Treatment delays in children and young adults with lymphoma: report from an East Africa Lymphoma Cohort Study

Background: Affordable treatments for lymphoma from the WHO's essential medicine list are available in low-income settings. However, precise diagnosis is often lacking and prolonged time to diagnosis and treatment results in poor treatment outcomes. So far, a detailed analysis of the root causes of the treatment delay is lacking. Methods: This prospective cohort study was conducted at three tertiary cancer hospitals in Tanzania and one cancer centre, St. Mary's Hospital-Lacor Hospital, in Northern Uganda. The study included patients with a confirmed diagnosis of lymphoma. The primary outcome was the median total treatment delay and its components. Total treatment delay was defined as the time taken from the onset of symptoms to receiving definitive cancer treatment. Results: The median age of patients was 12 years (IQR 9-18), and 100 (68%) were males. The median Total Treatment Delay for the entire cohort was 124 days (95% CI 107 - 136). Not started treatment probability for the entire cohort was 64% (95% CI 56-72) at 90 days and 30% (24 - 39) at 180 days. The median Total Treatment Delay for Burkitt lymphoma was 91 days (95% CI 80 - 115), while for DLBCL and Hodgkin lymphoma, it was 114 days (95% CI 84 - 148) and 232 days (95% CI 179 - 305), respectively. Conclusion: Significant treatment delay for lymphoma patients emanates from healthcare system-related factors. Due to delays in referrals from primary care and lack of capacity of pathology in secondary care, initial treatment decisions are still often based on clinical suspicion and urgency

Mortality in Sickle Cell Anemia in Africa: A Prospective Cohort Study in Tanzania

Background: The World Health Organization has declared Sickle Cell Anemia (SCA) a public health priority. There are 300,000 births/year, over 75% in Africa, with estimates suggesting that 6 million Africans will be living with SCA if average survival reaches half the African norm. Countries such as United States of America and United Kingdom have reduced SCA mortality from 3 to 0.13 per 100 person years of observation (PYO), with interventions such as newborn screening, prevention of infections and comprehensive care, but implementation of interventions in African countries has been hindered by lack of locally appropriate information. The objective of this study was to determine the incidence and factors associated with death from SCA in Dar-es-Salaam.Methods and Findings: A hospital-based cohort study was conducted, with prospective surveillance of 1,725 SCA patients recruited from 2004 to 2009, with 209 (12%) lost to follow up, while 86 died. The mortality rate was 1.9 (95% CI 1.5, 2.9) per 100 PYO, highest under 5-years old [7.3 (4.8-11.0)], adjusting for dates of birth and study enrollment. Independent risk factors, at enrollment to the cohort, predicting death were low hemoglobin (= 102 mu mol/L) [1.7 (1.0-2.9); p = 0.044] as determined by logistic regression.Conclusions: Mortality in SCA in Africa is high, with the most vulnerable period being under 5-years old. This is most likely an underestimate, as this was a hospital cohort and may not have captured SCA individuals with severe disease who died in early childhood, those with mild disease who are undiagnosed or do not utilize services at health facilities. Prompt and effective treatment for anemia in SCA is recommended as it is likely to improve survival. Further research is required to determine the etiology, pathophysiology and the most appropriate strategies for management of anemia in SCA

Mortality rates stratified by age at censoring or death.

<p>Mortality rates for 1,564 SCA patients enrolled and with more than one clinic visit. The rates take into account date of birth and date of recruitment into the study.</p

Age at enrollment, duration of follow-up and age at death.

<p>Age at enrollment, duration of follow-up and age at death.</p

Survival of SCA during the study, stratified by level of hemoglobin at enrollment.

<p>Survival of SCA during the study, stratified by level of hemoglobin at enrollment.</p

Laboratory features at enrollment visit associated with survival in SCA patients.

<p>Association between mortality and laboratory measurements at enrollment was explored using logistic regression.</p

The geographical distribution of registered SCA patients who live in Dar-es-Salaam.

<p>The geographical distribution of registered SCA patients who live in Dar-es-Salaam.</p