Prevention of treatment abandonment remains an important challenge to increase survival of Wilms tumor in sub-Saharan Africa: A report from Wilms Africa-CANCaRe Africa.

BACKGROUND: The Wilms Africa studies implemented an adapted Wilm's tumor (WT) treatment protocol in sub-Saharan Africa in two phases. Phase I began with four sites and provided out-of-pocket costs. Phase II expanded the number of sites, but lost funding provision. Objective is to describe the outcomes of Phase II and compare with Phase I. METHODS: Wilms Africa Phase I (n = 4 sites; 2014-2018) and Phase II (n = 8 sites; 2021-2022) used adapted treatment protocols. Funding for families' out-of-pocket costs was provided during Phase I but not Phase II. Eligibility criteria were age less than 16 years and newly diagnosed unilateral WT. We documented patients' outcome at the end of planned first-line treatment categorized as treatment abandonment, death during treatment, and disease-related events (death before treatment, persistent disease, relapse, or progressive disease). Sensitivity analysis compared outcomes in the same four sites. RESULTS: We included 431 patients in Phase I (n = 201) and Phase II (n = 230). The proportion alive without evidence of disease decreased from 69% in Phase I to 54% in Phase II at all sites (p = .002) and 58% at the original four sites (p = .04). Treatment abandonment increased overall from 12% to 26% (p < .001), and was 20% (p = .04) at the original four sites. Disease-related events (5% vs. 6% vs. 6%) and deaths during treatment (14% vs. 14% vs. 17%) were similar. CONCLUSION: Provision of out-of-pocket costs was important to improve patient outcomes at the end of planned first-line treatment in WT. Prevention of treatment abandonment remains an important challenge.

Effectiveness of a Wilms tumour treatment guideline adapted to local circumstances in sub-Saharan Africa: A report from Wilms Africa Phase II-CANCaRe Africa.

BACKGROUND: Wilms tumour (WT) is one of the cancer types targeted by the Global Initiative for Childhood Cancer (GICC). The objective of this study was to describe the outcomes of Wilms Africa Phase II in sub-Saharan Africa. METHODS: Wilms Africa Phase II used a comprehensive WT treatment protocol in a multi-centre, prospective study conducted in eight hospitals in Ethiopia (2), Ghana (2), Malawi, Cameroon, Zimbabwe and Uganda. Eligibility criteria were: age younger than 16 years, unilateral WT, diagnosed between 1 January 2021 and 31 December 2022. RESULTS: We included 230 WT patients, median age 3 years, 53% male. Median maximum tumour diameter at diagnosis was 13.6 cm and 33% of patients had metastatic disease. Nephrectomy was performed in 71% of patients, of whom 21% had a tumour rupture. Two-year event-free survival (EFS) was 41.3% ± 3.9% after a median follow-up of 17 months (range: 1-33 months), with treatment abandonment considered an event. Treatment abandonment occurred in 26% and death during treatment in 14%. Disease relapse occurred in 10%. Two-year EFS of the 26 patients who received radiotherapy was 64.5% ± 9.7% with no reported disease relapse. CONCLUSION: Patients continue to present late with advanced WT in sub-Saharan Africa, and their survival is below the 60% GICC target. Prevention of treatment abandonment and treatment-related mortality remain important. Earlier diagnosis and access to radiotherapy are expected to decrease disease-related mortality.

Exposure and health risk assessment of transition metals in rice found on the Ghanaian market.

This study investigates the concentration of transition metals in imported and local rice brands on sale in some Ghanaian markets and the biochemical influences on the health of the Ghanaian population. A comparative analysis with previous studies in Ghana reveals that levels of Fe (3.64-4.44 mg/kg), Cd (0.03 mg/kg) and Cu (14.07-38.13 mg/kg) in the current study are much lower than the 13.67-21.35, 1.67-3.01, and 14.07-38.13 mg/kg recorded for Fe, Cd, and Cu, respectively. Rice sold in the Ghanaian markets contained different transition metals of which some are essential (Zn, Cu, Mn, and Fe). The levels of transition metals, such as Mn, Zn, Cd, Cu, and Fe are in moderate concentrations, which are well within the maximum acceptable limit of the World Health Organization. This study has revealed that R5 and R9 from the USA and India, respectively, recorded hazard indices above the safe limit of 1 and can therefore have the potential to pose detrimental health complications to consumers in the long term.

Application of DPSIR model to ascertain driving forces and their impacts on the Volta basin.

