1
|
Byers RJ, Byers AJ, Mumba C, Mutuku A, Singer-Rupp J, Wilson M, Fleming K, Sayed S. Development of an online teaching platform to improve access to postgraduate pathology training in sub-Saharan Africa. Front Med (Lausanne) 2024; 11:1390560. [PMID: 38774394 PMCID: PMC11106480 DOI: 10.3389/fmed.2024.1390560] [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: 02/23/2024] [Accepted: 04/04/2024] [Indexed: 05/24/2024] Open
Abstract
Background Resource barriers to the provision of accessible training in cancer diagnosis in lower- and middle-income countries (LMICs) limit the potential of African health systems. Long-term provision via teaching visits from senior pathologists and trainee foreign placements is unsustainable due to the prohibitive costs of travel and subsistence. Emerging eLearning methods would allow pathologists to be trained by experts in a cheaper, more efficient, and more scalable way. Purpose This study aimed to develop an online teaching platform, starting with hematopathology, for trainee pathologists in sub-Saharan Africa, initially in Nairobi, Kenya, and Lusaka, Zambia. Methods Course materials were prepared for both Canvas and the Zoom eLearning platforms using digitally scanned slides of lymph nodes and bone marrow trephines. Initial in-person visits were made to each site to establish trainee rapport and maximize engagement, evaluate different methods and course content, and obtain feedback to develop the project. The knowledge of trainees before and after course completion was used to measure initial effectiveness. Online teaching with the preferred platform is to be continued for 1 year before re-evaluation for long-term effectiveness. Results Canvas was selected as the preferred delivery platform as it is freely available and has good functionality to support all required tasks. Face-to-face teaching was considered optimal to establish the initial rapport necessary to maximize subsequent engagement with online teaching. Challenges have included sub-optimal internet speeds and connections and scheduling issues. Weekly online hematopathology teaching sessions using live image capture microscope sessions, Zoom, and Canvas have been delivered to students in Kenya and Zambia, with good attendance and interaction in case discussions. Conclusion Our team has successfully designed and delivered an online training program in hematopathology to trainee pathologists in Kenya and Zambia, which has been ongoing for over a year. This project is now being scaled to other sub-Saharan countries and other sub-specialties.
Collapse
Affiliation(s)
- Richard J Byers
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Department of Histopathology, Manchester Royal Infirmary, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom
- African Strategies for Advancing Pathology, Denver, CO, United States
| | - Anita J Byers
- Department of Histopathology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | - Chibamba Mumba
- University of Zambia and University Teaching Hospital, Lusaka, Zambia
| | - Angela Mutuku
- African Strategies for Advancing Pathology, Denver, CO, United States
- Aga Khan University, Aga Khan University Hospital, Nairobi, Kenya
| | | | - Michael Wilson
- African Strategies for Advancing Pathology, Denver, CO, United States
- Department of Pathology and Laboratory Services, Denver Health and Department of Pathology, University of Colorado School of Medicine, Denver, CO, United States
| | - Kenneth Fleming
- Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Shahin Sayed
- African Strategies for Advancing Pathology, Denver, CO, United States
- Aga Khan University, Aga Khan University Hospital, Nairobi, Kenya
| |
Collapse
|
2
|
Ngwa W, Addai BW, Adewole I, Ainsworth V, Alaro J, Alatise OI, Ali Z, Anderson BO, Anorlu R, Avery S, Barango P, Bih N, Booth CM, Brawley OW, Dangou JM, Denny L, Dent J, Elmore SNC, Elzawawy A, Gashumba D, Geel J, Graef K, Gupta S, Gueye SM, Hammad N, Hessissen L, Ilbawi AM, Kambugu J, Kozlakidis Z, Manga S, Maree L, Mohammed SI, Msadabwe S, Mutebi M, Nakaganda A, Ndlovu N, Ndoh K, Ndumbalo J, Ngoma M, Ngoma T, Ntizimira C, Rebbeck TR, Renner L, Romanoff A, Rubagumya F, Sayed S, Sud S, Simonds H, Sullivan R, Swanson W, Vanderpuye V, Wiafe B, Kerr D. Cancer in sub-Saharan Africa: a Lancet Oncology Commission. Lancet Oncol 2022; 23:e251-e312. [PMID: 35550267 PMCID: PMC9393090 DOI: 10.1016/s1470-2045(21)00720-8] [Citation(s) in RCA: 102] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 01/13/2023]
