The need for a national cancer policy in Malawi

Cancer is causing a lot of suffering and death in Africa but is not considered a major health problem in Africa. This needs to change. Cancer should be given equal emphasis to HIV/AIDS, tuberculosis (TB) and Malaria. A national cancer policy is required in Malawi to develop and improve evidence-based cancer prevention, early diagnosis, curative and palliative therapy. A national cancer policy is crucial to ensure a priotised, clear, coordinated and sustained fight against cancer. When no policy exists, events are likely to be random, stakeholders and practitioners in the fight against cancer may not agree on how to proceed, may duplicate efforts or may neglect areas that would have greater nationwide impact resulting in poor quality activities and haphazard development.Malawi Medical Journal Vol. 20 (4) 2008: pp. 124-12

Oesophageal cancer and Kaposi’s Sarcoma in Malawi: a comparative analysis

Given that oesophageal cancer (OC) is common in Malawi and its outcome is so dismal, would it be pragmatic to promptly mitigate the effects of smoking, alcohol and aflatoxins rather than seek a higher degree of local evidencefor their role in OC? We retrospectively analysed a total of 13,217 OC andKaposi’s sarcoma (KS) cases as recorded in the Malawi National Cancer Registry from 1985 to February, 2006. We found no OC clustering to suggest a role for culturally variable habits like smoking, alcohol, maize use and maize storage in the country. It may be that drinking and eating hotfoods physically damages the oesophageal mucosa, this is in line with work recently reported from Asia. We also found that OC numbers have risen in line with KS (and HIV) suggesting a link between these conditions

Sonographic correlation of thyroid nodules with ultrasound aided fine needle non aspiration cytology

Objectives: To describe the sonographic patterns of thyroid nodules in patients undergoing thyroid ultrasound, to correlate sonographic characteristics of thyroid nodules to ultrasound aided fine needle non aspiration(US-FNNA) cytology and to determine the sensitivity and specificity of Ultrasound in characterising thyroid nodules.Design: Cross sectional study.Setting: The department of Radiology at Mulago Teaching and National Referral Hospital in Kampala Uganda. The Hospital is a 1,500-bed unit providing tertiary diagnostic, curative, rehabilitative, preventive and teaching services. Patients were recruited from both Medical and Surgical outpatient thyroid clinics.Subjects: All patients with thyroid nodules > 5 mm and who consented to have US aided-FNNA were enrolled consecutively.Results: One hundred and eighty one (181) participants were enrolled and final diagnoses were concluded in 177 of the participants (analysed) while four participants were excluded due to inadequate samples. The participants' age range was 19 to 83 years (mean age - 42 years ) and 93% were females. Five percent (n=9) were malignant, 18% suspiscious (n=34) and benign (n=134). The sonographic characteristics that were significantly correlated with final cytology diagnosis were a taller than wide AP diameter, micro-calcifications, heterogeneous and hypoechoic echo-patterns. Heterogeneous, hypoechoic and central vascularity had the highest sensitivity while wider than tall, anteroposterior diameter, no lymphadenopathy, and macro/no calcifications had the highest specificity.Conclusion: Sonographic features of micro-calcifications, taller than wide AP diameter, central vascularity and hypoechogenicity warrant US-FNNA. A bigger study correlating thyroid sonography with histological diagnosis is recommended

Regularity of laboratory supplies and delivery of histopathology services in the department of Pathology, Makerere University College of Health Sciences, Uganda, between January 2002 and April 2003

A retrospective study was undertaken in the department of Pathology, Makerere University College of Health Sciences and Mulago Hospital, Uganda, between January 2002 and April 2003 to determine the regularity of laboratory supplies and delivery of histopathology services. The requisition forms and dates of final reporting were obtained from department of Pathology records. The information on delivery of supplies was retrieved from Mulago hospital stores. Formalin (450 L) and isopropyl (2,505 L) were requisitioned, but only 145 L (32.2%) and 70 L (2.8%) respectively were received. Xylene 5L (11.1%) were issued out of 45 L requisitioned. Paraffin wax (900 Kg) was ordered and 200 Kg (22.2%) were supplied. Hematoxylin (850 gms) and silver nitrate (3,700 g) were ordered and none of each was issued. Eosin (100 gms) was supplied out of 200 g requisitioned. Microscope slides (721 packets) and cover slips (520 packets) were requisitioned, only 127 packets (17.6 %) and 90 packets (17.3 %) respectively were supplied. Surgical blades (2,836) were requisitioned and 760 (26.8 %) were given. No detergents and disinfectants were supplied. On average, it took 5 days to get supplies. Turnaround time of making diagnosis was 9 days. Approximately 52 specimens were either lost or misplaced out of 6,700 samples processed during this period. The amount of supplies received was far much lower than the amount requested. Give the high turnaround time in the histopathology service, a computerized laboratory logistics and inventory management systems (LMIS) should be established at the health settings in the country in order to ensure continuous availability of laboratory supplies and improve the turnaround time in laboratory services.KEY WORDS: Laboratory; Supplies; Histopathology; Service

Determination of LDL-cholesterol: direct measurement by homogeneous assay versus Friedewald calculation among Makerere University undergraduate fasting students

