Prevalence and correlates of depressive disorders in outpatients with breast cancer in Lagos, Nigeria.

OBJECTIVE: While the physical complications of breast cancer are often recognized and well managed, the psychological sequelae, especially depression are often unrecognized by healthcare providers and therefore under treated. This study aimed to assess the rate and correlate of depressive disorders in breast cancer survivors in Lagos, Nigeria. METHODS: Patients (n = 124) recruited from a breast cancer outpatient clinic were assessed for the DSM-IV diagnosis of depressive disorders using the Mini International Neuropsychiatric Interview (MINI). The staging of the cancer, length of diagnosis and treatment type were recorded. Also socio-demographic details and their perceived level of social support were obtained. RESULTS: Twenty-one (16.9%) were diagnosed as having Major Depressive Disorder, while 29 (23.4%) had Minor depressive disorder making a total of 50 (40.3%) cases with depression. The independent correlates of depression included being not married (odds ratio (OR) 3.09, 95% CI 1.30-7.42), perceived poor social support (OR 5.38, 95% CI 1.88-16.63) and advanced stage of the cancer (OR 3.22, 95% CI 1.32-8.26). CONCLUSION: Our study suggests a high rate of associated depression among patients with breast cancer in our environment. Clinicians should be encouraged and empowered to probe for symptoms of depression in these patient while larger hypothesis-driven studies are needed.

Levels of Awareness and Concentrations of Heavy Metals in the Blood of Electronic Waste Scavengers in Nigeria.

BACKGROUND: Electronic waste (e-waste) contains both valuable and hazardous materials. E-waste scavengers specialize in the collection and crude recycling of waste electronics to retrieve valuable metals, which are then sold. These activities provide an income for scavengers, but also expose them to toxic heavy metals such as lead (Pb) and copper (Cu). OBJECTIVES: The aim of the present study was to investigate the level of awareness and concentrations of heavy metals (Pb, Cu, zinc (Zn) and manganese (Mn)) in the blood levels of e-waste scavengers at Jakande dumpsite, Alaba International Market, Lagos, Nigeria. METHODS: Material and data were collected by empirical survey with the use of a questionnaire to obtain information from e-waste scavengers. Blood samples of the scavengers in the present study (30 adult males exposed to recycling processes) were collected and concentrations of heavy metals were determined through acid digestion and the use of an atomic absorption spectrophotometer (AGILENT 55B AA, 2010). RESULTS: The geometric means of blood levels of Pb, Cu, Zn and Mn were 11.0, 33.85, 126.15 and 19.38 µg / dL, respectively. High concentrations of Pb and Mn (11.0 and 19.38 µg / dL) were found in the blood samples, while Zn and Cu (126.15 and 33.85 µg / dL) showed low concentrations. The maximum blood level of lead (BPb) (24.0 µg / dL) was extremely high compared to the maximum BPb of occupationally exposed males. Statistical analysis of the questionnaires showed that all of the respondents were male, and more than half (56.7%) were between 21-30 years of age and had been involved in recycling of e-waste for 1-5 years. The results showed that 83% of the respondents were aware that hazardous fractions in e-waste require special treatment, while 76.7% were aware of the possible negative impact on their health. CONCLUSIONS: Lack of education, poverty and lack of effective enforcement of e-waste management and regulations are the major contributors to the current situation and thus scavengers carry on with their activities unhindered. The authors recommend the use of protective clothing, sensitization visits and awareness campaigns on the safe disposal of hazardous components. PARTICIPANT CONSENT: Obtained. ETHICS APPROVAL: The study was approved by the ethics committee of the Lagos State University Teaching Hospital, Ikeja Lagos. COMPETING INTERESTS: The authors declare no competing financial interests.

Role of Private Enterprise in Cancer Control in Low to Middle Income Countries.

Background. About 65% of cancer deaths globally occur in low to middle income countries (LMICs) where prioritization and allocation of resources to cancer care are often quite poor. In the absence of governmental focus on this problem, public-private partnerships may be an avenue to provide effective cancer control. Methods. This manuscript highlights the establishment of a nongovernmental organization (NGO) to stimulate the development of partnerships between oncology professionals, private enterprise, and academic institutions, both locally and internationally. Examples of capacity building, grant support, establishment of collaborative networks, and the development of a facility to provide clinical care are highlighted. Results. Collaborations were established between oncology professionals at academic institutions in the US and Nigeria. Cancer control workshops were conducted in Nigeria with grant support from the Union for International Cancer Control (UICC). A monthly tumor board conference was established at LASUTH in Lagos, and further capacity building is underway with grant support from the United States NCI. An outpatient, privately funded oncology clinic in Lagos has been launched. Conclusion. In LMICs, effective partnership between public and private institutions can lead to tangible strides in cancer control. The use of creative healthcare financing models can also support positive change.

Radiation therapy: a major factor in the five-year survival analysis of women with breast cancer in Lagos, Nigeria.

PURPOSE: This retrospective study was carried out to examine five-year survival from breast cancer cases diagnosed between 2005 and May 2008 in Nigerian women. MATERIAL AND METHODS: Two hundred and twenty-four patients were entered into the study. Five-year survival was evaluated using proportional hazard model proposed by Cox to assess variables such as age of diagnosis, menopausal status, and stage of the disease in the two treatment groups: surgery/chemotherapy or surgery/chemotherapy/radiotherapy. RESULTS: Findings revealed that the different staging of disease and treatment are independent predictors of disease outcome whereas age of diagnosis and menopausal status although associated with low hazards, are not significant. TNM Stage I (Hazard Ratio=0.153, 95% CI 0.45-0.51, P=0.003), II (Hazard Ratio=0.245, 95% CI 0.12-0.46, P=0.0001), and III (Hazard Ratio=0.449, 95% CI 0.31-0.46, P=0.0001) showed significantly greater survival rates compared to TNM Stage IV for patients receiving surgery/chemotherapy. Similarly, for patients receiving surgery/chemotherapy/radiotherapy TNM Stage II (Hazard Ratio=0.110, 95% CI 0.02-0.46, P=0.003) and III (Hazard Ratio=0.238, 95% CI 0.07-0.73, P=0.012) also showed significantly greater survival rates compared to TNM Stage IV. Treatment had a significant impact on survival independent of stage, age, and menopausal status. Patients receiving surgery/chemotherapy/radiotherapy had a significant increase in survival outcome for TNM Stage (II, P=0.045; III, P=0.0001); age groups (40-49, P=0.021; 50-59, P=0.016; 60-69, P=0.017; >70, P=0.025); and menopausal status (premenopausal, P=0.049; postmenopausal, P=0.0001) compared to those receiving surgery/chemotherapy. CONCLUSION: The five-year breast cancer survival rate in Lagos, Nigeria 24.1% (54/224) is relatively poor compared to most countries in the world and needs to be improved. Poor survival rates are mainly attributed to late presentation and poor follow-up, hence early detection through breast cancer awareness programs, appropriate logistics and better management of patients through guidelines for the treatment of breast need to be implemented to improve survival.