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Ngoma T, Adewole I, Ainsworth V, Chin D, Chin J, Elzawawy A, Joseph A, Mallum A, Ndlovu N, Ngoma M, Oladipo A, Swanson W, Ngwa W. Cancer control collaborations between China and African countries. Lancet Oncol 2024; 25:e164-e172. [PMID: 38547900 DOI: 10.1016/s1470-2045(23)00634-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/21/2023] [Accepted: 12/05/2023] [Indexed: 04/02/2024]
Abstract
Over the past decade, China has emerged as Africa's largest trade partner and source of foreign direct investment, with public health ranked as a top priority in China-Africa collaborations. During the same period, cancer has emerged as a leading cause of death in Africa, with more than 700 000 deaths per year and projections of more than 1 million deaths per year by 2030. In this Review, we explore the effects of increasing China-Africa collaborations on cancer control in Africa. We review the published literature on health-care assistance, research, education and training, and infrastructure and present the results of an institutional review board-approved survey of African oncology health-care professionals and institutional leaders that assessed their perception of the effects of China-Africa collaborations. From peer-reviewed articles and grey literature, we found that the number of China-Africa collaborations have grown substantially over the past decade in different areas, especially in patient care and infrastructure. Research publications have also surged in quantity in the past decade compared with previous years. However, the survey results suggest research collaborations remain infrequent and that medical professionals in African cancer centres rarely participate in direct research collaborations with Chinese institutions. The Review also highlights the challenges and benefits of increasing China-Africa collaborations. Challenges include insufficient monitoring and evaluation of the projects in Africa and poor coordination and alignment of the various initiatives. The benefits of these collaborations for Africa include improved health outcomes, strengthened health systems, and socioeconomic development. Benefits are also apparent for China, such as securing energy and resource supplies, expanded trade and investment opportunities, and improved diplomatic relations. Overall, China-Africa collaborations are increasing and having a substantial effect in both China and the African continent. Recommendations to minimise the challenges and maximise the benefits for more positive consequences on cancer control in Africa are discussed.
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Affiliation(s)
- Twalib Ngoma
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Isaac Adewole
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - David Chin
- United Health Services, Johnson City, NY, USA
| | - Jennifer Chin
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ahmed Elzawawy
- Suez Canal University, Ismailia, Egypt; Alsoliman Clinical and Radiation Oncology Center, Port Said, Egypt
| | - Adedayo Joseph
- Nigeria Sovereign Investment Authority-Lagos University Teaching Hospital Cancer Center, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Abba Mallum
- University of KwaZulu Natal, Durban South Africa and Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Ntokozo Ndlovu
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Mamsau Ngoma
- Academic Unit, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Aishat Oladipo
- Department of Clinical Oncology, Weill Cornell Medicine, New York, NY, USA
| | - William Swanson
- Department of Clinical Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Wilfred Ngwa
- The University of Massachusetts Lowell, Lowell, MA, USA; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA; Rutgers Global Health Institute, Rutgers University, New Brunswick, NJ, USA; Department of Information and Sciences, Information and Communications Technology University, Yaoundé, Cameroon
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Salako O, Enyi A, Miesfeldt S, Kabukye JK, Ngoma M, Namisango E, LeBaron V, Sisimayi C, Ebenso B, Lorenz KA, Wang Y, Ryan Wolf J, van den Hurk C, Allsop M. Remote Symptom Monitoring to Enhance the Delivery of Palliative Cancer Care in Low-Resource Settings: Emerging Approaches from Africa. Int J Environ Res Public Health 2023; 20:7190. [PMID: 38131741 PMCID: PMC10743024 DOI: 10.3390/ijerph20247190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/10/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
This paper brings together researchers, clinicians, technology developers and digital innovators to outline current applications of remote symptom monitoring being developed for palliative cancer care delivery in Africa. We outline three remote symptom monitoring approaches from three countries, highlighting their models of delivery and intended outcomes, and draw on their experiences of implementation to guide further developments and evaluations of this approach for palliative cancer care in the region. Through highlighting these experiences and priority areas for future research, we hope to steer efforts to develop and optimise remote symptom monitoring for palliative cancer care in Africa.
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Affiliation(s)
- Omolola Salako
- Radiation Biology, Radiotherapy and Radiodiagnosis (RBRR) Digital Health Hub, College of Medicine, Lagos University Teaching Hospital, Lagos 102215, Nigeria;
| | | | - Susan Miesfeldt
- Medical Oncology, Maine Medical Center, MaineHealth Cancer Care Center, Scarborough, ME 04106, USA;
| | - Johnblack K. Kabukye
- Uganda Cancer Institute, Upper Mulago Hill Road, Kampala P.O. Box 3935, Uganda;
- Swedish Program for ICT in Developing Regions (SPIDER), Department of Computer and Systems Sciences (DSV), Stockholm University, 164 55 Stockholm, Sweden
| | - Mamsau Ngoma
- Ocean Road Cancer Institute, Dar es Salaam P.O. Box 3592, Tanzania;
| | - Eve Namisango
- African Palliative Care Association, Kampala P.O. Box 72518, Uganda;
| | - Virginia LeBaron
- School of Nursing, University of Virginia, Charlottesville, VA 22903, USA;
| | - Chenjerai Sisimayi
- Department of Mathematics and Applied Mathematics, University of Johannesburg, Johannesburg 2006, South Africa;
| | - Bassey Ebenso
- School of Medicine, University of Leeds, Leeds LS2 9LU, UK;
| | - Karl A. Lorenz
- Ci2i, United States Department of Veterans Affairs, Menlo Park, CA 94025, USA;
- Primary Care and Population Health, Stanford School of Medicine, Stanford, CA 94305, USA
| | - Yan Wang
- School of Nursing, University of Pittsburgh, Pittsburgh, PA 15213, USA;
| | - Julie Ryan Wolf
- Departments of Dermatology and Radiation Oncology, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY 14642, USA;
| | - Corina van den Hurk
- R&D Department, Netherlands Comprehensive Cancer Organisation, 3501 DB Utrecht, The Netherlands;
| | - Matthew Allsop
- School of Medicine, University of Leeds, Leeds LS2 9LU, UK;
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Patel S, Olatunji EO, Joseph AO, Lasebikan N, Ngoma M, Ngoma TA, Nnko G, Chigbo DC, Ngwa W. An Analysis of Delays in Treatment Time for Prostate Cancer Patients in Sub-Saharan Africa. Int J Radiat Oncol Biol Phys 2023; 117:e610-e611. [PMID: 37785838 DOI: 10.1016/j.ijrobp.2023.06.1984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Time interval from diagnosis of prostate cancer to treatment is an important predictor of survival outcomes for patients. These time intervals can be prolonged in resource-limited settings, such as those in Sub-Saharan Africa (SSA). The purpose of this project was to analyze the time interval between diagnosis and either hormonal or radiotherapy treatment for prostate cancer patients in Nigeria and Tanzania. The outcomes can inform the implementation of the recent Lancet Oncology Commission recommendations on increasing access to radiotherapy services in SSA to curb the growing cancer burden in the region. MATERIALS/METHODS Data were extracted from electronic patient records at the NSIA-LUTH Cancer Center (NLCC) in Lagos, Nigeria and at the Ocean Road Cancer Institute (ORCI) in Dar Es Salaam, Tanzania. Included patients were prostate cancer patients who received hypofractionated radiotherapy (HFRT) at ORCI between January 6 - June 16, 2022, and either HFRT or conventionally fractionated radiotherapy (CFRT) at NLCC between February 1 - July 27, 2022. Simple descriptive statistics were used to calculate the mean time interval between the patient's date of diagnosis of prostate cancer and the start of hormonal or radiotherapy treatment. RESULTS Time to hormonal therapy was collected for 23 ORCI patients and 28 NLCC patients. The mean time interval from date of diagnosis to start of hormonal therapy was 19.3 weeks for patients in Tanzania and 8.0 weeks for patients in Nigeria. Time to radiotherapy was collected for 23 ORCI patients and 50 NLCC patients. The mean time interval from date of diagnosis to start of radiotherapy was 59.13 weeks for patients in Tanzania and 48.5 weeks for patients in Nigeria. CONCLUSION Prostate cancer patients in Nigeria and Tanzania experience significant delay in receiving hormonal and radiotherapy treatment, especially when compared to wait times in well-resourced countries. For example, a recent assessment of U.S. patients in the National Cancer Database who were diagnosed with prostate cancer between 2004-2015 revealed that the mean interval from diagnosis to definitive therapy (either surgery or some form of radiotherapy) was 11.3 weeks - significantly less than the mean times documented in our study of SSA patients (Cone et al., 2020). Additionally, patients in Tanzania experienced longer treatment delays compared to patients in Nigeria, highlighting potential disparities in access to care between SSA countries. These prolonged delay times are likely to negatively impact survival and represent an intervention opportunity to alleviate the cancer crisis in SSA.
