Cancer epidemiology fieldwork in a resource-limited setting: Experience from the western Kenya ESCCAPE esophageal cancer case-control pilot study

Abstract

Background: Case-control studies remain an important study design for aetiologic research on cancer, particularly when cohorts are not available. In addition to the potential biases inherent in this design, conducting fieldwork in settings with weak health care and information systems for cancer, such as in sub Saharan Africa, confer additional challenges which we present here with the aim to share experience to guide future studies. Methods: We undertook a hospital-based case-control study of squamous cell esophageal cancer at the Moi Teaching and Referral Hospital in Eldoret, West Kenya. Cases were recruited at endoscopy and controls from hospital wards, age and gender frequency-matched to cases. Urine, toenails, blood and tumour biopsy were collected and a questionnaire administered. Results: During this pilot phase, 143 cases and 155 controls were successfully recruited. Complete questionnaire data was obtained through e-data collection. Biospecimen collection was possible with support of an already existing equipped laboratory. We introduce changes made in the main study phase, including on expansion of the control groups to allow to consideration of selection bias. Conclusions: Extra attention and funding to train and monitor data quality and biospecimen collection and reimbursement of a large group held together by strong leadership are essential. We recommend studies based on regional treatment centres with their more defined catchment areas rather than in the capital cities as referral routes in multi-level health care systems are severely attrition prone.

Dental fluorosis and oral health in the African Esophageal Cancer Corridor: Findings from the Kenya ESCCAPE case–control study and a pan‐African perspective

“…This is the first ESCC case–control study in Eastern Africa to include a wide range of potential risk factors/confounders and multiple measures of oral health. Histological confirmation reduced outcome misclassification and selection bias was reduced through a non‐capital city setting and inclusion of different types of controls, as discussed in a detailed evaluation of the pilot phase . The irreversibility of dental fluorosis rules out the possibility of reverse causality, however interviewer‐bias was possible but reduced due to professional training.…”

“…The western Kenyan ESCCAPE (ESCC African PrEvention research) case–control study consisted of pilot (August 2013–September 2014) and main study recruitment phases (October 2015–April 2018). The detailed fieldwork experience is published . Cases were patients aged ≥18 years who underwent endoscopy at Moi Teaching and Referral Hospital (MTRH), Eldoret, where an esophageal tumor was visualized and a biopsy taken with a morphological examination that confirmed ESCC (90%) or did not rule it out.…”

Hot beverages and oesophageal cancer risk in western Kenya: Findings from the ESCCAPE case–control study

“…An EC case–control study was conducted at the Moi Teaching and Referral Hospital (MTRH) in the town of Eldoret in western Kenya . The hospital's catchment area covers >10 counties and extends 150 km to the Kenya‐Uganda border.…”

“…The study was approved by the Institutional Research and Ethics Committee of Moi University (000921) and the IARC Ethics Committee (IEC [14][15]. Written informed consent was sought after a full explanation of the study to participants, who received no payment for their involvement, but for cases the 1,000 Kenyan shillings fee for histological results was funded.…”

“…In the present article we examined associations of selfreported hot beverage temperatures and drinking habits with ESCC from the western Kenya ESCC African Prevention Research (ESCCAPE) case-control study. 14 We additionally investigated the effect of drinking temperatures on the anatomical sub-locations (i.e. the upper, lower or middle portion) of ESCC tumours-not previously investigated in relation to this risk factor.…”