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Weimer JM, Kuhn E, Ludwig M, Malle GL, Kapipi G, Schäfer VS, Sadiq A, Henke O. Effectiveness of an ultrasound basic cancer training program through on-site training and virtual case discussions in rural Tanzania: a proof-of-concept study. Ecancermedicalscience 2024; 18:1722. [PMID: 39026658 PMCID: PMC11257097 DOI: 10.3332/ecancer.2024.1722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Cancer rates are rising in low- and middle-income countries. While point-of-care ultrasound is now available globally and could serve to mitigate against this rise, its use in diagnosing cancers is inconsistent in lower-resourced healthcare contexts. This proof-of-concept study investigates the feasibility of an ultrasound training concept in a low-resource setting. It evaluates whether this educational concept led to improved knowledge and application of ultrasound diagnostics, cancer screening and staging and patient care. Material and methods The curriculum was developed through expert exchange and is based on the World Health Organisation's Manual of Diagnostic Ultrasound. It consisted of two didactic components: an on-site training phase across 5 days for a total of 24 hours, and a digital follow-up phase involving the meeting of a bi-weekly tumor board online. The learning objectives of the on-site training were normal imaging and recognition of common pathologies of the abdominal organs, vessels, lymph nodes, female breasts and lungs. The virtual tumour boards met to discuss cases and ultrasound findings, thus aiding continuing professional development after the training sessions had concluded. The face-to-face course component was accompanied by tests given before and after training as well as an evaluation sheet (Likert-scale with 1 = 'completely/very good' and 7 'not at all/very poor'). Results Of 20 participants from a rural hospital in Tanzania, a total of 16 were included in the analysis (clinical officers n = 6; medical officers n = 10). A significant increase in knowledge (p < 0.01) was measured both in the subjective self-assessment and in the theoretical competence tests. In multivariate linear regression, the status 'medical officers yes' (β = 5.4; p = 0.04) had a significant influence on theory test results at T2. During the 24 virtual tumour board meetings, 28 cases were discussed and a continuous improvement in image acquisition quality was observed. Conclusion The ultrasound education concept comes with a sustainable increase in clinical competence and improved oncological ultrasound screening locally. There is potential for the transfer of the concept to other locations, which can be explored in the future.
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Affiliation(s)
- Johannes Matthias Weimer
- Rudolf -Frey Learning Clinic, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz 55131, Germany
| | - Eva Kuhn
- Section Global Health, Institute of Hygiene and Public Health, University Hospital Bonn, Bonn 53127, Germany
| | - Michael Ludwig
- Section Global Health, Institute of Hygiene and Public Health, University Hospital Bonn, Bonn 53127, Germany
- Department of Internal Medicine I, Hospital of the German Armed Forces, Berlin 10115, Germany
| | | | - Godfrid Kapipi
- Marangu Lutheran Hospital, PO Box 107, Marangu, Tanzania
| | - Valentin Sebastian Schäfer
- Department of Rheumatology and Clinical Immunology, Clinic of Internal Medicine III, University Hospital Bonn, Bonn, Germany
| | - Adnan Sadiq
- Kilimanjaro Christian Medical University College, Moshi 2240, Tanzania
| | - Oliver Henke
- Section Global Health, Institute of Hygiene and Public Health, University Hospital Bonn, Bonn 53127, Germany
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Mwobobia JM, Knettel BA, Headley J, Msoka EF, Tarimo CS, Katiti V, Juhlin E, Osazuwa-Peters N. "Let him die. He caused it": A qualitative study on cancer stigma in Tanzania. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003283. [PMID: 38865307 PMCID: PMC11168623 DOI: 10.1371/journal.pgph.0003283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 04/30/2024] [Indexed: 06/14/2024]
Abstract
Cancer stigma presents a critical barrier to care seeking, contributing to delayed presentation and poor cancer outcomes worldwide. The burden of cancer in Tanzania is on the rise, with cancer being the third-leading cause of death in the country. Despite rising incidence and poor outcomes of cancer, cancer-related stigma interventions have received low prioritization. There is a need for sound research that focuses on understanding attitudes driving stigma, its impact on care-seeking and treatment adherence, and intervention models to reduce stigma. We used a cross-sectional qualitative study design. We administered three open-ended qualitative questions to 140 adults newly diagnosed with cancer in Moshi, Tanzania. The questions explored common attitudes toward people with cancer, the perceived impact of cancer-related stigma on care engagement, and ideas for reducing cancer stigma. Patients were recruited during routine appointments at the Cancer Center at Kilimanjaro Christian Medical Center. Data were analyzed using a team-based, applied