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Affiliation(s)
- S Patel
- Johns Hopkins Medicine, Baltimore, MD
| | | | | | - N Lasebikan
- University of Nigeria Teaching Hospital Enugu, Enugu, Nigeria
| | - M Ngoma
- Ocean Road Cancer Institute, Dar Es Salaam, United Republic of Tanzania
| | - T A Ngoma
- Ocean Road Cancer Institute, Dar Es Salaam, United Republic of Tanzania
| | - G Nnko
- Ocean Road Cancer Institute, Dar Es Salaam, United Republic of Tanzania
| | - D C Chigbo
- University of Nigeria Teaching Hospital, Lagos, Nigeria
| | - W Ngwa
- John Hopkins University Hospital, Baltimore, MD
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Patel S, Olatunji EO, Mallum AAI, Benjika B, Joseph AO, Joseph S, Lasebikan N, Mahuna H, Ngoma M, Ngoma TA, Nnko G, Chigbo DC, Vorster M, Ngwa W. Expanding Radiotherapy Access in Sub-Saharan Africa: An Analysis of Travel Burdens and Patient-Related Benefits of Hypofractionation. Int J Radiat Oncol Biol Phys 2023; 117:e613. [PMID: 37785843 DOI: 10.1016/j.ijrobp.2023.06.1989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The purpose of this project was to examine the travel burdens for radiotherapy patients in Nigeria, Tanzania, and South Africa, and to assess the patient-related benefits of hypofractionated radiotherapy (HFRT) for breast and prostate cancer patients in these countries. The outcomes can inform the implementation of the recent Lancet Oncology Commission recommendations on increasing the adoption of HFRT in Sub-Saharan Africa (SSA) to enhance radiotherapy access in the region. MATERIALS/METHODS Data were extracted from electronic patient records at the NSIA-LUTH Cancer Center (NLCC) in Lagos, Nigeria and the Inkosi Albert Luthuli Central Hospital (IALCH) in Durban, South Africa, from written records at the University of Nigeria Teaching Hospital (UNTH) Oncology Center in Enugu, Nigeria, and from phone interviews at Ocean Road Cancer Institute (ORCI) in Dar Es Salaam, Tanzania. Google Maps was used to calculate the shortest driving distance between a patient's home address and their respective radiotherapy center. QGIS was used to map the straight-line distances to each center. Descriptive statistics were used to compare transportation costs, time expenditures, and lost wages when using HFRT versus conventionally fractionated radiotherapy (CFRT) for breast and prostate cancer. All transportation- and wage-related cost data were contextualized within each country's monthly adjusted net national income (MANNI) per capita, as reported by 2020 data from the World Bank. RESULTS Patients in Nigeria (n = 390) traveled a median distance of 24.0 km (interquartile range (IQR) = 238.5 km) to NLCC and 86.7 km (IQR = 87.3 km) to UNTH, patients in Tanzania (n = 23) traveled a median distance of 537.0 km (IQR = 587.5 km) to ORCI, and patients in South Africa (n = 412) traveled a median distance of 18.0 km (IQR = 15.0 km) to IALCH. Estimated transportation cost savings for breast cancer patients in Lagos and Enugu were 12,895 Naira and 7,369 Naira (20% and 11% of MANNI per capita), respectively, and for prostate cancer patients were 25,329 and 14,276 Naira (38% and 22% of MANNI per capita), respectively. Prostate cancer patients in Tanzania saved a median of 137,765 Shillings (78% of MANNI per capita) in transportation costs. Significant time expenditures - a relevant consideration for patient convenience - were also saved for ORCI patients, including a median of 80.0 hours (includes travel, treatment, and wait times). Mean transportation cost savings for patients in South Africa were 4,777 Rand (72% of MANNI per capita) for breast cancer and 9,486 Rand (143% of MANNI per capita) for prostate cancer. CONCLUSION Cancer patients in SSA travel considerable distances to access radiotherapy services. HFRT decreases patient-related costs and time expenditures, which may increase radiotherapy access and alleviate the growing burden of cancer in the region.
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Affiliation(s)
- S Patel
- Johns Hopkins Medicine, Baltimore, MD
| | | | - A A I Mallum
- University of KwaZulu-Natal, Durban, South Africa
| | - B Benjika
- ICT University USA, Yaounde, Cameroon
| | | | - S Joseph
- Ocean Road Cancer Institute, Dar Es Salaam, United Republic of Tanzania
| | - N Lasebikan
- University of Nigeria Teaching Hospital Enugu, Enugu, Nigeria
| | - H Mahuna
- Ocean Road Cancer Institute, Dar Es Salaam, United Republic of Tanzania
| | - M Ngoma
- Ocean Road Cancer Institute, Dar Es Salaam, United Republic of Tanzania
| | - T A Ngoma
- Ocean Road Cancer Institute, Dar Es Salaam, United Republic of Tanzania
| | - G Nnko
- Ocean Road Cancer Institute, Dar Es Salaam, United Republic of Tanzania
| | - D C Chigbo
- University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - M Vorster
- University of KwaZulu-Natal, Durban, South Africa
| | - W Ngwa
- John Hopkins University Hospital, Baltimore, MD
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Mrema AS, Ngoma M, Josiah C, Lugina E, Mvungi N, Paul M, Mkuchika E, Nundu E, Iddy SK, Rugengamanzi E, Vuhahula YM, Kiwanga FC, Wood C, Mwaiselage J. HIV and Early Treatment Outcomes Among Women With Cervical Cancer Treated With Concurrent Chemoradiation in Tanzania. JCO Glob Oncol 2023; 9:e2200441. [PMID: 37738537 PMCID: PMC10581651 DOI: 10.1200/go.22.00441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/04/2023] [Accepted: 07/10/2023] [Indexed: 09/24/2023] Open
Abstract
PURPOSE Cervical cancer (CC) is the leading malignancy in Tanzania. Low-income countries are faced with double epidemics of HIV and CC. This study aimed to investigate how HIV and cancer stage at diagnosis affect early treatment outcomes among women with CC treated with concurrent chemoradiation in Tanzania in the highly active antiretroviral therapy era. MATERIALS AND METHODS This was a prospective cohort study of patients newly diagnosed with CC at the Ocean Road Cancer Institute from November 2019 to January 2020. The tumor response was assessed using RECIST 3 months post-treatment. The tumor response was categorized as a complete or partial response according to the ultrasound and pelvic examination findings. The univariate and multivariate logistic regression explained the relationship between several covariates (age, stage, HIV status, equivalent dose in 2 Gy fractions, chemotherapy cycles, and treatment time) and treatment response. RESULTS A total of 102 patients with CC were included in this study at baseline. After adjusting for other covariates, only completion of treatment within 56 days (odds ratio [OR], 9.23; 95% CI, 1.53 to 55.85; P = .016) and receiving at least three cycles of cisplatin (OR, 5.6; 95% CI, 1.47 to 21.34; P = .012) were significantly associated with complete tumor response. HIV status was not significantly associated with complete tumor response (OR, 1.534; 95% CI, 0.424 to 5.545; P = .5144). CONCLUSION Early treatment response was independent of HIV status. With wide coverage of anitretroviral therapy, patients with HIV can receive radical treatment and have the same early outcomes as their HIV-negative counterparts.
