Cc Obiorah

The role of hospital-based cancer registries in low and middle income countries—The Nigerian Case Study

BACKGROUND The incidence of cancer continues to rise all over the world and current projections show that there will be 1.27 million new cases and almost 1 million deaths by 2030. In view of the rising incidence of cancer in sub-Saharan Africa, urgent steps are needed to guide appropriate policy, health sector investment and resource allocation. We posit that hospital based cancer registries (HBCR) are fundamental sources of information on the frequent cancer sites in limited resource regions where population level data is often unavailable. In regions where population based cancer registries are not in existence, HBCR are beneficial for policy and planning. MATERIALS AND METHODS Nineteen of twenty-one cancer registries in Nigeria met the definition of HBCR, and from these registries, we requested data on cancer cases recorded from January 2009 to December 2010. 16 of the 19 registries (84%) responded. Data on year hospital was established; year cancer registry was established, no. of pathologists and types of oncology services available in each tertiary health facility were shown. Analysis of relative frequency of cancers in each HBCR, the basis of diagnosis recorded in the HBCR and the total number of cases recorded by gender was carried out. RESULTS The total number of cancers registered in these 11 hospital based cancer registries in 2009 and 2010 was 6484. The number of new cancer cases recorded annually in these hospital based cancer registries on average was 117 cases in males and I77 cases in females. Breast and cervical cancer were the most common cancers seen in women while prostate cancer was the commonest among men seen in these tertiary hospitals. CONCLUSION Information provided by HBCR is beneficial and can be utilized for the improvement of cancer care delivery systems in low and middle income countries where there are no population based cancer registries.

Developing National Cancer Registration in Developing Countries - Case Study of the Nigerian National System of Cancer Registries.

The epidemiological transition in sub-Saharan Africa (SSA) has given rise to a concomitant increase in the incidence of non-communicable diseases including cancers. Worldwide, cancer registries have been shown to be critical for the determination of cancer burden, conduct of research, and in the planning and implementation of cancer control measures. Cancer registration though vital is often neglected in SSA owing to competing demands for resources for healthcare. We report the implementation of a system for representative nation-wide cancer registration in Nigeria – the Nigerian National System of Cancer Registries (NSCR). The NSCR coordinates the activities of cancer registries in Nigeria, strengthens existing registries, establishes new registries, complies and analyses data, and makes these freely available to researchers and policy makers. We highlight the key challenges encountered in implementing this strategy and how they were overcome. This report serves as a guide for other low- and middle-income countries (LMIC) wishing to expand cancer registration coverage in their countries and highlights the training, mentoring, scientific and logistic support, and advocacy that are crucial to sustaining cancer registration programs in LMIC.

Experience with neonatal hydrometrocolpos in the Niger Delta area of Nigeria: Upsurge or increased recognition?

Background: Hydrometrocolpos (HMC) is a clinical condition in which there is a cystic distension of the vagina (hydrocolpos), uterus and sometimes, fallopian tubes (hydrosalpinx) with fluid. This study described our experience with cases of HMC seen in our practice, and highlighted the flare in our practice. Patients and Methods: A retrospective study of cases of HMC managed at the University of Port Harcourt Teaching Hospital between September 2010 and August 2012. Results: There were seven cases; their ages ranged from 2 to 27 days (median 13 days). All the patients had abdominal distension but abdominal mass was obvious only in four. Other features varied depending on the presence of sepsis or other associated anomalies. The diagnosis of HMC was missed in all cases by the referring clinicians. One patient was referred with the diagnosis of tracheoesophageal fistula and esophageal atresia, 2 with bladder outlet obstruction, 1 with intestinal obstruction, 2 with anorectal malformation, and 1 with neonatal sepsis. Ultrasound identified bulky uterus in two cases and upper urinary tract dilatation in 3 patients. Six patients had laparotomy, 1 had hymenotomy only. Postoperative complications were basically wound sepsis and rectovaginal fistula resulted. Conclusion: Diagnosis of HMC should be considered as a differential in newborn girls presenting with lower abdominal mass. Attention to clinical detail is necessary to avoid a misdiagnosis.

