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Oppong–Mensah YG, Odoom SF, Nyanor I, Amuzu EX, Yawnumah SA, Asafo‐Adjei E, Nguah SB, Ansong D, Osei‐Akoto A, Paintsil V. Hospitalizations among children with sickle cell disease enrolled in the Kumasi Sickle Cell Pan African Consortium (SPARCo) database: A cross sectional study. Health Sci Rep 2023; 6:e1534. [PMID: 37670846 PMCID: PMC10475768 DOI: 10.1002/hsr2.1534] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 07/15/2023] [Accepted: 08/17/2023] [Indexed: 09/07/2023] Open
Abstract
Background and Aims Sickle cell disease (SCD) is the commonest monogenic haemolytic disorder in Africa. Despite strides made in its management, a significant proportion of patients are hospitalized from the various complications of the disease. This study set out to describe the main causes and outcomes of hospitalizations among pediatric patients with SCD. Methods A cross-sectional study was conducted at the Pediatric Emergency Unit of Komfo Anokye Teaching Hospital within a period of 12 months to recruit pediatric SCD patients. This study looked at causes of admission, length of hospital stay (LOS), and outcome of admission. Results Of the 201 SCD patients recruited, 57.2% were males and majority were of SCD-SS phenotype 83.1%. The median age was 6 years. The three leading causes of hospitalization were Vaso-occlusive pain events (VOPE) (39.8%), acute chest syndrome (ACS) (25.9%), and infections (12.4%). Ten (5.0%) of the patients presented with a stroke. High admissions were observed in June (12.4%) and November (16.9%). The median (interquartile range [IQR]) LOS was 6 days (IQR: 4-10). Six (3.0%) of the patients died from complications of the disease during hospitalization. Conclusion VOPE, ACS, infections, and acute anaemia from hyperhaemolysis were observed as the most common causes of admissions among SCD patients. A good outcome of discharge was seen in most of the patients that were hospitalized with a median length of stay of 6 days. This study also strengthens the importance of a good SCD database with patient follow-ups for better outcomes in SCD patients.
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Affiliation(s)
| | | | - Isaac Nyanor
- Department of Child HealthKomfo Anokye Teaching HospitalKumasiGhana
| | | | | | | | - Samuel Blay Nguah
- Department of Child HealthKomfo Anokye Teaching HospitalKumasiGhana
- Department of Child Health, School of Medicine and DentistryKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Daniel Ansong
- Department of Child HealthKomfo Anokye Teaching HospitalKumasiGhana
- Department of Child Health, School of Medicine and DentistryKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Alex Osei‐Akoto
- Department of Child HealthKomfo Anokye Teaching HospitalKumasiGhana
- Department of Child Health, School of Medicine and DentistryKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Vivian Paintsil
- Department of Child HealthKomfo Anokye Teaching HospitalKumasiGhana
- Department of Child Health, School of Medicine and DentistryKwame Nkrumah University of Science and TechnologyKumasiGhana
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Nembaware V, Nnodu OE, Sangeda RZ, Paintsil V, Mazandu GK, Munung NS, Wonkam A, Martí-Carvajal AJ. Editorial: Building capacity for sickle cell disease research and healthcare. Front Genet 2023; 14:1226589. [PMID: 37501718 PMCID: PMC10369345 DOI: 10.3389/fgene.2023.1226589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/05/2023] [Indexed: 07/29/2023] Open
Affiliation(s)
- Victoria Nembaware
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Obiageli Eunice Nnodu
- Centre of Excellence for Sickle Cell Disease Research and Training (CESRTA), University of Abuja, Abuja, Nigeria
- Department of Haematology and Blood Transfusion, University of Abuja, Abuja, Nigeria
| | - Raphael Zozimus Sangeda
- Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Vivian Paintsil
- Directorate of Child Health-Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Department of Child Health- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Gaston Kuzamunu Mazandu
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Nchangwi S. Munung
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Ambroise Wonkam
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Genetic Medicine, Johns-Hopkins University School of Medicine, Baltimore, MD, United States
| | - Arturo J. Martí-Carvajal
- Cochrane Centre, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
- Cátedra Rectoral de Medicina Basada en Evidencia, Universidad de Carabobo, Valencia, Venezuela
- Faculty of Medicine, Francisco de Vitoria University, Madrid, Spain
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Yakubu RC, Paintsil V, Nguah SB. Weight estimation in two groups of Ghanaian children with chronic diseases using Broselow, Mercy, PAWPER XL and PAWPER XL-MAC tapes. Afr J Emerg Med 2023; 13:109-113. [PMID: 37152659 PMCID: PMC10154971 DOI: 10.1016/j.afjem.2023.04.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/08/2023] [Accepted: 04/11/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction The performance of various weight estimation methods in children with sickle cell disease (SCD) and heart disease (HD) has not been studied. We aimed to determine and compare the accuracies of the Broselow, Mercy, PAWPER XL and PAWPER XL-MAC tapes in Ghanaian children with no known chronic diseases (controls), SCD and HD. Methods We prospectively recruited 631 children (199 with HD, 209 SCD and 223 controls) from the Komfo Anokye Teaching Hospital (KATH). Their weights were estimated using the Broselow, Mercy, PAWPER XL and PAWPER XL-MAC tapes. These estimated weights were compared to measured weight using mean percentage error (MPE), the proportion of weight estimates within ±10% (P10) and ±20% (P20) of measured weight. Bland-Altman limits of agreement (LOA) were determined to assess the precision of weight estimation and agreement with measured weight. Results The PAWPER XL, Mercy and PAWPER XL-MAC were the most accurate in all groups of children studied. All methods except the Broselow tape (BT), which performed best in the control group, had their best performance among children with SCD with negligible critical error rates (proportion of children with weight estimates > 20% of their actual weight). The P20 in the various groups of children using the BT were 88.36%, 80.21% and 51.10% respectively in the control, SCD and HD groups. The Mercy, PAWPER XL and PAWPER XL MAC tapes were generally above 90% in all groups. Discussion The Mercy, PAWPER XL and PAWPER XL-MAC tapes performed significantly better than the BT in all groups of children studied. These methods of weight estimation performed best in children with SCD with very little critical error.
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Affiliation(s)
- Rafiuk Cosmos Yakubu
- School of Medicine, University for Development Studies, Tamale, Ghana
- Tamale Teaching Hospital, Tamale, Kumasi, Ghana
- Corresponding author at: Tamale Teaching Hospital, Tamale, Kumasi, Ghana.
| | - Vivian Paintsil
- Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Directorate of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Samuel Blay Nguah
- School of Medicine, University for Development Studies, Tamale, Ghana
- Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Fordjour FA, Kwarteng A, Paintsil V, Amanor E, Ackah EB, Amuzu EX, Sackey DS, Akoto AOY. Hemolysis scavenger proteins and renal function marker in children with sickle cell disease at steady state: A cross-sectional study. Health Sci Rep 2023; 6:e1177. [PMID: 37008811 PMCID: PMC10062495 DOI: 10.1002/hsr2.1177] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/08/2023] [Accepted: 03/13/2023] [Indexed: 04/04/2023] Open
Abstract
Background and Aims Hemolysis is a fundamental feature of sickle cell disease (SCD) contributing to the vaso-occlusive crisis of patients. The objectives of the study were to assess the link between hemolysis proteins and hematological parameters, and to validate cystatin C (CYS C) as a potent renal marker in diagnoising SCD. Method Here, a cross-sectional study carried out at the pediatric SCD clinic of the Komfo Anokye Teaching Hospital comprised 90 SCD children (HbSC, HbSF, and HbSS). ANOVA, t-test, and Spearman's rank correlation analysis were done. Elevated proteins levels were compared to standard values; alpha-1 microglobulin (A1M) (1.8-65 µg/L), CYS C (0.1-4.5 µmol/L), and haemopexin (HPX) (500-1500 µg/mL). Results The mean (standard deviation) age of participants was 9.830 (±0.3217) years, and 46% of them were males. From simple descriptive analysis, we observed that all but one patient had their HPX level below the reference range (<500 µg/mL). Here, A1M levels were shown to be within the appropriate reference range for all the patients except few patients. CYS C levels were also all within the required reference values. A Spearman's rank correlation test between full blood count and HPX generally suggested a weak but positive correlation; RBC (coef. = 0.2448; p = 0.0248), HGB (coef. = 0.2310; p = 0.030), hematocrit (coef. = 0.2509; p = 0.020), and platelet (coef. = 0.1545; p = 0.160). Mean corpuscular volume (coef. = -0.5645; p = 0.610) had a stronger but negative correlation with HPX. This study depicts a positive and stronger association between CYS C and HPX levels (coef. = 0.9996; p < 0.0001), validating the use of CYS C as a useful marker of renal function in persons with SCDs. Conclusion In the present study, we show that A1M levels were normal for most of the patients, hence CYS C levels are not alarming in this study. Further, there exists a correlation between hemolysis scavenger proteins and hematological parameters.
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Affiliation(s)
- Fatima A. Fordjour
- Department of MicrobiologyUniversity for Development StudiesTamaleGhana
- Department of Biochemistry and Biotechnology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Alexander Kwarteng
- Department of Biochemistry and Biotechnology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana
- Kumasi Centre for Collaborative Research in Tropical MedicineKumasiGhana
| | - Vivian Paintsil
- Child Health DirectorateKomfo Anokye Teaching HospitalKumasiGhana
- College of Health SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Ernest Amanor
- Department of Biochemistry and Biotechnology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Ezekiel B. Ackah
- School of Public HealthKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Evans X. Amuzu
- Child Health DirectorateKomfo Anokye Teaching HospitalKumasiGhana
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Paintsil V, Ally M, Isa H, Anie KA, Mgaya J, Nkanyemka M, Nembaware V, Oppong-Mensah YG, Ndobho F, Chirande L, Makubi A, Nnodu O, Wonkam A, Makani J, Ohene-Frempong K. Development of multi-level standards of care recommendations for sickle cell disease: Experience from SickleInAfrica. Front Genet 2023; 13:1052179. [PMID: 36712852 PMCID: PMC9877224 DOI: 10.3389/fgene.2022.1052179] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/29/2022] [Indexed: 01/15/2023] Open
Abstract
Introduction: Sickle Cell Disease (SCD) causes significant morbidity and mortality particularly in sub-Saharan Africa (SSA) where it contributes to early childhood deaths. There is need to standardize treatment guidelines to help improve overall SCD patient health outcomes. We set out to review existing guidelines on SCD and to set minimum standards for management of SCD for the different referral levels of healthcare. Methods: A standards of care working group (SoC-WG) was established to develop the SoC recommendations. About 15 available SCD management guidelines and protocols were reviewed and themes extracted from them. The first draft was on chosen themes with 64 major headings and subtopics. Using a summarised WHO levels of referral document, we were able to get six different referral levels of healthcare. The highest referral level was the tertiary facilities whilst the lowest level was the home setting. Recommendations for SCD management for the regional, district, sub-districts, health posts and CHPs compounds were also drafted. Results: The results from this review yielded a guidelines document which had recommendations for management of SCD on 64 topics and subtopic for all the six (6) different referral levels. Discussions: Every child with SCD need to receive comprehensive care that is coordinated at each level. This recommendation is unique in terms of the availability of recommendations for different levels of care as compared to the traditional guidelines which is more focused at the tertiary levels. Patients can access care at any of the other lower referral hospitals and be managed with recommendations that are in keeping with institutional resources at that level. When such patients need care that requires expertise that is not available at that level, the recommendations will be to refer to the appropriate referral level where those expertise are available. This encourages patients to have good clinical care nearer their homes but also having access to specialist screening modalities and expertise at the tertiary hospitals if need be. With this, patient are not limited to a specific referral level when interventions cannot be instituted for them. Conclusion: This SoC recommendations document is a useful material that can be used for consistent standards of treatment in SSA.
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Affiliation(s)
- Vivian Paintsil
- Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana,Directorate of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana,*Correspondence: Vivian Paintsil,
| | - Mwashungi Ally
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Hezekiah Isa
- Department of Haematology and Blood Transfusion, Centre of Excellence for Sickle Cell Disease Research and Training (CESRTA), University of Abuja, Abuja, Nigeria
| | - Kofi A. Anie
- London North West University Healthcare NHS Trust, Imperial College London, London, England
| | - Josephine Mgaya
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Malula Nkanyemka
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Victoria Nembaware
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Flora Ndobho
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Lulu Chirande
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Abel Makubi
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Obiageli Nnodu
- Department of Haematology and Blood Transfusion, Centre of Excellence for Sickle Cell Disease Research and Training (CESRTA), University of Abuja, Abuja, Nigeria
| | - Ambroise Wonkam
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Julie Makani
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
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Abdul G, Osei-Wusu W, Asare GA, Daud S, Opoku S, Tamakloe VCKT, Frimpong J, Sackey B, Boadu WIO, Paintsil V, Annani-Akollor ME, Wiafe YA, Anto EO, Addai-Mensah O. Biomarkers of oxidative stress and its nexus with haemoglobin variants and adverse foeto-maternal outcome among women with preeclampsia in a Ghanaian population: A multi-centre prospective study. PLoS One 2023; 18:e0283638. [PMID: 36996011 PMCID: PMC10062654 DOI: 10.1371/journal.pone.0283638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 03/14/2023] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION Haemoglobin variants and preeclampsia (PE) are associated with adverse fatal events of which oxidative stress may be an underlying factor. Oxidative stress (OS) among preeclamptic women with haemoglobin variants has been well established. It is, however, unclear whether haemoglobin variants induce OS to aggravate the risk of adverse foeto-maternal outcomes in pregnant women with preeclampsia. We measured the levels of OS biomarkers and determined the association between haemoglobin variants, and adverse foeto-maternal outcomes among pregnant women with PE. METHODS This multi-centre prospective study recruited 150 PE women from three major health facilities in both Bono and Bono east regions of Ghana from April to December 2019. Haemoglobin variants; HbAS, HbSS, HbSC, HbCC, and HbAC were determined by haemoglobin electrophoresis. OS biomarkers such as malondialdehyde (MDA), catalase (CAT), vitamin C, and uric acid (UA) along with haematological and biochemical parameters were estimated using standard protocol. Adverse pregnancy complications (APCs) such as post-partum haemorrhage (PPH), HELLP (Haemolysis, Elevated liver enzymes, Low platelet count) syndrome, preterm delivery, neonatal intensive care unit (NICU) admission, and neonatal jaundice were recorded. RESULTS Of the 150 pregnant women with preeclampsia, the distribution of haemoglobin AA, AS, AC, CC, SS and SC phenotypes were 66.0%, 13.3%, 12.7%, 3.3%, 3.3% and 1.3%, respectively. The most prevalent foeto-maternal outcomes among PE women were NICU admission (32.0%) followed by PPH (24.0%), preterm delivery (21.3%), HELLP syndrome (18.7%), and neonatal jaundice (18.0%). Except for vitamin C level which was significantly higher in patients with at least a copy of Haemoglobin S variant than those with at least a copy of Haemoglobin C variant (5.52 vs 4.55; p = 0.014), levels of MDA, CAT, and UA were not statistically significantly different across the various haemoglobin variants. Multivariate logistic regression model showed that participants with HbAS, HbAC, having at least a copy of S or C and participants with HbCC, SC, SS had significantly higher odds of neonatal jaundice, NICU admission, PPH and HELLP syndrome compared to participants with HbAA. CONCLUSION Reduced levels of vitamin C are common among preeclamptics with at least one copy of the HbC variant. Haemoglobin variants in preeclampsia contribute to adverse foeto-maternal outcomes with Haemoglobin S variants being the most influencing factor for PPH, HELLP, preterm labour, NICU admission, and neonatal jaundice.
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Affiliation(s)
- Ganiwu Abdul
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- University Clinic, University Health Directorate, University of Energy and Natural Resources, Sunyani, Ghana
| | - William Osei-Wusu
- Department of Medical Diagnostics, College of Health and Wellbeing, Kintampo, Ghana
| | - Gordon Akuffo Asare
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Medical Diagnostics, College of Health and Wellbeing, Kintampo, Ghana
| | - Samira Daud
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Haematology, Faculty of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Stephen Opoku
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Joseph Frimpong
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Benedict Sackey
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Wina Ivy Ofori Boadu
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Vivian Paintsil
- Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Max Efui Annani-Akollor
- Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Yaw Amo Wiafe
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Enoch Odame Anto
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Otchere Addai-Mensah
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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van Heerden J, Balagadde-Kambugu J, Angom R, Lusobya RC, Chantada G, Desjardins L, Fabian ID, Israels T, Paintsil V, Hessissen L, Diouf MN, Elayadi M, Turner SD, Kouya F, Geel JA. Evaluating the baseline survival outcomes of the "six Global Initiative for Childhood Cancer index cancers" in Africa. Pediatr Hematol Oncol 2022; 40:203-223. [PMID: 36369884 DOI: 10.1080/08880018.2022.2140860] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Limited survival data for the six Global Initiative for Childhood Cancer (GICC) priority cancers are available in Africa. Management of pediatric malignancies in Africa is challenging due to lack of resources, setting-specific comorbidities, high rates of late presentation and treatment abandonment. Reporting of outcome data is problematic due to the lack of registries. With the aim of evaluating the feasibility of baseline outcomes for the six index cancers, we present a descriptive analysis of respective survival rates in Africa. The survival rates were between 18% (lower middle-income countries) to 82.3% (upper middle-income countries) for acute lymphoblastic leukemia, between 26.9% (low-income countries) to 77.9% (upper middle-income countries) for nephroblastoma, between 23% (low-income countries) to 100% (upper middle-income countries), for retinoblastoma, 45% (low-income countries) to 95% (upper middle-income countries) for Hodgkin lymphoma and 28% (low-income countries) to 76% (upper middle-income countries) for Burkitt lymphoma. Solutions to improve survival rates and reported outcomes include establishing and funding sustainable registries, training and to actively include all countries in consortia from different African regions.HighlightsContinental differences in childhood cancer management such lack of resources, setting-specific comorbidities, high rates of late presentation and treatment abandonment, present challenges to the achievement of Global Initiative for Childhood Cancer goals.The available data registries do not adequately inform on the true incidences and outcomes of childhood cancers in Africa.The pathophysiology of some childhood cancers in Africa are associated with high-risk prognostic factors.Outcomes can be improved by greater regional collaboration to manage childhood cancer based on local resources and tumor characteristics.Some individual countries have reached the Global Initiative for Childhood Cancer goals for single cancers and it should be possible for more African countries to follow suit.