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Affiliation(s)
- Alita Steven Mrema
- Clinical Oncology Department, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Mamsau Ngoma
- Clinical Oncology Department, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Chacha Josiah
- Clinical Oncology Department, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Emmanuel Lugina
- Clinical Oncology Department, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Nanzoke Mvungi
- Clinical Oncology Department, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Magreth Paul
- Clinical Oncology Department, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Evelyne Mkuchika
- Clinical Oncology Department, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Emmanuel Nundu
- Clinical Oncology Department, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Salama Khamisi Iddy
- Clinical Oncology Department, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | | | | | | | - Charles Wood
- Louisiana State University Health Sciences Center, New Orleans, LA
| | - Julius Mwaiselage
- Clinical Oncology Department, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Patel S, Olatunji E, Mallum A, Benjika BB, Joseph AO, Joseph S, Lasebikan N, Mahuna H, Ngoma M, Ngoma TA, Nnko G, Onwualu C, Vorster M, Ngwa W. Expanding radiotherapy access in Sub-Saharan Africa: an analysis of travel burdens and patient-related benefits of hypofractionation. Front Oncol 2023; 13:1136357. [PMID: 37143940 PMCID: PMC10151787 DOI: 10.3389/fonc.2023.1136357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/20/2023] [Indexed: 05/06/2023] Open
Abstract
Purpose The purpose of this project was to examine the travel burdens for radiotherapy patients in Nigeria, Tanzania, and South Africa, and to assess the patient-related benefits of hypofractionated radiotherapy (HFRT) for breast and prostate cancer patients in these countries. The outcomes can inform the implementation of the recent Lancet Oncology Commission recommendations on increasing the adoption of HFRT in Sub-Saharan Africa (SSA) to enhance radiotherapy access in the region. Methods Data were extracted from electronic patient records at the NSIA-LUTH Cancer Center (NLCC) in Lagos, Nigeria and the Inkosi Albert Luthuli Central Hospital (IALCH) in Durban, South Africa, from written records at the University of Nigeria Teaching Hospital (UNTH) Oncology Center in Enugu, Nigeria, and from phone interviews at Ocean Road Cancer Institute (ORCI) in Dar Es Salaam, Tanzania. Google Maps was used to calculate the shortest driving distance between a patient's home address and their respective radiotherapy center. QGIS was used to map the straight-line distances to each center. Descriptive statistics were used to compare transportation costs, time expenditures, and lost wages when using HFRT versus conventionally fractionated radiotherapy (CFRT) for breast and prostate cancer. Results Patients in Nigeria (n=390) traveled a median distance of 23.1 km to NLCC and 86.7 km to UNTH, patients in Tanzania (n=23) traveled a median distance of 537.0 km to ORCI, and patients in South Africa (n=412) traveled a median distance of 18.0 km to IALCH. Estimated transportation cost savings for breast cancer patients in Lagos and Enugu were 12,895 Naira and 7,369 Naira, respectively and for prostate cancer patients were 25,329 and 14,276 Naira, respectively. Prostate cancer patients in Tanzania saved a median of 137,765 Shillings in transportation costs and 80.0 hours (includes travel, treatment, and wait times). Mean transportation cost savings for patients in South Africa were 4,777 Rand for breast cancer and 9,486 Rand for prostate cancer. Conclusion Cancer patients in SSA travel considerable distances to access radiotherapy services. HFRT decreases patient-related costs and time expenditures, which may increase radiotherapy access and alleviate the growing burden of cancer in the region.
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Affiliation(s)
- Saloni Patel
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
- *Correspondence: Saloni Patel,
| | - Elizabeth Olatunji
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Abba Mallum
- Department of Radiotherapy and Oncology, University of KwaZulu-Natal, Durban, South Africa
- Department of Oncology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | | | - Adedayo O. Joseph
- NSIA-LUTH Cancer Center, Lagos University Teaching Hospital, Lagos, Nigeria
| | | | - Nwamaka Lasebikan
- Oncology Center, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - Habiba Mahuna
- Ocean Road Cancer Institute, Dar Es Salaam, Tanzania
| | - Mamsau Ngoma
- Ocean Road Cancer Institute, Dar Es Salaam, Tanzania
| | - Twalib Athumani Ngoma
- Ocean Road Cancer Institute, Dar Es Salaam, Tanzania
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Godwin Nnko
- Ocean Road Cancer Institute, Dar Es Salaam, Tanzania
| | - Chinelo Onwualu
- Oncology Center, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - Mariza Vorster
- College of Health Science, University of KwaZulu-Natal, Durban, South Africa
| | - Wilfred Ngwa
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
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Ho YX, Morse RS, Lambden K, Mushi BP, Ngoma M, Mahuna H, Ngoma T, Miesfeldt S. How a Digital Case Management Platform Affects Community-Based Palliative Care of Sub-Saharan African Cancer Patients: Clinician-Users' Perspectives. Appl Clin Inform 2022; 13:1092-1099. [PMID: 36384234 PMCID: PMC9668489 DOI: 10.1055/s-0042-1758223] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background
Symptom control among cancer patients is a Tanzanian public health priority impacted by limited access to palliative care (PC) specialists and resources. Mobile Palliative Care Link (mPCL), a mobile/web application, aims to extend specialist access via shared care with local health workers (LHWs) with the African
P
alliative care
O
utcome
S
cale (POS) adapted for regular, automated symptom assessment as a core feature.
Objective
The aim of the study is to assess clinicians' attitudes, beliefs, and perceptions regarding mPCL usability and utility with their patients within a government-supported, urban Tanzanian cancer hospital setting.
Methods
We used a mixed methods approach including surveys, qualitative interviews, and system usage data to assess clinicians' experience with mPCL in a field study where discharged, untreatable cancer patients were randomized to mPCL or phone-contact POS collection.
Results
All six specialists and 10 LHWs expressed overall satisfaction with mPCL among 49 intervention arm patients. They perceived mPCL as a way to stay connected with patients and support remote symptom control. Timely access to POS responses and medical records were identified as key benefits. Some differences in perceptions of mPCL use and utility were seen between clinician groups; however, both expressed strong interest in continuing app use, recommending it to colleagues, and extending use throughout Tanzania. Primary use was for clinical status communication and care coordination. Pain and other symptom progression were the most frequently reported reasons for provider–patient interactions accounting for 34% (
n
= 44) and 12% (
n
= 15) of reasons, respectively. Usage barriers included time required to create a new clinical record, perceived need for response to non-urgent reminders or alerts, and training. necessary for competent use. System-level implementation barriers included variable patient access to smartphones and SIM cards and unreliable Internet access.
Conclusion
This work demonstrates broad clinician desire for digital health tools to support remote community-based PC among cancer patients, particularly pain management.
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Affiliation(s)
- Yun Xian Ho
- Dimagi, Inc., Cambridge, Massachusetts, United States,Address for correspondence Yun Xian Ho, PhD Dimagi, Inc.Cambridge, MA 02139United States
| | - Robert S. Morse
- DaVinci Usability, Inc., Lexington, Massachusetts, United States
| | - Kaley Lambden
- Dimagi, Inc., Cambridge, Massachusetts, United States
| | - Beatrice P. Mushi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mamsau Ngoma
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Habiba Mahuna
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Twalib Ngoma
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania,Ocean Road Cancer Institute, Dar es Salaam, Tanzania
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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: 81] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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9
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Wabl CA, Athanas R, Cubaka V, Mushi B, Ngoma M, Nsabimana N, Sama G, Tuyishime H, Uwamahoro P, Sanders JJ, Sudore RL, Van Loon K, Whitaker E, DeBoer RJ. Serious Illness Communication in Cancer Care in Africa: A Scoping Review of Empirical Research. JCO Glob Oncol 2022. [DOI: 10.1200/go.22.53000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Serious illness communication (SIC) in cancer care describes conversations between clinicians, patients, and families about prognosis and treatment decisions. Cultural context influences SIC. Researchers have studied SIC across diverse settings in Africa. We aimed to describe and synthesize the heterogeneous body of research on SIC practices, preferences, and needs in Africa to identify research and training priorities. METHODS Our search strategy identified studies that focused on SIC within cancer or palliative care in Africa. Following PRISMA guidelines, a systematic literature search was performed using PubMed, Embase, Web of Science, CINAHL, African Index Medicus, and PsycINFO, yielding 1811 unique titles. After sequential review of abstracts, full text, and cited references, 42 articles met inclusion criteria. Quantitative and qualitative data describing study characteristics, aims, methods, and findings were abstracted and analyzed using descriptive statistics and thematic analysis. Critical appraisal was performed using the Mixed Methods Appraisal Tool. RESULTS The 42 included articles were published from 1997-2021, half since 2017, representing 16 countries and all African Union regions: West (33%), East (29%), South (21%), North (12%), and Central (5%). Most study designs were qualitative (45%) or quantitative surveys (50%). Study participants included patients (35%), family caregivers (18%), doctors (18%), nurses (12%), and/or other (11%). Study aims focused on disclosure of diagnosis (27%) or prognosis (20%), breaking bad news (15%), general patient-clinician communication (12%), truth-telling (8%), shared decision-making (7%), information needs/preferences (5%), and/or advance care planning (5%). Despite diverse contexts, common themes emerged. Study authors frequently recommended communication skills training. Critical appraisal demonstrated high quality of studies overall. CONCLUSION Research on SIC in Africa has increased in recent years. Most studies have focused on information delivery by clinicians; fewer on eliciting information from patients (eg, shared decision-making, advanced care planning). Significant opportunities exist for further study and for communication skills training.