Abstract
In sub-Saharan Africa (SSA), urgent action is needed to curb a growing crisis in cancer incidence and mortality. Without rapid interventions, data estimates show a major increase in cancer mortality from 520 348 in 2020 to about 1 million deaths per year by 2030. Here, we detail the state of cancer in SSA, recommend key actions on the basis of analysis, and highlight case studies and successful models that can be emulated, adapted, or improved across the region to reduce the growing cancer crises. Recommended actions begin with the need to develop or update national cancer control plans in each country. Plans must include childhood cancer plans, managing comorbidities such as HIV and malnutrition, a reliable and predictable supply of medication, and the provision of psychosocial, supportive, and palliative care. Plans should also engage traditional, complementary, and alternative medical practices employed by more than 80% of SSA populations and pathways to reduce missed diagnoses and late referrals. More substantial investment is needed in developing cancer registries and cancer diagnostics for core cancer tests. We show that investments in, and increased adoption of, some approaches used during the COVID-19 pandemic, such as hypofractionated radiotherapy and telehealth, can substantially increase access to cancer care in Africa, accelerate cancer prevention and control efforts, increase survival, and save billions of US dollars over the next decade. The involvement of African First Ladies in cancer prevention efforts represents one practical approach that should be amplified across SSA. Moreover, investments in workforce training are crucial to prevent millions of avoidable deaths by 2030. We present a framework that can be used to strategically plan cancer research enhancement in SSA, with investments in research that can produce a return on investment and help drive policy and effective collaborations. Expansion of universal health coverage to incorporate cancer into essential benefits packages is also vital. Implementation of the recommended actions in this Commission will be crucial for reducing the growing cancer crises in SSA and achieving political commitments to the UN Sustainable Development Goals to reduce premature mortality from non-communicable diseases by a third by 2030.
Collapse
Affiliation(s)
- Wilfred Ngwa
- Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA; Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Information and Sciences, ICT University, Yaoundé, Cameroon.
| | - Beatrice W Addai
- Breast Care International, Peace and Love Hospital, Kumasi, Ghana
| | - Isaac Adewole
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Victoria Ainsworth
- Department of Physics and Applied Physics, University of Massachusetts Lowell, Lowell, MA, USA
| | - James Alaro
- National Cancer Institute, National Institute of Health, Bethesda, MD, USA
| | | | - Zipporah Ali
- Kenya Hospices and Palliative Care Association, Nairobi, Kenya
| | - Benjamin O Anderson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Non-communicable Diseases, WHO, Geneva, Switzerland
| | - Rose Anorlu
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Stephen Avery
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Prebo Barango
- WHO, Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Noella Bih
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Christopher M Booth
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - Otis W Brawley
- Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Lynette Denny
- Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa; South African Medical Research Council, Gynaecological Cancer Research Centre, Tygerberg, South Africa
| | | | - Shekinah N C Elmore
- Department of Radiation Oncology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Ahmed Elzawawy
- Department of Clinical Oncology, Suez Canal University, Ismailia, Egypt
| | | | - Jennifer Geel
- Division of Paediatric Haematology and Oncology, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Katy Graef
