Unmet Needs in Oncology Clinical Research and Treatment in Africa: Focus on Ghana

Cancer incidence is increasing worldwide and is a major cause of mortality. The relative magnitude of the increase is remarkably high in low human development index (HDI; 95%) and medium HDI (64%) countries. On the African continent, a corresponding increase in cancer burden is predicted, particularly for sub-Saharan Africa. Current epidemiologic data indicate that mortality rates of certain cancers, such as breast and cervical cancers, in sub-Saharan Africa are the highest in the world, and the cancer risks are broadly comparable to the risks in high-income countries, such as the United States and Europe. Although emerging data alludes to the unique genetic profile of cancer in African populations, most cancer therapies are introduced to Africa without confirmatory clinical trials. Therefore, there is an increasing need for clinical trials directed toward prevention, screening, diagnosis, and identification of innovative treatments in the African context. This review will discuss the increasing cancer burden in Africa, with a particular focus on Ghana, unmet clinical needs in cancer, current medical systems, clinical trial regulatory systems, and challenges to clinical trial recruitment.

Comparing radiological presentations of first and second strains of COVID-19 infections in a low-resource country

INTRODUCTION

The novel corona virus popularly referred to as COVID-19 disease and SARS-CoV-2 was first detected in Wuhan, China in December 2019. It was declared a pandemic by the World Health Organization (WHO) on March 11, 2020. In Ghana, the first two cases of COVID-19 infection were recorded on March 13, 2020 with a strain imported from Europe. In December 2020, a new strain from South Africa was detected in Ghana which was associated with higher transmission rates, severity of the disease, and higher number of recorded deaths. Our study aimed to record notable differences and similarities between infections due to the initial, and second strains of COVID-19 infections detected in Ghana during the last 12-months.

METHOD

This was a retrospective study involving 50 patients infected with the first strain, and another 50 patients infected with the second strain of the SARS-CoV-2 virus. Microsoft Excel-2013 was the analytical tool.

RESULTS

The data analysis supported publications suggesting that the new strain of the virus caused more severe infections, which were manifested on high resolution CT (HRCT) scans as more widespread alveolar disease, most commonly presenting as large areas of consolidation.

CONCLUSION

Despite numerous similarities in terms of the manifestation of COVID-19 infection on HRCT scans, notable difference supporting the notion of increased virulence and severity of disease were also recorded. The study findings demonstrate the need for heightened and sustained preventive measures needed to reduce, and eventually curb COVID-19 infection and mortality rates associated with the introduction of new virulent strains.

CT scan chest findings in symptomatic COVID-19 patients: a reliable alternative for diagnosis

Computed Tomography (CT) scan of the chest plays an important role in the diagnosis and management of Coronavirus disease 2019 (COVID-19), the disease caused by the novel coronavirus SARS-CoV-2. COVID-19 pneumonia shows typical CT Scan features which can aid diagnoses and therefore help in the early detection and isolation of infected patients. CT scanners are readily available in many parts of Ghana. It is able to show findings typical for COVID-19 infection of the chest, even in instances where Reverse Transcription Polymerase Chain Reaction (RTPCR) misses the diagnosis. Little is known about the diagnostic potential of chest CT scan and COVID-19 among physicians even though CT scan offers a high diagnostic accuracy.

Prostatic volume determination by transabdominal ultrasonography: Does accuracy vary significantly with urinary bladder volumes between 50 to 400 mL?

INTRODUCTION

In Ghana, trans-abdominal ultrasonography is the main sonographic method of prostatic volume evaluation. The examinations are done when the patient's bladder is full. However, the delay and the discomforting experiences associated with a full bladder have been well documented. In an attempt to investigate other less discomforting options, this study was undertaken to determine if sonographic transabdominal prostatic evaluations performed at urinary bladder volumes of 50-99 mL differ significantly to evaluations done at volumes of 100-199, 200-299 and 300-399 mL.