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Affiliation(s)
| | - Raymond Athanas
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Beatrice Mushi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mamsau Ngoma
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | | | - Godfrey Sama
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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10
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Vicent B, Meda J, Ngoma M, Wan L, Yinglan L. Risk factors and early cardiovascular outcomes in cancer patients treated with anthracycline-based chemotherapy in Tanzania: a protocol for a quasi-experimental study. Biol Methods Protoc 2022; 7:bpac006. [PMID: 35291267 PMCID: PMC8917873 DOI: 10.1093/biomethods/bpac006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/30/2022] [Indexed: 11/14/2022] Open
Abstract
The objective of this quasi-experimental study is to assess the risk factors and early cardiovascular outcomes in cancer patients treated with anthracycline-based chemotherapy in Tanzania. The study will be conducted at Ocean Road Cancer Institute in Dar es salaam, Tanzania. The study will have three phases: baseline survey, follow-up, and end-line survey. Participants will be newly diagnosed adult cancer patients who are eligible for anthracycline-based chemotherapy. A total of 427 participants will be involved. At baseline, participants will be evaluated for the cardiovascular risk factors before commencing chemotherapy. During follow-up, participants will commence their prescribed anthracycline and the cardiovascular indices monitored throughout until the patient completes the prescribed anthracycline cycles. After completing the prescribed anthracycline cycles, an end line survey will be conducted to evaluate any change in cardiovascular indices. The outcome variable in this study will be the change in biochemical data (high-density lipoprotein, low-density lipoprotein, triglyceride, and troponin I), blood pressure, and electrocardiographic information (heart rate and Bazett QT interval). Independent variables will be demographic characteristics, risk factors for cardiovascular disorders, current dietary practices, and body mass index. Descriptive statistics will be used to describe the participants. Independent and paired t-tests will be performed to make comparisons between and within groups. P-values <0.05 will be considered statistically significant. The results of this study will help clinicians and policymakers to understand the burden of early cardiovascular outcomes and plan for appropriate preventive strategies.
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Affiliation(s)
- Bankanie Vicent
- Xiangya School of Nursing, Central South University, Changsha, China
| | - John Meda
- College of Health Sciences, University of Dodoma, P.O. Box 259, Dodoma, Tanzania
| | - Mamsau Ngoma
- Ocean Road Cancer Institute, P.O. Box 3592, Dar es salaam, Tanzania
| | - Li Wan
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Li Yinglan
- Xiangya School of Nursing, Central South University, Changsha, China
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11
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Buckle GC, Mrema A, Mwachiro M, Ringo Y, Selekwa M, Mulima G, Some FF, Mmbaga BT, Mody GN, Zhang L, Paciorek A, Akoko L, Ayuo P, Burgert S, Bukusi E, Charles A, Chepkemoi W, Chesumbai G, Kaimila B, Kenseko A, Kibwana KS, Koech D, Macharia C, Moirana EN, Mushi BP, Mremi A, Mwaiselage J, Mwanga A, Ndumbalo J, Nvakunga G, Ngoma M, Oduor M, Oloo M, Opakas J, Parker R, Seno S, Salima A, Servent F, Wandera A, Westmoreland KD, White RE, Williams B, Mmbaga EJ, Van Loon K. Treatment outcomes of esophageal cancer in Eastern Africa: protocol of a multi-center, prospective, observational, open cohort study. BMC Cancer 2022; 22:82. [PMID: 35045815 PMCID: PMC8772224 DOI: 10.1186/s12885-021-09124-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 12/18/2021] [Indexed: 11/19/2022] Open
Abstract
Background Esophageal squamous cell carcinoma (ESCC) is a major cause of cancer morbidity and mortality in Eastern Africa. The majority of patients with ESCC in Eastern Africa present with advanced disease at the time of diagnosis. Several palliative interventions for ESCC are currently in use within the region, including chemotherapy, radiation therapy with and without chemotherapy, and esophageal stenting with self-expandable metallic stents; however, the comparative effectiveness of these interventions in a low resource setting has yet to be examined. Methods This prospective, observational, multi-center, open cohort study aims to describe the therapeutic landscape of ESCC in Eastern Africa and investigate the outcomes of different treatment strategies within the region. The 4.5-year study will recruit at a total of six sites in Kenya, Malawi and Tanzania (Ocean Road Cancer Institute and Muhimbili National Hospital in Dar es Salaam, Tanzania; Kilimanjaro Christian Medical Center in Moshi, Tanzania; Tenwek Hospital in Bomet, Kenya; Moi Teaching and Referral Hospital in Eldoret, Kenya; and Kamuzu Central Hospital in Lilongwe, Malawi). Treatment outcomes that will be evaluated include overall survival, quality of life (QOL) and safety. All patients (≥18 years old) who present to participating sites with a histopathologically-confirmed or presumptive clinical diagnosis of ESCC based on endoscopy or barium swallow will be recruited to participate. Key clinical and treatment-related data including standardized QOL metrics will be collected at study enrollment, 1 month following treatment, 3 months following treatment, and thereafter at 3-month intervals until death. Vital status and QOL data will be collected through mobile phone outreach. Discussion This study will be the first study to prospectively compare ESCC treatment strategies in Eastern Africa, and the first to investigate QOL benefits associated with different treatments in sub-Saharan Africa. Findings from this study will help define optimal management strategies for ESCC in Eastern Africa and other resource-limited settings and will serve as a benchmark for future research. Trial registration This study was retrospectively registered with the ClinicalTrials.gov database on December 15, 2021, NCT05177393. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-09124-5.
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Affiliation(s)
- Geoffrey C Buckle
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 505 Parnassus Ave, M1296, San Francsico, CA, 94143, USA.
| | - Alita Mrema
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | | | - Yona Ringo
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Msiba Selekwa
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Fatma F Some
- Moi University School of Medicine, Eldoret, Kenya
| | - Blandina T Mmbaga
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Gita N Mody
- University of North Carolina, Chapel Hill, USA
| | - Li Zhang
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 505 Parnassus Ave, M1296, San Francsico, CA, 94143, USA
| | - Alan Paciorek
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 505 Parnassus Ave, M1296, San Francsico, CA, 94143, USA
| | - Larry Akoko
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Paul Ayuo
- Moi University School of Medicine, Eldoret, Kenya
| | | | | | | | | | | | | | - Aida Kenseko
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - David Koech
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | | | | | - Alex Mremi
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Ally Mwanga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Gissela Nvakunga
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Mamsau Ngoma
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | | | - Mark Oloo
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Jesse Opakas
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Robert Parker
- Tenwek Hospital, Bomet, Kenya.,Warren Alpert School of Medicine at Brown University, Providence, RI, USA
| | - Saruni Seno
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - Furaha Servent
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Kate D Westmoreland
- University of North Carolina, Chapel Hill, USA.,UNC-Project Malawi, Lilongwe, Malawi
| | - Russell E White
- Tenwek Hospital, Bomet, Kenya.,Warren Alpert School of Medicine at Brown University, Providence, RI, USA
| | | | - Elia J Mmbaga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Katherine Van Loon
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 505 Parnassus Ave, M1296, San Francsico, CA, 94143, USA
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12
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Ngoma M, Mushi B, Morse RS, Ngoma T, Mahuna H, Lambden K, Quinn E, Sagan SB, Ho YX, Lucas FL, Mmari J, Miesfeldt S. mPalliative Care Link: Examination of a Mobile Solution to Palliative Care Coordination Among Tanzanian Patients With Cancer. JCO Glob Oncol 2021; 7:1306-1315. [PMID: 34406856 PMCID: PMC8457843 DOI: 10.1200/go.21.00122] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Late-stage cancer patient symptom control is a national priority in Tanzania. Mobile health promises to improve the reach of a limited pool of palliative care specialists through interprofessional, community-based care coordination. This work assessed the effectiveness of a smartphone- or Web-based app, mPalliative Care Link (mPCL), to extend specialist access via shared data and communication with local health workers. Central to mPCL is the African Palliative care Outcome Scale (POS), adapted for automated mobile symptom assessment and response. METHODS Adult patients with incurable cancer were randomly assigned at hospital discharge to mPCL versus phone-contact POS collection. Sociodemographic, clinical, and POS data were obtained at baseline. Twice-weekly POS responses were collected and managed via mPCL or phone contact with clinician study personnel for up to 4 months, on the basis of study arm assignment. Patient end-of-study care satisfaction was assessed via phone survey. RESULTS Forty-nine patients per arm participated. Comparison of baseline characteristics showed an insignificant trend toward more women (P = .07) and higher discharge morphine use (P = .09) in the mPCL group compared with phone-contact and significant between-group differences in cancer types (P = .003). Proportions of deaths were near equal between groups (mPCL: 27%; phone-contact: 29%). Overall symptom severity was significantly lower in the phone-contact group (P < .0001), and symptom severity decreased over time in both groups (P = .0001); however, between-group change in overall symptoms over time did not vary significantly (P = .34). Care satisfaction was generally high in both groups. CONCLUSION Higher symptom severity scores in the mPCL arm likely reflect between-group sociodemographic and clinical differences and clinical support of phone-contact arm participants. Similar rates of care satisfaction in both groups suggest that mPCL may support symptom-focused care coordination in a more efficient and scalable manner than phone contact. A broader study of mPCL's cost efficiency and utility in Tanzania is needed.