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Affiliation(s)
- Jaques van Heerden
- Pediatric Hematology and Oncology, Department of Pediatrics, Antwerp University Hospital, Antwerp, Belgium.,Pediatric hematology and Oncology, Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa.,Department of Pediatric Oncology, Uganda Cancer Institute, Kampala, Uganda
| | | | - Racheal Angom
- Department of Pediatric Oncology, Uganda Cancer Institute, Kampala, Uganda
| | - Rebecca Claire Lusobya
- Department of Ophthalmology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Guillermo Chantada
- Department of Pediatric Oncology, Hospital Sant Joan de Deu, Barcelona, Spain
| | | | - Ido Didi Fabian
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Tel-Aviv, Israel.,International Center for Eye Health London School of Hygiene and Tropical Medicine, London, UK
| | - Trijn Israels
- Department of Pediatrics, Queen Elizabeth Central Hospital, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Vivian Paintsil
- Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Laila Hessissen
- Pediatric Hematology and Oncology Center, University Mohammed V Rabat, Rabat, Morocco
| | | | - Moatasem Elayadi
- Department of Pediatric Oncology, National Cancer Institute, Egypt & Children Cancer Hospital of Egypt (CCHE-57357), Cairo University, Giza, Egypt
| | | | - Francine Kouya
- Department of Pediatric Oncology, Cameroon Baptist Convention Hospitals in Mutengene, Mbingo and Banso, Mutengene, Cameroon
| | - Jennifer A Geel
- Division of Pediatric Hematology-Oncology, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Witwatersrand, South Africa
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Amanor E, Kwarteng A, Larbi A, Fordjour FA, Koranteng KK, Sackey DS, Bannor E, Osei FA, Mohammed A, Ackah EB, Odoom SF, Nguah SB, Paintsil V, Osei-Akoto A. Iron stores in steady-state sickle cell disease children accessing care at a sickle cell disease clinic in Kumasi, Ghana: A cross-sectional study. Health Sci Rep 2022; 5:e934. [PMID: 36439047 PMCID: PMC9686355 DOI: 10.1002/hsr2.934] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/29/2022] [Accepted: 11/02/2022] [Indexed: 11/26/2022] Open
Abstract
Background and Aims Children with sickle cell disease (SCD) have an increased risk of multiple hemotransfusions and this can predispose them to elevated iron stores. The objectives of the study were to determine the extent of elevated iron stores and the associated risk factors in a population of steady-state SCD children in Ghana. Methods This cross-sectional study was conducted at the pediatric sickle cell clinic at the Komfo Anokye Teaching Hospital. Complete blood count and serum ferritin assay were performed for (n = 178) steady-state SCD children. Descriptive and multivariate logistic regression analysis were performed. Elevated iron stores were defined as serum ferritin levels >300 ng/ml. Statistical significance was considered at p < 0.05. Results The mean (standard deviation) age of the participants was 9.61 (±4.34) years, and 51% of them were males. About 17% of SCD children had elevated iron stores and receiving at least three hemotransfusions during the last 12 months was strongly associated with elevated iron stores (p < 0.001). History of chronic hemotransfusion increased the odds of having elevated iron store (adjusted odds ratio [aOR] = 11.41; 95% confidence interval [CI] = 3.11-30.85; p < 0.001) but SCD patients on hydroxyurea treatment had reduced-odds of having elevated iron stores (aOR = 0.18; 95% CI = 0.06-0.602; p = 0.006). Moreover, red blood cell (Coef. = -0.84; 95% CI = -0.37, -1.32; p = 0.001), hemoglobin (Coef. = -0.83; 95% CI = -0.05, -1.61; p = 0.04), hematocrit (Coef. = -0.85; 95% CI = -0.08, -1.63; p = 0.03), mean cell volume (Coef. = 0.02; 95% CI = 0.01, 0.03; p = 0.001) and mean cell hemoglobin (Coef. = 0.04; 95% CI = 0.01, 0.07; p = 0.002) could significantly predict serum ferritin levels. Conclusion The magnitude of elevated iron stores was high among children with SCD in steady-state. Red cell indices could provide invaluable information regarding the risk of elevated iron stores. SCD children who have a history of chronic hemotransfusion or had received at least three hemotransfusions in a year should be monitored for elevated iron stores.
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Affiliation(s)
- Ernest Amanor
- Department of Biochemistry and Biotechnology, College of Science Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | - Alexander Kwarteng
- Department of Biochemistry and Biotechnology, College of Science Kwame Nkrumah University of Science and Technology Kumasi Ghana.,Tropical Infections and Non-communicable Disease Research Group Kumasi Center for Collaborative Research in Tropical Medicine Kumasi Ghana
| | - Amma Larbi
- Department of Biochemistry and Biotechnology, College of Science Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | - Fatima Amponsah Fordjour
- Department of Biochemistry and Biotechnology, College of Science Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | - Kelvin Kwaku Koranteng
- Department of Biochemistry and Biotechnology, College of Science Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | - David Sebbie Sackey
- Department of Hematology, Laboratory Services Directorate Komfo Anokye Teaching Hospital Kumasi Ghana
| | - Emmanuel Bannor
- Department of Hematology, Laboratory Services Directorate Komfo Anokye Teaching Hospital Kumasi Ghana
| | - Francis Adjei Osei
- Department of International Health, School of Public Health Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | - Aliyu Mohammed
- Department of Biostatistics and Epidemiology, School of Public Health Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | - Ezekiel Bonwin Ackah
- Department of Medical Diagnostics, School of Public Health Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | | | - Samuel Blay Nguah
- Child Health Directorate Komfo Anokye Teaching Hospital Kumasi Ghana.,Department of Child Health, School of Medicine and Dentistry Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | - Vivian Paintsil
- Child Health Directorate Komfo Anokye Teaching Hospital Kumasi Ghana.,Department of Child Health, School of Medicine and Dentistry Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | - Alex Osei-Akoto
- Child Health Directorate Komfo Anokye Teaching Hospital Kumasi Ghana.,Department of Child Health, School of Medicine and Dentistry Kwame Nkrumah University of Science and Technology Kumasi Ghana
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Odoom SF, Newton SK, Nakua EK, Boahen KG, Nguah SB, Ansong D, Nyanor I, Amuzu EX, Amanor E, Osei FA, Mohammed A, Mensah NK, Martyn-Dickens C, Osei-Akoto A, Paintsil V. Penicillin V prophylaxis uptake among children living with sickle cell disease in a specialist sickle cell clinic in Ghana: A cross-sectional study. Health Sci Rep 2022; 5:e953. [PMID: 36439045 PMCID: PMC9686354 DOI: 10.1002/hsr2.953] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/18/2022] [Accepted: 11/11/2022] [Indexed: 11/27/2022] Open
Abstract
Background and Aims Penicillin V prophylaxis protects children living with sickle cell disease (SCD) from bacteria infections especially Streptococcus pneumonia. However, the uptake of penicillin V prophylaxis is difficult to assess and often poor among SCD patients. Therefore, this study sought to investigate oral penicillin V prophylaxis adherence among SCD children using urine assay and self-reported methods and the associated factors. Methods The study employed an analytical cross-sectional design in the assessment of penicillin V prophylaxis adherence using both urine assay and self-reported methods. Multiple logistic regression analysis was used to determine the factors associated with penicillin V prophylaxis adherence. A p value < 0.05 was considered statistically significant. Results Among the 421 SCD patients recruited, penicillin V prophylaxis adherence was observed to be 30.0% and 68.0% for the objective and subjective methods of assessment, respectively. For the objective method of assessment, being cared for by grandparents increased the odds of penicillin V adherence (adjusted odds ratio [aOR] = 3.68, confidence interval [CI] = 1.03-13.15). However, SCD patients within the ages of 10-14 years (aOR = 0.36, CI = 0.17-0.80), >14 years (aOR = 0.17, CI = 0.05-0.61), SCD patient cared for by married caregivers/parents (aOR = 0.32, CI = 0.14-0.72), SCD patient cared for by divorced caregivers/parents (aOR = 0.23, CI = 0.07-0.75), SCD patients taking homemade (herbal) preparations for the treatment of SCD (aOR = 0.42, CI = 0.21-0.83), and inappropriate intake of penicillin V prophylaxis (aOR = 0.27, CI = 0.11-0.67) reduced the odds of penicillin V adherence. For the subjective method of assessment, taking homemade preparation (herbal) for the treatment of SCD (aOR = 0.52, CI = 0.30-0.89) and inappropriate intake of penicillin V (aOR = 0.32, CI = 0.17-0.60) reduced the odds of penicillin V adherence. Conclusion This study reports a relatively low adherence rate of penicillin V prophylaxis among children living with SCD. Educating and counseling both SCD patients and/or caregivers on the need to be adherent to penicillin V prophylaxis could prevent complications that may arise from nonadherence.
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Affiliation(s)
- Samuel F Odoom
- Department of Epidemiology and Biostatistics, School of Public Health Kwame Nkrumah University of Science and Technology Kumasi Ghana.,Child Health Directorate Komfo Anokye Teaching Hospital Kumasi Ghana
| | - Sam K Newton
- School of Public Health Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | - Emmanuel K Nakua
- Department of Epidemiology and Biostatistics, School of Public Health Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | - Kennedy G Boahen
- Department of Clinical Microbiology, School of Medicine and Dentistry Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | - Samuel B Nguah
- Child Health Directorate Komfo Anokye Teaching Hospital Kumasi Ghana.,Department of Clinical Microbiology, School of Medicine and Dentistry Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | - Daniel Ansong
- Child Health Directorate Komfo Anokye Teaching Hospital Kumasi Ghana.,Department of Clinical Microbiology, School of Medicine and Dentistry Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | - Isaac Nyanor
- Child Health Directorate Komfo Anokye Teaching Hospital Kumasi Ghana
| | - Evans X Amuzu
- Child Health Directorate Komfo Anokye Teaching Hospital Kumasi Ghana
| | - Ernest Amanor
- Department of Biochemistry and Biotechnology, College of Science Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | - Francis A Osei
- School of Public Health Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | - Aliyu Mohammed
- Department of Epidemiology and Biostatistics, School of Public Health Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | | | | | - Alex Osei-Akoto
- Child Health Directorate Komfo Anokye Teaching Hospital Kumasi Ghana.,Department of Clinical Microbiology, School of Medicine and Dentistry Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | - Vivian Paintsil
- Child Health Directorate Komfo Anokye Teaching Hospital Kumasi Ghana.,Department of Clinical Microbiology, School of Medicine and Dentistry Kwame Nkrumah University of Science and Technology Kumasi Ghana
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Caniza MA, Homsi MR, Bate J, Adrizain R, Ahmed T, Alexander S, Bhattacharyya A, Copado‐Gutierrez JL, Gutierrez I, Lim YY, Morrissey L, Naidu G, Paintsil V, Radhakrishnan N, Mukkada S, Phillips R, Alexander KA, Pritchard‐Jones K. Answers to common questions about COVID-19 vaccines in children with cancer. Pediatr Blood Cancer 2022; 69:e29985. [PMID: 36114651 PMCID: PMC9538403 DOI: 10.1002/pbc.29985] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND The SARS-CoV-2 outbreak in 2020 evolved into a global pandemic, and COVID-19 vaccines became rapidly available, including for pediatric patients. However, questions emerged that challenged vaccine acceptance and use. We aimed to answer these questions and give recommendations applicable for use in pediatric patients with cancer by healthcare professionals and the public. METHODS A 12-member global COVID-19 Vaccine in Pediatric Oncology Working Group made up of physicians and nurses from all world regions met weekly from March to July 2021. We used a modified Delphi method to select the top questions. The Working Group, in four-member subgroups, answered assigned questions by providing brief recommendations, followed by a discussion of the rationale for each answer. All Working Group members voted on each recommendation using a scale of 1 to 10, 10 being complete agreement. A "pass" recommendation corresponded to an agreement ≥7.5. RESULTS We selected 15 questions from 173 suggested questions. Based on existing published information, we generated answers for each question as recommendations. The overall average agreement for the 24 recommendations was 9.5 (95% CI 9.4-9.6). CONCLUSION Top COVID-19 vaccine-related questions could be answered using available information. Reports on COVID-19 vaccination and related topics have been published at record speed, aided by available technology and the priority imposed by the pandemic; however, all efforts were made to incorporate emerging information throughout our project. Recommendations will be periodically updated on a dedicated website.
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Affiliation(s)
- Miguela A. Caniza
- Departments of Global Pediatric Medicine, St. Jude Children's Research HospitalMemphisTennesseeUSA,Departments of Infectious DiseasesSt. Jude Children's Research HospitalMemphisTennesseeUSA,Department of or PediatricsUniversity of Tennessee Health Science CenterMemphisTennesseeUSA
| | - Maysam R. Homsi
- Departments of Global Pediatric Medicine, St. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Jessica Bate
- Department of Paediatric OncologySouthampton Children's HospitalSouthamptonUK
| | - Riyadi Adrizain
- Department of Child HealthFaculty of Medicine Universitas Padjadjaran Dr. Hasan Sadikin General HospitalBandungIndonesia
| | - Tarek Ahmed
- Department of Pediatric OncologyChildren's Cancer Hospital EgyptCairoEgypt
| | - Sarah Alexander
- Division of Haematology/Oncology, Hospital for Sick Children, Department of PediatricsUniversity of TorontoTorontoCanada
| | | | | | - Ivan Gutierrez
- Department of Pediatric Infectious DiseasesResearch Group Colsubsidio InvestigaClinical Infantil ColsubsidioBogotáColombia,Division of Pediatric Infectious DiseasesClinica Infantil Santa María del LagoBogotáColombia
| | - Yan Yin Lim
- Division of NursingKK Women's and Children's HospitalSingaporeSingapore
| | - Lisa Morrissey
- Department of NursingBoston Children's HospitalBostonMassachusettsUSA
| | - Gita Naidu
- Department of Pediatric OncologyChris Hani Baragwanath Academic HospitalUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Vivian Paintsil
- Department of Child HealthSchool of Medicine and DentistryKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Nita Radhakrishnan
- Department of Pediatric Hematology OncologyPost Graduate Institute of Child HealthNoidaIndia
| | - Sheena Mukkada
- Departments of Global Pediatric Medicine, St. Jude Children's Research HospitalMemphisTennesseeUSA,Departments of Infectious DiseasesSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Robert Phillips
- Regional Department of Hematology and OncologyLeeds Children's HospitalLeedsUK,Centre for Reviews and DisseminationUniversity of YorkYorkUK
| | - Kenneth A. Alexander
- Department of PediatricsDivision of Infectious DiseasesNemours Children's Hospital‐FloridaOrlandoFloridaUSA
| | - Kathy Pritchard‐Jones
- Developmental Biology and Cancer Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthLondonUK
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11
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Fabian ID, Abdallah E, Abdullahi SU, Abdulqader RA, Abdulrahaman AA, Abouelnaga S, Ademola-Popoola DS, Adio A, Afifi MA, Afshar AR, Aggarwal P, Aghaji AE, Ahmad A, Akib MNR, Akinsete A, Al Harby L, Al Mesfer S, Al Ani MH, Alarcón Portabella S, Al-Badri SAF, Alcasabas APA, Al-Dahmash SA, Alejos A, Alemany-Rubio E, Alfa Bio AI, Alfonso Carreras Y, Al-Haddad CE, Al-Hussaini HHY, Ali AM, Alia DB, Al-Jadiry MF, Al-Jumaily U, Alkatan HM, All-Eriksson C, Al-Mafrachi AARM, Almeida AA, Alsawidi KM, Al-Shaheen AASM, Al-Shammary EH, Amankwaa-Frempong D, Amiruddin PO, Armytasari I, Astbury NJ, Atalay HT, Ataseven E, Atchaneeyasakul LO, Atsiaya R, Autrata R, Balaguer J, Balayeva R, Barranco H, Bartoszek P, Bartuma K, Bascaran C, Bechrakis NE, Beck Popovic M, Begimkulova AS, Benmiloud S, Berete RC, Berry JL, Bhaduri A, Bhat S, Bhattacharyya A, Biewald EM, Binkley E, Blum S, Bobrova N, Boldt H, Bonanomi MTBC, Bouda GC, Bouguila H, Brennan RC, Brichard BG, Buaboonnam J, Budiongo A, Burton MJ, Calderón-Sotelo P, Calle Jara DA, Camuglia JE, Cano MR, Capra M, Caspi S, Cassoux N, Castela G, Castillo L, Català-Mora J, Cavieres I, Chandramohan A, Chantada GL, Chaudhry S, Chawla B, Chen W, Chiwanga FS, Chuluunbat T, Cieslik K, Clark A, Cockcroft RL, Comsa C, Correa Llano MG, Corson TW, Couitchere L, Cowan-Lyn KE, Csóka M, Dangboon W, Das A, Das P, Das S, Davanzo JM, Davidson A, De Francesco S, De Potter P, Quintero D K, Demirci H, Desjardins L, Díaz Coronado RY, Dimaras H, Dodgshun AJ, Donato Macedo CR, Dragomir MD, Du Y, Du Bruyn M, Du Plessis J, Dudeja G, Eerme K, Eka Sutyawan IW, El Kettani A, Elbahi AM, Elder JE, Elhaddad AM, Elhassan MMA, Elzembely MM, Ericksen C, Essuman VA, Evina TGA, Ezegwui IR, Fadoo Z, Fandiño AC, Faranoush M, Fasina O, Fernández DDPG, Fernández-Teijeiro A, Foster A, Frenkel S, Fu LD, Fuentes-Alabi SL, Garcia JL, García Aldana D, Garcia Pacheco HN, Geel JA, Ghassemi F, Girón AV, Goenz MA, Gold AS, Goldberg H, Gole GA, Gomel N, Gonzalez E, Gonzalez Perez G, González-Rodríguez L, Gorfine M, Graells J, Gregersen PA, Grigorovski NDAK, Guedenon KM, Gunasekera DS, Gündüz AK, Gupta H, Gupta S, Gupta V, Hadjistilianou T, Hamel P, Hamid SA, Hamzah N, Hansen ED, Harbour JW, Hartnett ME, Hasanreisoglu M, Muhammad H, Hassan S, Hassan S, Hautz W, Haydar H, Hederova S, Hessissen L, Hongeng S, Hordofa DF, Hubbard GB, Hummelen M, Husakova K, Hussein Al-Janabi AN, Ibanga A, Ida R, Ilic VR, Islamov Z, Jairaj V, Janjua T, Jeeva I, Ji X, Jo DH, Jones MM, Kabesha Amani TB, Kabore RL, Kaliki S, Kalinaki A, Kamsang P, Kantar M, Kapelushnik N, Kardava T, Kebudi R, Keomisy J, Kepak T, Ketteler P, Khan ZJ, Khaqan HA, Khetan V, Khodabande A, Khotenashvili Z, Kim JW, Kim JH, Kiratli H, Kivela TT, Klett A, Koç I, Kosh Komba Palet JE, Krivaitiene D, Kruger M, Kulvichit K, Kuntorini MW, Kyara A, Lam GC, Larson SA, Latinović S, Laurenti KD, Lavy Y, Lavric Groznik A, Leverant AA, Li C, Li K, Limbu B, Liu CH, Quah B, López JP, Lukamba RM, Luna-Fineman S, Lutfi D, Lysytsia L, Madgar S, Magrath GN, Mahajan A, Maitra P, Maka E, Makimbetov EK, Maktabi A, Maldonado C, Mallipatna A, Manudhane R, Manzhuova L, Martín-Begue N, Masud S, Matende IO, Mattosinho CCDS, Matua M, Mayet I, Mbumba FB, McKenzie JD, Mehrvar A, Mengesha AA, Menon V, Mercado GJV, Mets MB, Midena E, Miller A, Mishra DKC, Mndeme FG, Mohamedani AA, Mohammad MT, Moll AC, Montero MM, Moreira C, Mruthyunjaya P, Msina MS, Msukwa G, Mudaliar SS, Muma KIM, Munier FL, Murray TG, Musa KO, Mushtaq A, Musika AA, Mustak H, Mustapha T, Muyen OM, Myezo KH, Naidu G, Naidu N, Nair AG, Natarajan S, Naumenko L, Ndoye Roth PA, Nency YM, Neroev V, Ng Y, Nikitovic M, Nkanga ED, Nkumbe HE, Numbi MN, Nummi K, Nuruddin M, Nyaywa M, Nyirenda C, Obono-Obiang G, Oliver SCN, Oporto J, Ortega-Hernández M, Oscar AH, Ossandon D, Pagarra H, Paintsil V, Paiva L, Palanivelu MS, Papyan R, Parrozzani R, Pascual Morales CR, Paton KE, Pe'er J, Peralta Calvo J, Perić S, Pham CTM, Philbert R, Plager DA, Pochop P, Polania RA, Polyakov V, Ponce J, Qadir AO, Qayyum S, Qian J, Refaeli D, Rahman A, Rajkarnikar P, Ramanjulu R, Ramasubramanian A, Ramirez-Ortiz MA, Randhawa JK, Randrianarisoa HL, Raobela L, Rashid R, Reddy M, Renner LA, Reynders D, Ribadu D, Ritter-Sovinz P, Rogowska A, Rojanaporn D, Romero L, Roy SR, Saab RH, Saakyan S, Sabhan AH, Sagoo MS, Said AMA, Saiju R, Salas B, San Román Pacheco S, Sánchez GL, Sanchez Orozco AJ, Sayalith P, Scanlan TA, Schlüter S, Schwab C, Sedaghat A, Seth R, Sgroi M, Shah AS, Shakoor SA, Sharma MK, Sherief ST, Shields CL, Sia D, Siddiqui SN, Sidi cheikh S, Silva S, Singh AD, Singh U, Singha P, Sitorus RS, Skalet AH, Soebagjo HD, Sorochynska T, Ssali G, Stacey AW, Staffieri SE, Stahl ED, Steinberg DM, Stones DK, Strahlendorf C, Suarez MEC, Sultana S, Sun X, Superstein R, Supriyadi E, Surukrattanaskul S, Suzuki S, Svojgr K, Sylla F, Tamamyan G, Tan D, Tandili A, Tang J, Tarrillo Leiva FF, Tashvighi M, Tateshi B, Teh KH, Tehuteru ES, Teixeira LF, Tekavcic Pompe M, Thawaba ADM, Theophile T, Toledano H, Trang DL, Traoré F, Tripathy D, Tuncer S, Tyau-Tyau H, Umar AB, Unal E, Uner OE, Urbak SF, Ushakova TL, Usmanov RH, Valeina S, Valente P, van Hoefen Wijsard M, Vasquez Anchaya JK, Vaughan LO, Veleva-Krasteva NV, Verma N, Victor AA, Viksnins M, Villacís Chafla EG, Villegas VM, Vishnevskia-Dai V, Waddell K, Wali AH, Wang YZ, Wangtiraumnuay N, Wetter J, Widiarti W, Wilson MW, Wime ADC, Wiwatwongwana A, Wiwatwongwana D, Wolley Dod C, Wong ES, Wongwai P, Wu SQ, Xiang D, Xiao Y, Xu B, Xue K, Yaghy A, Yam JC, Yang H, Yanga JM, Yaqub MA, Yarovaya VA, Yarovoy AA, Ye H, Yee RI, Yousef YA, Yuliawati P, Zapata López AM, Zein E, Zhang Y, Zhilyaeva K, Zia N, Ziko OAO, Zondervan M, Bowman R. The Global Retinoblastoma Outcome Study: a prospective, cluster-based analysis of 4064 patients from 149 countries. The Lancet Global Health 2022; 10:e1128-e1140. [PMID: 35839812 PMCID: PMC9397647 DOI: 10.1016/s2214-109x(22)00250-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 05/06/2022] [Accepted: 05/23/2022] [Indexed: 02/01/2023] Open
Abstract
Background Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. Methods We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. Findings The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope). Interpretation This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes. Funding Queen Elizabeth Diamond Jubilee Trust.