The treatment of patients for coronary heart disease risk requires knowledge of the plasma lipid levels. Low density lipoprotein cholesterol (LDL) levels make a strong basis for therapeutic decisions. Although there are incongruities among values of LDL from different methods of determining LDL, the clinician is not routinely informed of the method used. The purpose of this study was to compare LDL levels determined by the Friedewald equation with those assayed by the Kyowa Madox method. The lipid results previously measured by Kyowa Madox method among Makerere University fasting students and reported earlier wereretrieved. The measured values of total cholesterol (TC), High Density Lipoprotein cholesterol (HDL) and triacylglycerols (TG) were used to calculate LDL using Friedewald equation in which LDL= TC-HDL-TG/2.2mmol/L. The values obtained were compared non parametrically with the assayed values previously reported. Our results showed a high value of correlation between measured and calculated LDL so that in general, the two methods can be used interchangeably in this population. However, in cases of dyslipidaemia, the calculated values tend to be lower than the assayed values. It is therefore recommended that clinical laboratories should report the LDL values along with the determination method used, the alert values, the reference ranges, the desirable ranges and the therapeutic targets. © 2010 International Formulae Group. All rights reserved.Keywords: Homogeneous assay, LDL cholesterol, direct measurement, Friedewald equation, comparison

Effect of organic and inorganic phosphorus sources on maize yields in an acid soil in western Kenya

Maize production in western Kenya is commonly limited by P deficiencies and aluminum phytotoxicity. Due to high costs of imported fertilizers and lime, focus is now shifting to solutions that utilize local resources. We tested the effect of three inorganic P sources i.e., triple superphosphate (TSP), Minjingu phosphate rock (MPR) and Busumbu phosphate rock (BPR), each applied in combination with two organic materials (OMs) i.e., farmyard manure (FYM) and Tithonia diversifolia green manure (tithonia), or with urea on soil chemical properties related to soil acidity, P availability and maize yields for three consecutive seasons in western Kenya. The OMs and inorganic P sources were applied to provide 20 and 40 kg P ha-1 respectively in their combination. Where urea was used, the inorganic P sources were applied at 60 kg P ha-1. Maize did not respond to application of TSP, MPR or BPR with urea in the first two seasons. However, after three seasons, maize significantly responded to application of MPR with urea. FYM was more effective than tithonia in increasing the labile inorganic P pools but it gave lower maize yields than tithonia which was more effective in reducing the exchangeable Al. It appears that the ability of an OM to lower the exchangeable Al is more important inincreasing maize yields than its ability to increase P availability. The effectiveness of the inorganic P sources in increasing maize yields followed the order of their effectiveness in increasing available P, i.e., TSP[MPR [BPR, once Al phytotoxicity was reduced by application of tithonia but the difference between TSP and MPR was not significant. The extra maize yield obtained by the additional 40 kg P ha-1 from the inorganic P sources was, however, in most cases not substantial enough to justify their use. Economic considerations may therefore favour the use of tithonia or FYM when applied alone at 20 kg P ha-1 than when combined with any of the inorganic P sources used in this study at a total P rate of 60 kg ha-1

Phosphorus Sorption and Lime Requirements of Maize Growing Acid Soils of Kenya

In Kenya, maize (Zea mays L.) is mainly grown on acid soils in high rainfall areas. These soils are known for low available phosphorus (P), partly due to its sorption by aluminium (Al) and iron oxides. The study determined soil P sorption, lime requirements and the effects of lime on soil pH, Al levels and available P on the main maize growing acids soils in the highlands east and west of Rift Valley (RV), Kenya. Burnt lime containing 21% calcium oxide was used. The soils were strongly to extremely acid (pH 4.85-4.07), had high exchangeable Al3+ (> 2 cmol Al kg-1) and Al saturation (> 20% Al), which most maize germplasm grown in Kenya are sensitive to. The base cations, cation exchange capacity and available P (< 10 mg P kg-1 bicarbonate extractable P) were low, except at one site in the highlands east of RV indicative with history of high fertilizer applications. Highlands east of RV soils had higher P sorption (343-402 mg P kg-1) than the west (107-258 mg P kg-1), probably because of their high Al3+ ions and also the energies of bonding between the soil colloids and phosphate ions. Highlands east of RV also had higher lime requirements (11.4-21.9 tons lime ha-1) than the west (5.3-9.8 tons lime ha-1). Due to differences in soil acidity, Al levels and P sorption capacities within and between highlands east and west of RV, blanket P fertilizer and lime recommendations may not serve all soils equally well. Keywords: acid soils, phosphorus sorption, lime requirement

Effects of lime, phosphorus and rhizobia on Sesbania sesban performance in a Western Kenyan acid soil

Aluminium (Al) toxicity, phosphorus (P) deficiency and low rhizobia populations limit Sesbania (Sesbania sesban) performance in tropical acid soils. The study determined the i) indigenous rhizobia populations that nodulate sesbania and ii) effects of lime (0 and 4 t/ha), P-fertilizer (0 and 60 kg/ha) and acid tolerant rhizobia (0 and inoculation) on soil and selected sesbania accessions performance in Western Kenya acid soil. Study site had acid soil, low available P, nitrogen (N) and rhizobia populations that nodulate Sesbania (146 cells/g soil). Lime increased soil pH, while both lime and P-fertilizer increased available P. Aluminium toxicity tolerant and P-efficient accessions (SSBSA004, SSUG3, SSUG4 and SSUG5) had faster growth, higher nodulation, shoot P, and shoot N and response to treatments than the sensitive one (SSBSA203). After 7 months of growth, SSUG3 had highest shoot length (306 cm) and dry matter (5.64 tons/ha), hence, most suitable for building poles and fuel wood. SSUG5 accumulated the highest shoot N (222 kg N/ha) and was therefore, most suitable soil N replenishment. Thus, in acid P deficient and low rhizobial population soils of Western Kenya, the use of lime, P-fertilizer, rhizobia inoculation and Al toxicity tolerant Sesbania are important for Sesbania establishment and growth. Key words: Rhizobia, Sesbania, soil acidity, aluminum toxicity, lime, phosphorus