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Background. Study examined the determinants of mortality among adult HIV patients in a rural, tertiary hospital in southeastern Nigeria, comparing mortality among various ART regimens. Methods. Retrospective cohort study of 1069 patients on ART between August 2008 and October 2013. Baseline CD4 counts, age, gender, and ART regimen were considered in this study. Kaplan-Meier method was used to estimate survival and Cox proportional hazards models to identify multivariate predictors of mortality. Median follow-up period was 24 months (IQR 6–45). Results. 78 (7.3%) patients died with 15.6% lost to followup. Significant independent predictors of mortality include age (>45), sex (male > female), baseline CD4 stage (<200), and ART combination. Adjusted mortality hazard was 3 times higher among patients with CD4 count <200 cells/μL than those with counts >500 (95% CI 1.69–13.59). Patients on Truvada-based first-line regimens were 88% more likely to die than those on Combivir-based first line (95% CI 1.05–3.36), especially those with CD4 count <200 cells/μL. Conclusion. Study showed lower mortality than most studies in Nigeria and Africa, with mortality higher among males and patients with CD4 count <200. Further studies are recommended to further compare treatment outcomes between Combivir- and Truvada-based regimens in resource-limited settings using clinical indicators.

Background Access and availability of radiotherapy treatment is limited in most low- and middle-income countries, which leads to long waiting times and poor clinical outcomes. The aim of our study is to determine the magnitude of waiting times for radiotherapy in a resource-limited setting. Methods This is a retrospective cohort study of patients with the five most commonly treated cancers managed with radiotherapy between 2010 and 2014. Data includes diagnosis, patients’ demographics and treatment provided. The waiting time was categorised into intervals (1) between diagnosis and first radiation consultation (2) First consultation to radiotherapy treatment (3) Decision-to-treat to treatment and (4) Diagnosis to treatment. Results A total of 258 cases were involved, including cervical (50%; 129/258), breast (27.5%; 71/258), nasopharynx (12.8%; 33/258), colorectal (5%; 13/258) and prostate cancers (4.7%; 12/258). Mean age was 48 (±12.9) years. Treatment with radical intent comprised 67% (178/258) of cases, while 33% (80/258) had palliative treatment. The median time from diagnosis to first radiation consultation was 40 (IQR 17–157.75) days for all the patients, with prostate cancer having the longest time – 305 days (IQR 41–393.8). The median time between the first radiation oncology consultations and first radiotherapy treatment was 130.5 (IQR 14–211.5) days; cervical cancer patients waited a median of 139 (IQR 13–195.5) days. The median time between diagnosis and first radiotherapy for breast cancer patients was 329 (IQR 207–464) days, compared to 213 (IQR 101.5–353.5) days for all the patients. Conclusion The study shows that waiting time for radiotherapy in Nigeria was generally longer than what is recommended internationally. This reflects the need to improve access to radiotherapy in order to improve cancer treatment outcomes in resource-limited settings.

Cancer is fast growing out of the reach of trained oncologists and other experts. It was once thought to be a problem almost exclusive to the developed world but cancer is now a leading cause of morbidity and mortality in developing (resource-limited) countries thus making it a health priority. The need to deliver cancer care in resourcelimited settings is gaining urgency, with need for particular emphasis on the creation of cost-effective, rational algorithms utilizing affordable chemotherapeutics to treat curable disease. The delivery of comprehensive cancer care in resource-poor settings demands a concerted effort by a team of multidisciplinary care providers, even if they are not trained oncologists. This article seeks to highlight the challenges in managing cancers in the developing world using Nigerian Christian Hospital experience as an example. We suggest ways of improving the care of cancer patients in such settings. Cancer Care in Resource-Limited Settings: A Call for ActionKelechi Eguzo* and Brian Camazine Department of Surgery, Nigerian Christian Hospital, Km 18 Ikot Ekpene Road, Aba, Abia State, Nigeria Figure 1: Ratio of mortality to incidence in a ���� year by cancer type and country income. Case fatality (calculated by approximation from the ratio of mortality to incidence in a specific year) is much lower in highincome countries than in low-income countries for cancers that are treatable, such as childhood leukaemia (0·26 vs 0·78) and testicular cancer (0·05 vs 0·47), treatable if detected early, such as breast cancer (0·24 vs 0·48), or preventable, such as cervical cancer (0·37 vs 0·63). Estimates are based on International Agency for Research on Cancer GLOBOCAN data for 2002 and 2008 (http://globocan.iarc.fr) [3].