Managing trans-boundary water and its watershed areas is a challenging task. The riparian countries sharing the boundary may have different economic and national goals that can dictate the pressures exerted on water bodies and their catchments areas. The pressure will have dire consequences on the environment, the climate and the sustainability of the Volta River. This paper seeks to apply the Driving Forces-Pressure-State-Impact-Response (DPSIR) framework as a model to ascertain the driving forces and their impacts on the Black and the White sub-basins of the Volta River. The research was carried out through desk study of literature, reports and policies on the Volta basin as well as information from international bodies such as World Bank, United Nations, and European Union among others. The DPSIR framework thus established the state of the ecosystem, pressure exerted, impact and the responses to provide scientific basis for decision-making and address the impacts on the Volta River. The DPSIR framework was focused on Ghana and Burkina Faso due to their large share of the basin. Burkina Faso's share of the Volta basin area is 43 %, whereas, that of Ghana is 41.6 %. The use of DPSIR model will help stakeholders and policy makers in proper decision making. It was therefore recommended that there should be policy regulations to reduce the impact on the environment.

Current Realities of Wilms Tumor Burden and Therapy in Ghana.

BACKGROUND: Between 2005 and 2014, Ghana's Wilms tumor (WT) 2-year disease-free survival of 44% trailed behind that of high-income countries. This study aimed to uncover social determinants of health leading to preventable WT death in Ghana. METHODS: WT patient records (2014-2022) at Korle-Bu Teaching Hospital (KBTH; Ghana) were reviewed retrospectively. Demographics, clinical course, tumor characteristics, and survival were evaluated using t-tests, Pearson Chi-square, and multivariate Cox logistic regression. RESULTS: Of 127 patients identified, 65 were female. Median age was 44 months [IQR 25-66]. Forty-eight patients (38%) presented with distant metastasis (75% lung, 25% liver), which associated with hypoalbuminemia (p = 0.009), caregiver informal employment (p = 0.04), and larger tumors (p = 0.002). Despite neoadjuvant chemotherapy shrinking 84% of tumors, larger initial size associated with incomplete resection (p = 0.046). Of 110 nephrectomies, 31 patients had residual disease, negatively impacting survival (p = 2.7 × 10-5). Twenty-two patients (17%) abandoned treatment (45% before nephrectomy; 55% after nephrectomy), with seven patients ultimately lost to follow-up (LTFU). Decedents represented 43% of stage IV patients compared to 28% in other stages. Event-free survival (EFS) was 60% at 4 years with overall survival (OS) at 67%. CONCLUSIONS: Although Ghana's WT survival has improved, informal employment and distance from KBTH predisposed patients to delayed referral, greater tumor burden, hypoalbuminemia, and lower survival. TYPE OF STUDY: Prognosis Study. LEVEL OF EVIDENCE: II.

Residents' willingness-to-pay for attributes of rural health care facilities.

CONTEXT: As today's rural hospitals have struggled with financial sustainability for the past 2 decades, it is critical to understand their value relative to alternatives, such as rural health clinics and private practices. PURPOSE: To estimate the willingness-to-pay for specific attributes of rural health care facilities in rural Kentucky to determine which services and operational characteristics are most valued by rural residents. METHODOLOGY: We fitted choice experiment data from 769 respondents in 10 rural Kentucky counties to a conditional logit model and used the results to estimate willingness-to-pay for attributes in several categories, including hours open, types of insurance accepted, and availability of health care professionals and specialized care. FINDINGS: Acceptance of Medicaid/Medicare with use of a sliding fee scale versus acceptance of only private insurance was the most valued attribute. Presence of full diagnostic services, an emergency room, and 24-hour/7-day-per-week access were also highly valued. Conversely, the presence of specialized care, such as physical therapy, cancer care, or dialysis, was not valued. In total, respondents were willing to pay $225 more annually to support a hospital relative to a rural health clinic. CONCLUSION: Rural Kentuckians value the services, convenience, and security that rural hospitals offer, though they are not willing to pay more for specialized care that may be available in larger medical treatment centers. The results also inform which attributes might be added to existing rural health facilities to make them more valuable to local residents.

Silicene and transition metal based materials: prediction of a two-dimensional piezomagnet.

We use first-principles density functional theory based calculations to determine the stability and properties of silicene, a graphene-like structure made from silicon, and explore the possibilities of modifying its structure and properties through incorporation of transition metal ions (M: Ti, Nb, Ta, Cr, Mo and W) in its lattice, forming MSi(2). While pure silicene is stable in a distorted honeycomb lattice structure obtained by opposite out-of-plane displacements of the two Si sub-lattices, its electronic structure still exhibits linear dispersion with the Dirac conical feature similar to graphene. We show that incorporation of transition metal ions in its lattice results in a rich set of properties with a clear dependence on the structural changes, and that CrSi(2) forms a two-dimensional magnet exhibiting a strong piezomagnetic coupling.