Helicobacter pylori and precancerous lesions of the stomach in a Nigerian Metropolis: A Cohort Study

Introduction: Helicobacter pylori (H. pylori)-related atrophic gastritis transits through a sequential pathway of intestinal metaplasia, dysplasia to gastric cancer. Gastroscopy offers early detection, treatment and surveillance of gastric cancer.Aims: This study aims to study the prevalence of H. pylori infection and evaluate precancerous lesions (PCLs) of the stomach. Patients and Methods: This is a case controlled study of patients with dyspepsia undergoing gastroscopy at a referral endoscopy facility in Port Harcourt metropolis of Nigeria. The variables studied included demographics, clinical, endoscopic, and histopathologic findings. Statistical analysis of data was done using IBM SPSS Statistics for Windows, Version 20.0. (Armonk, NY, USA). Results: A total of 104 patients were included in the study. Age ranged from 20 to 80 years (mean 47.1 ± 14.4 years); 56 were males and 48 were females. H. pylori were detected in 40 (38.5%) mucosal biopsies. The prevalence of PCLs was: chronic atrophic gastritis 6.7% (7 cases); intestinal metaplasia 2.9% (3 cases); and dysplasia 5.8% (6 cases). There was no statistical significance in sex distribution of PCLs (P = 0.245). Conclusion: There is a low prevalence of H. pylori in this metropolitan population. Mandatory multiple topographically targeted biopsies, even with normal mucosal appearance, at gastroscopy in addition to surveillance of PCL are recommended for early detection of gastric cancer.

Comparability, diagnostic validity and completeness of Nigerian cancer registries.

BACKGROUND Like many countries in Africa, Nigeria is improving the quality and coverage of its cancer surveillance. This work is essential to address this growing category of chronic diseases, but is made difficult by economic, geographic and other challenges. PURPOSE To evaluate the completeness, comparability and diagnostic validity of Nigerias cancer registries. METHODS Completeness was measured using childrens age-specific incidence (ASI) and an established metric based on a modified Poisson distribution with regional comparisons. We used a registry questionnaire as well as percentages of death-certificate-only cases, morphologically verified cases, and case registration errors to examine comparability and diagnostic validity. RESULTS Among the childrens results, we found that over half of all cancers were non-Hodgkin lymphoma. There was also evidence of incompleteness. Considering the regional completeness comparisons, we found potential evidence of cancer-specific general incompleteness as well as what appears to be incompleteness due to inability to diagnose specific cancers. We found that registration was generally comparable, with some exceptions. Since autopsies are not common across Nigeria, coding for both them and death-certificate-only cases was also rare. With one exception, registries in our study had high rates of morphological verification of female breast, cervical and prostate cancers. CONCLUSIONS Nigerias registration procedures were generally comparable to each other and to international standards, and we found high rates of morphological verification, suggesting high diagnostic validity. There was, however, evidence of incompleteness.

Pattern of suicide in Nigeria: The Niger Delta Experience

Background: Suicide is becoming a major public health problem. Objective: To determine the pattern of suicide cases with respect to age, sex, and methods employed. Design: A 10-year retrospective study of suicide cases reported to the Coroner in Rivers and Abia states of Nigeria. Materials and Methods: Data on the age, sex, circumstances, and methods of all suicide cases handled by the authors were extracted and analyzed. Results: There were 32 cases (0.9%) of suicides out of a total of 3,555 medico-legal autopsies reviewed over the period. Of the 32 cases, 28 (87.5%) were males and 4 (12.5%) were females, giving a male to female ratio of 7:1. The age distribution showed a peak incidence in the third decade. The commonest method of committing suicide in this environment is by hanging. The range and mean of the ages is 16 - 64 yrs and 31 yrs, respectively. Conclusion: This review shows that the choice of how to die often depends on the most available and most convenient means at hand. Women chose less violent means of suicide such as drowning or poisoning, while males often chose violent methods such as hanging or firearms.

