Paediatric cancers at Butare University Teaching Hospital in Rwanda

Background: Cancer is an important cause of mortality in many of the economically developed nations of the world. More than 10% of all deaths in children below 15 years of age are caused by malignant diseases in developed countries. In the developing world, childhood cancers are yet to be recognized as a major pediatric illness due to several other competing causes of death like diarrheal illness and respiratory illness.Methods: A descriptive retrospective study of children admitted for cancer in Butare Teaching Hospital over a 7 years period (January 1999-December 2005) was carried out The study population included 36 children aged 0-15 years admitted with cancer at Butare university teaching Hospital. Data was analyzed using Epi data, SPSS11,5 computer programs.Results: The average age of our patients was 5.9 years with the youngest patient being 5 month old. The peak incidence of cancer was found in the 0-5 years age group and accounted for 21 patients (58, 3%). The Male to Female sex ratio was 1.7: 1. The most common types of cancer were: Burkett’s lymphoma, Non-Hodgkin Lymphoma and Hodgkin’s Lymphoma. Treatment included surgery for 17 patients(47.2%), chemotherapy for 4 patients (11.1%), surgery combined with post-operative chemotherapy for 1 patient (2.7%), the association of pre-operative chemotherapy + surgery + post-operative chemotherapy for 1 patient (2.7%) and palliative care for 13 patients (36.1%). The average length of hospital stay was 36.6 days ranging from 2 to 510 days. The hospital mortality rate was 27.7%.Recommendation: The creation of an oncology department and a National cancer Register are recommended

Perceived barriers to management of chronic kidney disease

INTRODUCTION: The number of patients with chronic kidney disease (CKD) is gradually increasing in developing countries such as Rwanda. Barriers to the management of CKD from nurses' perspectives is not an area that has been well explored. This study aimed to assess the perceived barriers to CKD management from the perspective of nurses working at the referral hospitals in Rwanda.METHODS: The study used a cross-sectional research design. The study setting was selected referral hospitals in Kigali. A convenience sample of 55 nurses was obtained and data was collected using a self-administered questionnaire. Analyses were done using descriptive and inferential statistics in the SPSS application.RESULTS: Respondents identified the most barriers to management of CKD as: limited knowledge of CKD (96%) and its risk factor of glomerulonephritis (93%), limited information of dialysis (98%) and fluid restriction (95%) treatment as well as a lack of further training on nephrology nursing (93%). Shortage of nephrologists and nurses (98%) and a multidisciplinary care team (95%) were resource barriers. Other barriers were limited knowledge of CKD risk factors: hypertension (78%) and HIV/AIDS (80%), limited in-service training (69%), and non-adherence (86%). The experience of respondents was associated with limited knowledge of CKD risk factors: hypertension (P =0.001), diabetes (P=0.001) and HIV/AIDS (P=0.040). The level of nursing obtained by the respondents was associated with a lack of further special training (p=0. 001), limited in-service training (P=0.028) and non-adherence of CKD patients (P=0.017).CONCLUSION: Barriers to CKD management in Rwanda are evident. There is a need for in-service training for nurses in order to improve the proper treatment of the CKD population.&nbsp