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Affiliation(s)
- Mamsau Ngoma
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Beatrice Mushi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Twalib Ngoma
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Habiba Mahuna
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | | | | | | | | | | | - Joshua Mmari
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
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13
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Nyagabona SK, Luhar R, Ndumbalo J, Mvungi N, Ngoma M, Meena S, Siu S, Said M, Mwaiselage J, Tarimo E, Buckle G, Selekwa M, Mushi B, Mmbaga EJ, Van Loon K, DeBoer RJ. Views from Multidisciplinary Oncology Clinicians on Strengthening Cancer Care Delivery Systems in Tanzania. Oncologist 2021; 26:e1197-e1204. [PMID: 34041817 PMCID: PMC8265360 DOI: 10.1002/onco.13834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 05/14/2021] [Indexed: 12/26/2022] Open
Abstract
Background In response to the increasing burden of cancer in Tanzania, the Ministry of Health, Community Development, Gender, Elderly and Children launched National Cancer Treatment Guidelines (TNCTG) in February 2020. The guidelines aimed to improve and standardize oncology care in the country. At Ocean Road Cancer Institute (ORCI), we developed a theory‐informed implementation strategy to promote guideline‐concordant care. As part of the situation analysis for implementation strategy development, we conducted focus group discussions to evaluate clinical systems and contextual factors that influence guideline‐based practice prior to the launch of the TNCTG. Materials and Methods In June 2019, three focus group discussions were conducted with a total of 21 oncology clinicians at ORCI, stratified by profession. A discussion guide was used to stimulate dialogue about facilitators and barriers to delivery of guideline‐concordant care. Discussions were audio recorded, transcribed, translated, and analyzed using thematic framework analysis. Results Participants identified factors both within the inner context of ORCI clinical systems and outside of ORCI. Themes within the clinical systems included capacity and infrastructure, information technology, communication, efficiency, and quality of services provided. Contextual factors external to ORCI included interinstitutional coordination, oncology capacity in peripheral hospitals, public awareness and beliefs, and financial barriers. Participants provided pragmatic suggestions for strengthening cancer care delivery in Tanzania. Conclusion Our results highlight several barriers and facilitators within and outside of the clinical systems at ORCI that may affect uptake of the TNCTG. Our findings were used to inform a broader guideline implementation strategy, in an effort to improve uptake of the TNCTGs at ORCI. Implications for Practice This study provides an assessment of cancer care delivery systems in a low resource setting from the unique perspectives of local multidisciplinary oncology clinicians. Situational analysis of contextual factors that are likely to influence guideline implementation outcomes is the first step of developing an implementation strategy for cancer treatment guidelines. Many of the barriers identified in this study represent actionable targets that will inform the next phases of our implementation strategy for guideline‐concordant cancer care in Tanzania and comparable settings. Guidelines to improve and standardize oncology care in Tanzania were developed in 2020. This study utilized focus group discussions to assess the barriers and facilitators to guideline implementation at Ocean Road Cancer Institute.
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Affiliation(s)
| | - Rohan Luhar
- Global Cancer Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
| | | | | | - Mamsau Ngoma
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Stephen Meena
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Sadiq Siu
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Mwamvita Said
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | | | - Edith Tarimo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Geoffrey Buckle
- Global Cancer Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
| | - Msiba Selekwa
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Beatrice Mushi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Elia John Mmbaga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,University of Oslo, Norway
| | - Katherine Van Loon
- Global Cancer Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
| | - Rebecca J DeBoer
- Global Cancer Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
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14
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Ngoma M, Miesfeldt S, Mushi B, Morse R, Ngoma TA, Mahuna H, Lambden K, Quinn E, Sagan S, Ho YX, Lucas FL, Mmari J. mPalliative Care Link: Examination of a mobile solution to palliative care coordination among Tanzanian cancer patients. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.1584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1584 Background: Cancer is a growing public health concern in Tanzania (and throughout sub-Saharan Africa), with a majority of cases presenting in late stage with associated distress, ie, pain. Access to specialty palliative care (PC) is a national priority in Tanzania; however, there are limited numbers of PC specialists (hereafter, specialists). Mobile health promises to extend the reach of a limited pool of specialists through inter-professional, community-based care coordination. This work assessed the effectiveness of a smartphone-/web-based application, mobile Palliative Care Link (mPCL), to extend specialist access via shared data and communication with local health workers (LHWs). Central to mPCL is the African Palliative care Outcome Scale (POS), adapted for automated, scheduled mobile symptom assessment and response. Methods: Following consent, incurable adult cancer patients were randomized at hospital discharge from a large urban, government-supported Tanzanian cancer institute to one of two study arms—mPCL or phone-contact POS collection. Baseline sociodemographic, clinical and POS data were recorded. Twice-weekly POS responses were collected and managed via mPCL or by phone-contact with clinician study personnel for up to 4-months depending on respective study arm. Patient end-of-study care satisfaction was assessed via phone-survey. Results: Forty-nine patients per arm participated. Comparison of baseline characteristics showed a trend toward more women ( p= 0.07) and higher discharge morphine use ( p= 0.09) in the mPCL versus phone-contact groups, respectively, and significant between-group differences in cancer types ( p= 0.003). Proportion of deaths were near-equal comparing groups [26% ( n= 13) mPCL versus 28% ( n= 14) phone-contact]. Overall symptom severity was lower in the phone-contact group ( p <0.0001) and symptom severity decreased over time in both groups ( p= 0.0001); however, between-group change in overall symptoms over time did not vary ( p= 0.34). Care satisfaction was high overall in both groups with few between-groups differences, ie, greater provider response to questions and concerns in the phone-contact arm and greater provision of spiritual support in the mPCL arm. Conclusions: Higher symptom severity scores in the mPCL arm likely reflecting between-group sociodemographic/clinical differences and clinical support of phone-contact arm participants. Similar rates of care satisfaction in both groups suggest that, compared to phone-based support, mPCL may facilitate effective symptom-focused care in a more efficient and scalable manner. Study limitations include a small sample of patients from a single urban hospital and lack of a true usual care arm. Broader study of mPCL’s cost-efficiency and utility in Tanzania is needed. This work promises to close a large PC gap in under-resourced settings throughout Tanzania and other LMICs.
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Affiliation(s)
- Mamsau Ngoma
- Ocean Road Cancer Institute Cancer Institute, Dar Es Salaam, Tanzania, United Republic of
| | | | - Beatrice Mushi
- Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania, United Republic of
| | | | - Twalib Athumani Ngoma
- International Network for Cancer Treatment and Research, Dar Es Salaam, Tanzania, United Republic of
| | - Habiba Mahuna
- Ocean Road Cancer Institute, Dar Es Salaam, Tanzania, United Republic of
| | | | | | | | | | - Frances L Lucas
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME
| | - Joshua Mmari
- Ocean Road Cancer Institute, Dar Es Salaam, Tanzania, United Republic of
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15
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Morse RS, Lambden K, Quinn E, Ngoma T, Mushi B, Ho YX, Ngoma M, Mahuna H, Sagan SB, Mmari J, Miesfeldt S. A Mobile App to Improve Symptom Control and Information Exchange Among Specialists and Local Health Workers Treating Tanzanian Cancer Patients: Human-Centered Design Approach. JMIR Cancer 2021; 7:e24062. [PMID: 33755022 PMCID: PMC8088847 DOI: 10.2196/24062] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/31/2020] [Accepted: 01/16/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Improving access to end-of-life symptom control interventions among cancer patients is a public health priority in Tanzania, and innovative community-based solutions are needed. Mobile health technology holds promise; however, existing resources are limited, and outpatient access to palliative care specialists is poor. A mobile platform that extends palliative care specialist access via shared care with community-based local health workers (LHWs) and provides remote support for pain and other symptom management can address this care gap. OBJECTIVE The aim of this study is to design and develop mobile-Palliative Care Link (mPCL), a web and mobile app to support outpatient symptom assessment and care coordination and control, with a focus on pain. METHODS A human-centered iterative design framework was used to develop the mPCL prototype for use by Tanzanian palliative care specialists (physicians and nurses trained in palliative care), poor-prognosis cancer patients and their lay caregivers (patients and caregivers), and LHWs. Central to mPCL is the validated African Palliative Care Outcome Scale (POS), which was adapted for automated, twice-weekly collection of quality of life-focused patient and caregiver responses and timely review, reaction, and tracking by specialists and LHWs. Prototype usability testing sessions were conducted in person with 21 key informants representing target end users. Sessions consisted of direct observations and qualitative and quantitative feedback on app ease of use and recommendations for improvement. Results were applied to optimize the prototype for subsequent real-world testing. Early pilot testing was conducted by deploying the app among 10 patients and caregivers, randomized to mPCL use versus phone-contact POS collection, and then gathering specialist and study team feedback to further optimize the prototype for a broader randomized field study to examine the app's effectiveness in symptom control among cancer patients. RESULTS mPCL functionalities include the ability to create and update a synoptic clinical record, regular real-time symptom assessment, patient or caregiver and care team communication and care coordination, symptom-focused educational resources, and ready access to emergency phone contact with a care team member. Results from the usability and pilot testing demonstrated that all users were able to successfully navigate the app, and feedback suggests that mPCL has clinical utility. User-informed recommendations included further improvement in app navigation, simplification of patient and caregiver components and language, and delineation of user roles. CONCLUSIONS We designed, built, and tested a usable, functional mobile app prototype that supports outpatient palliative care for Tanzanian patients with cancer. mPCL is expressly designed to facilitate coordinated care via customized interfaces supporting core users-patients or caregivers, LHWs, and members of the palliative care team-and their respective roles. Future work is needed to demonstrate the effectiveness and sustainability of mPCL to remotely support the symptom control needs of Tanzanian cancer patients, particularly in harder-to-reach areas.
