Potential New Approaches for Prostate Cancer Management in Resource-Limited Countries in Africa.

Prostate cancer is a major male malignancy in many sub-Saharan countries in Africa. Because of resource limitations, screening, early detection, diagnosis, and curative treatments are not available for many men on the subcontinent, and there are even barriers to the treatment of advanced-stage metastatic prostate cancer. We are making the case for new approaches to the detection, diagnosis, and treatment of this malignancy in sub-Saharan Africa and other low-resource regions-approaches that differ from the ones available and used in high-income countries. The development of one-step dipstick-type detection assays of serum prostate-specific antigen (PSA) offers an approach to prostate cancer detection, treatment and monitoring that circumvents issues related to laboratory quality control and is also low-cost. Curative-intent treatments of early-stage prostate cancer are often unavailable in low-resource contexts, and most prostate cancers are not detected in Africa until they are at an advanced stage. Hence, androgen deprivation treatments, including orchiectomy and older low-cost drugs, offer feasible and affordable approaches to prolong survival and sustain a reasonable quality of life. However, clinical trials are needed to identify which of these androgen deprivation treatments are most efficacious and best tolerated to make progress in providing medical care for men with prostate cancer in sub-Saharan Africa and other low- and lower-middle-income areas around the world.

Male responsibility and maternal morbidity: a cross-sectional study in two Nigerian states.

BACKGROUND: Nigeria continues to have high rates of maternal morbidity and mortality. This is partly associated with lack of adequate obstetric care, partly with high risks in pregnancy, including heavy work. We examined actionable risk factors and underlying determinants at community level in Bauchi and Cross River States of Nigeria, including several related to male responsibility in pregnancy. METHOD: In 2009, field teams visited a stratified (urban/rural) last stage random sample of 180 enumeration areas drawn from the most recent censuses in each of Bauchi and Cross River states. A structured questionnaire administered in face-to-face interviews with women aged 15-49 years documented education, income, recent birth history, knowledge and attitudes related to safe birth, and deliveries in the last three years. Closed questions covered female genital mutilation, intimate partner violence (IPV) in the last year, IPV during the last pregnancy, work during the last pregnancy, and support during pregnancy. The outcome was complications in pregnancy and delivery (eclampsia, sepsis, bleeding) among survivors of childbirth in the last three years. We adjusted bivariate and multivariate analysis for clustering. FINDINGS: The most consistent and prominent of 28 candidate risk factors and underlying determinants for non-fatal maternal morbidity was intimate partner violence (IPV) during pregnancy (ORa 2.15, 95%CIca 1.43-3.24 in Bauchi and ORa 1.5, 95%CI 1.20-2.03 in Cross River). Other spouse-related factors in the multivariate model included not discussing pregnancy with the spouse and, independently, IPV in the last year. Shortage of food in the last week was a factor in both Bauchi (ORa 1.66, 95%CIca 1.22-2.26) and Cross River (ORa 1.32, 95%CIca 1.15-1.53). Female genital mutilation was a factor among less well to do Bauchi women (ORa 2.1, 95%CIca 1.39-3.17) and all Cross River women (ORa 1.23, 95%CIca 1.1-1.5). INTERPRETATION: Enhancing clinical protocols and skills can only benefit women in Nigeria and elsewhere. But the violence women experience throughout their lives--genital mutilation, domestic violence, and steep power gradients--is accentuated through pregnancy and childbirth, when women are most vulnerable. IPV especially in pregnancy, women's fear of husbands or partners and not discussing pregnancy are all within men's capacity to change.

Novel use of fine needle aspiration (FNA) biopsy to diagnose cervical cancer in a low-resource setting: A case series Morovia, Liberia.

The role of pathology in improving cancer in resource-limited countries is essential, yet many barriers exist. FNA is a rapid, low-cost and efficient method for diagnosing cancer, planning treatment, and building a cancer registry.

Strengthening primary healthcare through community involvement in Cross River State, Nigeria: a descriptive study.

INTRODUCTION: In preparation for implementation of primary healthcare (PHC) services in Cross River State, a study to identify perceptions of communities and health systems concerning such interventions was conducted. METHODS: Existing PHC practices were documented through observation and document reviews, including facility checklists at frontline levels. Perceptions of consumers and providers on PHC were elucidated through 32 Focus Group Discussions (FGDs) and 78 semi-structured questionnaires. RESULTS: There was some level of implementation of the Nigerian PHC policy in the study districts. However, this policy emphasized curative instead of preventive services. Private partners perceived healthcare programmes as largely donor driven with poor release of allocations for health by government. CONCLUSION: Both providers and consumers presented similar perceptions on the current PHC implementation and similar perspectives on services to be prioritized. These common views together with their on-going participatory experience are important platforms for strengthening community participation in the delivery of PHC.