thematic approach and NVivo 12 software. All participants described stigma as a significant challenge for treatment and receiving support from their social networks. Perceptions of financial burden, misconceptions about cancer, such as the belief that it is contagious, and fear of death, were common attitudes driving cancer stigma. Most participants feared that symptoms would prevent them from being able to work and that the cost of cancer care would drive away loved ones. Stigma was not a ubiquitous response, as some participants reported increased care and social support from family members after a cancer diagnosis. Experiences of stigma contributed to feelings of shame, fear of burdening the family, reduced resources to access treatment, and disengagement from care. Common substitutes to medical therapies included religious interventions and traditional medicine, perceived as less expensive and less stigmatizing. Many participants felt they would benefit from improved financial support, professional counseling, and education for families and communities to reduce stigmatizing attitudes and enhance social support. There is a need for intervention studies focused on improving cancer literacy, community advocacy to reduce cancer stigma, and increasing emotional and practical support for people with cancer and their families. There is also a clear need for policy efforts to make cancer care more affordable and accessible to reduce the financial burden on patients and families.
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Affiliation(s)
- Judith M. Mwobobia
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Brandon A. Knettel
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Duke University School of Nursing, Durham, North Carolina, United States of America
| | - Jennifer Headley
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Elizabeth F. Msoka
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Victor Katiti
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Erika Juhlin
- Department of Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Nosayaba Osazuwa-Peters
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Population Health Sciences, Duke University, Durham, North Carolina, United States of America
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Mushy SE, Mkoka DA, Lukumay GG, Massae AF, Rohloff CT, Mgopa LR, Mwakawanga DL, Kohli N, Ross MW, Mkonyi E, Trent M, Athumani K, Kulasingam S, Rosser BRS. The need for and acceptability of a cancer training course for medical and nursing students in Tanzania: a convergent mixed methods study. BMC MEDICAL EDUCATION 2024; 24:614. [PMID: 38831409 PMCID: PMC11149309 DOI: 10.1186/s12909-024-05497-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 04/30/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND The cancer burden in Africa is on the rise. A Cancer Training Course on screening, prevention, care, and community education is crucial for addressing a wide range of cancer health issues. When appropriately educated healthcare providers on cancer provide care, patient care improves, and healthcare costs decrease. However, in Tanzania, doctors and nurses receive little or no training in primary cancer care in their bachelor's program. AIM This study assessed the need and acceptability of a cancer training course for nursing and medical doctor students at the Muhimbili University of Health and Allied Sciences (MUHAS) in Dar es Salaam, Tanzania. METHODS This study was a cross-sectional parallel mixed method study during the 3-month follow-up within the larger study on sexual health training for health professionals. The study was a randomized controlled (RCT), single-blind, parallel trial of sexual health training versus a waitlist control among health students at MUHAS in Tanzania. Descriptive analysis was performed to analyze the participants' demographic information, need, and acceptability of the cancer training courseto determine the frequencies and percentages of their distribution between disciplines. In addition, inductive thematic analysis was performed for the qualitative data. The RCT study was registered at Clinical Trial.gov (NCT03923582; 01/05/2021). RESULTS Data were collected from 408 students (272 medical doctors and 136 nursing students). The median age of the participants was 23 years. Most (86.0%) medical and 78.1% of nursing students reported receiving little to no cancer training. On the other hand, most (92.3%) medical and nursing (92.0%) students were interested in receiving cancer training. Furthermore, 94.1% of medical and 92.0% of nursing students needed a cancer training course in their undergraduate program. In addition, participants said a cancer training course would be important because it would help them improve the quality of cancer care and enhance the quality of life for patients by ensuring early diagnosis and treatment. CONCLUSION A cancer training course is both highly needed and acceptable to medical and nursing students. Implementation of this cancer training course will improve students' knowledge and skills and eventually improve the quality of cancer care and patients' quality of life by ensuring early diagnosis and management.