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12
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Paintsil V, Amuzu EX, Nyanor I, Asafo-Adjei E, Mohammed AR, Yawnumah SA, Oppong-Mensah YG, Nguah SB, Obeng P, Dogbe EE, Jonas M, Nembaware V, Mazandu G, Ohene-Frempong K, Wonkam A, Makani J, Ansong D, Osei-Akoto A. Establishing a Sickle Cell Disease Registry in Africa: Experience From the Sickle Pan-African Research Consortium, Kumasi-Ghana. Front Genet 2022; 13:802355. [PMID: 35281803 PMCID: PMC8908904 DOI: 10.3389/fgene.2022.802355] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 10/26/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Sickle cell disease (SCD) is the most common clinically significant hemoglobinopathy, characterized by painful episodes, anemia, high risk of infection, and other acute and chronic complications. In Africa, where the disease is most prevalent, large longitudinal data on patients and their outcomes are lacking. This article describes the experiences of the Kumasi Center for SCD at the Komfo Anokye Teaching Hospital (KCSCD-KATH), a Sickle Pan-African Research Consortium (SPARCO) site and a SickleInAfrica Consortium member, in establishing a SCD registry for the evaluation of the outcomes of patients. It also provides a report of a preliminary analysis of the data. The process of developing the registry database involved comprehensive review of the center's SCD patient medical records, incorporating data elements developed by the SickleInAfrica Consortium and obtaining ethical clearance from the local Institutional Review Board. From December 2017 to March 2020, 3,148 SCD patients were enrolled into the SCD registry. Enrollment was during the SCD outpatient clinic visits or through home visits. A significant proportion of the patients was from the newborn screening cohort (50.3%) and was males (52.9%). SCD-SS, SCD-SC, and Sβ +thalassemia were seen in 67.2, 32.5, and 0.3% patients, respectively. The majority of the patients were in a steady state at enrollment; however, some were enrolled after discharge for an acute illness admission. The top two clinical diagnoses for SCD-SS patients were sickle cell painful events and acute anemia secondary to hyperhemolysis with incidence rates of 141.86 per 10,000 person months of observation (PMO) and 32.74 per 10,000 PMO, respectively. In SCD-SC patients, the top two diagnoses were sickle cell painful events and avascular necrosis with incidence rates of 203.09 per 10,000 PMO and 21.19 per 10,000 PMO, respectively. The SPARCO Kumasi site has developed skills and infrastructure to design, manage, and analyze data in the SCD registry. The newborn screening program and alternative recruitment methods such as radio announcement and home visits for defaulting patients were the key steps taken in enrolling patients into the registry. The registry will provide longitudinal data that will help improve knowledge of SCD in Ghana and Africa through research.
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Affiliation(s)
- Vivian Paintsil
- Directorate of Child Health-Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Department of Child Health-Kwame Nkrumah University of Science and Technology, School of Medicine and Dentistry, Kumasi, Ghana
| | - Evans Xorse Amuzu
- Directorate of Child Health-Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Isaac Nyanor
- Directorate of Child Health-Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | | | | | | | - Samuel Blay Nguah
- Directorate of Child Health-Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Department of Child Health-Kwame Nkrumah University of Science and Technology, School of Medicine and Dentistry, Kumasi, Ghana
| | - Paul Obeng
- Directorate of Child Health-Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Department of Child Health-Kwame Nkrumah University of Science and Technology, School of Medicine and Dentistry, Kumasi, Ghana
| | - Elliot Eli Dogbe
- Directorate of Child Health-Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Mario Jonas
- Department of Pathology, Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Victoria Nembaware
- Department of Pathology, Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Gaston Mazandu
- Department of Pathology, Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Ambroise Wonkam
- Department of Pathology, Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Julie Makani
- SPARCo, Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar Es Salam, Tanzania
| | - Daniel Ansong
- Directorate of Child Health-Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Department of Child Health-Kwame Nkrumah University of Science and Technology, School of Medicine and Dentistry, Kumasi, Ghana
| | - Alex Osei-Akoto
- Directorate of Child Health-Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Department of Child Health-Kwame Nkrumah University of Science and Technology, School of Medicine and Dentistry, Kumasi, Ghana
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13
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Chagaluka G, Afungchwi GM, Landman L, Njuguna F, Hesseling P, Tchintseme F, Sung L, Paintsil V, Molyneux E, Chitsike I, Israels T. Treatment abandonment: A report from the collaborative African network for childhood cancer care and research-CANCaRe Africa. Pediatr Blood Cancer 2021; 68:e29367. [PMID: 34549506 DOI: 10.1002/pbc.29367] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/05/2021] [Accepted: 09/08/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND 'Treatmentabandonment' is a common and preventable cause of childhood cancer treatment failure in low- and middle-income countries (LMIC). Risk factors and effective interventions in LMIC are reported. Poverty and costs of treatment are perceived as overriding causes in sub-Saharan Africa. The objective of this study was to study potential determinants of treatment abandonment, including aspects of treatment costs in sub-Saharan Africa, to be better informed for planned future interventions. METHODS A multicentre, prospective, observational, cohort study was conducted in five hospitals in sub-Saharan Africa. Children younger than 16 years with newly diagnosed cancer treated as inpatient with curative intent were included. The occurrence of treatment abandonment and potential determinants including aspects of treatment costs were documented during the first 3 months of treatment. RESULTS We included 252 patients (median age 6.0, range 0.2-15.0 years, 54% male). The most common cancer was Burkitt lymphoma (63/252, 25%). Seven percent of patients (18 of 252) abandoned treatment. Two thirds (65%, 163/252) of patients had to borrow money to reach the hospital for the diagnosis and start of treatment. Treatment abandonment occurred more frequently in families who had to borrow money (16/163, 10%) versus those who did not (2/89, 2%; p = .026). CONCLUSIONS Limiting costs for families and improved counselling may reduce treatment abandonment. Development and implementation of interventions to reduce treatment abandonment are required in sub-Saharan Africa.
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Affiliation(s)
- George Chagaluka
- Queen Elizabeth Central Hospital (QECH), College of Medicine, Blantyre, Malawi
| | - Glenn Mbah Afungchwi
- Cameroon Baptist Convention Hospitals in Mutengene, Mbingo and Banso, Mbingo, Cameroon
| | - Lisa Landman
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Festus Njuguna
- Moi University/Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya
| | - Peter Hesseling
- Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Francine Tchintseme
- Cameroon Baptist Convention Hospitals in Mutengene, Mbingo and Banso, Mbingo, Cameroon
| | - Lillian Sung
- Division of Haematology/Oncology and Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vivian Paintsil
- Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Elizabeth Molyneux
- Queen Elizabeth Central Hospital (QECH), College of Medicine, Blantyre, Malawi
| | | | - Trijn Israels
- Queen Elizabeth Central Hospital (QECH), College of Medicine, Blantyre, Malawi.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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14
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Spreafico F, Fernandez CV, Brok J, Nakata K, Vujanic G, Geller JI, Gessler M, Maschietto M, Behjati S, Polanco A, Paintsil V, Luna-Fineman S, Pritchard-Jones K. Wilms tumour. Nat Rev Dis Primers 2021; 7:75. [PMID: 34650095 DOI: 10.1038/s41572-021-00308-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 02/08/2023]
Abstract
Wilms tumour (WT) is a childhood embryonal tumour that is paradigmatic of the intersection between disrupted organogenesis and tumorigenesis. Many WT genes play a critical (non-redundant) role in early nephrogenesis. Improving patient outcomes requires advances in understanding and targeting of the multiple genes and cellular control pathways now identified as active in WT development. Decades of clinical and basic research have helped to gradually optimize clinical care. Curative therapy is achievable in 90% of affected children, even those with disseminated disease, yet survival disparities within and between countries exist and deserve commitment to change. Updated epidemiological studies have also provided novel insights into global incidence variations. Introduction of biology-driven approaches to risk stratification and new drug development has been slower in WT than in other childhood tumours. Current prognostic classification for children with WT is grounded in clinical and pathological findings and in dedicated protocols on molecular alterations. Treatment includes conventional cytotoxic chemotherapy and surgery, and radiation therapy in some cases. Advanced imaging to capture tumour composition, optimizing irradiation techniques to reduce target volumes, and evaluation of newer surgical procedures are key areas for future research.
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Affiliation(s)
- Filippo Spreafico
- Department of Medical Oncology and Hematology, Paediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Conrad V Fernandez
- Department of Paediatrics, IWK Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jesper Brok
- Department of Paediatric Haematology and Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Kayo Nakata
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | | | - James I Geller
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Cincinnati, OH, USA
| | - Manfred Gessler
- Theodor-Boveri-Institute, Developmental Biochemistry, and Comprehensive Cancer Center Mainfranken, University of Wuerzburg, Wuerzburg, Germany
| | - Mariana Maschietto
- Research Center, Boldrini Children's Hospital, Genetics and Molecular Biology, Institute of Biology, State University of Campinas, Campinas, SP, Brazil
| | - Sam Behjati
- Wellcome Sanger Institute, Hinxton, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Angela Polanco
- National Cancer Research Institute Children's Group Consumer Representative, London, UK
| | - Vivian Paintsil
- Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Sandra Luna-Fineman
- Division of Hematology, Oncology and Bone Marrow Transplantation, Department of Paediatrics, University of Colorado, Aurora, CO, USA
| | - Kathy Pritchard-Jones
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
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15
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Israels T, Afungchwi GM, Chagaluka G, Hesseling P, Kouya F, Paintsil V, Landman L, Chitsike I, Njuguna F, Sung L, Molyneux E. Early death and treatment-related mortality: A report from SUCCOUR - Supportive Care for Children with Cancer in Africa. Pediatr Blood Cancer 2021; 68:e29230. [PMID: 34245228 DOI: 10.1002/pbc.29230] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/18/2021] [Accepted: 06/22/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Deaths during paediatric cancer treatment are common in Africa. It is often difficult to distinguish between treatment-related and disease-related causes. To prevent these deaths, it is important to study them and identify the cause. The Supportive Care for Children with Cancer in Africa (SUCCOUR) programme enabled a study with the objective to identify the reasons for early death during treatment. METHODS We conducted a multicentre prospective, observational cohort study in sub-Saharan Africa. Children younger than 16 years with newly diagnosed cancer treated with curative intent were included from 1 September 2019 until 30 March 2020. Data were abstracted in real time by trained personnel using standardised case report forms. The treating clinician's assessment of the cause of death and signs, symptoms and laboratory values of patients who died during the first 3 months of treatment (early death) were documented. RESULTS We included 252 patients (median age 6.0, range 0.2-15.0 years, 54% male). The most common cancer was Burkitt lymphoma (63/252, 25%). Fifteen percent of patients (37/252) died during the first 3 months of treatment. Of these 37 patients, 33 (89%) died of a treatment-related cause. Treatment-related mortality of all patients in the first 3 months of treatment was 13% (33/252). CONCLUSION Fifteen percent of patients had an early death during treatment and 13% had a treatment-related death. This suggests the need to improve supportive care. Implementation of supportive care pathways adapted to local circumstances may be helpful.
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Affiliation(s)
- Trijn Israels
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands.,Queen Elizabeth Central Hospital (QECH), College of Medicine, Blantyre, Malawi
| | | | - George Chagaluka
- Queen Elizabeth Central Hospital (QECH), College of Medicine, Blantyre, Malawi
| | - Peter Hesseling
- Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Francine Kouya
- Cameroon Baptist Convention Hospitals, Mutengene, Cameroon
| | - Vivian Paintsil
- Department of Child Health, Kumasi School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lisa Landman
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | - Inam Chitsike
- Department of Paediatrics and Child Health, University of Zimbabwe, Harare, Zimbabwe
| | - Festus Njuguna
- Department of Child Health and Paediatrics, Moi University, Eldoret, Kenya
| | - Lillian Sung
- Division of Haematology/Oncology and Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elizabeth Molyneux
- Queen Elizabeth Central Hospital (QECH), College of Medicine, Blantyre, Malawi
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16
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Israels T, Afungchwi GM, Klootwijk L, Njuguna F, Hesseling P, Kouya F, Paintsil V, Landman L, Chitsike I, Chagaluka G, Sung L, Molyneux E. Fever and neutropenia outcomes and areas for intervention: A report from SUCCOUR - Supportive Care for Children with Cancer in Africa. Pediatr Blood Cancer 2021; 68:e29224. [PMID: 34245212 DOI: 10.1002/pbc.29224] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/18/2021] [Accepted: 06/22/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Death during paediatric cancer treatment is common in sub-Saharan Africa. Using the infrastructure of Supportive Care for Children with Cancer in Africa (SUCCOUR), our objective was to describe fever and neutropenia (FN) characteristics and outcomes in order to identify potential areas for future intervention. METHODS A multicentre prospective, observational cohort study was conducted in sub-Saharan Africa. Data were collected from September 2019 to March 2020. Children below 16 years with newly diagnosed cancer treated with curative intent were included. Data were abstracted in real time using standardised case report forms by trained personnel. Characteristics and outcomes of FN during the first 3 months of treatment were documented. RESULTS A total of 252 patients were included (median age 6.0, range 0.2-15.0 years, 54% male). The most common cancer was Burkitt lymphoma (63/252, 25%). Among 104 FN episodes, 21 (21%) were associated with prolonged neutropenia (>1 week) and 32 (31%) were associated with profound neutropenia (absolute neutrophil count <0.1 × 109 /L). In 10/104 (10%) episodes, empiric antibiotics were started within 1 hour following fever onset and in 16/104 (15%) episodes, a blood culture was obtained before starting antibiotics. Malaria parasitaemia was detected in four of 104 (4%). A total of 11/104 (11%) patients died in the FN episodes. CONCLUSIONS Although in most, FN was not associated with prolonged or profound neutropenia, 11% resulted in death. Areas to target include blood cultures prior to antibiotics and earlier initiation of empiric antibiotics. Future efforts should modify FN practices to reduce treatment-related mortality.