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Affiliation(s)
| | | | - Erin Quinn
- Dimagi, Inc, Cambridge, MA, United States
| | - Twalib Ngoma
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Beatrice Mushi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | | | - Mamsau Ngoma
- Ocean Road Cancer Institute, Dar es Salaam, United Republic of Tanzania
| | - Habiba Mahuna
- Ocean Road Cancer Institute, Dar es Salaam, United Republic of Tanzania
| | | | - Joshua Mmari
- Ocean Road Cancer Institute, Dar es Salaam, United Republic of Tanzania
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Grossheim L, Ruff P, Ngoma T, Vanderpuye V, Mwango G, Ochieng P, Palmer D, Kouya F, Lasebikan N, Ntekim A, Ngoma M, Bih N, Malloum A, Elzawawy A, Kerr D, Ngwa W. Cancer and COVID-19 Experiences at African Cancer Centers: The Silver Lining. JCO Glob Oncol 2021; 7:410-415. [PMID: 33760639 PMCID: PMC8081519 DOI: 10.1200/go.20.00564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The COVID-19 pandemic significantly disrupted cancer care in Africa, further exposing major health disparities. This paper compares and contrasts the experiences of 15 clinicians in six different African cancer centers to highlight the positive aspects (silver linings) in an otherwise negative situation. METHODS Data are from personal experience of the clinicians working at the six cancer centers blended with what is available in the literature. RESULTS The impact of COVID-19 on cancer care appeared to vary not only across the continent but also over cancer centers. Different factors such as clinic location, services offered, available resources, and level of restrictions imposed because of COVID-19 were associated with these variations. Collectively, delays in treatment and limited access to cancer care were commonly reported in the different regions. CONCLUSION There is a lack of data on cancer patients with COVID-19 and online COVID-19 and cancer registries for Africa. Analysis of the available data, however, suggests a higher mortality rate for cancer patients with COVID-19 compared with those without cancer. Positive or silver linings coming out of the pandemic include the adoption of hypofractionated radiation therapy and teleoncology to enhance access to care while protecting patients and staff members. Increasing collaborations using online technology with oncology health professionals across the world are also being seen as a silver lining, with valuable sharing of experiences and expertise to improve care, enhance learning, and reduce disparities. Advanced information and communication technologies are seen as vital for such collaborations and could avail efforts in dealing with the ongoing pandemic and potential future crises.
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Affiliation(s)
| | - Paul Ruff
- University of the Witwatersrand, Johannesburg, South Africa
| | - Twalib Ngoma
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Verna Vanderpuye
- National Center for Radiotherapy, Korlebu Teaching Hospital, Accra, Ghana
| | | | | | | | | | | | | | - Mamsau Ngoma
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Noella Bih
- Dana Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | | | - David Kerr
- John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Wilfred Ngwa
- Dana Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Siwillis EM, Dharse NJ, Scanlan T, Ngoma M, Abraham ZS, Kahiu JWN, Million L. Pediatric Soft Tissue and Bone Sarcomas in Tanzania: Epidemiology and Clinical Features. J Glob Oncol 2020; 5:1-6. [PMID: 30917068 PMCID: PMC6449074 DOI: 10.1200/jgo.18.00258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Pediatric sarcomas represent an important group of childhood tumors that require treatment at Muhimbili National Hospital (MNH), the largest pediatric oncology center in Tanzania. Treatment is often adapted from established childhood protocols validated in clinical trials from the United States and the United Kingdom. There are no studies describing the types of pediatric sarcomas most commonly seen in Tanzania to understand similarities and disparities with other countries and which sarcomas to prioritize in adapting treatment protocols. The objective of this study was to establish a baseline of the epidemiologic and clinical features of pediatric sarcomas diagnosed at MNH. METHODS Information was collected on clinical and tumor features of all children seen at MNH pediatric oncology unit between 2011 and 2016 with a confirmed histologic diagnosis of either bone or soft tissue sarcoma (STS). RESULTS A total of 135 cases were analyzed; 89 (66%) were STS and 46 (34%) were bone sarcomas. There was a slight female predominance (n = 69; 51%), and the mean age (SD) of patients was 6.3 (5.1) years. Greater than 90% (n = 123) of the cases presented with a painless swelling. The commonest STS, accounting for almost three-fourths of the cases (n = 66) was rhabdomyosarcoma (RMS), with embryonal subtype being the most common RMS (n = 49; 74%). Osteosarcoma was the most common bone sarcoma, accounting for greater than 80% (n = 40) of the cases. Ewing sarcoma accounted for less than 15% (n = 6). Most of the patients presented with stage IV disease (n = 57; 87%) and lung was the commonest metastatic site. CONCLUSION To our knowledge, this report is the first study documenting the epidemiologic and clinical features of pediatric sarcomas in a modern Tanzanian pediatric hospital. Embryonal RMS and osteosarcomas should be prioritized for adapting treatment protocols from other countries.
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Affiliation(s)
- E Mithe Siwillis
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Nazima J Dharse
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Trish Scanlan
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mamsau Ngoma
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | | | - Lynn Million
- Stanford University School of Medicine, Stanford, CA
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Luhar R, Nyagabona SK, Tarimo E, Said M, Selekwa M, Meena SS, Mushi B, Mvungi N, Siu S, Ngoma M, Van Loon K, Ndumbalo J, DeBoer RJ. Implementation of Tanzania’s National Cancer Treatment Guidelines: A Qualitative Approach to Clinical Systems. JCO Glob Oncol 2020. [DOI: 10.1200/go.20.34000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In response to the increasing burden of cancer in Tanzania, the Tanzanian Ministry of Health Community Development, Gender, Elderly, and Children plans to launch their first National Cancer Treatment Guidelines. These guidelines will provide an opportunity to improve and standardize care at Ocean Road Cancer Institute (ORCI), the national cancer center, where previous data suggest that patients do not consistently receive standard treatment. A theory-informed implementation strategy will be conducted to facilitate the routine use of guidelines among health care providers at ORCI. As part of the needs assessment for this effort, this study explored the barriers to and facilitators of guideline-concordant care at ORCI. METHODS We conducted three focus groups with participants stratified by profession, which included oncologists, radiotherapists, oncology residents, and nurses. A discussion guide was used to generate discussion about multiple aspects of current clinical processes at ORCI. Audio recordings were transcribed and translated to English, and data were analyzed using the framework method. RESULTS A total of 21 participants helped identify institutional and systemic factors that were internal and external to the clinical systems at ORCI that may affect guideline-concordant care. These can be categorized into the following: strengths and facilitators, barriers, and suggestions for improvement. Internal facilitators include multidisciplinary patient management, government-sponsored free cancer care, community engagement, and providers’ motivation for continuous learning and improvement. Internal barriers include interdepartmental and interinstitutional communication gaps, resource limitations for specialized services, high patient volumes, and patient misconceptions and nonadherence. Participants offered many practical suggestions for improving clinical systems at ORCI. CONCLUSION Our results highlight several barriers and facilitators within and outside of the clinical systems at ORCI that may affect the uptake of the National Cancer Treatment Guidelines. Findings have been used to recommend quality improvement and environmental restructuring measures at ORCI that will inform the broader guideline implementation strategy.