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Affiliation(s)
- Stella Emmanuel Mushy
- School of Nursing Department of Community Health Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
- School of Nursing and Midwifery, The Muhimbili University of Health and Allied Sciences, Dar es Salaam, 65004, Tanzania.
| | - Dickson A Mkoka
- School of Nursing Department of Community Health Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gift G Lukumay
- School of Nursing Department of Community Health Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Agnes F Massae
- School of Nursing Department of Community Health Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Corissa T Rohloff
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Lucy R Mgopa
- Department of Psychiatric and Mental Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Dorkasi L Mwakawanga
- School of Nursing Department of Community Health Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Nidhi Kohli
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Michael W Ross
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Ever Mkonyi
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Maria Trent
- Schools of Medicine, Nursing, and Public Health, Johns Hopkins University, Baltimore, Maryland, US
| | - Kibwanda Athumani
- School of Nursing Department of Community Health Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Shalini Kulasingam
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - B R Simon Rosser
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Bayable A, Tegenaw A, Tesfaye Z, Lidetu T, Assefa A, Dessie G. Delay in health-seeking behaviour and associated factors among adult patients with cancer in Ethiopia: a multicentre cross-sectional study. BMJ Open 2023; 13:e071406. [PMID: 37643843 PMCID: PMC10465914 DOI: 10.1136/bmjopen-2022-071406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/14/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES Delays in obtaining proper cancer treatment can lead to advanced stages at diagnosis. Despite the problems, there is not enough evidence regarding delay in presentation. This study aims to assess delay in health-seeking behaviour and associated factors among adult patients with cancer in Ethiopia. DESIGN Multicentre cross-sectional study design. SETTING Data were collected from selected oncology centres in Ethiopia. PARTICIPANTS A multistage sampling technique was used to select 635 study participants from May 9 to June 9 2022. OUTCOME MEASURES Patients who have a duration of ≥3 months from symptom recognition to the first healthcare visit were considered as delay in health-seeking behaviour. Data were entered using Epi data and exported to SPSS for further analysis. Before analysis, model fitness was carried out using Hosmer and Lemeshow test. Variables with a p value<0.25 in the bivariable analysis were included in multivariable logistic regression. In multivariable logistic regression, a p value<0.05 significant level was considered as the factor for delay in health-seeking behaviour. RESULTS In this study, a total of 628 adult patients with cancer participated. A total of 72.6% of patients had a delay in health-seeking behaviour. Variables such as being female (AOR=2.81; 95% CI=1.29 to 6.14), rural residence (AOR=2.82; 95% CI=1.43 to 5.58), low social support (AOR=4.16; 95% CI=2.04 to 8.49), not having comorbidity (AOR=4.44; 95% CI=2.28 to 8.66), stage III cancer (AOR=3.73; 95% CI=1.37 to 9.98), stage IV cancer (AOR=3.07; 95% CI=1.28 to 6.41), additional symptoms (AOR=3.03; 95% CI=1.55 to 5.94), never heard about cancers (AOR=4.09; 95% CI=2.06 to 8.11) and never heard about cancer screening (AOR=2.16; 95% CI=1.06 to 4.40) were identified as factors for delay in health-seeking behaviour. CONCLUSION This study showed that relatively higher magnitude in which approximately three-fourth of adult patients with cancer were delayed in seeking medical attention. As a result, more effort must be made to tackle delay in health-seeking behaviour and associated factors.