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Affiliation(s)
- Trijn Israels
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Larissa Klootwijk
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | - Festus Njuguna
- Department of Child Health and Paediatrics, Moi University, Eldoret, Kenya
| | - Peter Hesseling
- Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Francine Kouya
- Cameroon Baptist Convention Hospitals, Mutengene, Cameroon
| | - Vivian Paintsil
- Department of Child Health, Kumasi School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lisa Landman
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | - Inam Chitsike
- Department of Paediatrics and Child Health, University of Zimbabwe, Harare, Zimbabwe
| | - George Chagaluka
- Queen Elizabeth Central Hospital (QECH), College of Medicine, Blantyre, Malawi
| | - Lillian Sung
- Division of Haematology/Oncology and Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elizabeth Molyneux
- Queen Elizabeth Central Hospital (QECH), College of Medicine, Blantyre, Malawi
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17
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Chitsike I, Paintsil V, Sung L, Njuguna F, Mavinkurve-Groothuis A, Kouya F, Hesseling P, Kaspers G, Afungchwi GM, Ilbawi A, Renner L, Pritchard-Jones K, Hessissen L, Molyneux E, Chagaluka G, Israels T. Working Together to Build a Better Future for Children With Cancer in Africa. JCO Glob Oncol 2021; 6:1076-1078. [PMID: 32673078 PMCID: PMC7392779 DOI: 10.1200/go.20.00170] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Inam Chitsike
- Department of Pediatrics, College of Health Sciences, Harare, Zimbabwe
| | - Vivian Paintsil
- Directorate of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Lillian Sung
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Festus Njuguna
- Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - Francine Kouya
- Department of Pediatric Oncology, Mbingo Baptist Convention Hospital, Mbingo, Cameroon
| | - Peter Hesseling
- Department of Pediatrics and Child Health, Stellenbosch University, South Africa
| | - Gertjan Kaspers
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Amsterdam, the Netherlands
| | - Glenn M Afungchwi
- Department of Pediatric Oncology, Mbingo Baptist Convention Hospital, Mbingo, Cameroon
| | - Andre Ilbawi
- Global Initiative for Childhood Cancer, WHO, Geneva, Switzerland
| | - Lorna Renner
- Department of Child Health, University of Ghana Medical School, Accra, Ghana
| | | | - Laila Hessissen
- Pediatric Hematology and Oncology Center, Mohamed V University, Rabat, Morocco
| | | | | | - Trijn Israels
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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18
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Anie KA, Olayemi E, Paintsil V, Owusu-Dabo E, Adeyemo TA, Sani MU, Galadanci NA, Nnodu O, Tluway F, Adjei DN, Mensah P, Sarfo-Antwi J, Nwokobia H, Gambo A, Benjamin A, Salim A, Osae-Larbi JA, Ofori-Acquah SF. Sickle Cell Disease Genomics of Africa (SickleGenAfrica) Network: ethical framework and initial qualitative findings from community engagement in Ghana, Nigeria and Tanzania. BMJ Open 2021; 11:e048208. [PMID: 34301659 PMCID: PMC8311318 DOI: 10.1136/bmjopen-2020-048208] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To provide lay information about genetics and sickle cell disease (SCD) and to identify and address ethical issues concerning the Sickle Cell Disease Genomics of Africa Network covering autonomy and research decision-making, risk of SCD complications and organ damage, returning of genomic findings, biorepository, data sharing, and healthcare provision for patients with SCD. DESIGN Focus groups using qualitative methods. SETTING Six cities in Ghana, Nigeria and Tanzania within communities and secondary care. PARTICIPANTS Patients, parents/caregivers, healthcare professionals, community leaders and government healthcare representatives. RESULTS Results from 112 participants revealed similar sensitivities and aspirations around genomic research, an inclination towards autonomous decision-making for research, concerns about biobanking, anonymity in data sharing, and a preference for receiving individual genomic results. Furthermore, inadequate healthcare for patients with SCD was emphasised. CONCLUSIONS Our findings revealed the eagerness of patients and parents/caregivers to participate in genomics research in Africa, with advice from community leaders and reassurance from health professionals and policy-makers, despite their apprehensions regarding healthcare systems.
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Affiliation(s)
- Kofi A Anie
- Faculty of Medicine, Imperial College London, London, UK
- Haematology and Sickle Cell Centre, London North West University Healthcare NHS Trust, London, UK
| | - Edeghonghon Olayemi
- Department of Haematology, University of Ghana Medical School, University of Ghana, Accra, Ghana
- Ghana Institute of Clinical Genetics, Accra, Ghana
| | - Vivian Paintsil
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Directorate of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Ellis Owusu-Dabo
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Titilope Adenike Adeyemo
- Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Mahmoud U Sani
- Department of Medicine, Bayero University and Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Najibah Aliyu Galadanci
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Obiageli Nnodu
- Department of Haematology and Centre of Excellence for Sickle Cell Disease Research and Training, University of Abuja, Abuja, Nigeria
| | - Furahini Tluway
- Sydney Brenner Institute for Molecular Bioscience, University of the Witwatersrand, Johannesburg, South Africa
| | - David Nana Adjei
- School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Legon, Ghana
| | | | | | | | | | | | - Arafa Salim
- Community Liaison, Dar es Salaam, Tanzania, United Republic of
| | - Judith A Osae-Larbi
- West African Genetic Medicine Centre (WAGMC), College of Health Sciences, University of Ghana, Legon, Ghana
| | - Solomon Fiifi Ofori-Acquah
- School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Legon, Ghana
- West African Genetic Medicine Centre (WAGMC), College of Health Sciences, University of Ghana, Legon, Ghana
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19
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Brown BJ, Madu A, Sangeda RZ, Nkya S, Peprah E, Paintsil V, Mmbando BP, Gyamfi J, Okocha CE, Asala SA, Nembaware V, Jonas M, Kengne AP, Chimusa ER, Nguweneza A, Isa HA, Nnebe-Agumadu U, Adekile AD, Osei-Akoto A, Ohene-Frempong K, Balandya E, Nnodu OE, Wonkam A. Utilization of Pneumococcal Vaccine and Penicillin Prophylaxis in Sickle Cell Disease in Three African Countries: Assessment among Healthcare Providers in SickleInAfrica. Hemoglobin 2021; 45:163-170. [PMID: 34355623 PMCID: PMC10022452 DOI: 10.1080/03630269.2021.1954943] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 10/20/2022]
Abstract
Sickle cell disease is a genetic disease with a predisposition to infections caused by encapsulated organisms, especially Streptococcus pneumoniae. Pneumococcal vaccines and prophylactic penicillin have reduced the rate of this infection and mortality in sickle cell disease. However, implementation of these interventions is limited in Africa. The objectives of the study were to assess health care providers' behaviors with the implementation of pneumococcal vaccination and penicillin prophylaxis and to identify barriers to their use. A 25-item online questionnaire was administered through SickleinAfrica: a network of researchers, and healthcare providers, in Ghana, Nigeria, and Tanzania, working to improve health outcomes of sickle cell disease in Africa. Data was collected and managed using the Research Electronic Data Capture (REDCap), tools and data analysis was done using STATA version 13 and R statistical software. Eighty-two medical practitioners responded to the questionnaire. Only 54.0 and 48.7% of respondents indicated the availability of published guidelines on sickle cell disease management and pneumococcal vaccine use, respectively, at their facilities. The majority (54.0%) perceived that the vaccines are effective but over 20.0% were uncertain of their usefulness. All respondents from Ghana and Tanzania affirmed the availability of guidelines for penicillin prophylaxis in contrast to 44.1% in Nigeria. Eighty-five percent of respondents affirmed the need for penicillin prophylaxis but 15.0% had a contrary opinion for reasons including the rarity of isolation of Streptococcus pneumoniae in African studies, and therefore, the uncertainty of its benefit. Lack of published guidelines on the management of sickle cell disease and doubts about the necessity of prophylactic measures are potential barriers to the implementation of effective interventions.
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Affiliation(s)
- Biobele J. Brown
- Department of Paediatrics, Haematology & Oncology Unit, College of Medicine, University of Ibadan & University College Hospital, Ibadan, Nigeria
| | - Anazoeze Madu
- Department of Haematology, University of Nigeria, Nsukka, Nigeria
| | - Raphael Z. Sangeda
- Department of Pharmaceutical Microbiology, Muhimbili University of Health & Allied Sciences, Dar es Salaam, Tanzania
| | - Siana Nkya
- Department of Biological Sciences, Dar es Salaam University College of Education, Dar es Salaam, Tanzania
| | - Emmanuel Peprah
- Department of Social & Behavioral Sciences, New York University School of Global Public Health, New York, NY, USA
| | - Vivian Paintsil
- Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Bruno P. Mmbando
- Tanga Research Centre, National Institute for Medical Research, Tanga, Tanzania
| | - Joyce Gyamfi
- Department of Social & Behavioral Sciences, New York University School of Global Public Health, New York, NY, USA
| | - Chide E. Okocha
- Department of Haematology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Samuel A. Asala
- Centre of Excellence for Sickle Cell Disease Research & Training, University of Abuja, Abuja, Nigeria
| | - Victoria Nembaware
- Faculty of Health Sciences, Department of Pathology, Division of Human Genetics, University of Cape Town, Cape Town, South Africa
| | - Mario Jonas
- Faculty of Health Sciences, Department of Pathology, Division of Human Genetics, University of Cape Town, Cape Town, South Africa
| | - Andre P. Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council & Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Emile R. Chimusa
- Faculty of Health Sciences, Department of Pathology, Division of Human Genetics, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Arthemon Nguweneza
- Faculty of Health Sciences, Department of Pathology, Division of Human Genetics, University of Cape Town, Cape Town, South Africa
| | - Hezekiah A. Isa
- Centre of Excellence for Sickle Cell Disease Research & Training, University of Abuja, Abuja, Nigeria
| | - Uche Nnebe-Agumadu
- Department of Paediatrics, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Adekunle D. Adekile
- Faculty of Medicine, Department of Paediatrics, Kuwait University, Jabriya, Kuwait
| | - Alex Osei-Akoto
- Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | | | - Emmanuel Balandya
- Department of Physiology, Muhimbili University of Health & Allied Sciences, Dar es Salaam, Tanzania
| | - Obiageli E. Nnodu
- Centre of Excellence for Sickle Cell Disease Research & Training, University of Abuja, Abuja, Nigeria
| | - Ambroise Wonkam
- Faculty of Health Sciences, Department of Pathology, Division of Human Genetics, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - The SickleInAfrica Consortium
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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20
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Buser JM, Bakari A, Seidu AA, Paintsil V, Osei-Akoto A, Amoah R, Otoo B, Moyer CA. Stigma Associated With Sickle Cell Disease in Kumasi, Ghana. J Transcult Nurs 2021; 32:757-764. [PMID: 33855912 DOI: 10.1177/10436596211008216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION People with sickle cell disease (SCD) often face stigmatization in Ghana and elsewhere in Africa. Research is needed to understand whether it is necessary to design an SCD stigma reduction program in the Ghanaian setting. The aim of this study was to explore the perception of stigmatization for adults with SCD in Kumasi, Ghana. METHODOLOGY Using in-depth qualitative interviews, researchers conducted a phenomenological study to investigate the perception of stigmatization for people with SCD in Kumasi, Ghana. Snowball and purposive sampling was used to identify the participants. RESULTS Participants (n = 12) were mostly female, Akan, and Christian. Researchers categorized three main themes: (a) Feelings of social isolation, (b) Fear of disclosure, and (c) Bullying about physical appearance. DISCUSSION The findings highlight the need to develop effective strategies to counteract stigma. Transcultural health care providers can implement stigma reduction interventions that might be applicable throughout Africa where findings are likely to resonate with patients with SCD.
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Affiliation(s)
| | | | - Abdul-Aziz Seidu
- James Cook University, Townsville, Queensland, Australia.,University of Cape Coast, Cape Coast, Ghana
| | - Vivian Paintsil
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Alex Osei-Akoto
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Buser JM, Bakari A, Seidu AA, Osei-Akoto A, Paintsil V, Amoah R, Otoo B, Moyer CA. Caregiver Perception of Sickle Cell Disease Stigma in Ghana: An Ecological Approach. J Pediatr Health Care 2021; 35:84-90. [PMID: 32883582 PMCID: PMC7738399 DOI: 10.1016/j.pedhc.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/01/2020] [Accepted: 08/01/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Sickle cell disease (SCD) stigma is a major community health issue. The challenges of caring for someone with SCD can be overwhelming. We explored stigma and related factors for caregivers of pediatric patients with SCD in Kumasi, Ghana. METHOD Guided by the Ecological Systems Theory, we used in-depth interviews with a semistructured guide to learn about the perception of stigmatization for Ghanaian caregivers of patients with SCD. RESULTS Overall, participants were knowledgeable about SCD. We identified three themes, including (1) blame for SCD, (2) public misconception about SCD, and (3) shame for the financial burden of SCD. DISCUSSION Findings demonstrate the need to design an SCD stigma reduction program for caregivers, families, and the community. Providers need to consider SCD stigma and interaction with multiple ecological levels, including the family, community, health care system, culture, and health policy in Ghana. Findings can be used as a catalyst to explore the reduction of stigmatization in other sub-Saharan countries.
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Fabian ID, Stacey AW, Foster A, Kivelä TT, Munier FL, Keren-Froim N, Gomel N, Cassoux N, Sagoo MS, Reddy MA, Harby LA, Zondervan M, Bascaran C, Abdallah E, Abdullahi SU, Boubacar SA, Ademola-Popoola DS, Adio A, Aghaji AE, Portabella SA, Alfa Bio AI, Ali AM, Alia DB, All-Eriksson C, Almeida AA, Alsawidi KM, Antonino R, Astbury NJ, Atsiaya R, Balaguer J, Balwierz W, Barranco H, Popovic MB, Benmiloud S, Guebessi NB, Berete RC, Biddulph SJ, Biewald EM, Blum S, Bobrova N, Boehme M, Bornfeld N, Bouda GC, Bouguila H, Boumedane A, Brichard BG, L MC, Castela G, Català-Mora J, Chantada GL, Chernodrinska VS, Chiwanga FS, Cieslik K, Comsa C, Correa Llano MG, Csóka M, Da Gama IV, Davidson A, Potter PD, Desjardins L, Dragomir MD, Bruyn MD, Kettani AE, Elbahi AM, Elgalaly D, Elhaddad AM, Ali Elhassan MM, Elzembely MM, Essuman VA, Evina TGA, Fasina O, Fernández-Teijeiro A, Gandiwa M, Aldana DG, Geel JA, Gizachew Z, Gregersen PA, Guedenon KM, Hadjistilianou T, Hassan S, Hederova S, Hessissen L, Hordofa DF, Hummlen M, Husakova K, Ida R, Ilic VR, Jenkinson H, Amani Kabesha TB, Kabore RL, Kalinaki A, Kapelushnik N, Kardava T, Kemilev PK, Kepak T, Khotenashvili Z, Klett A, Kosh Komba Palet JE, Krivaitiene D, Kruger M, Kyara A, Lachmann ES, Latinović S, Lecuona K, Lukamba RM, Lumbroso L, Lysytsia L, Maka E, Makan M, Manda C, Begue NM, Matende IO, Matua M, Mayet I, Mbumba FB, Mengesha AA, Midena E, Mndeme FG, Mohamedani AA, Moll AC, Moreira C, Msina MS, Msukwa G, Muma KI, Murgoi G, Musa KO, Mustak H, Muyen OM, Naidu G, Naumenko L, Ndoye Roth PA, Neroev V, Nikitovic M, Nkanga ED, Nkumbe H, Nyaywa M, Obono-Obiang G, Oguego NC, Olechowski A, Oscar AH, Osei-Bonsu P, Painter SL, Paintsil V, Paiva L, Papyan R, Parrozzani R, Parulekar M, Pawinska-Wasikowska K, Perić S, Philbert R, Pochop P, Polyakov VG, Pompe MT, Pons JJ, Raobela L, Renner LA, Reynders D, Ribadu D, Riheia MM, Ritter-Sovinz P, Saakyan S, Said AM, Román Pacheco SS, Scanlan TA, Schoeman J, Seregard S, Sherief ST, Cheikh SS, Silva S, Sorochynska T, Ssali G, Stathopoulos C, Kranjc BS, Stones DK, Svojgr K, Sylla F, Tamamyan G, Tandili A, Tateshi B, Theophile T, Traoré F, Tyau-Tyau H, Umar AB, Urbak SF, Ushakova TL, Valeina S, Hoefen Wijsard MV, Veleva-Krasteva NV, Viksnins M, Wackernagel W, Waddell K, Wade PD, Wali Nigeria AH, Wime AD, Dod CW, Yanga JM, Yarovaya VA, Yarovoy AA, Zein E, Sharabi S, Zhilyaeva K, Ziko OA, Bowman R. Travel burden and clinical presentation of retinoblastoma: analysis of 1024 patients from 43 African countries and 518 patients from 40 European countries. Br J Ophthalmol 2020; 105:1435-1443. [PMID: 32933936 DOI: 10.1136/bjophthalmol-2020-316613] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/28/2020] [Accepted: 08/17/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND The travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe. METHODS A cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and 1024 treatment-naïve patients with retinoblastoma residing in 43 African countries. RESULTS Capture rate was 42.2% of expected patients from Africa and 108.8% from Europe. African patients were older (95% CI -12.4 to -5.4, p<0.001), had fewer cases of familial retinoblastoma (95% CI 2.0 to 5.3, p<0.001) and presented with more advanced disease (95% CI 6.0 to 9.8, p<0.001); 43.4% and 15.4% of Africans had extraocular retinoblastoma and distant metastasis at the time of diagnosis, respectively, compared to 2.9% and 1.0% of the Europeans. To reach a retinoblastoma centre, European patients travelled 421.8 km compared to Africans who travelled 185.7 km (p<0.001). On regression analysis, lower-national income level, African residence and older age (p<0.001), but not travel distance (p=0.19), were risk factors for advanced disease. CONCLUSIONS Fewer than half the expected number of patients with retinoblastoma presented to African referral centres in 2017, suggesting poor awareness or other barriers to access. Despite the relatively shorter distance travelled by African patients, they presented with later-stage disease. Health education about retinoblastoma is needed for carers and health workers in Africa in order to increase capture rate and promote early referral.
