Ima-Obong Ekanem

Helminth associated hypereosinophilia and tropical endomyocardial fibrosis (EMF) in Nigeria.

There should be a recognisable trend between the incidence of hypereosinophilia and the duration of tropical endomyocardial fibrosis (EMF), if the hypothesis, that EMF is the burnt out phase of eosinophil associated heart disease, is correct. We tested this hypothesis in a prospective study of 89 consecutive EMF cases over an 18 year period at two Nigerian locations (Ife in South West and Calabar in South East). We carefully dated the duration of EMF symptoms at first presentation and screened for hypereosinophilia (eosinophilia > or = 1500/mm3), and their causes. When no cause was identified for hypereosinophilia we gave a therapeutic trial with diethylcarbamazine to the patients. An eosinophil count > or = 1000/mm3 was recorded in 80% of 24 cases seen within 6 months; 55% of 46 cases seen 0-24 months; 54% of 18 cases seen 25-48 months and 21% of 25 cases seen more than 49 months of onset of symptoms: while the respective distribution of eosinophil count > or = 1500/mm3 for similar periods were 66, 44, 27 and 21%. This reflects a highly significant (P < 0.001) inverse relationship between hypereosinophilia and the duration of EMF and strengthens the concept that EMF (without eosinophilia) represents the late stage of eosinophilic heart disease. The localisation of endemic EMF to the low-lying tropical rain forest Zone and its predominant occurrence among rural dwellers and farmers suggest a vector borne etiologic agent. Microfilaria was the most likely cause of hypereosinophilia in the cases presented.

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.

Malignancies in AIDS patients: the experience of a tertiary hospital in a high prevalence zone

Material and methods A five year retrospective study was carried out to review the frequency of diagnosis of three tumours classified as AIDS defining malignancies (Kaposi sarcoma, non Hodgkin lymphoma, cervical cancer) and one non AIDS defining malignancy (squamous cell carcinoma of the conjunctiva), also commonly diagnosed in these patients. Records of the patients which are histologically confirmed and diagnosed between 1 January 2005 and 31 January 2009 were sorted out and their retroviral status classified.

Five year cancer incidence in Calabar, Nigeria (2009–2013)

Cancer incidence rates are presented for the Calabar Cancer Registry, a population-based cancer registry (PBCR) covering the population of two Local Government Areas (LGAs) of Calabar the capital of Cross-River State, Nigeria. (375,196 inhabitants in 2006). During the period 2009-2013, a total of 719 new cases were registered comprising 320 men (an age standardised incidence rate (ASR) of 78.8 per 100,000) and 399 women (ASR of 86.9 per 100,000). Breast and cervical cancers account for 60.4% of all cancers in women, with breast cancer (ASR 35 per 100,000) almost twice as common as cervix cancer (ASR 21 per 100,000) and occurring in rather younger women. Prostate cancer was the most common cancer in men (ASR 50.8 per 100,000). Hodgkins lymphoma was common in both sexes, and there were moderate numbers of HIV-related cancers recorded (Kaposi sarcoma, non Hodgkin lymphoma, and squamous cell carcinomas of conjunctiva).

AIDS-related lymphoma at the University of calabar teaching hospital (Nigeria): a seven year review

Results Fifty-four patients with lymphoma were seen within the period (2005-2011).Non-Hodgkin’s lymphoma (NHL) was the most frequent 35(63%) Hodgkin’s lymphoma (HL) 8(18.2%), Burkitt’s lymphoma(BL) 7(15.9%) and nasopharyngeal lymphoma(NL) 1(2.3%). ARL was 12(18.2%) with NHL, HL, and NL contributing 9(62%), 2(25%), 1(12.5%) respectively. Mortality was significantly higher in the ARL than in the non-ARL group. Conclusions ARL is not a rarity in our environment. A survey of all the HIV treatment centres will reveal a larger statistics. A greater understanding of the biology of this complex is needed. Training of `all care providers to effectively manage the disease is highly recommended. The cost of drugs for the treatment of the lymphoma is prohibitive to most of the indigent patients who present to our centre.

