Ocean Road Cancer Institute

Dar es Salaam, Tanzania

Ocean Road Cancer Institute

Dar es Salaam, Tanzania

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Kangolle A.C.,Ocean Road Cancer Institute
BMC International Health and Human Rights | Year: 2010

Background. Cancer is a rapidly increasing problem in developing countries. Access, quality and efficiency of cancer services in developing countries must be understood to advance effective cancer control programs. Health services research can provide insights into these areas. Discussion. This article provides an overview of oncology health services in developing countries. We use selected examples from peer-reviewed literature in health services research and relevant publicly available documents. In spite of significant limitations in the available data, it is clear there are substantial barriers to access to cancer control in developing countries. This includes prevention, early detection, diagnosis/treatment and palliation. There are also substantial limitations in the quality of cancer control and a great need to improve economic efficiency. We describe how the application of health data may assist in optimizing (1) Structure: strengthening planning, collaboration, transparency, research development, education and capacity building. (2) Process: enabling follow-up, knowledge translation, patient safety and quality assurance. (3) Outcome: facilitating evaluation, monitoring and improvement of national cancer control efforts. There is currently limited data and capacity to use this data in developing countries for these purposes. Summary. There is an urgent need to improve health services for cancer control in developing countries. Current resources and much-needed investments must be optimally managed. To achieve this, we would recommend investment in four key priorities: (1) Capacity building in oncology health services research, policy and planning relevant to developing countries. (2) Development of high-quality health data sources. (3) More oncology-related economic evaluations in developing countries. (4) Exploration of high-quality models of cancer control in developing countries. Meeting these needs will require national, regional and international collaboration as well as political leadership. Horizontal integration with programs for other diseases will be important. © 2010 Hanna and Kangolle; licensee BioMed Central Ltd.


Kersten E.,University of California at San Francisco | Scanlan P.,Ocean Road Cancer Institute | Dubois S.G.,University of California at San Francisco | Matthay K.K.,University of California at San Francisco
Pediatric Blood and Cancer | Year: 2013

Background: In order to understand the disparity in childhood leukemia survival in low-income countries (LICs) compared to high-income countries (HICs), we evaluated the resources available at Tanzania's national pediatric oncology ward, and clinical characteristics, disease course and outcomes of children diagnosed with acute leukemia from 2008 through 2010. Procedures: A chart review and assessment of services was performed to assess childhood leukemia diagnoses, treatment, and outcomes in Tanzania at the Ocean Road Cancer Institute (ORCI) from January 1, 2008 to December 31, 2010. Results were compared to those from a 2005 evaluation that showed only one of 20 children with leukemia surviving at 1 year. Results: During the study period, 106 patients presented with leukemia, including 81 patients with acute lymphoblastic leukemia (ALL) and 25 with acute myeloid leukemia (AML). Forty-nine of 58 (84%) patients with ALL, and six of 17 (35%) with AML who received therapy and had complete data, achieved complete remission. Estimated 2-year event-free survival for all patients with ALL was 33%; for AML it was 0%. Ten patients died prior to initiation of therapy, 19 died of toxicity, and eight abandoned therapy. Conclusions: Though leukemia survival in Tanzania remains far below that in HICs, survival rates for ALL have significantly improved in recent years due to standardization of treatment regimens and better staff, though AML outcome remains dismal. Ongoing improvements in pediatric leukemia outcomes will require strategies to improve awareness and early access to treatment coupled with improvements in diagnostic capabilities, supportive care, and training. Pediatr Blood Cancer 2013;60:2047-2053. © 2013 Wiley Periodicals, Inc.


Buonaguro F.M.,Instituto Nazionale Tumori IRCCS Fond Pascale | Gueye S.N.,Cheikh Anta Diop University | Wabinga H.R.,Makerere University | Ngoma T.A.,Ocean Road Cancer Institute | And 2 more authors.
Infectious Agents and Cancer | Year: 2013

