Epidemiology of childhood and adolescent cancer in Bangladesh, 2001-2014.

BACKGROUND: Cancer burden among children and adolescents is largely unknown in Bangladesh. This study aims to provide a comprehensive overview on childhood and adolescent cancers and to contribute to the future strategies to deal with these diseases in Bangladesh. METHODS: Data on malignant neoplasms in patients aged less than 20 years diagnosed between 2001 and 2014 (N = 3143) in Bangladesh was collected by the National Institute of Cancer Research and Hospital and ASHIC Foundation. The age pattern and distribution of cancer types were analysed and the incidence rates were calculated. RESULTS: The age-standardised incidence rate was 7.8 per million person-years for children (0-14 years) in the last time period (2011-2014). Retinoblastoma (25%) and leukaemia (18%) were the most common childhood cancers. For adolescents (15-19 years), the age-specific incidence rate was 2.1 per million person-years in the same time period. Most common adolescent cancers were malignant bone tumours (38%), germ cell and gonadal tumours (17%), and epithelial tumours (16%). There were more boys affected (M: F ratio 2.0 in children and 1.4 in adolescents) than girls. CONCLUSION: Cancer incidences were lower than expected most likely due to a low level of awareness about cancer among clinicians and the population, inadequate access to health care, lack of diagnostic equipment and incomplete recording of cases. Improvements on different levels should be made to get a better epidemiologic insight and to detect cancer earlier resulting in a better outcome for affected children and adolescents.

Pathogens causing diarrhoea among Bangladeshi children with malignancy: Results from two pilot studies.

BACKGROUND: Diarrhoea is a frequent symptom in children with cancer, and occurs due to a composite effect of underlying disease and immunosuppression consequent to therapy, malnutrition, and non-infective aetiologies such as mucositis. In a large proportion of cases, the aetiology of diarrhoea remains unknown but is often attributed to multiple pathogens including parasites. AIM: To identify and describe the pathogens causing diarrhoea in Bangladeshi children with cancer. METHODS: Two cross-sectional pilot studies were conducted involving paediatric oncology patients with diarrhoea. Stool samples were collected from children who were hospitalised with or without being treated with chemotherapy during the study period, and had diarrhoea at any stage during their admission. In the first study, stool samples were tested by conventional microbiological methods and by polymerase chain reaction for parasites, and by immunoassays for Clostridium difficile. In the second study, conventional microbiology was conducted for bacteria and parasites including an enzyme-linked immunosorbent assay for Cryptosporidium antigen, and in a subset, immunoassays for Clostridium difficile. RESULTS: In the first study Giardia lamblia was detected in 68.5% of samples, Entamoeba histolytica in 13%, Cryptosporidium in 5.6%, non-toxigenic C. difficile in 22.4%, and other bacteria in 5.2%. In the second study, E. histolytica was detected in 10% of samples, Cryptosporidium in 4.3%, G. lamblia in 1.4%, C. difficile in 5.1%, and other bacteria in 5.7% of samples. CONCLUSION: These pilot data suggest that parasites are important aetiologies of diarrhoea in Bangladeshi children with malignancy. While molecular diagnostic tools detect an array of stool pathogens with greater sensitivity, conventional diagnostic methods are also useful.

Evaluation of delays in diagnosis and treatment of childhood malignancies in Bangladesh.

INTRODUCTION: Malignancy is one of the leading causes of morbidity and mortality worldwide. According to GLOBOCAN 2012, an estimated 14.1 million new cancer cases and 8.2 million cancer-related deaths occurred in 2012. It is estimated that childhood malignancies are 0.5-4.6% of total malignancies. However, from the point of view of potential year lost due to childhood malignancies, it is more important than adult. MATERIALS AND METHODS: To find out the probable components for the delay in diagnosis and treatment of childhood malignancies in Bangladesh, cross-sectional observational study was done at the National Institute of Cancer Research and Hospital, Dhaka, Bangladesh, from January 2014 to June 2014. RESULTS: A total of 171 patients were included in the study. They were divided into four age groups. The mean age was 8.422 years with standard deviation ± 5.381 years and their age ranged from 2 months to 18 years. In aggregate, about 70% of the cases had to wait for more than 90 days for the treatment. About 15% had to wait for 31-60 days. Negligible percentage of patients got treatment before 30 days. Among the three components of delay, patients delay was influenced by age of the child, economic status of the family, parental education, and awareness of the parents about malignancy. CONCLUSION: More than one-third of the pediatric patients had to wait three months or more for treatment to start for various reasons. By raising awareness among the stake holders this problem can be minimized. Further studies are recommended to explore the other factors which might cause delayed referral.