Pattern and clinical management of penile cancer in Rwanda

Introduction: Penile cancer is rare in developed countries but has a high prevalence in some developing countries. Surgery includes inguinal lymphadenectomy, which remains the mainstay treatment of the disease.Objective: This study reports on the epidemiological profile of penile cancer and clinical management options in Rwanda. Patients and methods: From January 2015 to June 2016, a multicenter cross-sectional, prospective cohort study was conducted involving all male patients presenting with penile cancer after two national radio campaigns and a Ministry of Health instruction to all district hospitals. All patients with positive biopsy were included. Surgical treatment aligned with published guidelines. Clinical characteristics, surgery, pathology, and early follow-up data were collected.Results: Over 18 consecutive months, 30 male patients were enrolled. The mean age was 60 years [range 33–83]. All patients were uncircumcised before symptom onset; 50% had phimosis and 20% were HIV- positive. The estimated prevalence of penile cancer in Rwanda was 0.37 per 100,000 men. At presentation, 96.7% of patients had a T2-4 disease and 43.3% were with clinically non-palpable inguinal lymph nodes (cNO). After penectomy, bilateral inguinal lymphadenectomy was performed in 10 (33.3%) patients (modified and radical in 16 and 4 limbs, respectively). Complications included surgical site infection (10%), lymphocele (10%), urethral meatus stenosis (6.7%), skin necrosis (3.3%) and two (6.7%) patients with metastatic disease died in hospital.Conclusion: Penile cancer is a rare but significant disease in Rwanda. Patients present with advanced disease. After treatment of the primary tumor, modified inguinal lymphadenectomy appears to be a safe method of cure and staging for patients with clinically impalpable inguinal lymph nodes. Our early results provide a compelling insight into this rare but serious disease

A minimum estimate for the incidence of gastric cancer in Eastern Kenya

We documented available information concerning incident cases of gastric cancer in part of Kenya's Eastern Province between 1991 and 1993. By reviewing the records of all major health facilities in the area, 200 cases of gastric carcinoma were found giving an annual average crude incidence rate of 7.01 per 100 000 males and 3.7 for females (world age-standardised rates, 14.3 for males and 7.1 for females). There is likely to be underascertainment of cases especially among those aged over 65 years. Previous incidence estimates for the same area of Kenya were reviewed and a 10-fold increase in the recorded indirectly standardised incidence rate between the periods 1965–70 and 1991–93 was noted but this may be due to improved diagnostic facilities. The recent rates in this part of Kenya are comparable to Eastern European rates and similar to those recorded in other highland regions of Africa. © 2001 Cancer Research Campaig

Paediatric Cancers at Butare University Teaching Hospital in Rwanda.

Background: Cancer is an important cause of mortality in many of the economically developed nations of the world. More than 10% of all deaths in children below 15 years of age are caused by malignant diseases in developed countries. In the developing world, childhood cancers are yet to be recognized as a major pediatric illness due to several other competing causes of death like diarrheal illness and respiratory illness. Methods: A descriptive retrospective study of children admitted for cancer in Butare Teaching Hospital over a 7 years period (January 1999-December 2005) was carried out The study population included 36 children aged 0-15 years admitted with cancer at Butare university teaching Hospital. Data was analyzed using Epi data, SPSS11,5 computer programs. Results: The average age of our patients was 5.9 years with the youngest patient being 5 month old. The peak incidence of cancer was found in the 0-5 years age group and accounted for 21 patients (58, 3%). The Male to Female sex ratio was 1.7: 1. The most common types of cancer were: Burkett’s lymphoma, Non-Hodgkin Lymphoma and Hodgkin’s Lymphoma. Treatment included surgery for 17 patients(47.2%), chemotherapy for 4 patients (11.1%), surgery combined with post-operative chemotherapy for 1 patient (2.7%), the association of pre-operative chemotherapy + surgery + post-operative chemotherapy for 1 patient (2.7%) and palliative care for 13 patients (36.1%). The average length of hospital stay was 36.6 days ranging from 2 to 510 days.The hospital mortality rate was 27.7%. Recommendation: The creation of an oncology department and a National cancer Register are recommended

Syndrome de Sweet vésiculo-bulleux

Un homme de 74 ans souffrant d’une myélodysplasie de type anémie réfractaire avec excès de blastes suivait un traite-ment par azacitidine depuis 2 semaines à raison de deux injections abdominales sous-cutanées par jour. Il développait deux zones érythémateuses indurées centrées sur les sites d’injections avec une douleur importante, associées à une altération de son état général, avec fièvre et fris-sons qui n’étaient pas été améliorées lors de l’arrêt des injections d’azacitidine et d’un traitement antibiotique. Le patient avait une induration importante de toute la paroi abdominal