Improving early diagnosis and referrals to life-saving care for children with cancer in Cameroon
| dc.contributor.advisor | Kruger, Mariana | en_ZA |
| dc.contributor.advisor | Hesseling, Peter Bernard | en_ZA |
| dc.contributor.author | Afungchwi, Glenn Mbah | en_ZA |
| dc.contributor.other | Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health. | en_ZA |
| dc.date.accessioned | 2021-02-27T08:28:56Z | |
| dc.date.accessioned | 2021-04-21T14:30:10Z | |
| dc.date.available | 2021-02-27T08:28:56Z | |
| dc.date.available | 2021-04-21T14:30:10Z | |
| dc.date.issued | 2021-03 | |
| dc.description | Thesis (PhD)--Stellenbosch University, 2021. | en_ZA |
| dc.description.abstract | 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. | en_ZA |
| dc.description.abstract | AFRIKAANSE OPSOMMING: Kinderkanker is geneesbaar, maar oorlewingsyfers in lande met lae en middelinkomste (LLMI’s), veral Afrika Suid van die Sahara, is oor die algemeen laag. In 2018 het die Internasionale Vereniging vir Kinderonkologie (SIOP) en die Wêreldgesondheidsorganisasie (WGO) ’n inisiatief van stapel gestuur om die oorlewingskoers van kinderkanker teen 2030 wêreldwyd tot 60% te verbeter. Aangesien die meerderheid kinders met kanker in LLMI’s woon, moet die klem val op inisiatiewe om oorlewing in dié lande te verbeter. Hierdie PhD-proefskrif ondersoek die voorkoms van kinderkanker in die Noordwes-Kameroen; hoe om vroeë diagnose van kinders met kanker te verbeter; en die rol van sosio-ekonomiese steun aan gesinne met ’n kind met kanker in die Kameroen. Hoofstuk 2 van die proefskrif gee ’n literatuuroorsig, wat die bestuur van kinderkanker in Afrika vir die tydperk 2014 tot 2018 dokumenteer. As deel van ’n tweelingprogram tussen die Universiteit Stellenbosch en die Kameroen “Baptist Convention Health Services” wat in 2003 gevestig is, is ’n hospitaalgebaseerde kinderkankerregister prospektief ontleed om die kinderkankerlas in die Noordwes-Kameroen tussen 2004 en 2015 te bepaal, en daar word in hoofstuk 3 hieroor berig. Burkitt-limfoom was die algemeenste diagnose, gevolg deur nefroblastoom en retinoblastoom, ofskoon Burkitt-limfoomdiagnoses mettertyd afgeneem het, waarskynlik vanweë die verbetering in die diagnose van ander kinderkankers. Die registerdata is nuttig vir die beplanning van verbeterde kliniese dienste en kan in die toekoms behulpsaam wees met die ontwikkeling van ’n bevolkingsgebaseerde kinderkankerregister in die Kameroen. Om die vroeë diagnose en verwysing van kinders met vermoedelike gevalle van kanker te verbeter, is ’n verpleegster-geleide opleidingsprogram in ses gesondheidsdistrikte van die Noordwes-Kameroen met die ondersteuning van die Sanofi Espoir-stigting se “My Child Matters”-program uitgevoer. Hierdie laekoste-opleidingsprogram het die kennis wat noodsaaklik is vir die vroeë herkenning van tekens van kinderkanker verbeter, terwyl dit in ander laeinkomste-omgewings vir ’n verbeterde vroeë diagnose van kinderkanker herhaal kan word (Hoofstuk 4). Die volgende stap was om die armoedevlak te ondersoek aan die hand van ’n opname onder gesinne met kinders met Burkitt-limfoom, asook die verband met betrekking tot die nakoming van die behandeling. Die armoedevlak (gemeet aan sosio-ekonomiese omstandighede) het nie die nakoming van behandeling of opvolging met hierdie kinders beïnvloed nie, waarskynlik weens die liefdadigheidsgedrewe finansiële steun met betrekking tot verblyf, kospakkies en vervoerbefondsing. Die oorlewingsyfer was egter laer vir kinders in enkelma-huishoudings, wat aandui dat ’n meer geïndividualiseerde model van steungebaseerde sorg vir sodanige enkelouergesinne nodig is (Hoofstuk 5). Aangesien die gebruik van tradisionele en komplementêre medisyne (T&CM) algemeen in Kameroen is, is verdere ondersoek gedoen om die gebruik eerstens in gesinne met kinders met Burkitt-limfoom te bepaal en daarna in gesinne met kinders oor die hele kankerspektrum heen. Die aanvanklike studie is deur die gesondheidsorgspan met potensiële vooreerdeel ten opsigte van nie-openbaarmaking gedoen, maar beduidende gebruik van T&CM (Hoofstuk 6a) is gevind. Die opvolgstudie het gevolglik onderhoudvoerders betrek wat nie deel van die gesondheidsorgspan was nie, ten einde die vooroordeel ten opsigte van nie-openbaarmaking te verminder. Die meerderheid gesinne met kinders met kanker het T&CM voor diagnose gebruik, terwyl slegs ’n kwart van die gesinne T&CM ná diagnose gebruik het (Hoofstuk 6b). Die gebruik van T&CM het verslegtende kankersimptome tot gevolg gehad en was finansieel duur vir gesinne. Die helfte van die ouers/voogde was nie bereid om die gebruik van T&CM aan hul behandelende gesondheidsorgspan openbaar te maak nie. ’n Laaste stap was om die ontwikkeling van kinderonkologiedienste in die Kameroen oor die afgelope 20 jaar te ondersoek. Behandelingsprogramme is grotendeels met behulp van internasionale tweelingprogramme en die ondersteuning van liefdadigheidsorganisasies ontwikkel, aangesien daar geen finansiële steun van die staat was nie (Hoofstuk 7). Oor die tydperk het die oorlewing van kinderkanker verbeter en is die personeelkapasiteit vir die bestuur van kinderkanker bepaal.Hierdie proefskrif het plaaslik bewys gelewer van die suksesvolle bestuur van kinderkanker in die Kameroen met voorstelle oor uitvoerbare aksies wat nodig is om ’n 60%-kinderkankeroorlewingskoers in ooreenstemming met die WGO-SIOP-inisiatief in 2030 te behaal. | af_ZA |
| dc.description.version | Doctoral | en_ZA |
| dc.format.extent | 283 pages | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/10019.1/109881 | |
| dc.language.iso | en_ZA | en_ZA |
| dc.publisher | Stellenbosch : Stellenbosch University | en_ZA |
| dc.rights.holder | Stellenbosch University | en_ZA |
| dc.subject | Medical referral | en_ZA |
| dc.subject | Life-saving care | en_ZA |
| dc.subject | Cancer in children | en_ZA |
| dc.subject | Cancer -- Diagnosis | en_ZA |
| dc.subject | Cameroon | en_ZA |
| dc.subject | UCTD | en_ZA |
| dc.title | Improving early diagnosis and referrals to life-saving care for children with cancer in Cameroon | en_ZA |
| dc.type | Thesis | en_ZA |