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Affiliation(s)
- Ido Didi Fabian
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK .,The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Tel-Aviv, Israel
| | - Andrew W Stacey
- Department of Ophthalmology, University of Washington, Seattle, WA, US
| | - Allen Foster
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Tero T Kivelä
- Ocular Oncology Service, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Francis L Munier
- Jules-Gonin Eye Hospital, Fondation Asile de Aveugles, University of Lausanne, Lausanne, Switzerland
| | | | - Nir Gomel
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nathalie Cassoux
- Institut curie, université de Paris medicine Paris V Descartes, Paris, France
| | - Mandeep S Sagoo
- NIHR Biomedical Research Center for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology and London Retinoblastoma Service, Royal London Hospital, London, UK
| | - M Ashwin Reddy
- The Royal London Hospital, Barts Health NHS Trust, and Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Lamis Al Harby
- The Royal London Hospital, Barts Health NHS Trust, and Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Marcia Zondervan
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Covadonga Bascaran
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Elhassan Abdallah
- Ophthalmology Department of Rabat, Mohammed V university, Rabat, Morocco
| | | | | | - Dupe S Ademola-Popoola
- University of Ilorin and University of IlorinTeaching Hospital, Ilorin, Kwara State, Nigeria
| | - Adedayo Adio
- Department of Ophthalmology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Ada E Aghaji
- Department of Ophthalmology, College of Medicine, University of Nigeria, Enugu, Nigeria
| | | | | | - Amany M Ali
- Pediatric Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Donjeta B Alia
- University Hospital Center 'Mother Theresa', Tirana, Albania
| | | | | | | | | | - Nicholas J Astbury
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Rose Atsiaya
- Light House For Christ Eye Center, Mombasa, Kenya
| | - Julia Balaguer
- Pediatric Oncology Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Walentyna Balwierz
- Institute of Pediatrics, Jagiellonian University Medical College, Childrens University Hospital of Krakow, Krakow, Poland
| | - Honorio Barranco
- Pediatric Oncology Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Maja Beck Popovic
- Unit of Pediatric Hematology-Oncology, University Hospital CHUV, Lausanne, Switzerland
| | - Sarra Benmiloud
- Department of Pediatric Oncology, University Hassan II Fès, Fez, Morocco
| | | | - Rokia C Berete
- Ophthalmologic Department of the Teaching Hospital of Treichville, Abidjan, Côte d'ivoire
| | | | - Eva M Biewald
- University Hospital Essen, Department of Ophthalmology, University Duisburg-Essen, Essen, Germany
| | - Sharon Blum
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Tel-Aviv, Israel
| | - Nadia Bobrova
- The Filatov Institute of Eye diseases and Tissue Therapy, Odessa, Ukraine
| | - Marianna Boehme
- University Hospital Essen, Department of Ophthalmology, University Duisburg-Essen, Essen, Germany
| | - Norbert Bornfeld
- University Hospital Essen, Department of Ophthalmology, University Duisburg-Essen, Essen, Germany
| | - Gabrielle C Bouda
- Center Hospitalier Universitaire Yalgado Ouédraogo de Ouagadougou, Ouagadougou, Burkina Faso
| | - Hédi Bouguila
- Institut Hédi-Raïs d'Ophtalmologie de Tunis, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunis, Tunisia
| | - Amaria Boumedane
- Etablissement Hospitalière Spécialise Emir Abdelkader CEA Service d'Oncologie Pédiatrique, Oran, Algeria
| | | | | | - Guilherme Castela
- Centro Hospital Universitário de Coimbra, University of Coimbra, Coimbra, Portugal
| | | | | | - Violeta S Chernodrinska
- Eye Clinic, University Hospital 'Alexandrovska', Department of Ophthalmology, Medical University, Sofia, Bulgaria
| | | | - Krzysztof Cieslik
- Department of Ophthalmology, The Children's Memorial Health Institute, Warsaw, Poland
| | - Codruta Comsa
- Oncology Institute 'Prof. Dr. Al. Trestioreanu' Bucharest, Romania
| | | | - Monika Csóka
- Semmelweis University Budapest, Budapest, Hungary
| | | | - Alan Davidson
- Red Cross Children's War Memorial Hospital and the University of Cape Town, Cape Town, South Africa
| | | | | | | | | | - Asmaa El Kettani
- Center Hospitalier et Universitaire Ibn Rochd, Casablanca, Morocco
| | - Amal M Elbahi
- Tripoli Eye Hospital, Tripoli University, Tripoli, Libya
| | - Dina Elgalaly
- Children's Cancer Hospital Egypt 57357, Cairo, Egypt
| | | | - Moawia M Ali Elhassan
- Oncology Department, National Cancer Institute, University of Gezira, Wadi Madani, Sudan
| | - Mahmoud M Elzembely
- Pediatric Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Vera A Essuman
- Ophthalmology Unit, Department of Surgery, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | | | - Oluyemi Fasina
- Department of Ophthalmology, University College Hospital/University of Ibadan, Ibadan, Oyo State, Nigeria
| | | | - Moira Gandiwa
- Lions Sight First Eye Hospital, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | - Jennifer A Geel
- University of the Witwatersrand, Johannesburg, South Africa.,Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Zelalem Gizachew
- Addis Ababa University, School of Medicine, Department of Ophthalmology, Addis Ababa, Ethiopia
| | - Pernille A Gregersen
- Department of Clinical Genetics, and Center for Rare Disorders, Aarhus University Hopspital, Aarhus, Denmark
| | - Koffi M Guedenon
- Département de Pédiatrie, CHU Sylvanus Olympio, Université de Lomé, Lomé, Togo
| | | | - Sadiq Hassan
- Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Laila Hessissen
- Pediatric Hematology and Oncology Department of Rabat - Mohammed V University, Rabat, Morocco
| | - Diriba F Hordofa
- Department of Pediatrics and Child Health, Jimma University Medical Center, Jimma, Ethiopia
| | - Marlies Hummlen
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | | | - Russo Ida
- Bambino Gesù IRCCS Children's Hospital, Rome, Italy
| | - Vesna R Ilic
- Institute for Oncology and Radiology, Belgrade, Serbia
| | - Helen Jenkinson
- Birmingham Children's Hospital Eye Department, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Rolande L Kabore
- Center Hospitalier Universitaire Yalgado Ouédraogo de Ouagadougou, Ouagadougou, Burkina Faso
| | - Abubakar Kalinaki
- Makerere University College of Health Sciences, Department of Ophthalmology, Kamplala, Uganda
| | - Noa Kapelushnik
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Tel-Aviv, Israel
| | - Tamar Kardava
- Ophthalmology Department, Central Children's Hospital of Georgia, Tbilisi, Georgia
| | - Pavlin Kroumov Kemilev
- Eye Clinic, University Hospital 'Alexandrovska', Department of Ophthalmology, Medical University, Sofia, Bulgaria
| | - Tomas Kepak
- University Hospital Brno, Masaryk University and ICRC/St. Anna University Hospital, Brno, Czech Republic
| | - Zaza Khotenashvili
- Ophthalmology Department, Central Children's Hospital of Georgia, Tbilisi, Georgia
| | - Artur Klett
- East Tallinn Central Hospital, Tallinn, Estonia
| | | | - Dalia Krivaitiene
- Chidren's Ophthalmology Department, Chidren's Hospital of Vilnius, University Hospital Santaros Clinic, Vilnius, Lithuania
| | - Mariana Kruger
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Alice Kyara
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | | | - Slobodanka Latinović
- Clinical Center Of Vojvodina - University Eye Clinic, Eye Research Foundation Vidar - Latinović, Novi Sad, Serbia
| | - Karin Lecuona
- Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Robert M Lukamba
- University Clinics of Lubumbashi, University of Lubumbashi, Lubumbashi, DRC
| | | | - Lesia Lysytsia
- The Okhmatdyt National Children's Hospital, Kiev, Ukraine
| | - Erika Maka
- Semmelweis University Budapest, Budapest, Hungary
| | - Mayuri Makan
- Sekuru Kaguvi Eye Unit, Parirenyatwa Group of Hospitals, Harare, Zimbabwe
| | - Chatonda Manda
- Lions Sight First Eye Hospital, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Nieves Martín Begue
- Department of Pediatric Ophthalmology, Hospital Vall d'Hebron, Barcelona, Spain
| | | | | | - Ismail Mayet
- University of the Witwatersrand, Johannesburg, South Africa
| | - Freddy B Mbumba
- Botswana Government - Scottish Livingstone Hospital, Molepolole, Botswana
| | | | - Edoardo Midena
- Department of Ophthalmology, University of Padova, Padova, Italy
| | | | - Ahmed A Mohamedani
- Pathology Department, Faculty of Medicine, University of Gezira, Wadi Madani, Sudan
| | - Annette C Moll
- Department of Ophthalmology, Amsterdam UMC, Amsterdam, Netherlands
| | - Claude Moreira
- Service d'oncologie pédiatrique de l'hôpital Aristide le Dantec, Dakar, Senegal
| | | | - Gerald Msukwa
- Lions Sight First Eye Hospital, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | - Gabriela Murgoi
- Oncology Institute 'Prof. Dr. Al. Trestioreanu' Bucharest, Romania
| | - Kareem O Musa
- Department of Ophthalmology, Lagos University Teaching Hospital/College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Hamzah Mustak
- Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | | | - Gita Naidu
- University of the Witwatersrand, Johannesburg, South Africa
| | - Larisa Naumenko
- N.N. Alexandrov National Cancer Center of Belarus, Minsk, Belarus
| | | | - Vladimir Neroev
- Moscow Helmholtz Research Institute of Eye Diseases, Moscow, Russia
| | | | - Elizabeth D Nkanga
- Calabar Children's Eye Center, Department of Ophthalmology University of Calabar Teaching Hospital Calabar Cross River State, Nigeria
| | - Henry Nkumbe
- Magrabi ICO Cameroon Eye Institute, Yaounde, Cameroon
| | | | | | - Ngozi C Oguego
- Department of Ophthalmology, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Andrzej Olechowski
- Department of Ophthalmology, The Children's Memorial Health Institute, Warsaw, Poland
| | - Alexander Hugo Oscar
- Eye Clinic, University Hospital 'Alexandrovska', Department of Ophthalmology, Medical University, Sofia, Bulgaria
| | | | - Sally L Painter
- Birmingham Children's Hospital Eye Department, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Luisa Paiva
- National Ophthalmological Institute of Angola, Luanda, Angola
| | - Ruzanna Papyan
- Yerevan State Medical University, Department of Oncology and Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after R.H. Yeolyan, Yerevan, Armenia
| | | | - Manoj Parulekar
- Birmingham Children's Hospital Eye Department, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Katarzyna Pawinska-Wasikowska
- Institute of Pediatrics, Jagiellonian University Medical College, Childrens University Hospital of Krakow, Krakow, Poland
| | - Sanja Perić
- University Hospital Center Zagreb, Zagreb, Croatia
| | - Remezo Philbert
- Center Hospitaliere Universitaire de Kamenge, Bujumbura, Burundi
| | - Pavel Pochop
- Department of Ophthalmology for Children and Adults, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Vladimir G Polyakov
- Head and Neck Tumors Department, SRI of Pediatric Oncology and Hematology of N.N. Blokhin National Medical Research Center of Oncology of Russian Federation, Moscow, Russian Federation.,Medical Academy of Postgraduate Education, Moscow, Russia
| | - Manca T Pompe
- Univ. Medical Center Ljubljana, Univ.Eye Hospital Ljubljana, Ljubljana, Slovenia
| | | | - Léa Raobela
- Center Hospitalier Universitaire Joseph Ravoahangy Andrianavalona, Antananarivo, Madagascar
| | - Lorna A Renner
- University of Ghana School of Medicine and Dentistry, Korle Bu Teaching Hospital, Accra, Ghana
| | | | | | | | - Petra Ritter-Sovinz
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology/Oncology, Medical University of Graz, Graz, Austria
| | - Svetlana Saakyan
- Moscow Helmholtz Research Institute of Eye Diseases, Moscow, Russia
| | - Azza Ma Said
- Ophthalmology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | | | | | | | - Sadik T Sherief
- Addis Ababa University, School of Medicine, Department of Ophthalmology, Addis Ababa, Ethiopia
| | - Sidi Sidi Cheikh
- Ophthalmology department, Nouakchott Medical University, Nouakchott, Mauritania
| | - Sónia Silva
- Centro Hospital Universitário de Coimbra, University of Coimbra, Coimbra, Portugal
| | | | - Grace Ssali
- Mulago National Referral and Teaching Hospital, Kamplala, Uganda
| | - Christina Stathopoulos
- Jules-Gonin Eye Hospital, Fondation Asile de Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Branka Stirn Kranjc
- Univ. Medical Center Ljubljana, Univ.Eye Hospital Ljubljana, Ljubljana, Slovenia
| | - David K Stones
- Department of Paediatrics and Child Health, University of the Free Sate, Bloemfontein, South Africa
| | - Karel Svojgr
- Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | | | - Gevorg Tamamyan
- Yerevan State Medical University, Department of Oncology and Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after R.H. Yeolyan, Yerevan, Armenia
| | - Alketa Tandili
- University Hospital Center 'Mother Theresa', Tirana, Albania
| | | | | | - Fousseyni Traoré
- Pediatric Oncology Service, Gabriel Toure Hospital, Bamako, Mali
| | | | - Ali B Umar
- Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Steen F Urbak
- Department of ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Tatiana L Ushakova
- Head and Neck Tumors Department, SRI of Pediatric Oncology and Hematology of N.N. Blokhin National Medical Research Center of Oncology of Russian Federation, Moscow, Russian Federation.,Medical Academy of Postgraduate Education, Moscow, Russia
| | | | | | - Nevyana V Veleva-Krasteva
- Eye Clinic, University Hospital 'Alexandrovska', Department of Ophthalmology, Medical University, Sofia, Bulgaria
| | | | | | | | | | | | - Amelia Dc Wime
- National Ophthalmological Institute of Angola, Luanda, Angola
| | | | - Jenny M Yanga
- Service d'Ophtalmologie, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, DRC
| | - Vera A Yarovaya
- S.Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russia
| | - Andrey A Yarovoy
- S.Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russia
| | - Ekhtelbenina Zein
- Assistante Hospitalo - Universitaire, Faculte de Medecine de Nouakchott Medecin Oncopediatre, Center National d'Oncologie, Nouakchott, Mauritania
| | - Shirley Sharabi
- Radiology Department, Sheba Medical Center, Ramat-Gan, Israel
| | | | - Othman Ao Ziko
- Ophthalmology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Richard Bowman
- Ophthalmology Department, Great Ormond Street Children's Hospital, London, UK
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Eden T, Burns E, Freccero P, Renner L, Paintsil V, Dolendo M, Scanlan T, Khaing AA, Pina M, Islam A, Chunda-Liyoka C, Kouya F, Molyneux E. Erratum to “Are essential medicines available, reliable and affordable in low-middle income countries?” [J. Cancer Policy 19 (March) (2019) 100180]. J Cancer Policy 2020. [DOI: 10.1016/j.jcpo.2020.100239] [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: 11/26/2022]
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Chagaluka G, Paintsil V, Renner L, Weijers J, Chitsike I, Borgstein E, Kamiza S, Afungchwi GM, Kouya F, Hesseling P, Molyneux E, Israels T. Improvement of overall survival in the Collaborative Wilms Tumour Africa Project. Pediatr Blood Cancer 2020; 67:e28383. [PMID: 32391983 DOI: 10.1002/pbc.28383] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/26/2020] [Accepted: 04/19/2020] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The Collaborative Wilms Tumour (WT) Africa Project implemented an adapted WT treatment guideline in six centres in sub-Saharan Africa. The primary objectives were to describe abandonment of treatment, death during treatment, event-free survival (EFS) and relapse following implementation. An exploratory objective was to compare outcomes with the baseline evaluation, a historical cohort preceding implementation. METHODS The Collaborative WT Africa Project is a multi-centre prospective clinical trial that began in 2014. Funding was distributed to all participating centres and used to cover treatment, travel and other associated costs for patients. Patient characteristics, tumour characteristics and events were described. RESULTS In total, 201 WT patients were included. Two-year EFS was 49.9 ± 3.8% when abandonment of treatment was considered an event. Relapse of disease occurred in 21% (42 of 201) of all included patients and in 26% (42 of 161) of those who had a nephrectomy. Programme implementation was associated with significantly higher survival without evidence of disease at the end of treatment (52% vs 68.5%, P = .002), significantly reduced abandonment of treatment (23% vs 12%, P = .009) and fewer deaths during treatment (21% vs 13%, P = .06). CONCLUSION This collaborative implementation of an adapted WT treatment guideline, using relatively simple and low-cost interventions, was feasible. Two-year EFS was almost 50%. In addition, a significant decrease in treatment abandonment and an increase in survival at the end of treatment were observed compared to a pre-implementation cohort. Future work should focus on decreasing deaths during treatment and will include enhancing supportive care.
