David Makumi (1)

Elizabeth Abongo (2)  Lawrence Gichini (3)

1, 2,3, The Aga Khan University Hospital, Nairobi.

Objective.

Describe a low cost model of

cancer control by availing specific

services in shopping malls and community

centers.

Background: Kenya Some Health indicators

Population 39 million Life expectancy at birth:

Male: 52Female: 55

Total expenditure on health as % of GDP 4.3%

Risk of getting cancer before age 75: 14.1%

Risk of dying from Cancer before age 75: 12%

Medical oncologists: 3 Radiation Oncologists <20

Source: WHO Statistics 2010 Globocan 2008

Cancer background: I

Double burden of Non communicable and Communicable diseases in compounded by poor access to healthcare.

Breast, Cervical, GIT cancer are top two cancers in women, H&N, Prostate and GI top in Men

80% of Women present with stage 3 or 4 disease.

Nairobi Cancer Registry 2006

Reasons for late diagnosis.

Lack of knowledge by the population about the symptoms.

fear, denial and a fatalistic attitude towards cancer.

Belief in traditional medicines.Lack of Access to Screening:

=Affordability. =Acceptability. =Availability.

Nairobi Cancer Registry 2006

Cancer: background

Justification

Problem of large-scale ill health in rural and urban Kenya not primarily a technical-medical issue.

Key requirement to meeting the health care needs of urban dwellers is not just newer medical technologies, but a culturally acceptable cost effective innovative cancer control .

Why community centres? = Devoid of the impersonal, intimidating hospital

atmosphere =Provide a more women friendly environment. =Clients are in control

Material & Methods.

To be successful, the screening program used a public health model

Aimed at Good population coverage for screening.

Respect for the local customs, dignity, privacy and autonomy of the women and Involved grass root women right from the planning stages.

All women had clinical breast examination and were taught self breast examination during the encounter with a health care provider and given essential information on risk reduction.

Self administered questionnaire on her breast health and risk assessment.

Data on clinical findings entered and analyzed using SPSS.

PUBLICITY •Media•Fliers•Churches•communities

INCENTIVES.

•Discounted breast imaging / pathology rates.

•FREE C.B.E.•One to One encounter with health providers• cancer information •Education & information material

FOLLOW-UP

REFFERALS

Need for Cancer Control

Interventions

Model

Findings This is an ongoing program. 8000+

women have been screened through clinical breast examinations in retail outlets over the last 24 months..

15% of the women presented with breast problems such as fixed lumps with lymph nodes and bloody nipple discharge.

20% have done mammograms which they would not have otherwise done.

Other health concerns are also addressed.

The project is ongoing.

Age distribution

Age (years)

65.060.055.050.045.040.035.030.025.020.015.0

160

140

120

100

80

60

40

20

0

Std. Dev = 9.59

Mean = 31.4

N = 471.00

FEMALE BREAST AND CERVICAL CANCER:

0

10

20

30

40

50

60

0-4 5 to 9 10 to14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-85

AGE- GROUPS

NO

. OF

CA

SES

Breast

Cervix uteri

Have you ever had a nurse or a doctor examine your breast?

Have you ever had a Nurse or doctor examine your breast

Have you ever had a Nurse or doctor examine your breast

NOYES

Pe

rce

nt

80

60

40

20

0

70% have Never had a CBE.

? Lack of awareness on both HCP & Client.

? Failure of health professionals.

Use of hormonal contraceptive /HRT

NOYES

Co

un

t150

140

130

120

110

100

90

80

Regularly perform a

YES

NO

Discussion Need for health planners, policy makers, and

other stakeholders to engage and involve communities in designing new and innovative cost effective health care delivery models is Urgent.

Populations buy into Cancer Control interventions when implemented at community level.

Clinical Breast Examination are a suitable option for countries in economic transition, where incidence rates are on the increase but limited resources do not permit screening by mammography

Conclusion

Urban areas face a myriad of health challenges from rapid population growth, pollution, unplanned settlements, and an increase in both communicable and non communicable diseases.

A model of partnering with the community institutions in implementing cancer control interventions will help address the unfolding cancer epidemic at community level

This is where effective cancer control starts.

Thank you

References Baxter, N. (2001). Canadian Task Force on Preventive Health Care.: Preventive health care, 2001 update:

should women be routinely taught breast self-examination to screen for breast cancer? Canadian Medical Association Journal, 164 (13): 1837-46.

Carlson, R.W., Anderson, B.O., Chopra, R., Eniu, A.E., & Love, RR. (2003). Treatment of breast cancer in countries with limited resources. The Breast Journal, 9(s2), S67–S74.

CIA. (2008). Kenya, The World Fact Book. Retrieved February 20, 2008, from https://www.cia.gov/library/publications/the-world-factbook/geos/ke.html.

Disease Control Priorities Project (DCPP). (2007). Controlling Cancer in Developing Countries Retrieved April 10, 2008, from http://dcp2.org/file/79/DCPP-Cancer.pdf

Gachenge, B. (2007, November 7) Breast Cancer War Undermined by Lack of Radiologists. The Daily Nation.

Harvey, B.J., Miller, A.B., Baines, C.J., & Corey, P.N. (1997). Effect of breast self-examination techniques on the risk of death from breast cancer. Canadian Medical Association Journal, 157 (9): 1205-12.

Pezzatini M., Marino, G., Conte, S., & Catracchia, V. (2007) Oncology: a forgotten territory in Africa. Annals of Oncology, 18: 2046-2047.

Remennick, L. (2006). The Challenge of Early Breast Cancer Detection among Immigrant and Minority Women in Multicultural Societies. The Breast Journal, 12 (s1), S103–S110

Republic of Kenya Ministry of Health. (2006). Health Facilities by District. Retrieved March 31, 2008, from http://www.health.go.ke/HMIS.htm

Shyyan, R., Masood, S., Badwe, R.A., Errico, K.M., Liberman, L., Ozmen, V., et al. (2006). Breast Cancer in Limited-Resource Countries: Diagnosis and Pathology. The Breast Journal, 12(s1), S27–S37

Smith, R., Caleffi, M., Ute-Susann, A., Chen, T.H.H., Duffy, S.W., Francheschi, D., et al. (2006) Breast Cancer in Limited-Resource Countries: Early Detection and Access to Care. The Breast Journal, 12(s1), S16-S26

World Health Organization. (2002). National Cancer Control Programmes: Policies and Managerial Guidelines. Geneva, Switzerland: WHO

World Health Organization. (2006). Country Health System Fact Sheet 2006, Kenya. Retrieved Sept 10, 2009, from http://www.afro.who.int/home/countries/fact_sheets/kenya.pdf

Zotov V., & Shyyan R. (2003) Introduction of breast cancer screening in Chernihiv Oblast in the Ukraine: report of a PATH breast cancer assistance program experience. The Breast Journal., 9(s2), S75–S80.

http://www.who.int/whosis/mort/profiles/ accessed 5th April 2010 Nairobi cancer registry, 2006 Report