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Background and context: In Nigeria, cancer leads to >72,000 deaths per annum (30,924 for male and 40,647 for female). This number is set to increase given that there are 102,000 new cases of cancer every year. The estimated incidence for prostate cancer is (12%) and estimated mortality prostate (13%). Prostate cancer is the third leading cancer death in Nigeria and the leading cause of cancer deaths in Nigerian men. However, very little or nothing is said about prostate cancer in Nigeria. Every October, virtually all cancer NGOs roll out their drums of awareness focused on breast cancer, prostate cancer is always missing, while several men die in silence and pain because their prostate cancer was discovered at late stages. Men on Blue is a health intervention focused on closing the gap of awareness, education and screenings for prostate cancer in rural communities of Lagos, Abuja and Enugu. The intervention will use 3 core strategies, such as: prostate cancer awareness, prostate cancer screenings and social media campaigns. Our target is to screen 2000 men, reach 20,000 men directly, reach 30,000 women and youth directly in rural communities of Lagos, Abuja and Enugu and 5 million indirectly through traditional and social media in Nigeria. Aim: To reduce the incidence of prostate cancer through the creation of a platform for prostate cancer awareness, screening and support in Nigeria. Program/Policy process: The program use focused on phasing out late diagnosis of prostate cancer through screenings outreaches in local communities in Nigeria. Men are always missing in cancer awareness and programs, hence, the program will bring men to the fore of cancer awareness. Outcomes: It is expected that this program will increase the level of prostate cancer awareness in Nigeria through the translation of information materials in local languages, engage men to lead the campaign and the use of strategic social media campaign. What was learned: Preliminary results of the planning process of the program, showed that several men are battling with prostate cancer, however, very few is said about them and they are dying in silence. Their voice need to be heard in sub-Saharan Africa.

Objectives: Cancer causes significant morbidity and mortality in Nigeria, but the country lacks an organized cancer control system. Low awareness of cancers among health professionals in the country contributes to weak cancer control capabilities and poor patient outcomes in Nigeria. This study describes findings from a community-based education intervention by Medical Women's Association of Nigeria and American Society of Clinical Oncology in Akwa Ibom State. Methods: Intervention was the Cancer Control in Primary Care Course. It featured didactic lectures with multimedia components (n=11), demonstrations and simulations (n=4), as well as plenary sessions (n=7). Topics covered included cancer epidemiology (breast/cervical), patient navigation, cancer management, inter-professional collaboration and discussions on Akwa Ibom cancer control framework. Participants (n=124) included physicians, nurses and health policymakers in the state. Mixed methods evaluation of the course formed the basis for data collection and analysis. Results: Ninety-two percent of participants (114/124) completed the evaluation. Majority (51%, 58/114) were general nurses, and the average number of years in practice was 20 (±12.3) years. Evaluation of knowledge showed a median knowledge score of 21 (maximum = 25) points. "I have been able to [learn] about cancer in a more detailed way for the first time" (#7). Ninety-seven percent (111/114) planned to improve their practice patterns, especially regarding patient/public education on cancer prevention and advocacy for early detection. Identified barriers to knowledge implementation were lack of support from administration, colleagues and inadequate manpower. Conclusions: This workshop achieved its objectives of improving the cancer management competence of participants, while promoting inter-professional collaboration.