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Affiliation(s)
- Rohan Luhar
- University of California, San Francisco, San Francisco, CA
| | - Sarah K. Nyagabona
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Edith Tarimo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mwamvita Said
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Msiba Selekwa
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Beatrice Mushi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Sadiq Siu
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Mamsau Ngoma
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
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Ndumbalo J, Mvungi N, Meena S, Ngoma M, Mseti M, Buckle G, Van Loon K, DeBoer RJ, Mwaiselage J. Development of Tanzania’s First National Cancer Treatment Guidelines. JCO Glob Oncol 2020. [DOI: 10.1200/go.20.30000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Tanzania and other low-income countries face a growing burden of cancer and a pressing need to strengthen cancer care delivery systems. The overall case fatality from cancer is disproportionately higher in low-income countries, and adherence to standard treatment guidelines is a critical component of addressing disparities in outcomes. In 2017, Tanzania’s Ministry of Health, Community Development, Gender, Elderly, and Children (MOHCDGEC) commissioned leaders at Ocean Road Cancer Institute to develop Tanzania’s first National Cancer Treatment Guidelines. METHODS In 2017, we convened 90 stakeholders from 15 institutions in Tanzania to form 10 different technical working groups (TWGs). TWGs were organized according to disease-specific categories and were composed of representatives from relevant disciplines, including surgeons, gynecologists, pediatricians, radiologists, pathologists, oncologists, social workers, dieticians, and nurses. Each TWG conducted a review of the current literature and prepared a summary of the epidemiology, diagnostic, and staging procedures; options for management; and essential medicines currently available in Tanzania. In 2018, after multiple revisions and meetings of each TWG, the guidelines underwent an external review with 2 oncologists from Tanzania participating in consultations with approximately 30 disease-specific experts at the University of California, San Francisco. RESULTS Guidelines were developed for a total of 70 diseases. The guidelines are intended to be facilitative, enabling, and providing the basis for the attainment of high standards in the management of cancers in a resource-constrained setting. Guidelines were formatted for dissemination in both hard copy and soft copy using the AgileMD platform. CONCLUSION In February 2020, Tanzania’s MOHCDGEC disseminated its first-ever National Cancer Treatment Guidelines. After dissemination, MOHCDGEC will implement a monitoring and evaluation strategy that ensures and promotes the use of the guidelines. We have developed a theory-informed implementation strategy that focuses on education, workflow modifications, and behavior change that will be piloted at Ocean Road Cancer Institute.
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Affiliation(s)
| | | | - Stephen Meena
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Mamsau Ngoma
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Mark Mseti
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
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20
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Miesfeldt S, Ngoma TA, Mushi B, Ngoma M, Mahuna H, Morse R, Ho YX, Quinn E, Lambden KX, Sagan S, Mmari J, Mmbaga E, Lucas FL. M-palliative care link: Improving symptom control and information exchange among specialists and local health workers treating late-STAGE Tanzanian cancer patients. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e24146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e24146 Background: Lack of effective end-of-life symptom control among late-stage cancer patients is a Tanzanian public health priority, calling for innovative community-based solutions. Mobile health technology holds promise; however, existing resources are limited and access to palliative care specialists is poor. This work aimed to develop a secure mobile-/web-based symptom assessment/control communication system (m-Palliative Care Link; mPCL) that extends access to a limited number of palliative care specialists (hereafter, specialists). mPCL is based on the existing patient-focused African Palliative care Outcome Scale (POS), adapted for mobile symptom assessment, and is designed to support end-of-life care coordination among specialists, patients/caregivers, and local health workers (LHWs) (i.e., user groups). Methods: In partnership with Tanzanian specialists, mPCL was developed following a user-centered design process. mPCL prototype usability testing was conducted with 5-7 participants per user group and included a combination of hands-on observations as well as collection of feedback on ease-of-use and recommendations for modifications. User input was incorporated into the mPCL prototype iteration, tested via field study with 45 late-stage cancer patients discharged from Ocean Road Cancer Institute in Dar es Salaam. A brief mPCL usability/utility survey, including closed- and open-ended survey items, was conducted with field study participants from user groups at six weeks. Results: Prototype usability test participants successfully used the application and indicated that it would be very helpful. Recommendations from usability testing included redesign data collection tools, simplify patient/caregiver application, and broaden clinical data access. Six-week field study survey data showed that a significant majority (range: 68-100%) of specialists and patients “definitely agreed” that mPCL improved patient-provider communication, symptom-based care, care access, both quality of life and care, and reduced need for travel. Nearly all specialists and patients (93% and 98%, respectively) reported that mPCL was easy to use. Conclusions: mPCL promises to assess and address the symptom-control needs of late-stage cancer patients. Due to its reliance on existing technology/personnel, mPCL should be sustainable and scalable among cancer patients and those with other chronic diseases in low resource settings.
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Affiliation(s)
| | - Twalib Athumani Ngoma
- International Network for Cancer Treatment and Research, Dar Es Salaam, Tanzania, United Republic of
| | - Beatrice Mushi
- Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania, United Republic of
| | - Mamsau Ngoma
- Ocean Road Cancer Institute cancer institute, Dar Es Salaam, Tanzania, United Republic of
| | - Habiba Mahuna
- Ocean Road Cancer Institute, Dar Es Salaam, Tanzania, United Republic of
| | | | | | | | | | | | - Joshua Mmari
- Ocean Road Cancer Institute, Dar Es Salaam, Tanzania, United Republic of
| | - Elia Mmbaga
- Muhimbili University, Dar Es Salaam, Tanzania, United Republic of
| | - Frances L Lucas
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME
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Abstract
Cervical cancer is the fourth most common cancer in women, and the seventh overall, with an estimated 528,000 new cases and 266,000 deaths in 2012 [1]. Almost nine out of ten (87%) cervical cancer deaths occur in the less-developed regions of the world. The cervical cancer incidence significantly increases after 20 years of age and peaks at 50 years of age. Because cervical cancer mainly affects African women at a relatively young age, the socio-economic consequences are enormous. The human papillomavirus (HPV) is central to the development of cervical neoplasia and can be detected in 99.7% of cervical cancers. Hence primary prevention aims at reducing human papillomavirus (HPV) infection by HPV vaccine administration. Secondary prevention involves cervical cancer screening and management of precancerous lesions via either Pap smear, visual inspection with acetic acid (VIA) or with lugols iodine (VILI) or HPV testing for high-risk HPV types.
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Affiliation(s)
- Mamsau Ngoma
- Ocean Road Cancer Institute, PO Box 5408, Dar Es Salaam, Tanzania
| | - Philippe Autier
- International Prevention Research Institute, Espace Européen d'Ecully, Bâtiment G, Allée Claude Debussy, 69130 Ecully ouest Lyon, France
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Abstract
Decision makers dealing with resource allocation in Africa have the impression that cancer research is a luxury. As a result of this, very few or no resources are allocated for cancer research in Africa. Since in healthcare, clinical and epidemiological research provides an evidence base for formulation of health policies and facilitates decision making by policy makers, the lack of evidence base makes decision making intuitive. A situation like this is not cost-effective and is unacceptable. It is, therefore, important that for Africa to make effective decisions to improve the health of its population, cancer research informing policy and decision makers is a necessity and not a luxury.
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Affiliation(s)
- Twalib Ngoma
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences (MUHAS), PO box 65001, Dar es Salaam, Tanzania
| | - Mamsau Ngoma
- Academic Unit, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
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Nyagabona S, Rubagumya F, Longombe A, Manirakiza A, Maniragaba T, Lulabuka N, Nguma I, Mkuchika E, Ngoma M, Dharsee N. Breast Cancer Support Group at Ocean Road Cancer Institute in Dar es Salaam. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.53300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background and context: Breast cancer is a common type of cancer among women worldwide, with about 2 million new cases diagnosed in the yearly. It is the second common cancer and leading cause of cancer mortality among women in Tanzania, after cervical cancer. More than 70% of breast cancer patients in developed countries are diagnosed at early stages, whereas in low and middle-income countries, only 20%–60% of patients are diagnosed early. Physician in developed countries consults on average 15-20 breast cancer patients daily, while in developing countries the number triples. This high load does not allow a treating physician to spend ample time with patients explaining hence leaving patients not informed about their diagnosis, side effects of treatments and even living with the physical, emotional and psychological challenges of their disease. Residents at the Ocean Road Cancer Institute (ORCI), initiated a patient support group targeting breast cancer patients for feasibility. Aim: Provide forum for patients with same diagnosis to share common challenges Provide peer emotional, psychosocial support and cancer education Organize activities that will help to spread awareness to the community Initiate projects to improve socioeconomic status of breast cancer survivors in Tanzania Strategy/Tactics: Involved the ORCI administration from the beginning Involved the academic and research unit of ORCI Residents prepared session curriculum and teaching materials Sessions took place once a month Sessions were two hours long divided into three components, where the first is introduction of participants, then survivors led discussions or lectures prepared by an expert in the topic and lastly closing remarks by a physician Breakfast was provided Program/Policy process: Open membership for all breast cancer patients Physician lead face to face peer discussions Institutional acknowledgment of the support group Provision of primary registry of patients for follow-up Provision of a link to other social organizations Outcomes: Increase knowledge of cancer in general and breast cancer in particular A total of seven sessions were held to date For each session, participation ranged from 30-50 breast cancer survivors, and on average attendance was 4 sessions out of 7 Topics covered over a period of seven months included Coping with a cancer diagnosis and treatment Living with cancer and its changes to daily life Exercise Nutrition Breast cancer general knowledge Collaboration with other stake holders including IST secondary school students who initiated breast prosthesis knitting club What was learned: A need to reach out and give psycho-social support to ORCI patients Through education we can improve treatment adherence Possible partners are available if we reach out Exist a need to address misconceptions in the community so as to avoid stigma to patients.
