NRU :: Browsing by Author "Wabinga, Henry"

Browsing by Author "Wabinga, Henry"

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African Burkitt Lymphoma: Age-Specific Risk and Correlations with Malaria Biomarkers
(The American journal of tropical medicine and hygiene, 2011) Emmanuel, Benjamin; Kawira, Esther; Ogwang, Martin D.; Wabinga, Henry; Magatti, Josiah; Nkrumah, Francis; Neequaye, Janet; Bhatia, Kishor; Brubaker, Glen; Biggar, Robert J.; Mbulaiteye, Sam M.
African Burkitt lymphoma is an aggressive B-cell, non-Hodgkin lymphoma linked to Plasmodium falciparum malaria. Malaria biomarkers related to onset of African Burkitt lymphoma are unknown. We correlated agespecific patterns of 2,602 cases of African Burkitt lymphoma (60% male, mean ± SD age = 7.1 ± 2.9 years) from Uganda, Ghana, and Tanzania with malaria biomarkers published from these countries. Age-specific patterns of this disease and mean multiplicity of P. falciparum malaria parasites, defined as the average number of distinct genotypes per positive blood sample based on the merozoite surface protein-2 assessed by polymerase chain reaction, were correlated and both peaked between 5 and 9 years. This pattern, which was strong and consistent across regions, contrasted parasite prevalence, which peaked at 2 years and decreased slightly, and geometric mean parasite density, which peaked between 2 and 3 years and decreased sharply. Our findings suggest that concurrent infection with multiple malaria genotypes may be related to onset of African Burkitt lymphoma.
Agreement between Diagnoses of Childhood Lymphoma assigned in Uganda and by an International Reference Laboratory
(Clinical epidemiology, 2012) Orem, Jackson; Sandin, Sven; Odida, Michael; Wabinga, Henry; Mbidde, Edward; Wabwire-Mangen, Fred; Meijer, Chris JLM; Middeldorp, Jaap M.; Weiderpass, Elisabete
Correct diagnosis is key to appropriate treatment of cancer in children. However, diagnostic challenges are common in low-income and middle-income countries. The objective of the present study was to assess the agreement between a clinical diagnosis of childhood non- Hodgkin lymphoma (NHL) assigned in Uganda, a pathological diagnosis assigned in Uganda, and a pathological diagnosis assigned in The Netherlands. The study included children with suspected NHL referred to the Mulago National Referral Hospital, Kampala, Uganda, between 2004 and 2008. A clinical diagnosis was assigned at the Mulago National Referral Hospital, where tissue samples were also obtained. Hematoxylin and eosin-stained slides were used for histological diagnosis in Uganda, and were re-examined in a pathology laboratory in The Netherlands, where additional pathological, virological and serological testing was also carried out. Agreement between diagnostic sites was compared using kappa statistics.
Assessment of Survival Outcomes of Histopatho-Logical Subtypes of Colorectal Adenocarcinoma in Ugandan Patients
(New Horizons in Medicine and Medical Research, 2022) Wismayer, Richard; Kiwanuka, Julius; Wabinga, Henry; Odida, Michael
In the West, high grade mucinous adenocarcinomas are more common in younger patients and are associated with a poor prognosis. The survival outcomes of the various histopathologic subtypes of colorectal adenocarcinoma (CRC) and lymphovascular invasion (LVI) are unknown in Uganda. We looked at the survival rates of various histopathologic subtypes of CRC and LVI in Ugandan patients.
Breast Cancer Risk Factors among Ugandan Women at a Tertiary Hospital: A Case-Control Study
(Oncology, 2016) Galukande, Moses; Wabinga, Henry; Mirembe, Florence; Karamagi, Charles
Although East Africa, like other countries in sub-Saharan Africa, has a lower incidence of breast cancer than high-income countries, the disease rate is rising steeply in Africa; it has nearly tripled in the past few decades in Uganda. There is a paucity of studies that have examined the relation between reproductive factors and breast cancer risk factors in Ugandan women. Objective: To determine breast cancer risk factors among indigenous Ugandan women. Methods: This is a hospital-based unmatched case-control study. Interviews were conducted between 2011 and 2012 using structured questionnaires. Patients with histologyproven breast cancer were recruited over a 2-year period. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results: A total of 350 women were recruited; 113 were cases and 237 were controls. The mean age was 47.5 years (SD 14) for the cases and 45.5 years (SD 14.1) for the controls. The odds of breast cancer risk seemed lower for those who breastfed (adjusted OR = 0.04; 95% CI: 0.01, 0.18). There was no significance for early age at first full-term birth (adjusted OR = 1.96; 95% CI: 0.97, 3.96; p = 0.061), and urban residence carried no increased odds of breast cancer either (p = 0.201). Conclusion: Breastfeeding seems to be associated with reduced odds of breast cancer
Breast cancer survival experiences at a tertiary hospital in sub-Saharan Africa: a cohort study
(World journal of surgical oncology, 2015) Galukande, Moses; Wabinga, Henry; Mirembe, Florence
Cancer of the breast is a major health burden and the most common cancer among women worldwide. Though its incidence is fourfold greater in high-income countries, in sharp contrast, mortality rates are greatest among the low-income countries. Early detection linked to appropriate treatment is the most effective strategy to improve survival. The purpose of this study therefore was to establish the survival experiences of women with breast cancer at a Ugandan hospital. Methods: This study is an observational analytical study. It involved 262 women during the periods 2004 to 2007 and 2010 to 2012. Kaplan Meier method and Cox regression were used to calculate breast cancer mortality and cumulative survival experiences. Results: Sixty-three out of 262 (23 %) deaths were observed; mean age was 45 years, and 91 observations ended on or before follow-up. Luminal B median survival was months. The 5-year cumulative survival was 51.8 %. There were no stage I and II deaths. There were no differences in survival by phenotype adjusted for age, but there were differences for stage IV (p = 0.05). Conclusions: The cumulative 5-year survival was 51.8 %. The burden of advanced disease and associated mortality were high, and a significant number of patients were lost to follow-up after their first contact.