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Affiliation(s)
- George Chagaluka
- Department of Paediatrics, College of Medicine, Blantyre, Malawi
| | - Vivian Paintsil
- Directorate of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Lorna Renner
- Department of Child Health, University of Ghana Medical School, Accra, Ghana
| | - Janna Weijers
- Academy Outreach Programme, Princess Máxima Center for Paediatric Oncology, Bilthoven, The Netherlands
| | - Inam Chitsike
- Department of Paediatrics, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Eric Borgstein
- Department of Surgery, College of Medicine, Blantyre, Malawi
| | - Steve Kamiza
- Department of Histopathology, College of Medicine, Blantyre, Malawi
| | - Glenn M Afungchwi
- Department of Paediatric Oncology, Mbingo Baptist Convention Hospital, Mbingo, Cameroon
| | - Francine Kouya
- Department of Paediatric Oncology, Mbingo Baptist Convention Hospital, Mbingo, Cameroon
| | - Peter Hesseling
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | | | - Trijn Israels
- Academy Outreach Programme, Princess Máxima Center for Paediatric Oncology, Bilthoven, The Netherlands
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Fabian ID, Abdallah E, Abdullahi SU, Abdulqader RA, Adamou Boubacar S, Ademola-Popoola DS, Adio A, Afshar AR, Aggarwal P, Aghaji AE, Ahmad A, Akib MNR, Al Harby L, Al Ani MH, Alakbarova A, Portabella SA, Al-Badri SAF, Alcasabas APA, Al-Dahmash SA, Alejos A, Alemany-Rubio E, Alfa Bio AI, Alfonso Carreras Y, Al-Haddad C, Al-Hussaini HHY, Ali AM, Alia DB, Al-Jadiry MF, Al-Jumaily U, Alkatan HM, All-Eriksson C, Al-Mafrachi AARM, Almeida AA, Alsawidi KM, Al-Shaheen AASM, Al-Shammary EH, Amiruddin PO, Antonino R, Astbury NJ, Atalay HT, Atchaneeyasakul LO, Atsiaya R, Attaseth T, Aung TH, Ayala S, Baizakova B, Balaguer J, Balayeva R, Balwierz W, Barranco H, Bascaran C, Beck Popovic M, Benavides R, Benmiloud S, Bennani Guebessi N, Berete RC, Berry JL, Bhaduri A, Bhat S, Biddulph SJ, Biewald EM, Bobrova N, Boehme M, Boldt HC, Bonanomi MTBC, Bornfeld N, Bouda GC, Bouguila H, Boumedane A, Brennan RC, Brichard BG, Buaboonnam J, Calderón-Sotelo P, Calle Jara DA, Camuglia JE, Cano MR, Capra M, Cassoux N, Castela G, Castillo L, Català-Mora J, Chantada GL, Chaudhry S, Chaugule SS, Chauhan A, Chawla B, Chernodrinska VS, Chiwanga FS, Chuluunbat T, Cieslik K, Cockcroft RL, Comsa C, Correa ZM, Correa Llano MG, Corson TW, Cowan-Lyn KE, Csóka M, Cui X, Da Gama IV, Dangboon W, Das A, Das S, Davanzo JM, Davidson A, De Potter P, Delgado KQ, Demirci H, Desjardins L, Diaz Coronado RY, Dimaras H, Dodgshun AJ, Donaldson C, Donato Macedo CR, Dragomir MD, Du Y, Du Bruyn M, Edison KS, Eka Sutyawan IW, El Kettani A, Elbahi AM, Elder JE, Elgalaly D, Elhaddad AM, Elhassan MMA, Elzembely MM, Essuman VA, Evina TGA, Fadoo Z, Fandiño AC, Faranoush M, Fasina O, Fernández DDPG, Fernández-Teijeiro A, Foster A, Frenkel S, Fu LD, Fuentes-Alabi SL, Gallie BL, Gandiwa M, Garcia JL, García Aldana D, Gassant PY, Geel JA, Ghassemi F, Girón AV, Gizachew Z, Goenz MA, Gold AS, Goldberg-Lavid M, Gole GA, Gomel N, Gonzalez E, Gonzalez Perez G, González-Rodríguez L, Garcia Pacheco HN, Graells J, Green L, Gregersen PA, Grigorovski NDAK, Guedenon KM, Gunasekera DS, Gündüz AK, Gupta H, Gupta S, Hadjistilianou T, Hamel P, Hamid SA, Hamzah N, Hansen ED, Harbour JW, Hartnett ME, Hasanreisoglu M, Hassan S, Hassan S, Hederova S, Hernandez J, Hernandez LMC, Hessissen L, Hordofa DF, Huang LC, Hubbard GB, Hummlen M, Husakova K, Hussein Al-Janabi AN, Ida R, Ilic VR, Jairaj V, Jeeva I, Jenkinson H, Ji X, Jo DH, Johnson KP, Johnson WJ, Jones MM, Kabesha TBA, Kabore RL, Kaliki S, Kalinaki A, Kantar M, Kao LY, Kardava T, Kebudi R, Kepak T, Keren-Froim N, Khan ZJ, Khaqan HA, Khauv P, Kheir WJ, Khetan V, Khodabande A, Khotenashvili Z, Kim JW, Kim JH, Kiratli H, Kivelä TT, Klett A, Komba Palet JEK, Krivaitiene D, Kruger M, Kulvichit K, Kuntorini MW, Kyara A, Lachmann ES, Lam CPS, Lam GC, Larson SA, Latinovic S, Laurenti KD, Le BHA, Lecuona K, Leverant AA, Li C, Limbu B, Long QB, López JP, Lukamba RM, Lumbroso L, Luna-Fineman S, Lutfi D, Lysytsia L, Magrath GN, Mahajan A, Majeed AR, Maka E, Makan M, Makimbetov EK, Manda C, Martín Begue N, Mason L, Mason JO, Matende IO, Materin M, Mattosinho CCDS, Matua M, Mayet I, Mbumba FB, McKenzie JD, Medina-Sanson A, Mehrvar A, Mengesha AA, Menon V, Mercado GJVD, Mets MB, Midena E, Mishra DKC, Mndeme FG, Mohamedani AA, Mohammad MT, Moll AC, Montero MM, Morales RA, Moreira C, Mruthyunjaya P, Msina MS, Msukwa G, Mudaliar SS, Muma KI, Munier FL, Murgoi G, Murray TG, Musa KO, Mushtaq A, Mustak H, Muyen OM, Naidu G, Nair AG, Naumenko L, Ndoye Roth PA, Nency YM, Neroev V, Ngo H, Nieves RM, Nikitovic M, Nkanga ED, Nkumbe H, Nuruddin M, Nyaywa M, Obono-Obiang G, Oguego NC, Olechowski A, Oliver SCN, Osei-Bonsu P, Ossandon D, Paez-Escamilla MA, Pagarra H, Painter SL, Paintsil V, Paiva L, Pal BP, Palanivelu MS, Papyan R, Parrozzani R, Parulekar M, Pascual Morales CR, Paton KE, Pawinska-Wasikowska K, Pe'er J, Peña A, Peric S, Pham CTM, Philbert R, Plager DA, Pochop P, Polania RA, Polyakov VG, Pompe MT, Pons JJ, Prat D, Prom V, Purwanto I, Qadir AO, Qayyum S, Qian J, Rahman A, Rahman S, Rahmat J, Rajkarnikar P, Ramanjulu R, Ramasubramanian A, Ramirez-Ortiz MA, Raobela L, Rashid R, Reddy MA, Reich E, Renner LA, Reynders D, Ribadu D, Riheia MM, Ritter-Sovinz P, Rojanaporn D, Romero L, Roy SR, Saab RH, Saakyan S, Sabhan AH, Sagoo MS, Said AMA, Saiju R, Salas B, San Román Pacheco S, Sánchez GL, Sayalith P, Scanlan TA, Schefler AC, Schoeman J, Sedaghat A, Seregard S, Seth R, Shah AS, Shakoor SA, Sharma MK, Sherief ST, Shetye NG, Shields CL, Siddiqui SN, Sidi Cheikh S, Silva S, Singh AD, Singh N, Singh U, Singha P, Sitorus RS, Skalet AH, Soebagjo HD, Sorochynska T, Ssali G, Stacey AW, Staffieri SE, Stahl ED, Stathopoulos C, Stirn Kranjc B, Stones DK, Strahlendorf C, Suarez MEC, Sultana S, Sun X, Sundy M, Superstein R, Supriyadi E, Surukrattanaskul S, Suzuki S, Svojgr K, Sylla F, Tamamyan G, Tan D, Tandili A, Tarrillo Leiva FF, Tashvighi M, Tateshi B, Tehuteru ES, Teixeira LF, Teh KH, Theophile T, Toledano H, Trang DL, Traoré F, Trichaiyaporn S, Tuncer S, Tyau-Tyau H, Umar AB, Unal E, Uner OE, Urbak SF, Ushakova TL, Usmanov RH, Valeina S, van Hoefen Wijsard M, Varadisai A, Vasquez L, Vaughan LO, Veleva-Krasteva NV, Verma N, Victor AA, Viksnins M, Villacís Chafla EG, Vishnevskia-Dai V, Vora T, Wachtel AE, Wackernagel W, Waddell K, Wade PD, Wali AH, Wang YZ, Weiss A, Wilson MW, Wime ADC, Wiwatwongwana A, Wiwatwongwana D, Wolley Dod C, Wongwai P, Xiang D, Xiao Y, Yam JC, Yang H, Yanga JM, Yaqub MA, Yarovaya VA, Yarovoy AA, Ye H, Yousef YA, Yuliawati P, Zapata López AM, Zein E, Zhang C, Zhang Y, Zhao J, Zheng X, Zhilyaeva K, Zia N, Ziko OAO, Zondervan M, Bowman R. Global Retinoblastoma Presentation and Analysis by National Income Level. JAMA Oncol 2020; 6:685-695. [PMID: 32105305 PMCID: PMC7047856 DOI: 10.1001/jamaoncol.2019.6716] [Citation(s) in RCA: 144] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs.
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Affiliation(s)
| | - Ido Didi Fabian
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - Elhassan Abdallah
- Ophthalmology Department of Rabat, Mohammed V University, Rabat, Morocco
| | | | | | | | | | - Adedayo Adio
- Department of Ophthalmology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | | | | | - Ada E Aghaji
- Department of Ophthalmology, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Alia Ahmad
- The Children's Hospital and the Institute of Child Health, Lahore, Pakistan
| | | | - Lamis Al Harby
- The Royal London Hospital, Barts Health NHS Trust, and Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Aygun Alakbarova
- Zarifa Aliyeva National Center of Ophthalmology, Baku, Azerbaijan
| | | | - Safaa A F Al-Badri
- Pediatric Oncology Unit, Children Welfare Teaching Hospital, College of Medicine, University of Baghdad, Baghdad, Iraq
| | | | | | - Amanda Alejos
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | | | | | | | - Christiane Al-Haddad
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Amany M Ali
- Pediatric Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Donjeta B Alia
- University Hospital Center Mother Theresa, Tirana, Albania
| | - Mazin F Al-Jadiry
- Pediatric Oncology Unit, Children Welfare Teaching Hospital, College of Medicine, University of Baghdad, Baghdad, Iraq
| | | | - Hind M Alkatan
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | | | | | | | | | | | | | | | - Nicholas J Astbury
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hatice T Atalay
- Department of Ophthalmology, School of Medicine, Gazi University, Ankara, Turkey
| | | | - Rose Atsiaya
- Lighthouse For Christ Eye Centre, Mombasa, Kenya
| | - Taweevat Attaseth
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Than H Aung
- Yangon Eye Hospital, University of Medicine 1, Yangon, Myanmar
| | | | - Baglan Baizakova
- Scientific Center of Pediatrics and Pediatric Surgery, Almaty, Kazakhstan
| | - Julia Balaguer
- Pediatric Oncology Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Walentyna Balwierz
- Institute of Pediatrics, Jagiellonian University Medical College, Children's University Hospital of Krakow, Krakow, Poland
| | - Honorio Barranco
- Pediatric Oncology Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Covadonga Bascaran
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Maja Beck Popovic
- Pediatric Hematology-Oncology Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Raquel Benavides
- Hospital Nacional de Niños Dr Carlos Sáenz Herrera, San Jose, Costa Rica
| | - Sarra Benmiloud
- Department of Pediatric Oncology, University Hassan II Fès, Fez, Morocco
| | | | - Rokia C Berete
- Ophthalmologic Department of the Teaching Hospital of Treichville, Abidjan, Côte d'Ivoire
| | - Jesse L Berry
- Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles
| | | | - Sunil Bhat
- Department of Pediatric Hematology and Oncology, Narayana Health City, Bangalore, India
| | | | - Eva M Biewald
- Department of Ophthalmology, Essen University Hospital, University Duisburg-Essen, Essen, Germany
| | - Nadia Bobrova
- The Filatov Institute of Eye Diseases and Tissue Therapy, Odessa, Ukraine
| | - Marianna Boehme
- Department of Ophthalmology, Essen University Hospital, University Duisburg-Essen, Essen, Germany
| | - H C Boldt
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City
| | | | - Norbert Bornfeld
- Department of Ophthalmology, Essen University Hospital, University Duisburg-Essen, Essen, Germany
| | - Gabrielle C Bouda
- Centre Hospitalier Universitaire Yalgado Ouédraogo de Ouagadougou, Ouagadougou, Burkina Faso
| | - Hédi Bouguila
- Institut Hédi Raïs d'Ophtalmologie, Faculté de Médecine, Université Tunis El Manar, Tunis, Tunisia
| | - Amaria Boumedane
- Etablissement Hospitalière Spécialise Emir Abdelkader CEA Service d'Oncologie Pédiatrique, Oran, Algeria
| | - Rachel C Brennan
- Solid Tumor Division, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | | | | | | | - Jayne E Camuglia
- Department of Ophthalmology, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Miriam R Cano
- Salud Ocular, Ministerio de Salud Publica, Asuncion, Paraguay
| | | | - Nathalie Cassoux
- Institut Curie, Université de Paris Medicine Paris V Descartes, Paris, France
| | - Guilherme Castela
- Centro Hospital Universitário de Coimbra, University of Coimbra, Coimbra, Portugal
| | | | | | - Guillermo L Chantada
- Hospital Sant Joan de Déu, Barcelona, Spain
- Hospital Garrahan, Buenos Aires, Argentina
- NationalScientific and Technical Research Council, CONICET, Buenos Aires, Argentina
| | - Shabana Chaudhry
- Paediatric Ophthalmology Department, Mayo Hospital and College of Allied Visual Sciences, King Edward Medical University, Lahore, Pakistan
| | - Sonal S Chaugule
- Department of Ophthalmic Plastic Surgery, Orbit and Ocular Oncology, PBMA's H. V. Desai Eye Hospital, Pune, Maharashtra, India
| | | | - Bhavna Chawla
- Ocular Oncology Service, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Violeta S Chernodrinska
- Eye Clinic, Department of Ophthalmology, University Hospital Alexandrovska, Medical University, Sofia, Sofia, Bulgaria
| | | | | | - Krzysztof Cieslik
- Department of Ophthalmology, The Children's Memorial Health Institute, Warsaw, Poland
| | | | - Codruta Comsa
- Institute of Oncology, Prof. Dr Al. Trestioreanu, Bucharest, Romania
| | - Zelia M Correa
- Wilmer Eye Institute, Johns Hopkins Medicine, Baltimore, Maryland, and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | | | | | | | - Xuehao Cui
- Department of Ophthalmology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Wantanee Dangboon
- Department of Ophthalmology, Songklanagarind Hospital, Prince of Songkla University, Songkla, Thailand
| | - Anirban Das
- Department of Pediatric Hematology-Oncology, Tata Medical Center, Kolkata, India
| | - Sima Das
- Ocular Oncology Services, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | | | - Alan Davidson
- Red Cross War Memorial Children's Hospital and the University of Cape Town, Cape Town, South Africa
| | | | | | - Hakan Demirci
- Department of Ophthalmology, Kellogg Eye Center, University of Michigan, Ann Arbor
| | | | | | - Helen Dimaras
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrew J Dodgshun
- Department of Paediatrics, University of Otago, Christchurch, Children's Haematology and Oncology Center, Christchurch Hospital, Christchurch, New Zealand
| | - Craig Donaldson
- The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | | | - Monica D Dragomir
- Institute of Oncology, Prof. Dr Al. Trestioreanu, Bucharest, Romania
| | - Yi Du
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | | | - Kemala S Edison
- Ophthalmology Department, Dr M. Djamil General Hospital, Faculty of Medicine, Andalas University, West Sumatra, Indonesia
| | - I Wayan Eka Sutyawan
- Department of Ophthalmology, Faculty of Medicine, Udayana University, Sanglah Eye Hospital, Bali, Indonesia
| | - Asmaa El Kettani
- Center Hospitalier et Universitaire Ibn Rochd, Casablanca, Morocco
| | - Amal M Elbahi
- Tripoli Eye Hospital, University of Tripoli, Tripoli, Libya
| | - James E Elder
- Department of Ophthalmology, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
| | - Dina Elgalaly
- Children's Cancer Hospital Egypt 57357, Cairo, Egypt
| | | | - Moawia M Ali Elhassan
- Department of Oncology, National Cancer Institute, University of Gezira, Wadi Madani, Sudan
| | - Mahmoud M Elzembely
- Pediatric Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Vera A Essuman
- Ophthalmology Unit, Department of Surgery, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | | | | | | | - Mohammad Faranoush
- Pediatric Growth and Development Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Rasool Akram Hospital, Tehran, Iran
| | - Oluyemi Fasina
- Department of Ophthalmology, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | | | | | - Allen Foster
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Shahar Frenkel
- Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Soad L Fuentes-Alabi
- Pediatric Oncology Department, Benjamin Bloom National Children's Hospital, San Salvador, El Salvador
| | | | - Moira Gandiwa
- Lions Sight First Eye Hospital, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | | | | | - Jennifer A Geel
- Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Fariba Ghassemi
- Retina and Vitreous Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ana V Girón
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | - Zelalem Gizachew
- Department of Ophthalmology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Marco A Goenz
- Pediatric Oncology Department, Benjamin Bloom National Children's Hospital, San Salvador, El Salvador
| | - Aaron S Gold
- Murray Ocular Oncology and Retina, Miami, Florida
| | | | - Glen A Gole
- Department of Ophthalmology, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Nir Gomel
- Department of Ophthalmology, Sourasky Medical Center Tel Aviv, School of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efren Gonzalez
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | - Henry N Garcia Pacheco
- Pediatric Oncology Unit, Instituto Regional de Enfermedades Neoplásicas del Sur, Arequipa, Perú
| | - Jaime Graells
- Unidad de Oncologia Ocular Hospital Oncologico Luis Razzetti, Caracas, Venezuela
| | - Liz Green
- IAM NOOR Eye Care Programme, Afghanistan
| | - Pernille A Gregersen
- Department of Clinical Genetics and Center for Rare Disorders, Aarhus University Hospital, Aarhus, Denmark
| | | | - Koffi M Guedenon
- Département de Pédiatrie, CHU Sylvanus Olympio, Université de Lomé, Lomé, Togo
| | | | - Ahmet K Gündüz
- Department of Ophthalmology, Ankara University School of Medicine, Ankara, Turkey
| | - Himika Gupta
- Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Sanjiv Gupta
- King George's Medical University, Lucknow, India
| | | | - Patrick Hamel
- Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montréal, Quebec, Canada
| | | | | | - Eric D Hansen
- John A. Moran Eye Center, University of Utah, Salt Lake City
| | - J William Harbour
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Murat Hasanreisoglu
- Department of Ophthalmology, School of Medicine, Gazi University, Ankara, Turkey
| | - Sadiq Hassan
- Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
| | - Shadab Hassan
- Department of Pediatric Ophthalmology and Strabismus, Al Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | | | - Jose Hernandez
- Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú
| | | | - Laila Hessissen
- Pediatric Hematology and Oncology Center, Mohammed V University, Rabat, Morocco
| | - Diriba F Hordofa
- Department of Pediatrics and Child Health, Jimma University Medical Center, Jimma, Ethiopia
| | - Laura C Huang
- Byers Eye Institute, Stanford University, Stanford, California
| | | | - Marlies Hummlen
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | | | | | - Russo Ida
- Bambino Gesù IRCCS Children's Hospital, Rome, Italy
| | - Vesna R Ilic
- Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | | | | | - Helen Jenkinson
- Eye Department, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Xunda Ji
- Department of Ophthalmology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dong Hyun Jo
- Fight Against Angiogenesis-Related Blindness Laboratory, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | | | - William J Johnson
- Storm Eye Institute, Medical University of South Carolina, Charleston
| | - Michael M Jones
- The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | | | - Rolande L Kabore
- Centre Hospitalier Universitaire Yalgado Ouédraogo de Ouagadougou, Ouagadougou, Burkina Faso
| | - Swathi Kaliki
- Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, India
| | - Abubakar Kalinaki
- Department of Ophthalmology, Makerere University College of Health Sciences Kamplala, Uganda
| | - Mehmet Kantar
- Division of Pediatric Oncology, School of Medicine, Ege University, Izmir, Turkey
| | | | - Tamar Kardava
- Ophthalmology Department, Central Children's Hospital of Georgia, Tbilisi, Georgia
| | - Rejin Kebudi
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Cerrahpaşa Faculty of Medicine and Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Tomas Kepak
- St. Anne's University Hospital Brno, Masaryk University, and International Clinical Research Center/St Anna University Hospital, Brno, Czech Republic
| | | | | | - Hussain A Khaqan
- Department of Ophthalmology, Postgraduate Medical Institute, Ameer-Ud-Din Medical College, Lahore General Hospital, Lahore, Pakistan
| | - Phara Khauv
- Angkor Hospital for Children, Krong Siem Reap, Cambodia
| | - Wajiha J Kheir
- Duke Eye Center, Duke University Hospital, Durham, North Carolina
| | | | - Alireza Khodabande
- Retina and Vitreous Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zaza Khotenashvili
- Ophthalmology Department, Central Children's Hospital of Georgia, Tbilisi, Georgia
| | - Jonathan W Kim
- Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles
| | - Jeong Hun Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hayyam Kiratli
- Ocular Oncology Service, Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Tero T Kivelä
- Ocular Oncology Service, Department of Ophthalmology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Artur Klett
- East Tallinn Central Hospital, Tallinn, Estonia
| | | | - Dalia Krivaitiene
