Outcome of childhood malignancies at the University of Port Harcourt Teaching Hospital: a call for implementation of palliative care.

Background: Cancers in children are yet to be recognised as an important cause of childhood morbidity and mortality in developing countries where more than 70% of the world annual cases occur. Despite the limited resources and whatever the projected outcome, children with cancer need treatment, be it curative or palliative. Objectives: To determine outcome of cancers in children at the UPTH; identify factors that influence outcome, highlight the need for palliative care. Method: A retrospective study of cases of childhood malignancies admitted into Paediatric Oncology unit of UPTH over a two year period. Clinical profile of patients and outcome were analyzed using SPSS version 20.0. Results: Sixty cases were analysed: 35(58.3%) males, 25(41.7%) females giving a M:F ratio of 1.4:1. Under-fives constituted 55%. Twenty-seven (45%) patients presented within 4 weeks of onset of symptoms. Median duration of symptoms before presentation was 8 weeks while 36 (60%) had metastatic disease at diagnosis. Twenty patients (33.3%) defaulted with or without specific treatment. Mortality was recorded in 26(43.4%) of cases. Conclusion: There were more cases of cancer amongst under-fives with male preponderance. Late presentation, financial constraints and high default rate were contributory factors to poor outcome in most cases. Lack of palliative care left many families to face their sufferings.

Experience of collaboration between a Dutch surgical team in a Ghanaian Orthopaedic Teaching Hospital.

Background: Surgery is an indivisible, indispensable part of healthcare. In Africa, surgery may be thought of as the neglected stepchild of global public health. We describe our experience over a 3-year period of intensive collaboration between specialized teams from a Dutch hospital and local teams of an orthopaedic hospital in Effiduase-Koforidua, Ghana. Intervention: During 2010-2012, medical teams from our hospital were deployed to St. Joseph’s Hospital. These teams were completely self-supporting. They were encouraged to work together with the local-staff. Apart from clinical work, effort was also spent on education/ teaching operation techniques/ regional anaesthesia techniques/ scrubbing techniques/ and principles around sterility. Results: Knowledge and quality of care has improved. Nevertheless, the overall level of quality of care still lags behind compared to what we see in the Western world. This is mainly due to financial constraints; restricting the capacity to purchase good equipment, maintaining it, and providing regular education. Conclusion: The relief provided by institutions like Care-to-Move is very valuable and essential to improve the level of healthcare. The hospital has evolved to such a high level that general European teams have become redundant. Focused and dedicated teams should be the next step of support within the nearby future.

Barriers to colorectal cancer screening in Asia: A systematic review

Purpose: Colorectal cancer (CRC) is among the top five cancers afflicting both men and women globally. Once predominantly a Western disease, it has begun to rise in Asian countries as well. This systematic review aims to compile and analyze the various barriers towards colorectal cancer screening in Asia, and to determine if the barriers are consistent throughout the continent. Methods: Article Inclusion criteria for based on year of publication from year 2008 till 2015, has been conducted in Asia, and written in English language. A total of 23 studies were included in this review, chosen via primary search of journal websites and databases, and a secondary search through the reference lists of eligible articles. Results: It was found that major barriers of colorectal cancer screening are; poor education/knowledge, negative perceptions towards screening, aversion to test results, financial constraints, time constraints, lack of physicians’ recommendation, limited/difficult access to screening locations, fatalistic beliefs, low perceived risks, language barriers, confidence in traditional medicine/distrust in Western medicine, ignorance and old age. Conclusion: Lack of knowledge/education is the most critical barrier that is linked to a majority of other barriers that can hinder a person from undergoing CRC screening for early prevention, detection and treatment. Majority of these barriers encountered regarding the poor rates of CRC screening are similar across countries in Asia.