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Affiliation(s)
- Alem Bayable
- Department of Adult Health Nursing, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Abebu Tegenaw
- Department of Adult Health Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Zerihun Tesfaye
- Department of Emergency and Critical Care, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Tadios Lidetu
- Department of Adult Health Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Amare Assefa
- Department of Oncology, College of Medicine and Health Science, Jimma University, Jimma, Ethiopia
| | - Getenet Dessie
- Department of Adult Health Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Knettel B, Minja L, Msoka E, Tarimo C, Katiti V, Pan W, Mwobobia J, Juhlin E, Knippler E, Watt M, Suneja G, Kimani S, Abouelella D, Mmbaga B, Osazuwa-Peters N. Culturally-informed adaptation and psychometric properties of the Cataldo Cancer Stigma Scale in Northern Tanzania. J Psychosoc Oncol 2023; 42:286-298. [PMID: 37534869 PMCID: PMC10837313 DOI: 10.1080/07347332.2023.2241458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
BACKGROUND Cancer-related stigma impacts patients' emotional health, care engagement, and cancer outcomes, but few measures of cancer stigma exist. We culturally adapted and assessed psychometric properties of the Cataldo Cancer Stigma Scale (CCSS) in Tanzania. METHODS We administered the CCSS short version (21 items), plus 12 locally-derived items, to 146 adult cancer patients. We conducted exploratory factor analysis, examined internal consistency/reliability, and assessed convergent validity with relevant measures. RESULTS We identified a 17-item cancer stigma scale with strong psychometric properties and four subscales: enacted stigma, shame and blame, internalized stigma, and disclosure concerns. Stigma was rare except for disclosure concerns. Stigma was positively associated with depression and anxiety and negatively associated with social support, quality of life, and illness acceptance. CONCLUSIONS The scale provides valid, culturally-informed measurement of cancer stigma in Tanzania. Future studies should assess associations with care engagement, which will inform interventions to reduce stigma and improve outcomes.
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Affiliation(s)
- Brandon Knettel
- Duke University School of Nursing, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Linda Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Elizabeth Msoka
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre Cancer Care Centre, Moshi, Tanzania
| | | | - Victor Katiti
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Wei Pan
- Duke University School of Nursing, Durham, NC, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Judith Mwobobia
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Erika Juhlin
- Department of Head and Neck Surgery, Duke University Medical Center, Durham, NC, USA
| | - Elizabeth Knippler
- Duke University School of Nursing, Durham, NC, USA
- Duke Center for AIDS Research, Duke University, Durham, NC, USA
| | - Melissa Watt
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Gita Suneja
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT, USA
| | - Stephen Kimani
- Department of Medicine, Division of Medical Oncology, University of Utah, Salt Lake City, UT, USA
| | - Dina Abouelella
- Department of Head and Neck Surgery, Duke University Medical Center, Durham, NC, USA
| | - Blandina Mmbaga
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Nosayaba Osazuwa-Peters
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Department of Head and Neck Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Durham, NC, USA
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Akoko L, Brand N, Kotecha V, Byabato S, Ndumbalo J, Mwashambwa M, Mwakigonja A, Lowry A. Colorectal cancer in Tanzania: the current status and future directions. Ecancermedicalscience 2023; 17:1564. [PMID: 37396097 PMCID: PMC10310332 DOI: 10.3332/ecancer.2023.1564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Globally, colorectal cancer (CRC) is the third most common malignancy and the second most common cause of cancer death. By 2030, the incidence is expected to increase to reach 2.2 million cases and 1.1 million deaths. In Sub-Saharan Africa, accurate cancer incidence data is limited, but anecdotally, clinicians note a significant rise in the incidence of CRC in the past decade. To educate clinicians on the growing burden of CRC, the Tanzanian Surgical Association hosted a 4-day CRC symposium from 3rd to 6th October 2022. Following the meeting, a group of multidisciplinary stakeholders created a working group whose first task was to assess the epidemiology, presentation and available resources for CRC care in Tanzania. The findings of that assessment are described in this article. Findings The true incidence of CRC in Tanzania is currently unknown. However, individual high-volume centres have noted a dramatic rise in cases of colon and rectal cancer on their wards. A review of the published data on CRC in Tanzania showed that most patients present with CRC late and the limited availability of endoscopic and diagnostic services poses a challenge for accurately staging these patients prior to treatment. Multidisciplinary care, including surgery, chemotherapy and radiation, is available for the treatment of CRC in Tanzania, although the capacity and quality of these services vary throughout the country. Conclusion There is a substantial burden of CRC in Tanzania that appears to be increasing. While there is capacity in the country to provide all aspects of multidisciplinary care, late presentation, limited access to diagnostic and treatment services and poor coordination continue to be significant barriers to providing optimal treatment to these patients.