- Children's Ophthalmology Department, Children's Hospital of Vilnius, University Hospital Santaros Clinic, Vilnius, Lithuania
| | - Mariana Kruger
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Kittisak Kulvichit
- Vitreo-Retina Research Unit, Department of Ophthalmology, Chulalongkorn University, Bangkok, Thailand
| | | | - Alice Kyara
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Eva S Lachmann
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carol P S Lam
- Hong Kong Eye Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Geoffrey C Lam
- Perth Children's Hospital, University of Western Australia, Perth, Western Australia, Australia
| | - Scott A Larson
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City
| | - Slobodanka Latinovic
- Clinical Center of Vojvodina, University Eye Clinic, Eye Research Foundation Vidar-Latinović, Novi Sad, Serbia
| | - Kelly D Laurenti
- Division of Ophthalmology, Feinberg School of Medicine, Northwestern University, and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Bao Han A Le
- John A. Burns School of Medicine, University of Hawaii, Honolulu, and University of Southern California Roski Eye Institute, Los Angeles
| | - Karin Lecuona
- Division of Ophthalmology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Cairui Li
- Affiliated Hospital of Dali University, Dali City, China
| | - Ben Limbu
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | | | - Juan P López
- Ophthalmology Department, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Robert M Lukamba
- University Clinics of Lubumbashi, University of Lubumbashi, Lubumbashi, Democratic Rrepublic of Congo
| | | | - Sandra Luna-Fineman
- Pediatric Hematology/Oncology/Stem Cell Transplantation, Center for Global Health, Children's Hospital Colorado, University of Colorado, Aurora
| | - Delfitri Lutfi
- Department of Ophthalmology, Dr Soetomo General Hospital, Airlangga University, Surabaya, Indonesia
| | | | - George N Magrath
- Storm Eye Institute, Medical University of South Carolina, Charleston
| | - Amita Mahajan
- Pediatric Hematology-Oncology Unit, Apollo Center for Advanced Pediatrics, Indraprastha Apollo Hospital, New Delhi, India
| | | | - Erika Maka
- Semmelweis University, Budapest, Hungary
| | - Mayuri Makan
- Sekuru Kaguvi Eye Unit, Parirenyatwa Group of Hospitals, Harare, Zimbabwe
| | | | - Chatonda Manda
- Lions Sight First Eye Hospital, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Nieves Martín Begue
- Department of Pediatric Ophthalmology, Hospital Vall d'Hebron, Barcelona, Spain
| | | | | | | | - Miguel Materin
- Duke Eye Center, Duke University Hospital, Durham, North Carolina
| | | | - Marchelo Matua
- Ruharo Eye Centre, Ruharo Mission Hospital, Mbarara, Uganda
| | - Ismail Mayet
- University of the Witwatersrand, Johannesburg, South Africa
| | | | - John D McKenzie
- Department of Ophthalmology, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Ocular Oncology, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Aurora Medina-Sanson
- Department of Oncology, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Azim Mehrvar
- MAHAK Hematology Oncology Research Center, Mahak Hospital, Tehran, Iran
| | | | | | | | - Marilyn B Mets
- Division of Ophthalmology, Feinberg School of Medicine, Northwestern University, and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Edoardo Midena
- Department of Ophthalmology, University of Padova, Padova, Italy
| | | | | | - Ahmed A Mohamedani
- Department of Pathology, Faculty of Medicine, University of Gezira, Wad Medani, Sudan
| | | | - Annette C Moll
- Department of Ophthalmology, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - Rosa A Morales
- Hospital Infantil Manuel de Jesús Rivera, Managua, Nicaragua
| | - Claude Moreira
- Service d'Oncologie Pédiatrique de l'Hôpital Aristide le Dantec, Dakar, Senegal
| | | | | | - Gerald Msukwa
- Lions Sight First Eye Hospital, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | | | - Francis L Munier
- Jules-Gonin Eye Hospital, Fondation Asile de Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Gabriela Murgoi
- Institute of Oncology, Prof. Dr Al. Trestioreanu, Bucharest, Romania
| | | | - Kareem O Musa
- Department of Ophthalmology, Lagos University Teaching Hospital, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Asma Mushtaq
- The Children's Hospital and the Institute of Child Health, Lahore, Pakistan
| | - Hamzah Mustak
- Division of Ophthalmology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Gita Naidu
- University of the Witwatersrand, Johannesburg, South Africa
| | - Akshay Gopinathan Nair
- Aditya Jyot Eye Hospital, Mumbai, India
- Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, India
| | - Larisa Naumenko
- N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Belarus
| | | | - Yetty M Nency
- Child Health Department, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Vladimir Neroev
- Moscow Helmholtz Research Institute of Eye Diseases, Moscow, Russia
| | - Hang Ngo
- Ho Chi Minh Eye Hospital, Ho Chi Minh, Vietnam
| | - Rosa M Nieves
- Hospital Infantil Dr Robert Reid Cabral, Santo Domingo, Dominican Republic
| | - Marina Nikitovic
- Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Elizabeth D Nkanga
- Department of Ophthalmology, Calabar Children's Eye Center, University of Calabar Teaching Hospital, Calabar Nigeria
| | - Henry Nkumbe
- Magrabi ICO Cameroon Eye Institute, Yaounde, Cameroon
| | - Murtuza Nuruddin
- Chittagong Eye Infirmary and Training Complex, Chittagong, Bangladesh
| | | | | | - Ngozi C Oguego
- Department of Ophthalmology, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Andrzej Olechowski
- Department of Ophthalmology, The Children's Memorial Health Institute, Warsaw, Poland
| | - Scott C N Oliver
- Sue Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora
| | | | - Diego Ossandon
- Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | | | | | - Sally L Painter
- Eye Department, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | | | - Luisa Paiva
- National Ophthalmological Institute of Angola, Luanda, Angola
| | - Bikramjit P Pal
- H M Diwan Eye Foundation, and Tata Medical Center, Kolkata, India
| | | | - Ruzanna Papyan
- Department of Oncology, Yerevan State Medical University, and Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after R. H. Yeolyan, Yerevan, Armenia
| | | | - Manoj Parulekar
- Eye Department, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | | | | | - Katarzyna Pawinska-Wasikowska
- Institute of Pediatrics, Jagiellonian University Medical College, Children's University Hospital of Krakow, Krakow, Poland
| | - Jacob Pe'er
- Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Sanja Peric
- University Hospital Center Zagreb, Zagreb, Croatia
| | - Chau T M Pham
- Vietnam National Institute of Ophthalmology, Ha Noi, Vietnam
| | - Remezo Philbert
- Centre Hospitalier Universitaire de Kamenge, Bujumbura, Burundi
| | | | - Pavel Pochop
- Department of Ophthalmology for Children and Adults, Second Faculty of Medicine, Charles University, and Motol University Hospital, Prague, Czech Republic
| | | | - Vladimir G Polyakov
- Head and Neck Tumors Department, SRI of Pediatric Oncology and Hematology, N.N. Blokhin Russian Cancer Research Center, Moscow, Russia
- Russian Medical Academy of Postgraduate Education, Moscow, Russia
| | - Manca T Pompe
- University Eye Hospital Ljubljana, University Medical Center Ljubljana, Ljubljana, Slovenia
| | | | - Daphna Prat
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
| | | | - Ignatius Purwanto
- Sardjito Hospital, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Seema Qayyum
- The Children's Hospital and the Institute of Child Health, Lahore, Pakistan
| | - Jiang Qian
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Ardizal Rahman
- Ophthalmology Department, Dr M. Djamil General Hospital, Faculty of Medicine, Andalas University, West Sumatra, Indonesia
| | | | | | | | | | | | - Marco A Ramirez-Ortiz
- Department of Ophthalmology, Hospital Infantil de Mexico Federico Gómez, Mexico City, Mexico
| | - Léa Raobela
- Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona, Antananarivo, Madagascar
| | - Riffat Rashid
- Department of Oculoplasty and Ocular Oncology, Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh
| | - M Ashwin Reddy
- The Royal London Hospital, Barts Health NHS Trust, and Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Ehud Reich
- Department of Ophthalmology, Davidoff Center for Oncology, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
| | - Lorna A Renner
- School of Medicine and Dentistry, Korle-Bu Teaching Hospital, University of Ghana, Accra, Ghana
| | | | | | | | - Petra Ritter-Sovinz
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Duangnate Rojanaporn
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Livia Romero
- Unidad de Oncologia Ocular Hospital Oncologico Luis Razzetti, Caracas, Venezuela
| | - Soma R Roy
- Chittagong Eye Infirmary and Training Complex, Chittagong, Bangladesh
| | - Raya H Saab
- Children's Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Svetlana Saakyan
- Moscow Helmholtz Research Institute of Eye Diseases, Moscow, Russia
| | - Ahmed H Sabhan
- Pediatric Oncology Unit, Children Welfare Teaching Hospital, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Mandeep S Sagoo
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital, and UCL Institute of Ophthalmology and London Retinoblastoma Service, Royal London Hospital, London, United Kingdom
| | - Azza M A Said
- Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Rohit Saiju
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Beatriz Salas
- Hospital Dr Manuel Ascencio Villarroel, Cochabamba, Bolivia
| | | | | | | | | | | | | | - Ahad Sedaghat
- Department of Ophthalmology, Rasool Akram Hospital, Tehran, Iran
| | | | - Rachna Seth
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ankoor S Shah
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | - Sadik T Sherief
- Department of Ophthalmology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sorath Noorani Siddiqui
- Department of Pediatric Ophthalmology and Strabismus, Al Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Sidi Sidi Cheikh
- Ophthalmology Department, Nouakchott Medical University, Nouakchott, Mauritania
| | - Sónia Silva
- Centro Hospital Universitário de Coimbra, University of Coimbra, Coimbra, Portugal
| | - Arun D Singh
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Usha Singh
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Penny Singha
- Department of Ophthalmology, Songklanagarind Hospital, Prince of Songkla University, Songkla, Thailand
| | - Rita S Sitorus
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, and Dr Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Alison H Skalet
- Casey Eye Institute, Oregon Health & Science University, Portland
| | - Hendrian D Soebagjo
- Department of Ophthalmology, Dr Soetomo General Hospital, Airlangga University, Surabaya, Indonesia
| | | | - Grace Ssali
- Mulago National Referral Hospital, Kampala, Uganda
| | - Andrew W Stacey
- Department of Ophthalmology, University of Washington, Seattle
| | - Sandra E Staffieri
- Department of Ophthalmology, Royal Children's Hospital, Parkville, Victoria, Australia
- Centre for Eye Research Australia, University of Melbourne, East Melbourne, Victoria, Australia
| | - Erin D Stahl
- Children's Mercy Hospital, Kansas City, Missouri
| | - Christina Stathopoulos
- Jules-Gonin Eye Hospital, Fondation Asile de Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Branka Stirn Kranjc
- University Eye Hospital Ljubljana, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - David K Stones
- Department of Paediatrics and Child Health, University of the Free State, Bloemfontein, South Africa
| | | | | | - Sadia Sultana
- Department of Oculoplasty and Ocular Oncology, Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh
| | - Xiantao Sun
- Henan Children's Hospital, Affiliated Children's Hospital of Zhengzhou University, Zhengzhou, China
| | - Meryl Sundy
- Casey Eye Institute, Oregon Health & Science University, Portland
| | - Rosanne Superstein
- Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montréal, Quebec, Canada
| | - Eddy Supriyadi
- Sardjito Hospital, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Shigenobu Suzuki
- Department of Ophthalmic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Karel Svojgr
- Department of Pediatric Hematology and Oncology, Second Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | | | - Gevorg Tamamyan
- Department of Oncology, Yerevan State Medical University, and Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after R. H. Yeolyan, Yerevan, Armenia
| | - Deborah Tan
- Singapore National Eye Center, Singapore, Singapore
| | - Alketa Tandili
- University Hospital Center Mother Theresa, Tirana, Albania
| | | | - Maryam Tashvighi
- MAHAK Hematology Oncology Research Center, Mahak Hospital, Tehran, Iran
| | | | - Edi S Tehuteru
- National Cancer Center, Dharmais Cancer Hospital, Jakarta, Indonesia
| | - Luiz F Teixeira
- Pediatric Oncology Institute, Federal University of São Paulo, São Paulo, Brazil
- Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil
| | - Kok Hoi Teh
- Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | | | - Helen Toledano
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Doan L Trang
- Vietnam National Institute of Ophthalmology, Ha Noi, Vietnam
| | - Fousseyni Traoré
- Pediatric Oncology Service, Gabriel Toure Hospital, Bamako, Mali
| | | | - Samuray Tuncer
- Department of Ophthalmology, Faculty of Medicine, Ocular Oncology Service, Istanbul University, Istanbul, Turkey
| | | | - Ali B Umar
- Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
| | - Emel Unal
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Ankara University, Ankara, Turkey
| | | | - Steen F Urbak
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Tatiana L Ushakova
- Head and Neck Tumors Department, SRI of Pediatric Oncology and Hematology, N.N. Blokhin Russian Cancer Research Center, Moscow, Russia
- Russian Medical Academy of Postgraduate Education, Moscow, Russia
| | | | | | | | - Adisai Varadisai
- Vitreo-Retina Research Unit, Department of Ophthalmology, Chulalongkorn University, Bangkok, Thailand
| | | | | | - Nevyana V Veleva-Krasteva
- Eye Clinic, Department of Ophthalmology, University Hospital Alexandrovska, Medical University, Sofia, Sofia, Bulgaria
| | | | - Andi A Victor
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, and Dr Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | | | | | - Vicktoria Vishnevskia-Dai
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | - Keith Waddell
- Ruharo Eye Centre, Ruharo Mission Hospital, Mbarara, Uganda
| | | | | | - Yi-Zhuo Wang
- Department of Paediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Avery Weiss
- Department of Ophthalmology, University of Washington, Seattle
| | - Matthew W Wilson
- Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Amelia D C Wime
- National Ophthalmological Institute of Angola, Luanda, Angola
| | | | | | | | - Phanthipha Wongwai
- Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Daoman Xiang
- Department of Pediatric Ophthalmology, Guangzhou Children's Hospital and Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | | | - Jason C Yam
- Hong Kong Eye Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Huasheng Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jenny M Yanga
- Service d'Ophtalmologie, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
| | | | - Vera A Yarovaya
- S.Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russia
| | - Andrey A Yarovoy
- S.Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russia
| | - Huijing Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | | | - Putu Yuliawati
- Department of Ophthalmology, Faculty of Medicine, Udayana University, Sanglah Eye Hospital, Bali, Indonesia
| | | | - Ekhtelbenina Zein
- Assistante Hospitalo Universitaire, Faculte de Medecine de Nouakchott Medecin Oncopediatre, Center National d'Oncologie, Nouakchott, Mauritania
| | - Chengyue Zhang
- Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yi Zhang
- Department of Paediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Junyang Zhao
- Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xiaoyu Zheng
- Department of Ophthalmology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | | | - Nida Zia
- The Indus Hospital, Karachi, Pakistan
| | - Othman A O Ziko
- Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Marcia Zondervan
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Richard Bowman
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Ophthalmology Department, Great Ormond Street Hospital, London, United Kingdom
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Makani J, Sangeda RZ, Nnodu O, Nembaware V, Osei-Akoto A, Paintsil V, Balandya E, Kent J, Luzzatto L, Ofori-Acquah S, Olopade OI, Pallangyo K, Minja IK, Jonas M, Mazandu GK, Mulder N, Ohene-Frempong K, Wonkam A. SickleInAfrica. Lancet Haematol 2020; 7:e98-e99. [PMID: 32004491 DOI: 10.1016/s2352-3026(20)30006-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Julie Makani
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Raphael Z Sangeda
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | | | - Alex Osei-Akoto
- Komfo Anokye Teaching Hospital, Kumasi, Ghana; Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Emmanuel Balandya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jill Kent
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Lucio Luzzatto
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Solomon Ofori-Acquah
- University of Pittsburgh, Pittsburgh, PA, USA; University of Ghana, Accra, Ghana
| | | | - Kisali Pallangyo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Irene K Minja
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mario Jonas
- University of Cape Town, Cape Town, South Africa
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Smith-Togobo C, Pedersen MØ, Jensen SG, Duduyemi B, Gyasi RK, Ofori MF, Paintsil V, Renner L, Nørgaard P, Hviid L. Reliable cell and tissue morphology-based diagnosis of endemic Burkitt lymphoma in resource-constrained settings in Ghana. BMC Cancer 2019; 19:1270. [PMID: 31888714 PMCID: PMC6937736 DOI: 10.1186/s12885-019-6488-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 12/20/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Endemic Burkitt lymphoma (eBL) is an aggressive B-cell lymphoma, which is a common childhood cancer in areas with intense transmission of Plasmodium falciparum parasites. Early and accurate diagnosis is a prerequisite for successful therapy, but it optimally involves advanced laboratory investigations. These are technologically demanding, expensive, and often difficult to implement in settings where eBL is prevalent. Diagnosis is thus generally based on clinical assessment and morphological examination of tumour biopsies or fine-needle aspirates (FNAs). METHODS The purpose of the present study was to assess the accuracy of eBL diagnosis at two tertiary hospitals in Ghana. To that end, we studied FNAs from 29 eBL patients and 21 non-eBL lymphoma patients originally diagnosed in 2018. In addition, we examined 111 archival formalin-fixed and paraffin-embedded (FFPE) biopsies from Ghanaian patients originally diagnosed as eBL (N = 55) or non-eBL (N = 56) between 2010 and 2017. Availability-based subsets of samples were subjected to haematoxylin-eosin or Giemsa staining, C-MYC immunohistochemistry, and fluorescence in situ hybridisation (FISH) analysis of c-myc rearrangements. RESULTS We found a good correlation between original diagnosis and subsequent retrospective assessment, particularly for FNA samples. However, evidence of intact c-myc genes and normal C-MYC expression in samples from some patients originally diagnosed as eBL indicates that morphological assessment alone can lead to eBL over-diagnosis in our study area. In addition, several FFPE samples could not be assessed retrospectively, due to poor sample quality. Therefore, the simpler FNA method of obtaining tumour material is preferable, particularly when careful processing of biopsy specimens cannot be guaranteed. CONCLUSION We conclude that the accuracy of eBL diagnostic tools available in Ghana is generally adequate, but could be improved by implementation of additional pathology laboratory investigations. Improved attention to adequate preservation of archival samples is recommended.