Infectious Agents and Cancer is introducing a new section of Clinical Oncology with the main objective of stimulating debate through articles published in the section. Infectious diseases have been the major causes of morbidity and mortality in human populations, and have dominated the medical approach to clinical and public health. Successful efforts to control mortality from acute infections have paved the way for chronic, mostly indolent, infections to become major causes of morbidity. Cancer, hitherto thought to be rare in resource-limited settings, is becoming a major contributor. The changes in mortality patterns are due, in part, to diseases linked to rapid changes in lifestyle, urbanization, and pollution. These diseases include many of the non-infection associated cancers. However, there is a dearth of information about the burden, pathogenesis, and therapeutic approaches about cancer in resource-limited countries. There are also substantial other challenges, including economic, infrastructure, technology, and personnel. The Journal advocates for interactive local-global (lo-bal) efforts to generate relevant knowledge about cancer burden, pathogenesis, and therapeutic approaches using a bottom-up approach to sharpen the focus on local and global relevance of research and clinical and public practice, particularly in resource-limited countries. The section on Clinical Oncology in Infectious Agents and Cancer will harness these "lo-bal" strategies to reduce substantially the time from concept, discovery, and development and implementation of locally and globally applicable diagnostic and therapeutic technologies. © 2013 Buonaguro et al.; licensee BioMed Central Ltd.


PubMed | Muhimbili University of Health and Allied Sciences, University of Pennsylvania, University of Massachusetts Lowell, Ocean Road Cancer Institute and Harvard University
Type: Journal Article | Journal: Medical physics | Year: 2017

Recent publications have highlighted the potential of Information and Communication Technologies (ICTs) to catalyze collaborations in cancer care, research and education in global radiation oncology. This work reports on the use of ICTs for global Medical Physics education and training across three countries: USA, Tanzania and Kuwait METHODS: An online education platform was established by Radiation Oncology Faculty from Harvard Medical School, and the University of Pennsylvania with integrated Medical Physics Course modules accessible to trainees in Tanzania via partnership with the Muhimbili University of Health and Allied Sciences, and the Ocean Road Cancer Institute. The course modules incorporated lectures covering Radiation Therapy Physics with videos, discussion board, assessments and grade center. Faculty at Harvard Medical School and the University of Massachusetts Lowell also employed weekly Skype meetings to train/mentor three graduate students, living out-of-state and in Kuwait for up to 9 research credits per semester for over two semesters towards obtaining their graduate degrees RESULTS: Students were able to successfully access the Medical Physics course modules and participate in learning activities, online discussion boards, and assessments. Other instructors could also access/co-teach the course modules from USA and Tanzania. Meanwhile all three graduate students with remote training via Skype and email made major progress in their graduate training with each one of them submitting their research results as abstracts to be presented at the 2016 AAPM conference. One student has also published her work already and all three are developing these abstracts for publication in peer-reviewed journals.Altogether, this work highlights concrete examples/model on how ICTs can be used for capacity building in Medical Physics across continents, for both education and research training needed for Masters/PhD degrees. The developed modules and model will be scaled to benefit many more trainees and other developing countries.


Dartell M.,Danish Cancer Society | Rasch V.,University of Southern Denmark | Munk C.,Danish Cancer Society | Kahesa C.,Ocean Road Cancer Institute | And 4 more authors.
Sexually Transmitted Diseases | Year: 2013

BACKGROUND: Human papillomavirus (HPV) is one of the most common sexually transmitted infections worldwide. The prevalence is dependent on several known factors notably sexual behavior and age, and factors still under scrutiny. OBJECTIVE: This study aimed to examine risk factors for high-risk (HR) HPV infection among HIV-positive and HIV-negative women from the general population of Tanzania and to assess whether specific risk factors could contribute to the high prevalence of HR HPV infection in older age found in some populations including Tanzanian women. METHODS: A cross-sectional study of 3699 women from Tanzania was conducted. We obtained information on sociodemographic and lifestyle factors through personal interview. Cervical swabs were collected for detection of HR HPV (Hybrid Capture 2; Qiagen, Hildesheim, Germany) and genotyping (LiPaExtra; Innogenetics, Gent, Belgium). Finally, we obtained a blood sample for HIV testing. RESULTS: HIV positivity was the strongest risk factor for HR HPV (odds ratio, 4.1; 95% confidence interval, 3.3-5.3). Young age, shorter duration of present relationship, and increasing number of sex partners were also associated with higher risk for HR HPV. Among women 20 to 29 years old, especially number of partners (P = 0.005) and HIV positivity (P < 0.0001) determined the risk. In underweight women 50 years or older (P = 0.004) and HIV positivity (P = 0.0009) increased the risk, whereas increasing number of partners was not related to the risk of HR HPV (P = 0.46). CONCLUSIONS: Human papillomavirus risk factors among HIV-positive and HIV-negative women were similar, but the strength of association was greater among HIV-positive women, notably for lifetime number of sex partners, time in present relationship, genital warts, and body mass index. We were not able to identify a clear explanation for the high HPV prevalence among older women. However, in the age-stratified analysis, potential indicators of decreased immunity increased the risk for HPV infection among older women, whereas in younger women, risk was particularly associated with sexual activity. Copyright © 2013 American Sexually Transmitted Diseases Association. All rights reserved.