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Affiliation(s)
- Larry Akoko
- Department of Surgery, Muhimbili University for Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
- Larry Akoko and Nathan Brand contributed equally and are designated as co-first authors
| | - Nathan Brand
- Department of Surgery, Muhimbili University for Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
- Department of Surgery, University of California San Francisco, San Francisco, CA 94115, USA
- Larry Akoko and Nathan Brand contributed equally and are designated as co-first authors
| | - Vihar Kotecha
- Department of Surgery, Catholic University for Health and Allied Sciences, PO Box 1464, Mwanza, Tanzania
| | - Sam Byabato
- Department of Surgery, Catholic University for Health and Allied Sciences, PO Box 1464, Mwanza, Tanzania
| | - Jerry Ndumbalo
- Clinical Oncology Department, Ocean Road Cancer Institute, PO Box 3592, Dar es Salaam, Tanzania
| | - Masumbuko Mwashambwa
- Department of Surgery, University of Dodoma School of Medicine and Dentistry, Dodoma 41218, Tanzania
| | - Amos Mwakigonja
- Department of Pathology, Muhimbili University for Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
| | - Ann Lowry
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
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Pumphrey I, Serventi F, Kahakwa A, Massawe A, Henke AA, Henke O. Impact of COVID-19 on delivery of oncology services in Northern Tanzania: a cross-sectional study of community health workers and patients undergoing cancer treatment at the Kilimanjaro Christian Medical Centre. BMJ Open 2023; 13:e069142. [PMID: 37080627 PMCID: PMC10123862 DOI: 10.1136/bmjopen-2022-069142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVE To ascertain how the COVID-19 pandemic was perceived by oncology patients and community health workers (CHWs) and whether this contributed to disruptions in cancer care. DESIGN Cross-sectional study using (1) structured telephone interviews with patients and (2) structured questionnaires completed by CHWs. SETTING Outpatient and community care at Kilimanjaro Christian Medical Centre's Cancer Care Centre (KCMCCCC), Northern Tanzania. PARTICIPANTS 300 oncology patients (158 men and 142 women) who had attended KCMCCCC between January and April 2020 and 78 CHWs (16 men and 62 women) in the KCMC regional palliative care network who conducted home visits to patients with cancer during the period January to April 2020. PRIMARY OUTCOME MEASURES For patients, missed appointments and fear of COVID-19 more than postponement of their treatment. For CHWs, no primary outcome (a broad range of questions on perception of the pandemic were asked). RESULTS 30% of patients said they missed appointments due to the pandemic, the most commonly cited reasons being financial problems (37%) and fear of acquiring COVID-19 infection during travel and/or in the hospital (37%). Only 12.7% of patients said they feared COVID-19 more than postponement of cancer treatment. 88% of CHWs noticed differences in delivering home care since the start of the pandemic, with 58% saying they had noticed more patients dying and 74% saying that more patients were relying on local healers. 31% of CHWs said they feared home visits because of COVID-19 and 46% perceived patients feared home visits due to COVID-19. However, 92% felt home visits should continue. CONCLUSION These results indicated that while there was a significant degree of disruption and fear around the COVID-19 pandemic, the majority of patients and CHWs did not fear of COVID-19 more than disruption to cancer care. This highlights the importance to these groups of maintaining access to vital cancer services.
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Affiliation(s)
- India Pumphrey
- Institute for Tropical Medicine and Public Health, Charite-Universitatsmedizin Berlin, Berlin, Germany
| | - Furaha Serventi
- Department of Oncology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania, United Republic of
| | - Atukuzwe Kahakwa
- Department of Oncology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania, United Republic of
| | - Anna Massawe
- Department of Oncology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania, United Republic of
| | - Antje Annaliese Henke
- Department of Oncology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania, United Republic of
- Institute for Medical Epidemiology, Biostatistics and Informatics, Center of Health Sciences, Martin-Luther-Universitat Halle-Wittenberg, Halle, Germany
| | - Oliver Henke
- Department of Oncology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania, United Republic of
- Institute for Hygiene and Public Health, Section Global Health, University of Bonn, Bonn, Germany
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Kidayi PL, Manhica H, Mtuya CC, Johnson MM, Furaha S, Aune RE, Björling G. Quality of Cancer Care in Tanzania as Experienced by Patients: A Qualitative Study. SAGE Open Nurs 2023; 9:23779608231157332. [PMID: 36814460 PMCID: PMC9940171 DOI: 10.1177/23779608231157332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/09/2023] [Accepted: 01/29/2023] [Indexed: 02/19/2023] Open
Abstract
Introduction Cancer is a disease of public importance in Tanzania. Considering a limited health care system with few cancer centers and low health literacy in general, people are diagnosed at late stage and face difficulties in accessing care for their cancer. All these challenges affect the caring situation for the nurses who meet the patients at the cancer care centers. Objective This study aimed to explore the journey of cancer care experienced by patients with cancer.Research questions:How do patients experience the quality of care at the cancer care centers?How do patients experience the family's and the community's role? Methods Semi-structured qualitative interviews were carried out with 15 patients treated for colorectal-, breast-, or prostate cancer in three cancer care centers in Tanzania. A purposive sampling was used. Qualitative content analysis according to Graneheim and Lundman was employed. Results Three main themes and six sub-themes emerged. The main themes were e xperiences of cancer care services, the role of the family, community challenges and cancer care. The sub-themes were communication, resource allocation at the cancer care centers, fmily's denial, family challenges, limitations of primary care and misconceptions, and accessibility of cancer service and the health care system. The findings show that patients experienced incapacitated health care facilities for cancer care, misconceptions in the community and challenges for the families. Conclusions The quality of cancer care in Tanzania needs to be improved, patients face challenges in all levels of health care facilities, including families, and the community at large. The distance to oncology care, economic hardship, and lack of knowledge in the community including families, lead to late diagnosis and suffering for the patients. There is a great need for education regarding cancer within healthcare, as well as in the community, to change the situation for patients with cancer.