- BIO Ventures for Global Health, Seattle, WA, USA
| | - Sumit Gupta
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Nazik Hammad
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Laila Hessissen
- Pediatric Oncology Department, Pediatric Teaching Hospital, Rabat, Morocco
| | - Andre M Ilbawi
- Department of Non-communicable Diseases, WHO, Geneva, Switzerland
| | - Joyce Kambugu
- Department of Pediatrics, Uganda Cancer Institute, Kampala, Uganda
| | - Zisis Kozlakidis
- Laboratory Services and Biobank Group, International Agency for Research on Cancer, WHO, Lyon, France
| | - Simon Manga
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | - Lize Maree
- Department of Nursing Education, University of the Witwatersrand, Johannesburg, South Africa
| | - Sulma I Mohammed
- Department of Comparative Pathobiology, Center for Cancer Research, Purdue University, West Lafayette, IN, USA
| | - Susan Msadabwe
- Department of Radiation Therapy, Cancer Diseases Hospital, Lusaka, Zambia
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University Hospital, Nairobi, Kenya
| | | | - Ntokozo Ndlovu
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Kingsley Ndoh
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Mamsau Ngoma
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Twalib Ngoma
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Timothy R Rebbeck
- Dana-Farber Cancer Institute, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Lorna Renner
- Department of Paediatrics, University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | - Anya Romanoff
- Department of Health System Design and Global Health, Icahn School of Medicine, The Mount Sinai Hospital, New York, NY, USA
| | - Fidel Rubagumya
- Department of Oncology, Rwanda Military Hospital, Kigali, Rwanda; University of Global Health Equity, Kigali, Rwanda
| | - Shahin Sayed
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | - Shivani Sud
- Department of Radiation Oncology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Hannah Simonds
- Division of Radiation Oncology, Tygerberg Hospital and University of Stellenbosch, Stellenbosch, South Africa
| | | | - William Swanson
- Department of Physics and Applied Physics, Dana-Farber Cancer Institute, University of Massachusetts Lowell, Lowell, MA, USA
| | - Verna Vanderpuye
- National Centre for Radiotherapy, Oncology, and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | | | - David Kerr
- Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| |
Collapse
|
3
|
Sayed S, Mutasa R, Kaaya E, Mudenda V, Rajiv E, Vuhahula E, Rajab J, Lukande R, Walong E, Mutuku A, Fleming K. Establishing the College of Pathologists of East, Central and Southern Africa - The Regional East Central and Southern Africa College of Pathology. Afr J Lab Med 2020; 9:979. [PMID: 32537427 PMCID: PMC7276350 DOI: 10.4102/ajlm.v9i1.979] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/04/2020] [Indexed: 11/29/2022] Open
Abstract
Issues The scarcity of pathologists in sub-Saharan Africa is a well established fact that is attributable to few training programmes in the region; this is further compounded by the lack of harmonised curricula, training and exams within and without member countries. Description of the intervention Through the Association of Pathologists of East, Central and Southern Africa, the College of Pathologists of East, Central and Southern Africa (COPECSA) was formed with the clear-cut goal of establishing a regional and internationally recognised college to support and inform good quality medical and laboratory practice by promoting leadership, mentorship and excellence in the safe practice of pathology through training, exams, accreditation, advocacy and professional development for health. Lessons learnt Since its inception in 2010, COPECSA has conferred fellowships to 120 practising pathologists in the East, Central and Southern Africa in partnership with international organisations; the college has been awarded five competitive grants and conducted several quality improvement workshops. Recommendations This paper describes the journey that COPECSA has made towards standardising the practice and training of pathology in the East Central and Southern Africa region.