Olesen T.B.,Danish Cancer Society | Iftner T.,Universitaetsklinikum | Mwaiselage J.,Ocean Road Cancer Institute | Kahesa C.,Ocean Road Cancer Institute | And 5 more authors.
Sexually Transmitted Diseases | Year: 2013

Background: Infection with high-risk (HR) human papillomavirus (HPV) is associated with penile cancer in men, cervical cancer in women, and anal cancer and certain types of head and neck cancers in both sexes. Few studies have assessed the prevalence and type distribution of HPV among men in sub-Saharan Africa, where the rates of HIVand penile and cervical cancer are high. Material and Methods: We used data from a cross-sectional study among 1813 men in Tanzania. Penile samples were tested using Hybrid Capture 2, and genotyping was done by the INNO-LiPA HPVGenotyping Extra test. Blood samples were tested for HIV. The overall and type-specific prevalence and 95% confidence interval of HPV was estimated in relation to age and HIV status. Results: The overall prevalence of HPV was 20.5% (95% confidence interval, 18.7-22.4), the most prevalent HR HPV types being HPV52, HPV51, HPV16, HPV18, HPV35, and HPV66. The HR HPV prevalence was significantly higher in HIV-positive men (25.7%) than in HIVnegative men (15.8%; P = 0.0027). The prevalence of HPV16, HPV18 and multiple HR HPVs tended to be higher among HIV-positive men (statistically nonsignificant), whereas no differences were observed for the other HPV types. Conclusions: We found a high prevalence of HPV types 52, 51, 16, 18, 35, and 66. This information is of relevance in the understanding of HPV type distributions across populations. Although the prevalence of HPV16 and HPV18 was slightly higher among HIV-positive men, our results indicate that HIV status does not strongly influence the distribution of HPV types. Therefore, the currently available HPV vaccines could prevent HPV infection independently of HIV status. Copyright © 2013 by the American Sexually Transmitted Diseases Association.


Perng P.,University of Michigan | Perng W.,University of Michigan | Ngoma T.,Ocean Road Cancer Institute | Kahesa C.,Ocean Road Cancer Institute | And 3 more authors.
International Journal of Gynecology and Obstetrics | Year: 2013

Objective To investigate promoters and barriers for cervical cancer screening in rural Tanzania. Methods We interviewed 300 women of reproductive age living in Kiwangwa village, Tanzania. The odds of attending a free, 2-day screening service were compared with sociodemographic variables, lifestyle factors, and knowledge and attitudes surrounding cervical cancer using multivariable logistic regression. Results Compared with women who did not attend the screening service (n = 195), women who attended (n = 105) were older (OR 4.29; 95% CI, 1.61-11.48, age 40-49 years versus 20-29 years), listened regularly to the radio (OR 24.76; 95% CI, 11.49-53.33, listened to radio 1-3 times per week versus not at all), had a poorer quality of life (OR 4.91; CI, 1.96-12.32, lowest versus highest score), had faced cost barriers to obtaining health care in the preceding year (OR 2.24; 95% CI, 1.11-4.53, yes versus no), and held a more positive attitude toward cervical cancer screening (OR 4.64; 95% CI, 1.39-15.55, least versus most averse). Conclusion Efforts aimed at improving screening rates in rural Tanzania need to address both structural and individual-level barriers, including knowledge and awareness of cervical cancer prevention, cost barriers to care, and access to health information. © 2013 International Federation of Gynecology and Obstetrics.