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Affiliation(s)
- Paulo L. Kidayi
- Faculty of Nursing, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Hélio Manhica
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden,Sophiahemmet University, Stockholm, Sweden
| | - Christina C. Mtuya
- Faculty of Nursing, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Mahande Michael Johnson
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Serventi Furaha
- Cancer Care Centre, Kilimanjaro Medical Centre, Moshi, Tanzania
| | - Ragnhild E. Aune
- Department of Material Sciences, Norwegian University of Technology and Science, Trondheim, Norway
| | - Gunilla Björling
- Faculty of Nursing, Kilimanjaro Christian Medical University College, Moshi, Tanzania,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden,Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden,Gunilla Björling, Department of Nursing, School of Health and Welfare, Jönköping University, P.O. Box 1026, SE-551 11 Jönköping, Sweden.
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Henke O, Qader AQ, Malle GL, Kuiate JR, Hennig L, Demeke T, Stroetmann C, Henke AA, Alaric TT, Rushanyan M, Enssle C, Bussmann H. International cooperation to fight cancer's late-stage presentation in low- and middle-income countries. Clin Exp Metastasis 2023; 40:1-3. [PMID: 36646888 PMCID: PMC9898318 DOI: 10.1007/s10585-022-10196-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 11/27/2022] [Indexed: 01/18/2023]
Abstract
Cancer is becoming a massive public health burden in low- and middle-income countries (LMIC). 70% of all cancer deaths globally are attributed to LMIC while the incidence proportion is below 60%. The main reason for the higher mortality rate is "late-stage presentation" of patients with stage III or IV diseases when being diagnosed. Main reasons for this are limited (financial) resources, poor knowledge of health service provider about cancer, misbelieves and fear among patients as well as low health literacy rate. During the 1st International Conference on Hospital Partnerships, conducted by the German Agency for International Cooperation (GIZ), cancer specialists from seven LMIC and Germany discussed opportunities, challenges and solutions of the development of cancer services. Two days of in-depths discussion identified five topics to be playing a key role in the effort to reduce the cancer burden in LMIC: Health Policy & Financing, Barriers to Access, Capacity Building, Cancer Registries and Adapted Treatment Guidelines. By using mind-mapping technique, stakeholders, core topics, main and important topics were visualized and interconnections displayed. Many topics can be addressed through international cooperations but political willingness and commitment in the respective countries plays the crucial role. An essential contribution will be to assist policy makers in formulating and endorsing affordable and effective health policies. Another lesson learned from this workshop is the similarity of challenges among the participating representatives from different LMIC. The authors of this letter emphasize on the importance of building international long-term cooperations to advance oncology care on a global scale.