METHODS

A prostatic study of adult patients was undertaken in Accra, from 2014 to 2015. Using an ultrasound machine, 79 sets of prostatic measurements were recorded at a urinary bladder volume of 50-99 mL (V1 as our reference volume), and at least one of three other urinary bladder volumes (V2 = 100-199 mL, V3 = 200-299 mL and V4 = 300-399 mL), in 66 males. Twelve of the participants had multiple sets of prostate volume measurements. SPSS was used to analyse the data. T-test, Bland-Altman plots and linear regression were used to compare and test for the existence of proportional biases in measurements.

RESULTS

There was a statistically significant difference in prostatic volumes recorded at V1 and V2 (P = 0.017). However, the prostatic volume differences recorded for V1/V3, and V1/V4 groups of data were all not statistically significant (P > 0.05). The limits of agreement for the set of measurements spread from approximately -29 to +18 mL for V1/V2, -48 to +36 mL for V1/V3 and -12 to +12 mL for V1/V4 variables. There was no proportional bias in the V1/V2 (P = 0.55) and V1/V4 (P = 0.463) measurements.

CONCLUSION

Urinary bladder volume of 50-99 mL produces prostatic volume measurements comparable to volumes measured in patients with a full (300-399 mL), or nearly full urinary bladder (200-299 mL). A urinary bladder volume of 50-99 mL may therefore be adequate for scanning the prostate gland, and is likely to be tolerated much better by patients.

MRI to determine the chronological age of Ghanaian footballers

Background. The chronological age of the ordinary Ghanaian has often been difficult to verify as registration at birth is not compulsory. Consequently, an accurate method of age determination is needed in competitive age-restricted sports.Objective. To evaluate the age of Ghanaian soccer players who are aspiring to play for the national under-17 (U17) team, using the degree of fusion of the distal radius on magentic resonance imaging (MRI) and comparing it with the Fédération Internationale de Football Association (FIFA) MRI grading.Methods. MRI scans of the left wrists of 86 players aspiring to play for the national U17 football team were recruited for the study during a ‘justify your inclusion tournament’ organised by the Ghana Football Association between June and August 2012. The study was conducted in a diagnostic centre in Accra using a 0.35T MRI scanner. The images were analysed using the previously published FIFA grading system.Results. The mean chronological age of the players was 15.4 years (standard deviation ±0.7; range 12 - 17). The study showed that 43.0% of the MRI images were grade 6 (≥17 years) in relation to the degree of fusion of the distal radius, and 93.0% of the grade 6 players were aged 15 - 16 years chronologically. There was no significant correlation between the chronological age and the degree of fusion (r=0.075; p=0.493).Conclusion. Ghanaian U17 soccer players seem to be more biologically mature than a normative population of the same age category. The lack of correlation between age category and degree of fusion supports the suspicion that most Ghanaian players may not know their true age.

MRI to determine the chronological age of Ghanaian footballers

Background. The chronological age of the ordinary Ghanaian has often been difficult to verify as registration at birth is not compulsory. Consequently, an accurate method of age determination is needed in competitive age-restricted sports.Objective. To evaluate the age of Ghanaian soccer players who are aspiring to play for the national under-17 (U17) team, using the degree of fusion of the distal radius on magentic resonance imaging (MRI) and comparing it with the Fédération Internationale de Football Association (FIFA) MRI grading.Methods. MRI scans of the left wrists of 86 players aspiring to play for the national U17 football team were recruited for the study during a ‘justify your inclusion tournament’ organised by the Ghana Football Association between June and August 2012. The study was conducted in a diagnostic centre in Accra using a 0.35T MRI scanner. The images were analysed using the previously published FIFA grading system.Results. The mean chronological age of the players was 15.4 years (standard deviation ±0.7; range 12 - 17). The study showed that 43.0% of the MRI images were grade 6 (≥17 years) in relation to the degree of fusion of the distal radius, and 93.0% of the grade 6 players were aged 15 - 16 years chronologically. There was no significant correlation between the chronological age and the degree of fusion (r=0.075; p=0.493).Conclusion. Ghanaian U17 soccer players seem to be more biologically mature than a normative population of the same age category. The lack of correlation between age category and degree of fusion supports the suspicion that most Ghanaian players may not know their true age.