Building capacity for geospatial cancer research in Uganda: a feasibility study
(The Lancet Global Health, 2019) Beyer, Kirsten; Lukande, Robert; Kasasa, Simon; Kavanya, Gray; Nambooze, Sarah; Amulen, Phoebe; Cassidy, Laura; Tumwesigye, Nazarius; Babikako, Harriet; Anguzu, Ronald; Oyana, Tonny; Wabinga, Henry
There is a growing epidemic of cancer and other non-communicable diseases in sub-Saharan Africa. Targeted, specific, cost-effective strategies are needed to manage the growing burden of cancer. In high-resource settings, geospatial analysis has transformed cancer control through geographic targeting of interventions and policies. A similar approach could improve cancer control in sub-Saharan Africa; however, georeferenced cancer data and increased geospatial research capacity are needed. Here, we aimed to assess the feasibility of geocoding and mapping small-area cancer data from a cancer registry in Uganda. We established a partnership including the Makerere University Department of Pathology, School of Public Health and College of Computing and Information Sciences, the Kampala Cancer Registry, Uganda, and the Medical College of Wisconsin, USA. The overarching goal of our multidisciplinary and multi-institutional partnership is to increase geospatial cancer research capacity at Makerere University to enhance the prioritisation and targeting of limited cancer prevention and control resources in Uganda. Two medical students from the Medical College of Wisconsin, mentored by faculty at their own institution and Makerere University, worked in Kampala with registry staff to identify, enter, and quality-check geographic codes of residence for approximately 1522 cervical cancer records from 2005 to 2014. Information about district (n=1520, 99·9%) and subcounty (n=1486, 97·6%) was available for the vast majority of cases, and the parish was identifiable for a large proportion of cases (n=1242, n=81·6%), with increasing availability in more recent years. A seed grant is supporting ongoing capacity building at the Kampala Cancer Registry, including the purchase of new computing hardware and software and the implementation of a revised geographic data collection protocol to support future geospatial analysis of Kampala Cancer Registry data.
Burden of Placental Malaria among Pregnant Women Who Use or Do Not Use Intermittent Preventive Treatment at Mulago Hospital, Kampala
(Malaria Research and Treatment, 2016) Odongo, Charles Okot; Odida, Michael; Wabinga, Henry; Obua, Celestino; Byamugisha, Josaphat
Intermittent preventive treatment of malaria in pregnancy with sulphadoxine-pyrimethamine (SP-IPTp) is widely used to reduce the incidence of adverse pregnancy outcomes. As a monitor for continued effectiveness of this intervention amidst SP resistance, we aimed to assess malaria burden among pregnant women who use or do not use SP-IPTp. In a descriptive cohort study at Mulago Hospital, Kampala, 87 women who received two supervised doses of SP-IPTp were followed up until delivery. Controls were pregnant women presenting in early labour without history of SP-IPTp. Histopathological investigation for placental malaria (PM) was performed using the Bulmer classification criterion. Thirty-eight of the 87 women returned for delivery and 33 placentas were successfully collected and processed along with 33 placentas from SP nonusers. Overall, 12% (4/33) of the users had evidence of PM compared to 48% (16/33) of nonusers. Among nonusers, 17/33, 8/33, 2/33, and 6/33 had no placental infection, active infection, active-chronic infection, and past-chronic infection, respectively. Among users, respective proportions were 29/33, 2/33, 0/33, and 2/33. No difference in birth weights was apparent between the two groups, probably due to a higher proportion of infections occurring later in pregnancy. Histological evidence here suggests that SP continues to offer substantial benefit as IPTp.