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Affiliation(s)
- S. Nyagabona
- Muhimbili University of Health and Allied Sciences, Clinical Oncology, Dar es Salaam, United Republic of Tanzania
- Ocean Road Cancer Institute, Clinical Services, Dar es Salaam, United Republic of Tanzania
| | - F. Rubagumya
- Muhimbili University of Health and Allied Sciences, Clinical Oncology, Dar es Salaam, United Republic of Tanzania
| | - A. Longombe
- Muhimbili University of Health and Allied Sciences, Clinical Oncology, Dar es Salaam, United Republic of Tanzania
| | - A. Manirakiza
- Muhimbili University of Health and Allied Sciences, Clinical Oncology, Dar es Salaam, United Republic of Tanzania
| | - T. Maniragaba
- Muhimbili University of Health and Allied Sciences, Clinical Oncology, Dar es Salaam, United Republic of Tanzania
| | - N. Lulabuka
- Muhimbili University of Health and Allied Sciences, Clinical Oncology, Dar es Salaam, United Republic of Tanzania
| | - I. Nguma
- Muhimbili University of Health and Allied Sciences, Clinical Oncology, Dar es Salaam, United Republic of Tanzania
| | - E. Mkuchika
- Muhimbili University of Health and Allied Sciences, Clinical Oncology, Dar es Salaam, United Republic of Tanzania
| | - M. Ngoma
- Ocean Road Cancer Institute, Academic and Research Department, Dar es Salaam, United Republic of Tamzania
| | - N. Dharsee
- Ocean Road Cancer Institute, Academic and Research Department, Dar es Salaam, United Republic of Tamzania
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Ngwa W, Ngoma T, Zietman A, Mayr N, Elzawawy A, Winningham TA, Balogun O, Enwerem-Bromson N, Ntizimira C, Olopade OI, Oluwole D, Odedina F, Williams M, Flanigan J, Asana L, Ngwa K, Avery S, Pollard JM, Roland T, Funwi-gabga N, Mbarika V, Hardenbergh P, Winkfield K, Pipman Y, Stefan C, Ngoma M, Mohammed S, Katz M, Erno S, Moni J, Fitzgerald T, Tonlaar N, Efstathiou J, Gierga D, Ayo C, Knaul F, Gospodarowicz M, Makrigiorgos GM, Nguyen PL. Closing the Cancer Divide Through Ubuntu: Information and Communication Technology-Powered Models for Global Radiation Oncology. Int J Radiat Oncol Biol Phys 2015; 94:440-9. [PMID: 26867873 DOI: 10.1016/j.ijrobp.2015.10.063] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 10/28/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Wilfred Ngwa
- Department of Radiation Oncology, Dana Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts; Department of Physics and Applied Physics, University of Massachusetts Lowell, Lowell, Massachusetts.
| | - Twalib Ngoma
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Anthony Zietman
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Nina Mayr
- Department of Radiation Oncology, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Ahmed Elzawawy
- African Organization for Research and Training in Cancer, Rondebosch, South Africa
| | | | - Onyinye Balogun
- Department of Radiation Oncology, Weill Cornell Medical College, New York
| | - Nelly Enwerem-Bromson
- Program of Action for Cancer Therapy, International Atomic Energy Agency, Vienna, Austria
| | | | | | | | - Folakemi Odedina
- African Organization for Research and Training in Cancer, Rondebosch, South Africa; College of Pharmacy, University of Florida, Gainesville, Florida
| | - Makeda Williams
- Center for Global Health, National Cancer Institute, Rockville, Maryland
| | - John Flanigan
- Center for Global Health, National Cancer Institute, Rockville, Maryland
| | - Lydia Asana
- African Renaissance Ambassador Corporation, Orlando, Florida
| | - Kenneth Ngwa
- African Renaissance Ambassador Corporation, Orlando, Florida
| | - Stephen Avery
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julianne M Pollard
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Teboh Roland
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Neba Funwi-gabga
- Southern Alberta Institute of Technology, Calgary, Alberta, Canada
| | - Victor Mbarika
- Information and Communication Technology University, Baton Rouge, Louisiana
| | | | - Karen Winkfield
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Yakov Pipman
- International Educational Activities Committee, American Association of Physicists in Medicine, College Park, Maryland
| | - Christina Stefan
- African Organization for Research and Training in Cancer, Rondebosch, South Africa; South African Medical Research Council, Cape Town, South Africa
| | - Mamsau Ngoma
- Ocean Road Cancer Institute, Dar Es Salaam, Tanzania
| | - Sulma Mohammed
- Department of Comparative Pathobiology and Purdue University Center for Cancer Research, Purdue University, West Lafayette, Indiana
| | | | - Sajo Erno
- Department of Physics and Applied Physics, University of Massachusetts Lowell, Lowell, Massachusetts
| | - Janaki Moni
- Department of Radiation Oncology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Thomas Fitzgerald
- Department of Radiation Oncology, University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - Jason Efstathiou
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - David Gierga
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | | | - Felicia Knaul
- Harvard Global Equity Initiative, Harvard Medical School, Boston, Massachusetts
| | - Mary Gospodarowicz
- Princess Margaret Cancer Centre, 610 University Avenue, M5G 2M9, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - G Mike Makrigiorgos
- Department of Radiation Oncology, Dana Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
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Menon J, Ngoma M, Kalima K, Hestad K. P4.048 Gender Effect of HIV on Neuropsychological Functioning. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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van der Hoek W, van Oosterhout JJ, Ngoma M. An outbreak of dysentery in Zambia. S Afr Med J 1996; 86:93-4. [PMID: 8685797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Takashima I, Ngoma M, Hashimoto N. Antimicrobial effects of a new carboxyquinolone drug, Q-35, on five serogroups of Leptospira interrogans. Antimicrob Agents Chemother 1993; 37:901-2. [PMID: 8388204 PMCID: PMC187807 DOI: 10.1128/aac.37.4.901] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
New carboxyquinolone drugs, including the recently developed Q-35, were evaluated for their in vitro potency against five serogroups of Leptospira interrogans. Q-35, ofloxacin, ciprofloxacin, and tosufloxacin showed MICs (0.05 to 0.20 microgram/ml) comparable to those of tetracycline. However, MBCs of these drugs varied between 10- and 100-fold above the MIC for most strains tested. Q-35 was shown to be active against L. interrogans in vitro as judged by the MICs obtained.
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Affiliation(s)
- I Takashima
- Department of Veterinary Public Health, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Japan
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Ngoma M, Suzuki A, Takashima I, Sato G. Antibiotic resistance of Escherichia coli and Salmonella from apparently healthy slaughtered cattle and pigs, and diseased animals in Zambia. Jpn J Vet Res 1993; 41:1-10. [PMID: 8230941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Escherichia (E.) coli and Salmonella (S.) choleraesuis (subsp. choleraesuis and subsp. salamae) from apparently healthy slaughtered cattle and pigs in 1989 in Zambia, were examined for antibiotic resistance and the presence of conjugative R plasmid. Salmonella strains from diseased animals (cattle, chickens, leopards, lions and warthogs) were similarly tested. The majority of the cattle had been nomadically kept in so-called "traditional farms" while all the pigs were from commercial farms. More pigs (39%; 41/105) harboured drug-resistant E. coli than cattle (6.7%; 7/105). Moreover, the number of drug-resistant E. coli was higher among strains from pigs (31.2%; 49/157) than cattle (4.2%; 7/167). For both cattle and pigs, drug resistance was more frequently observed against tetracycline, streptomycin, sulfadimethoxine and ampicillin than other antibiotics and the single resistance pattern occurred most frequency, especially among pig E. coli strains. Drug-resistant Salmonella was recorded in 3.6% (1/28) of strains from slaughtered cattle and 31.3% (10/32) of those from diseased animals. Drug-resistant E. coli from pigs and cattle carried R plasmid at high frequency.
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Affiliation(s)
- M Ngoma
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka
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Abstract
A group of 30 black African patients and a group of 30 occidental patients, all presenting a hysterical structure, were compared with regard to clinical manifestations, provoking psychosocial stressors and histrionic personality traits. Cultural characteristics in several areas are discussed as possible explanations of the differences found.
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Ngoma M, Pierloot R. [Hysterical manifestations in Black Africa. Pilot study conducted at the Neuro-Psycho-Pathology Center, Kinshasa]. Acta Psychiatr Belg 1983; 83:488-500. [PMID: 6670577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In a retrospective study on twenty Zairese patients, presenting a hysterical personality structure, the different forms of decompensation have been described and classified according to the DSM III criteria. Even taking into account the inconstancy of hysterical manifestations and the use of criteria not adapted to the local context, some of the described syndromes seem rather atypical. Such findings should stimulate the African psychiatry to develop its own nosographical criteria.
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Ngoma M, Vandereycken W. [Some observations on "Briquet syndrome" and hysteria]. Acta Psychiatr Belg 1982; 82:319-27. [PMID: 7164840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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