Neonatal Deaths and Autopsy Rates in a Nigerian Tertiary Hospital: A 10-Year Trend Analysis in University of Calabar Teaching Hospital, Calabar, Nigeria

The pains and challenges of pregnancy and delivery are made worse when the resultant neonate dies. Fortunately, many of these neonatal deaths can be prevented if autopsies are routinely conducted to ascertain the immediate and remote causes of death toward subsequent prevention. Unfortunately, there is paucity of studies on neonatal autopsy rates (NARs) in many developing countries, with few reports indicating unacceptably low rates. This study was therefore aimed at assessing the trend in neonatal deaths and autopsy rates in Calabar, Nigeria. Trend analysis of retrospective data obtained from medical records of neonatal deaths and deliveries was conducted. Neonatal mortality rate (NMR) and NAR were obtained for each of the years within 2004-2013. Ethical approval was obtained from the ethical committee of University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria. In the 10-year study period, there were 22,916 deliveries with a male:female ratio of 1:0.95. There were 1136 neonatal deaths, yielding a total NMR of 49.6 per 1000 live births (ranging from 26.7 in 2011 to 93.7 in 2004). Bimodal peak in NMR was found at 2008 and 2012. Eighty six neonatal autopsies were conducted within the study period yielding a mean autopsy rate of 7.57%, ranging from 0% in 2008 to 25.0% in 2013. This study found unacceptably high NMR and low NAR in the study setting. There was, however, gradual decrease in mortality and increase in autopsy rates through the study period. It is essential to redouble the efforts at improving public health education and awareness on the relevance of autopsy toward improved health service delivery. Similar studies are recommended in other similar and dissimilar settings.

Cancers Attributable to Infectious Agents in Nigeria: 2012-2014

Abstract 60Background:Infections by certain viruses, bacteria, and parasites have been identified as risk factors for some cancers. In 2008, there were 12.7 million new cancer cases worldwide. About 2 million of these new cases were attributable to infections, which represent 16.1% of new cancer cases. The majority of these cancers occurred in less-developed regions of the world, where the Population Attributable Fraction (PAF) was estimated to be 23%. We carried out this study to evaluate the numbers of cancers in Nigeria from 2012-2014 that are attributable to infections using data from Population Based Cancer Registries (PBCR) in Nigeria.Methods:We considered cancers associated with Epstein-Barr virus (EBV), Human Papilloma Virus (HPV), Hepatitis B and C Virus (HBV/HCV), Human Immunodeficiency Virus and Human Herpes Virus 8 (HIV/HHV8), Helicobacter pylori, and Schistosoma haematobium that have been classified as oncogenic by IARC. We obtained data on the infection-associated cancers from registry datab...

P-B16 The Burden of human papilloma virus associated cancers in Nigeria 2012–2014

Background:The Human Papilloma Virus (HPV) is a necessary cause of cervical cancer and is associated with other cancers including vulval, vaginal, anal, penile and oropharyngeal cancers. In this study, we evaluate the burden of HPV associated cancers using data from population based cancer registries (PBCR) in Nigeria. Methods:We obtained data on cancers that are considered to be associated with HPV based on the IARC monograph 100b including cancers of the Cervix (C.53), Vulva (C.51), Vagina (C.52), Anus (C.21), Penis (C.60) and Oropharynx (C.01, C.09, C.10) from PBCR in Abuja (Central Nigeria), Enugu (Eastern Nigeria) and Calabar (South Eastern Nigeria). Previous literature using prevalence data and relative risks suggest that the Population Attributable Fractions (PAFs) for HPV associated cancers in developing countries were Cervical (100%) Vulval and Vaginal (40%), Anal (90%), Oropharynx (12%) in women and, Penile (40%) Anal (90%) Oropharynx (12%) in men. Results:Among women, the 3 PBCR reported a total of 2,986 cases of cancer between 2012 and 2014 with 493 HPV associated cancers contributing 16.5% of the total cancers. Of the 493 HPV associated cancers, 430 were cervical cancers, 27 vulva cancers, 20 anal cancers, 8 vaginal cancers and 8 oropharyngeal cancers. Of these 463 (94%) were attributable to HPV infection. The PBCR reported 1875 cancers in men between 2012 and 2014. Of these, 40 were HPV associated cancers including 22 anal cancers, 16 oropharyngeal cancers and 2 penile cancers constituting (2%) of all cancers in men. Some 23 (57.5%) of the 40 HPV associated cancers were attributable to HPV infection. Conclusion:Cervical and vulva cancers were the most common HPV associated cancers among Nigerian women and anal cancers was the commonest HPV associated cancer in Nigerian men. Our findings suggest that approximately 57.5% of all HPV associated cancers in men and over 90% of all HPV associated cancers in women can be prevented if HPV infection is eliminated.

Prostate Cancer Incidence in Calabar - Nigeria

Aim: The aim of this study is to determine the incidence of prostate cancer in men living in Calabar- Nigeria, which has not been determined up till now. Study Design: A trend analysis of prostate cancer cases in Calabar between 1