Ngoma T.,Ocean Road Cancer Institute | Muwonge R.,International Agency for Research on Cancer | Mwaiselage J.,Ocean Road Cancer Institute | Kawegere J.,Ocean Road Cancer Institute | And 2 more authors.
International Journal of Gynecology and Obstetrics | Year: 2010

Objective: To evaluate the feasibility and performance of screening for cervical cancer using visual inspection with acetic acid (VIA) or with Lugol's iodine (VILI) in Dar es Salaam, Tanzania. Methods: The accuracy of tests for detecting cervical intraepithelial neoplasia (CIN) was assessed in a cross-sectional study of 10 378 women. All women who were screened underwent colposcopy, and biopsies were offered to those with abnormal colposcopy results. Results: The positivity rates were 3.8% for VIA and 4.8% for VILI. The peak positivity rates for both visual tests were observed just after training or re-training and gradually declined thereafter. CIN 1 was diagnosed in 41 women, CIN 2-3 in 33 women, and invasive cancer in 200 women, showing high detection rates of invasive cancer. The sensitivity and specificity for the detection of CIN 2-3 lesions were 60.6% (95% confidence interval [CI], 42.1-77.1) and 98.2% (95% CI, 97.9-98.4), respectively, for VIA; and 93.9% (95% CI, 79.8-99.3) and 97.3% (95% CI, 97.0-97.6), respectively, for VILI. Two-thirds of the women detected with CIN 2-3 lesions were treated. Conclusion: Both visual screening tests are useful and accurate, especially in low-income settings. Standardization of assessment of the visual inspection techniques, continual training and supervision, and quality control measures are important for successful visual screening programs. © 2010 International Federation of Gynecology and Obstetrics.


Ngoma T.,Ocean Road Cancer Institute | Mandeli J.,Mount Sinai School of Medicine | Holland J.F.,Mount Sinai School of Medicine
International Journal of Cancer | Year: 2015

Cancer is usually diagnosed late in rural Africa leading to incurability and abbreviated survival. Many curable cancers present on the body surface, often recognizable early by laymen as suspicious, justifying professional referral. Cancer diagnoses in two randomly chosen Tanzanian villages were compared after conventional dispensary self-referral vs. proactive visits in the home. Village navigators organized trips for professional consultation. In the control village 21% were self-referred, 20% of them were sent on as suspicious, 78% had cancer (8% in men) 0.9% of the village population. In the intervention village 99% were screened, 14% were referred for professional opinion, 93% had cancer (32% in men) 1.6% (p-<-0.01 compared with control village). In the second and third years similar activity yielded 0.5% cancer annually in the control village for a 3 year total of 1.86% whereas interventional villagers had 1.4% and 0.6% cancer for a 3 year total of 3.56% (p-<-0·001). Downstaging was recognized in the second and third years of intervention from 23 to 51 to 74% Stages I and II (p-<-0.001) but in the control village Stages I and II changed from 11% to 22% to 37% (p-=-NS). The greatest downstaging occurred in breast and cervix cancers. What's new? High cancer mortality in Africa is associated with an array of factors, including deficiencies in public education and health resources, which are likely to persist for decades to come. In the interest of effecting cancer control quickly and by economically practicable means, the authors of the present investigation in Tanzania compared routine self-referral against proactive visitation by health aides trained in the identification of suspected lesions. Significant improvement toward earlier cancer diagnosis was observed in the village where proactive visitation was implemented. Proactive referral could significantly improve the effectiveness of therapy, leading to reductions in cancer mortality in Africa. © 2014 UICC.


Peters L.M.,University of Michigan | Soliman A.S.,University of Michigan | Bukori P.,Ocean Road Cancer Institute | Mkuchu J.,Ocean Road Cancer Institute | Ngoma T.,Ocean Road Cancer Institute
Journal of Cancer Education | Year: 2010

The Ocean Road Cancer Institute (ORCI) in Tanzania sees about 3,000 new cancer patients annually, 47% of whom have advanced cervical cancer. We interviewed 98 women from the screening clinic and 49 women from the new cancer treatment clinic about their education, income, occupation, residence, medical history, and knowledge about cancer. Women in the screening clinic had higher socioeconomic levels, as shown by more education and employment than women in the new-patient clinic. Patients from the screening clinic were also younger, lived in near ORCI, and had better knowledge of cancer than women from the new-patient treatment clinic. Educational programs focused on the importance of cervical screening in rural remote areas of Tanzania may have a positive impact on the early detection and identification of patients at early disease stages. © Springer 2010.

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