Early Detection of Paediatric Cancer: Equipping Primary Health‑Care Workers in Nigeria

Background: Paediatric cancer patients in Nigeria continue to arrive at specialist centers with advanced‑stage disease. The reasons for this are myriad, not least of which are delays in detection, diagnosis, and referral for treatment. While delayed presentation has often been reported from the perspective of delays from caregivers’ decisions, institutional deficiencies in the health care system may account for an unmeasured portion of the factors leading to delayed presentation. This project centered around training of health‑care professionals at community level to detect potential paediatric cancer signs and refer appropriately. Aim: The aim of the study is to access the immediate impact of training on early detection and referral of possible paediatric cancer cases in the community and primary level health care workers and professionals in the Southwest Nigeria. Materials and Methods: This was a retrospective review of the training impact in three South‑Western states in Nigeria. Scores before and after the training were analyzed using the IBM SPSS statistics, version 23 (IBM, Armonk, NY, USA). Results: A total of 732 primary health care workers were trained. In the pre assessment evaluations, 44.8% of participants reported that cancer did not occur in children, 47.2% did not know any referral pathway for a child suspected of cancer. The post training assessment indicated an improvement in participants’ understanding of common paediatric cancers types and how to refer a suspected case for specialist diagnosis and attention. Mean scores before and after the training were 3.5/15 and 12.5/15, respectively. Conclusion: Training health-care professionals working at the community level can have an immediate and measurable impact on early detection and referral for paediatric cancers, as seen by the difference in pre training and post training assessment scores. There remains a need for continuous training to ensure early referral and ultimately increase survival indices of children diagnosed with cancer in Nigeria

Dosimetric effect of the gantry rotations of a novel trunk phantom using an area integration algorithm

Background: Treatment planning systems (TPSs) have proved to be a useful tool in predetermining how a treatment outcome will be in radiotherapy. The accuracy of any TPS to calculate dose to any arbitrary point within a material is largely dependent on the mathematical algorithm used. Aims: The purpose of this study was to design a local trunk phantom and use the phantom to check the percentage dose accuracy of the Area Integration Algorithm of a Precise PLAN 2.16 TPS if it is in agreement with results obtained from manufacturer's verification by varying the gantry angle and whether it is within ± 5% International Commission on Radiation Units and Measurements (ICRU) minimal limit. Materials and Methods: The study was executed with a locally designed phantom made of Plexiglas with six insert and an ionization chamber port. The phantom was simulated using a HiSpeed NX/i computed tomography scanner and Precise PLAN 2.16 TPS for application of beam setup parameters. The mimicked organs for the inserts were: 25%–75% Glycerol-Water for liver, pure carboxyl methyl cellulose was used for lungs, 30%–70% Glycerol-Water for muscle, 40%–60% Glycerol-Water was used for adipose, pure Sodium hypochlorite was used for bone and pure sodium laureth sulfate (Texapon) for kidney. Results: The maximum percentage (%) deviation with a large field for six inhomogeneous inserts and with bone only homogeneous inserts were 3.4% and 2.9%, respectively. The maximum % deviation with a small field for six inhomogeneous inserts was 3.2%. The % deviation between the solid water phantom and the locally designed phantom was 3.5%. Conclusion: The Area Integration Algorithm has shown an overall accuracy of 4% below 5% ICRU minimal limit. There was no statistically significant difference in field sizes and in inhomogeneity/homogeneity, respectively. Variation exists in % deviation for small field size with parallel opposed field between our verification and the manufacturers