Collapse
Affiliation(s)
- Shahin Sayed
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Nairobi, Kenya
| | - Rudo Mutasa
- Department of Pathology, University of Zimbabwe, Harare, Zimbabwe
| | - Ephata Kaaya
- Department of Pathology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Victor Mudenda
- Department of Pathology, University Teaching Hospital, Lusaka, Zambia
| | - Erasmus Rajiv
- Department of Chemical Pathology, Stellenbosch University, Stellenbosch, South Africa
| | - Edda Vuhahula
- Department of Pathology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Jamilla Rajab
- Department of Human Pathology, University of Nairobi, Kenyatta National Hospital, Nairobi, Kenya
| | - Robert Lukande
- Department of Pathology, Makerere University, Kampala, Uganda
| | - Edwin Walong
- Department of Human Pathology, University of Nairobi, Kenyatta National Hospital, Nairobi, Kenya
| | - Angela Mutuku
- College of Pathologists of East Central and Southern Africa, ECSA Health Community, Arusha, United Republic of Tanzania
| | - Kenneth Fleming
- Green Templeton College, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
5
|
Wilson ML, Ayers S, Berney D, Eslan A, Guarner J, Lester S, Masia R, Moloo Z, Mutuku A, Roberts D, Stall J, Sayed S. Improving Anatomic Pathology in Sub-Saharan Africa to Support Cancer Care. Am J Clin Pathol 2018; 149:310-315. [PMID: 29471457 DOI: 10.1093/ajcp/aqx158] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Cancer care requires both accurate pathologic diagnosis as well as pathologic cancer staging. We evaluated three approaches to training pathologists in sub-Saharan Africa to perform pathologic cancer staging of breast, cervix, prostate, and colorectal cancers. METHODS One of three training methods was used at each workshop: didactic, case-based testing (CBT), or a blended approach. The project involved 52 participants from 16 pathology departments in 11 countries in East, Central, and Southern Africa. Evaluation of each method included pre- and postworkshop knowledge assessments, online pre- and postworkshop surveys of practice changes at the individual and institutional levels, and selected site visits. RESULTS While CBT resulted in the highest overall average postassessment individual scores, both CBT and blended approaches resulted in 19% increases in average scores from pre- to postworkshop assessments. Institutions that participated in the blended workshop had increased changes in practice as indicated by the institutional survey. CONCLUSIONS Both CBT and a blended approach are effective methods for training pathologists in pathologic cancer staging. Both are superior to traditional lectures alone.
Collapse
Affiliation(s)
- Michael L Wilson
- Department of Pathology and Laboratory Services, Denv er Health, Denver, CO
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO
- African Strategies for Advancing Pathology, Denver, CO
| | | | - Daniel Berney
- African Strategies for Advancing Pathology, Denver, CO
- Department of Cellular Pathology, Barts Cancer Institute at Queen Mary University of London, London, UK
| | - Alexia Eslan
- African Strategies for Advancing Pathology, Denver, CO
| | - Jeannette Guarner
- African Strategies for Advancing Pathology, Denver, CO
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Susan Lester
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA
- Department of Pathology, Harvard Medical School, Boston, MA
| | - Ricard Masia
- Department of Pathology, Harvard Medical School, Boston, MA
- Department of Pathology, Massachusetts General Hospital, Boston
| | - Zahir Moloo
- African Strategies for Advancing Pathology, Denver, CO
- College of Pathologists of East, Central, and South Africa, Nairobi, Kenya
- Department of Pathology, Aga Khan University Hospital Nairobi, Nairobi, Kenya
| | - Angela Mutuku
- College of Pathologists of East, Central, and South Africa, Nairobi, Kenya
- Department of Pathology, Aga Khan University Hospital Nairobi, Nairobi, Kenya
| | - Drucilla Roberts
- African Strategies for Advancing Pathology, Denver, CO
- Department of Pathology, Harvard Medical School, Boston, MA
- Department of Pathology, Massachusetts General Hospital, Boston
| | - Jennifer Stall
- Department of Pathology, Harvard Medical School, Boston, MA
- Department of Pathology, Massachusetts General Hospital, Boston
| | - Shahin Sayed
- African Strategies for Advancing Pathology, Denver, CO
- College of Pathologists of East, Central, and South Africa, Nairobi, Kenya
- Department of Pathology, Aga Khan University Hospital Nairobi, Nairobi, Kenya
| |
Collapse
|