Doctoral Degrees (Paediatrics and Child Health)

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Browsing Doctoral Degrees (Paediatrics and Child Health) by browse.metadata.advisor "Hesseling, Peter Bernard"

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    Improving early diagnosis and referrals to life-saving care for children with cancer in Cameroon
    (Stellenbosch : Stellenbosch University, 2021-03) Afungchwi, Glenn Mbah; Kruger, Mariana; Hesseling, Peter Bernard; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.
    ENGLISH ABSTRACT: Childhood cancer is curable, but survival rates in low- and middle-income countries (LMICs), especially sub-Saharan Africa, are generally low. In 2018, the International Society of Paediatric Oncology (SIOP) and the World Health Organization (WHO) launched an initiative to improve childhood cancer survival to 60% by 2030 globally. As the majority of children with cancer live in LMICs, the emphasis should be on initiatives to improve survival in these countries. This PhD dissertation has investigated the incidence of childhood cancer in Northwest Cameroon, how to improve early diagnosis of children with cancer and the role of socioeconomic support of families with a child with cancer in Cameroon. Chapter 2 of this dissertation is a literature review, documenting the management of childhood cancer in Africa for the period 2014 to 2018. As part of a twinning programme between Stellenbosch University and the Cameroon Baptist Convention Health Services established in 2003, a hospital-based childhood cancer registry was prospectively analysed to determine the childhood cancer burden in Northwest Cameroon between 2004 and 2015 and is reported on in Chapter 3. Burkitt lymphoma was the most common diagnosis, followed by nephroblastoma and retinoblastoma, but Burkitt lymphoma diagnosis has decreased over time, probably due to the improvement in diagnosis of other childhood cancers. The registry data is useful to plan improved clinical services and may assist in future with the development of a population-based childhood cancer registry in Cameroon. To improve early diagnosis and referral of children with suspected cancers, a nurse-led training programme was conducted in six health districts of Northwest Cameroon with the support of the Sanofi Espoir Foundation’s My Child Matters programme. This low-cost training programme improved knowledge essential for early recognition of childhood cancer signs and could be replicated in other low-income settings for improved early diagnosis of childhood cancer (Chapter 4). The next step was to investigate the destitution level through a survey of families with children with Burkitt lymphoma and the association with adherence to treatment. Destitution level (measured by socioeconomic circumstances) did not affect adherence to treatment or follow-up for these children, probably due to the charity-driven financial support with regard to accommodation, food parcels and transport funding. However, survival rate was lower for children in single-mother households, which indicated the need for a more individualised model of support-based care for such single-parent families (Chapter 5).As traditional and complementary medicine (T&CM) use was common in Cameroon, further investigation was carried out to determine the use first in families with children with Burkitt lymphoma and thereafter in families with children across the spectrum of cancer. The initial study was done by the health care team with potential nondisclosure bias but found significant use of T&CM (Chapter 6a). The follow-up study therefore involved interviewers not part of the health care team to minimise nondisclosure bias. The majority of families of children with cancer had used (T&CM) before diagnosis while only a quarter of families had used T&CM after diagnosis (Chapter 6b). The use of T&CM resulted in worsening cancer symptoms and was financially costly to families. Half of the parents/guardians were not willing to disclose the use of T&CM to their treating health care team. A final step was to examine the development of paediatric oncology services in Cameroon over the last 20 years. Treatment programmes were developed largely with the help of international twinning programmes and support from charities as there was no financial support from the state (Chapter 7). Over the period, childhood cancer survival improved and staff capacity for the management of childhood cancer was established.This dissertation has provided local evidence of successful management of childhood cancer in Cameroon with suggestions regarding feasible actions necessary to achieve 60% childhood cancer survival by 2030 in line with the WHO-SIOP initiative.