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Affiliation(s)
- Cecilia Smith-Togobo
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Ghana
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
- Centre for Medical Parasitology at Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mette Ø Pedersen
- Department of Pathology, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Steffen G Jensen
- Department of Pathology, Herlev and Gentofte Hospital, Herlev, Denmark
| | | | - Richard K Gyasi
- Department of Pathology, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Michael F Ofori
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Vivian Paintsil
- Department of Child Health, Komfo Anokye Hospital, Kumasi, Ghana
| | - Lorna Renner
- Department of Child Health, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Peter Nørgaard
- Department of Pathology, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Lars Hviid
- Centre for Medical Parasitology at Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark.
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28
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Munung NS, Nembaware V, de Vries J, Bukini D, Tluway F, Treadwell M, Sangeda RZ, Mazandu G, Jonas M, Paintsil V, Nnodu OE, Balandya E, Makani J, Wonkam A. Establishing a Multi-Country Sickle Cell Disease Registry in Africa: Ethical Considerations. Front Genet 2019; 10:943. [PMID: 31649726 PMCID: PMC6795756 DOI: 10.3389/fgene.2019.00943] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 07/01/2019] [Accepted: 09/05/2019] [Indexed: 12/03/2022] Open
Abstract
Sickle cell disease (SCD) is one of the most prevalent genetic conditions in sub-Saharan Africa. It is a chronic, lifelong disease often characterized by severe pain. However, SCD has received little investment terms of health research, though there is currently a growing pool of SCD data from health and research facilities in different countries. To facilitate research on SCD in Africa, the SickleInAfrica consortium has established a SickleInAfrica registry. The registry will store a systematic collection of longitudinal data from persons with SCD across sub-Saharan Africa, and currently, participants are being enrolled in Ghana, Nigeria, and Tanzania. In establishing this registry, the SickleInAfrica consortium decided to actively identify and anticipate possible ethical issues that may arise in the development and management of the registry. This was motivated, in part, by the near absence of well documented ethical issues for registry research in Africa, more-so for registries enrolling participants across multiple countries and for a genetic condition. The consortium aims to establish standards for the equitable use of data stored in the registry. This paper presents a comprehensive report on the ethical considerations that came up in setting up a genetic disease registry across multiple African countries and how they were addressed by the SickleInAfrica consortium. Major issues included: active involvement of patients in the initiation and management of the registry; questions of assent and re-consent; the importance of ensuring that fears of exploitation are not replicated in African–African research collaborations; and the importance of public engagement in the management of registries. Drawing on this experience, SickleInAfrica plans to set up an ethics helpdesk for genetic disease registries and research in Africa.
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Affiliation(s)
- Nchangwi Syntia Munung
- Department of Medicine, University of Cape Town, Cape Town, South Africa.,SickleInAfrica Data Coordinating Centre (SADaCC), University of Cape Town, Cape Town, South Africa
| | - Victoria Nembaware
- SickleInAfrica Data Coordinating Centre (SADaCC), University of Cape Town, Cape Town, South Africa.,Division of Human Genetics, University of Cape Town, Cape Town, South Africa
| | - Jantina de Vries
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Daima Bukini
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Furahini Tluway
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Marsha Treadwell
- Department of Hematology/Oncology, UCSF Benioff Children's Hospital Oakland, California, United States.,Department of Pediatrics, UCSF School of Medicine, California, United States
| | - Raphael Zozimus Sangeda
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.,Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gaston Mazandu
- SickleInAfrica Data Coordinating Centre (SADaCC), University of Cape Town, Cape Town, South Africa.,Division of Human Genetics, University of Cape Town, Cape Town, South Africa
| | - Mario Jonas
- SickleInAfrica Data Coordinating Centre (SADaCC), University of Cape Town, Cape Town, South Africa.,Division of Human Genetics, University of Cape Town, Cape Town, South Africa
| | - Vivian Paintsil
- Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Obiageli E Nnodu
- Center for Sickle Cell Disease Research and Training, University of Abuja, Abuja, Nigeria
| | - Emmanuel Balandya
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Julie Makani
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Ambroise Wonkam
- SickleInAfrica Data Coordinating Centre (SADaCC), University of Cape Town, Cape Town, South Africa.,Division of Human Genetics, University of Cape Town, Cape Town, South Africa
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Eden T, Burns E, Freccero P, Renner L, Paintsil V, Dolendo M, Scanlan T, Khaing AA, Pina M, Islam A, Chunda-Liyoka C, Kouya F, Molyneux E. Are essential medicines available, reliable and affordable in low-middle income countries? J Cancer Policy 2019. [DOI: 10.1016/j.jcpo.2018.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Israels T, Molyneux E, Pidini D, Chagaluka G, Nana P, Paintsil V, Renner L, Amankwah E, Hesseling P, Mbah G, Kouya F, Chitsikei I, Katsekera E. Data collection in the Collaborative Wilms Tumour Africa Project. Pediatric Hematology Oncology Journal 2018. [DOI: 10.1016/j.phoj.2018.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Israels T, Paintsil V, Nyirenda D, Kouya F, Mbah Afungchwi G, Hesseling P, Tump C, Kaspers G, Burns L, Singh Arora R, Chagaluka G, Nana P, Renner L, Molyneux E. Improved outcome at end of treatment in the collaborative Wilms tumour Africa project. Pediatr Blood Cancer 2018; 65:e26945. [PMID: 29350457 DOI: 10.1002/pbc.26945] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/05/2017] [Accepted: 12/03/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND The Collaborative Wilms Tumour (WT) Africa Project has implemented an adapted WT treatment guideline in sub-Saharan Africa as a multi-centre prospective clinical trial. A retrospective, baseline evaluation of end-of-treatment outcome was performed for a 2-year period prior to the introduction of this guideline. The collaborative project aims to reduce both treatment abandonment and death during treatment to less than 10% for improving survival. PROCEDURE All participating centres obtained local Institutional Research Board (IRB) approval and implemented the adapted WT treatment guideline. End-of-treatment outcome was documented for 2 years. It was divided into alive without evidence of disease, treatment abandonment, death during treatment and persistent disease. The outcome of children enroled in the first 2 years of the prospective clinical trial has been compared to the outcome before the start of the project. RESULTS One hundred twenty-two patients were included in the baseline evaluation (2011-2012) and 133 in the first 2 years of the collaborative clinical trial (2014-2015). The percentage of patients alive without evidence of disease at the end of treatment increased from 52% (63/122) to 68% (90/133; P = 0.01). Treatment abandonment decreased from 23% (28/122) to 13% (17/133; P = 0.03). Death during treatment decreased from 21% (26/122) to 13% (17/133; P = 0.07). CONCLUSION This collaboration, using relatively simple and low-cost interventions, led to a significant decrease in treatment abandonment and increase in survival without evidence of disease at the end of treatment.
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Affiliation(s)
- Trijn Israels
- Academy outreach and Department of solid tumours, Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands.,Department of Paediatrics, Amphia Hospital, Breda, The Netherlands
| | - Vivian Paintsil
- Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Dalida Nyirenda
- Department of Paediatrics, College of Medicine, Blantyre, Malawi
| | - Francine Kouya
- Department of Paediatric Oncology, Mbingo Baptist Hospital, Mbingo, Cameroon
| | | | - Peter Hesseling
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Clara Tump
- Department of Artificial Intelligence, University of Amsterdam, Amsterdam, The Netherlands
| | - Gertjan Kaspers
- Academy outreach and Department of solid tumours, Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands.,Department of Paediatric Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Liz Burns
- Head of Operations, World Child Cancer, London, United Kingdom
| | | | - George Chagaluka
- Department of Paediatrics, College of Medicine, Blantyre, Malawi
| | - Philippa Nana
- Department of Paediatric Oncology, Mbingo Baptist Hospital, Mbingo, Cameroon
| | - Lorna Renner
- Department of Child Health, University of Ghana School of Medicine and Dentistry, Accra, Ghana
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Kwarteng-Siaw M, Paintsil V, Toboh CK, Owusu-Ansah A, Green NS. Assessment of Transition Readiness in Adolescents with Sickle Cell Disease and their Caretakers, A single institution experience. ACTA ACUST UNITED AC 2017; 3:171-179. [PMID: 30035240 PMCID: PMC6054488 DOI: 10.17554/j.issn.2409-3548.2017.03.47] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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] [Indexed: 01/19/2023]
Abstract
AIM Sickle Cell Disease (SCD) is associated with high child mortality and birth incidence in sub-Saharan Africa. Improved SCD medical services in Ghana aims to enhance survival into adulthood, creating emerging need for transition from pediatric to adult care. Anticipating transition for adolescents with SCD, we sought to understand patient and caretaker perspectives on transition to adult care within Ghana. MATERIALS AND METHODS Structured interviews were conducted with a sample of patients ages 12–15 years and accompanying adults at Ghana’s Komfo Anokye Teaching Hospital Sickle Cell Clinic (KATH SCC) covering four areas: SCD medical knowledge, symptom self-management, psychosocial impact, and transition preparation. RESULTS In total, 46 children (mean age 13 years) paired with 46 adults were interviewed. Most children and caretakers had some knowledge about SCD and disease management. At least one-third lacked knowledge about SCD as an inherited condition. Youth were significantly more concerned about family burden and social stigmatization than adults. Most were unaware that patients are expected to switch care to adult medical providers by age 15 years, but were willing to transfer if needed. CONCLUSIONS Our clinic-based assessment at KATH SCC identified needs of adolescents and caretakers for education and counseling about disease, self-management, transition, family burden, and stigmatization. These findings provide insights into perspectives and educational gaps of families treated for SCD. Results suggest consideration of transition planning for adolescents with SCD and their caretakers in Ghana. Generalizability of our findings and practical methods to address needs for transition within Africa remain to be tested.
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Affiliation(s)
- Miriam Kwarteng-Siaw
- Department of Pediatrics, Columbia University Medical Center, New York, NY, the United States
| | - Vivian Paintsil
- Sickle Cell Clinic, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Amma Owusu-Ansah
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh School of Medicine; Center for Translational and International Hematology, Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA. the United States
| | - Nancy S Green
- Department of Pediatrics, Columbia University Medical Center, New York, NY, the United States
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Anie KA, Paintsil V, Owusu-Dabo E, Ansong D, Osei-Akoto A, Ohene-Frempong K, Amissah KA, Addofoh N, Ackah EB, Owusu-Ansah AT, Ofori-Acquah SF. Organ damage in sickle cell disease study (ORDISS): protocol for a longitudinal cohort study based in Ghana. BMJ Open 2017; 7:e016727. [PMID: 28851791 PMCID: PMC5629623 DOI: 10.1136/bmjopen-2017-016727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Sickle cell disease is highly prevalent in Africa with a significant public health burden. Nonetheless, morbidity and mortality in sickle cell disease that result from the progression of organ damage is not well understood. The Organ Damage in Sickle Cell Disease Study (ORDISS) is designed as a longitudinal cohort study to provide critical insight into cellular and molecular pathogenesis of chronic organ damage for the development of future innovative treatment. METHODS AND ANALYSIS ORDISS aims to recruit children aged 0-15 years who attend the Kumasi Centre for Sickle Cell Disease based at the Komfo Anokye Teaching Hospital in Kumasi, Ghana. Consent is obtained to collect blood and urine samples from the children during specified clinic visits and hospitalisations for acute events, to identify candidate and genetic markers of specific organ dysfunction and end-organ damage, over a 3 year period. In addition, data concerning clinical history and complications associated with sickle cell disease are collected. Samples are stored in biorepositories and analysed at the Kumasi Centre for Collaborative Research in Tropical Medicine, Ghana and the Centre for Translational and International Haematology, University of Pittsburgh, USA. Appropriate statistical analyses will be performed on the data acquired. ETHICS AND DISSEMINATION Research ethics approval was obtained at all participating sites. Results of the study will be submitted for publication in peer-reviewed journals, and the key findings presented at national and international conferences.
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Affiliation(s)
- Kofi A Anie
- Haematology and Sickle Cell Centre, London North West Healthcare NHS Trust, Central Middlesex Hospital, London, UK
- Faculty of Medicine, Imperial College London, London, UK
| | - Vivian Paintsil
- Directorate of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Ellis Owusu-Dabo
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Daniel Ansong
- Directorate of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Department of Child Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Alex Osei-Akoto
- Directorate of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Department of Child Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | - Nicholas Addofoh
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ezekiel Bonwin Ackah
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Amma Twumwa Owusu-Ansah
- Center for Translational and International Hematology, Heart, Lung, and Blood Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Solomon Fiifi Ofori-Acquah
- Center for Translational and International Hematology, Heart, Lung, and Blood Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
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Paintsil V, Owusu-Afriyie O, Nguah SB, Dogbe J, Osei-Tutu L, Osei-Akoto A. Hodgkins lymphoma: Clinicopathologic features in paediatric patients presenting at the Komfo Anokye Teaching Hospital-Kumasi. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e21007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Paintsil V, David H, Kambugu J, Renner L, Kouya F, Eden T, Hesseling P, Molyneux E, Israels T. The Collaborative Wilms Tumour Africa Project; baseline evaluation of Wilms tumour treatment and outcome in eight institutes in sub-Saharan Africa. Eur J Cancer 2014; 51:84-91. [PMID: 25465189 DOI: 10.1016/j.ejca.2014.10.030] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 10/28/2014] [Accepted: 10/30/2014] [Indexed: 01/22/2023]
Abstract
AIM Reported survival of Wilms tumour in sub-Saharan Africa is below 50%. A published International Society of Pediatric Oncology (SIOP) Pediatric Oncology in Developing Countries (PODC) consensus adapted treatment guideline is implemented as a multi-centre prospective clinical trial at eight centres in sub-Saharan Africa. A baseline evaluation has been done to help decide on priorities to improve outcome and to assess improvements over time. METHODS A retrospective chart review was performed of patients admitted with Wilms tumour in the three years (2011-2013) preceding the collaborative trial. Patient outcome at the end of treatment was documented for all patients diagnosed in 2011 and 2012. Outcome was classified as (1) alive, no evidence of disease; (2) alive with disease; (3) died during treatment and (4) incomplete treatment. Details on treatment facilities, staff and estimated cost of treatment are documented. RESULTS Every year 114-130 patients are diagnosed. The mean survival at end of treatment is 39% (69/176) ranging from 11% to 61%. Incomplete treatment is the most common cause of treatment failure with 31% (54/176), ranging from 14% to 48% between centres. Twenty-six percent (46/176) of patients died during treatment, ranging from 13% to 37%. Estimated cost of treatment for parents ranged from 100 US$ to 1100 US$ and was considered an important cause of failure to complete treatment. CONCLUSION Overall two year survival is estimated at 25%. Prevention of incomplete treatment is possible and will positively affect outcome. Sharing similar local challenges in this regional collaborative project helps to identify and implement feasible, sustainable and successful strategies.
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Affiliation(s)
- Vivian Paintsil
- Dept of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Haileyesus David
- Dept of Paediatric Oncology, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
| | - Joyce Kambugu
- Dept of Paeds Oncology, Uganda Cancer Institute, Kampala, Uganda
| | - Lorna Renner
- Dept of Child Health, University of Ghana Medical School, Accra, Ghana
| | - Francine Kouya
- Dept of Paediatric Oncology, Mbingo Baptist Hospital, Cameroon
| | - Tim Eden
- Acad Unit of Paediatric and Adolescent Oncology, University of Manchester, UK
| | - Peter Hesseling
- Dept of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | | | - Trijn Israels
- Dept of Paediatric Oncology, VU University Medical Center, Amsterdam, The Netherlands; Co-chair International Society of Pediatric Oncology (SIOP) Pediatric Oncology in Developing Countries (PODC).
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