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Affiliation(s)
- Oliver Henke
- Section Global Health, University Hospital Bonn, Bonn, Germany.
| | | | | | - Jules Roger Kuiate
- Department of Biochemistry, University of Dschang, Foréké-Dschang, Cameroon
| | - Lisa Hennig
- Heidelberg Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Clara Stroetmann
- Institute of Epidemiology, Biometry and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Antje Anneliese Henke
- Institute of Epidemiology, Biometry and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | | | | | | | - Hermann Bussmann
- Department of Applied Tumor Biology, University Hospital Heidelberg, Heidelberg, Germany
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Kidayi PL, Manhica H, Nakazzi S, Mtuya CC, Aune RE, Serventi F, Mahande MJ, Björling G. "Caring for Breast Cancer Patients Is a Work That Brings Sorrow": A Qualitative Interview Study with Nurses in Tanzania. SAGE Open Nurs 2023; 9:23779608231187241. [PMID: 37441435 PMCID: PMC10333987 DOI: 10.1177/23779608231187241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 06/20/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction Breast cancer is increasing in sub-Saharan Africa (SSA), and most women are diagnosed at a late stage. This leads to increased suffering for the patients and challenging care situations for nurses. Limited resources in healthcare, lack of oncology training, and low health literacy in society result in even more demanding situations for nurses. Objective The objective was to explore nurses' experiences of caring women for with breast cancer in Tanzania. Methods The study employed a descriptive qualitative design. Fifteen nurses, working in oncology units in three major hospitals in Tanzania were interviewed using a semistructured interview guide. The participants had a minimum of 6 months experience of caring for breast cancer patients. Purposive sampling was used. Data were analyzed by qualitative content analysis. Results Two main themes emerged: Challenges in caring for breast cancer patients and Nurses' psychological distress. The late diagnosis was very challenging for the nurses. Low health literacy regarding breast cancer disease and treatment, patients' financial difficulties, minimal oncology nursing education, and technology in healthcare systems were also major challenges. The nurses experienced psychological distress, lost hope, and faced ethical dilemmas while providing cancer care. Conclusion The findings of this study conclude that nurses face emotional distress and ethical dilemmas while caring for patients with breast cancer. Late diagnosis, lack of infrastructure and resources, and low health literacy among patients, family, and healthcare providers have a great impact on the stress that the nurses experience.
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Affiliation(s)
- Paulo L. Kidayi
- Faculty of Nursing, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Hélio Manhica
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Health Promotion, Sopiahemmet University, Stockholm, Sweden
| | - Sandra Nakazzi
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Christina C. Mtuya
- Faculty of Nursing, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Ragnhild E. Aune
- Department of Material Sciences, Norwegian University of Technology and Science, Trondheim, Norway
| | - Furaha Serventi
- Kilimanjaro Christian Medical Centre Cancer Care Centre, Moshi, Tanzania
| | - Michael Johnson Mahande
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Gunilla Björling
- Faculty of Nursing, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Mulonda JK, Havenga Y, de Villiers M. Healthcare Providers' Perceptions of the Cancer Pain Management Barriers at a Hospital in Zambia: A Qualitative Study. SAGE Open Nurs 2023; 9:23779608231197008. [PMID: 37675152 PMCID: PMC10478529 DOI: 10.1177/23779608231197008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/21/2023] [Accepted: 07/29/2023] [Indexed: 09/08/2023] Open
Abstract
Introduction Cancer incidence and mortality are increasing worldwide, and pain is the most common symptom patients experience. Despite developments in cancer pain management and guidelines, the pain often remains undertreated. Effective pain management ultimately involves overcoming several complex institutional, patient, and healthcare provider-related barriers. Objective The objective of the study was to explore and describe healthcare providers' perceptions of the cancer pain management barriers at a hospital in Zambia. Method A descriptive qualitative study was conducted. Data were collected from 10 purposively sampled medical doctors and registered nurses using prepiloted semistructured individual interviews. Interviews were audio recorded and transcribed verbatim. Thematic analysis was done, and trustworthiness was enhanced based on the criteria described by Lincoln and Guba. Ethical principles, as outlined in the Declaration of Helsinki, were adhered to. Results Three themes emerged, namely patient-related barriers (biographic characteristics, patient knowledge and perceptions), healthcare provider-related barriers (knowledge and perceptions and language barriers), and institution-related barriers (resource limitations and lack of standards and guidelines). Healthcare providers' views that cultural beliefs about cancer being caused by witchcraft and the use of traditional medicine and services are barriers to cancer pain management were unique to this study. Conclusion Cancer pain management requires a total pain management approach that addresses the barriers to pain management strategies from a patient, healthcare provider, and institutional perspective. The knowledge deficit among patients and healthcare providers is a barrier to cancer pain management and one of the most common challenges reported in the literature. This study further points toward a need to develop culturally competent healthcare providers.