Clinicopathological report of children and young adults with nephrotic syndrome undergoing renal biopsy at workshops in Port Harcourt, Nigeria

Background: Kidney biopsy is a procedure that is not commonly performed in Nigeria. This study reports the clinical and pathological findings in children who underwent renal biopsies during nephrology workshops held in Port Harcourt in 2014 and 2015. Methods: The native kidney biopsies were processed and evaluated using light microscopy only. Results: Nineteen patients (10 females) were biopsied. The mean age was 11.0 ± 6.5 years and the range was 1.8 to 21 years. Eleven patients had steroid-dependent nephrotic syndrome (SDNS) whereas eight were steroidresistant (SRNS). Hypertension and haematuria were present more often in SDNS. There were 11 cases (58%) with non-proliferative lesions, including minimal change disease (4 cases), focal segmental glomerulosclerosis (4 cases) and collapsing glomerulopathy (3 cases). The proliferative lesions (8 cases) included membranoproliferative (mesangiocapillary) glomerulonephritis (MPGN, 5 cases), mesangial proliferative glomerulonephritis (2 cases) and MPGN with collapsing glomerulopathy (1 case). Overall, the most common pathological diagnosis was MPGN (26%). Hypertension was more common with proliferative than with non-proliferative lesions (63% versus 36%). Conclusions: Although MPGN was the most common morphological lesion among children with nephrotic syndrome, bigger studies are necessary to confirm this. Efforts should be intensified in acquiring the expertise and infrastructure for performing and interpreting renal biopsies in Port Harcourt in order to optimize patient management.

Malignant renal tumours seen in the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

Introduction: Malignant renal tumours (MRTs) pose significant morbidity and mortality. In adults, renal cell carcinoma (RCC) constitutes about 90% of these tumours whereas in children, the majority are nephroblastomas. Males are generally more affected than females. Nuclear grade, tumour stage, size and histopathological subtype are prognostic factors. In our environment, patients with MRTs commonly present late. Methods: Clinical and demographic details of patients who had malignant tumours diagnosed on renal biopsy tissue between 2002 and 2013 at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria, were extracted from pathology request forms. Slides were retrieved from the archives and reviewed. The tumours were classified according to WHO and ISUP criteria. Results: Kidney biopsies constituted 0.8% of the biopsy specimens processed within the period; 60% of these were malignant lesions. Half (51%) of the patients with MRTs were males and 81% were children (the majority aged 0–4 years). Among children, the incidence decreased steadily with age. Seventy-three percent were nephroblastomas, exclusively occurring in children. Renal cell carcinoma constituted 19.4%, with papillary carcinoma being the commonest subtype, whereas non-Hodgkin’s lymphoma and rhabdomyosarcoma constituted 6% and 1.5%, respectively. The mean gross weight of the tumour masses was 1.3 kg and the average duration of symptoms prior to presentation was 18.3 months. The majority presented with abdominal masses. Conclusions: Although the renal biopsy rate is generally low in our environment, we found that the most common renal malignancy was nephroblastoma in children. In adults, renal cell carcinoma, mainly of the papillary type, was predominant. Most cases present late.

Influence of Socio-Cultural Factors on Homicide: The Nigeria Case Study

Background: Understanding the socio-cultural factors that underlie homicide is central to prevention of such cases. This study was carried out to determine the similarities and differences in the patterns of homicide in two socio-culturally diverse parts of Nigeria. Materials and Method: Duplicate copies of autopsy reports of homicide victims in Port Harcourt, Rivers State and Kano city, Kano State over 11 and 6 year periods respectively were retrieved and analyzed for age, gender, circumstances of death, mechanisms of death, causes of death and types of weapons used. Results: show that 1,004 cases (91/year rate) and 113 cases (18/year rate) of homicides were recorded respectively in Port Harcourt and Kano city during the study periods. The predominant age group of victims in the two cities was the 21 to 30 year age group, with male: female ratio of 12:1 and 16:1 for Port Harcourt and Kano city respectively. The top ranking weapons of choice were firearm (68.9%) in Port Harcourt and sharp daggers (44.2%) in Kano city. While armed robbery and cult attacks were common in Port Harcourt, ethno-religious clashes predominated among circumstances surrounding homicides in Kano. While head injuries in the Port Harcourt homicides were mostly from gunshots those in Kano city were mostly due to blunt trauma. Conclusion: This study has shown that socio-cultural differences in religion, type of weapons available and to which local residents are exposed to during upbringing, gender role, functional rule of law, use of psycho-active substances and increased population and its dynamics are important factors that determine patterns of homicide in Nigeria.