospital Israelita Albert Einstein; , A.C. Camargo Cancer Center, Sao Paulo; , Federal University of Health Sciences/Santa Casa de Misericordia, Porto Alegre, Brazil; and , Universidad de la Republica, Montevideo, Uruguay; , Basic Health International, San Salvador, El Salvador; and , University of New Mexico, Albuquerque, NM
| | - Kathleen M Schmeler
- , , , , and , The University of Texas MD Anderson Cancer Center, Houston; , Su Clinica Familiar, Brownsville; , The University of Texas Medical Branch, Galveston, TX; , Hospital Central de Maputo, Maputo, Mozambique; , , Cancer Diseases Hospital, Lusaka, Zambia; , , , and , Hospital de Cancer de Barretos, Barretos; , , , and , Hospital Israelita Albert Einstein; , A.C. Camargo Cancer Center, Sao Paulo; , Federal University of Health Sciences/Santa Casa de Misericordia, Porto Alegre, Brazil; and , Universidad de la Republica, Montevideo, Uruguay; , Basic Health International, San Salvador, El Salvador; and , University of New Mexico, Albuquerque, NM
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33
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Kantelhardt EJ, Muluken G, Sefonias G, Wondimu A, Gebert HC, Unverzagt S, Addissie A. A Review on Breast Cancer Care in Africa. Breast Care (Basel) 2015; 10:364-70. [PMID: 26989354 DOI: 10.1159/000443156] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The global incidence of breast cancer (BC) is rising, especially in low- and middle-income countries. The purpose of this review is to summarize existing publications on BC care in Africa. PATIENTS AND METHODS A systematic search in MEDLINE and smaller databases was carried out to identify African studies on BC treatment, and an additional PubMed search was performed for relevant topics on BC care. RESULTS A total of 219 publications, mainly from North and West Africa, were found by systematic search. We also selected articles on BC epidemiology, risk factors, clinical presentation, and cancer control in Africa. CONCLUSIONS Publications on BC treatment are mostly from hospital case series. Evidence on treatment from prospective randomized trials that address the specific characteristics of African patients is lacking. The epidemiologic data shows rising incidences in Africa. The prevalence of risk factors is changing by age group, geographic region, and over time. The clinical picture of BC differs from that of Western countries due to the high proportion of young patients (on account of the African population with a high proportion of young people) and late presentation. Global collaborative efforts are needed to address the rising need for improved BC care in Africa.
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Affiliation(s)
- Eva J Kantelhardt
- Department of Gynecology, Martin-Luther-University, Halle (Saale), Germany
| | - Gizaw Muluken
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getachew Sefonias
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ayele Wondimu
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Susanne Unverzagt
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle (Saale), Germany
| | - Adamu Addissie
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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