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Affiliation(s)
- Jennipher Kombe Mulonda
- Adelaide Tambo School of Nursing Science, Tshwane University of Technology, Pretoria, South Africa
| | - Yolanda Havenga
- Adelaide Tambo School of Nursing Science, Tshwane University of Technology, Pretoria, South Africa
| | - Martjie de Villiers
- Adelaide Tambo School of Nursing Science, Tshwane University of Technology, Pretoria, South Africa
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Fekadu A, Rick TJ, Tigeneh W, Kantelhardt EJ, Incrocci L, Jemal A. Clinicopathology and Treatment Patterns of Head and Neck Cancers in Ethiopia. JCO Glob Oncol 2022; 8:e2200073. [PMID: 35939776 PMCID: PMC9470133 DOI: 10.1200/go.22.00073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Head and neck cancers are the third most common cancers treated with radiation in Ethiopia. There is, however, a lack of published data on clinical and pathological characteristics and treatment patterns of head and neck cancers in the country. The objective of the study was to assess clinical and pathological characteristics and treatment patterns of head and neck cancers at Tikur Anbessa Specialized Hospital, which housed the only radiotherapy facility in Ethiopia during the study period. Curative radiation dosing for #headandneck #cancer in #Ethiopia is challenged by the limitations of 2D radiation and long wait times. @JCOGO_ASCO
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Affiliation(s)
- Adugna Fekadu
- Department of Radiation Oncology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tara J. Rick
- Department of Radiation Oncology, Erasmus MC, Rotterdam, the Netherlands
| | | | | | - Luca Incrocci
- Department of Radiation Oncology, Erasmus MC, Rotterdam, the Netherlands
| | - Ahmedin Jemal
- Surveillance and Health Service Research, American Cancer Society, Atlanta, GA
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Henke O, Bruchhausen W, Massawe A. Use of Herbal Medicine Is Associated With Late-Stage Presentation in Tanzanian Patients With Cancer: A Survey to Assess the Utilization of and Reasons for the Use of Herbal Medicine. JCO Glob Oncol 2022; 8:e2200069. [PMID: 35820080 PMCID: PMC9296184 DOI: 10.1200/go.22.00069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE In Tanzania, patients with cancer present late with advanced stages. Among other reasons, the use of herbal medicine (HM) might contribute to delay in diagnosis and treatment. This study aims to understand the utilization of HM and the reasons for its' use. METHODS A semistructured 30-item questionnaire with closed- and open-ended questions was applied to a cohort of patients with cancer at Kilimanjaro Christian Medical Centre. Content analysis was performed for answers to open-ended questions. RESULTS Three hundred two patients were interviewed, 50.9% males and 49.1% females. The mean age was 64 years. 71.6% were in stages III/IV. 70.5% patients used HM and 67.1% started conventional medicine after stopping HM, 7.5% started HM after conventional medicine, and 24.9% combined both. Stage IV patients used HM as first line significantly more often in comparison: stage I 55.6%; II 58.1%; III 57.2%; and IV 70.6%. 77.5% did not tell their doctors about the use of HM. Commonest reasons to use HM were belief in cure, hope of symptom relief, lack of cancer services, and tradition. CONCLUSION The majority of patients used HM before consulting a doctor, which contributes to stage IV presentation. Use of HM alongside with chemotherapy is mostly not known to the treating physician and may lead to interactions. These findings must alert health care workers and health policymakers to further foster health education about cancer and its treatment. Further research is needed to understand the wide use of HM among Tanzanian patients with cancer and the role that traditional and spiritual healers play in the field of cancer care. Use of herbal medicines is common in Tanzania and leads to delays in cancer diagnosis that impedes curative treatment.![]()
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Affiliation(s)
- Oliver Henke
- Cancer Care Centre, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Section Global Health, Institute for Hygiene and Public Health, University Hospital of Bonn, Bonn, Germany
| | - Walter Bruchhausen
- Section Global Health, Institute for Hygiene and Public Health, University Hospital of Bonn, Bonn, Germany
| | - Anna Massawe
- Cancer Care Centre, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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