Burden of Risk Factors for Cervical Cancer Among Women Living in East Africa: An Analysis of the Latest Demographic Health Surveys Conducted Between 2014 and 2017
(JCO Global Oncology, 2021-07-15) Abila, Derrick Bary; Wasukira, Sulaiman Bugosera; Ainembabazi, Provia; Wabinga, Henry
In East Africa, cervical cancer is a leading cause of morbidity and mortality among women diagnosed with cancer. In this study, we describe the burden of risk factors for cervical cancer among women of reproductive age in five East African countries. For each country, using STATA13 software and sampling weights, we analyzed the latest Demographic and Health Survey data sets conducted between 2014 and 2017 in Burundi, Kenya, Rwanda, Tanzania, and Uganda. We included women age 15-49 years and considered six risk factors (tobacco use, body mass index, age at first sexual intercourse, age at first birth, number of children, and hormonal contraceptive use). Of the 93,616 women from the five countries, each country had more than half of the women younger than 30 years and lived in rural areas. Pooled proportion of women with at least one risk factor was 89% (95% CI, 87 to 91). Living in a rural area in Burundi (adjusted incidence rate ration 0.94; 95% CI, 0.9 to 0.99; P = .019) and Rwanda (adjusted incidence rate Ration 0.92; 95% CI, 0.88 to 0.96; P < .001) was associated with a lower number of risk factors compared with living in an urban area. In all the countries, women with complete secondary education were associated with a lower number of risk factors compared with those with no education. This study reveals a high burden of risk factors for cervical cancer in East Africa, with a high proportion of women exposed to at least one risk factor. There is a need for interventions to reduce the exposure of women to these risk factors.
Coverage and Socio-Economic Inequalities in Breast Cancer Screening in Lowand Middle-Income Countries: Analysis of Demographic and Health Surveys Between 2010 and 2019
(JCO Global, 2022-05-05) Abila, Derrick Bary; Kangoma, Grace; Kisuza, Ruth Ketty; Wasukira, Sulaiman Bugosera; Ainembabazi, Provia; Wabinga, Henry
The World Health Organisation (WHO) launched the Global Breast Cancer Initiative (GBCI) in 2020 intending to reduce global breast cancer mortality by 2.5% per year until 2040, thereby averting an estimated 2.5 million deaths. In this study, we aimed to determine the coverage and socio-economic inequalities in the screening for breast cancer over one decade before the establishment of the GBCI.
Determinants of Primary Pyomyositis in Northern Uganda
(British Journal of Medicine and Medical Research, 2015) Kitara, David Lagoro; Bwangamoi, Paul Okot; Wabinga, Henry; Odida, Michael
To describe the determinants of primary pyomyositis in Northern Uganda.Study Design and Setting: A case-control and a cohort study designs were conducted in Hospitals in Northern Uganda. Primary pyomyositis patients were consecutively recruited and followed to discharge. Controls had minor trauma and were age and sex matched with cases. Patients were admitted, investigated (clinical features, imaging, hematology, clinical chemistry and histology from muscle biopsy); managed surgically and followed up to discharge. Those that did not meet the inclusion criteria for diagnosis histologically were excluded. Ethical approval was obtained from Gulu University IRB.
Dietary Risk Factors for Colorectal Cancer in an Indigenous East African Population
(Perspective of Recent Advances in Medical Research, 2022) Wismayer, Richard; Kiwanuka, Julius; Wabinga, Henry; Odida, Michael
Low-income countries in East Africa have a lower incidence of colorectal cancer (CRC) than high-income countries; however, the incidence has steadily increased in the last few decades. In East Africa, the extent to which genetic and environmental factors, particularly dietary factors, contribute to the aetiology of CRC is unclear. Therefore, the objective of our study was to determine the relationship between dietary factors and CRC in an indigenous population in East Africa. We conducted a case-control study and recruited 128 cases and 256 controls, block matched for age (±5 years) and sex. Data regarding diet were obtained from all the participants using an interview-based questionnaire. The potential dietary risk factors and protective factors evaluated included the type, frequency of meat consumed and the type and frequency of fibre foods consumed. The frequency was either 4x and above/week or 2-3x/week or 1x/week or never. Ordinal and conditional logistic regression analyses were used to determine the odds ratios associated with the different risk and protective factors. The mean age (SD) was 53.5(16.2) years and the male:female ratio was 1:1 for all the participants. The most significant risk factors included consumption of boiled beef 2-3x/week (aOR:1.63; p<0.001) and consumption of fried chicken 2-3x/week (aOR: 2.60; p=0.027). Consumption of high fibre foods, including:- cassava for ≥4x/week (aOR: 0.40; p=0.016), millet for 1x/week (aOR: 0.49; p=0.034) and for ≥4x/week (aOR:0.32; p=0.001), spinach for ≥4x/week (aOR:0.30; p=0.003), and potatoes 2-3x/week (aOR: 0.44; p=0.041), were protective against CRC.
Dose-Modified Oral Chemotherapy in the Treatment of AIDS-Related Non-Hodgkin’s Lymphoma in East Africa
(2009-05-26) Mwanda, Walter O; Orem, Jackson; Fu, Pingfu; Banura, Cecilia; Kakembo, Joweria; Onyango, Caren Auma; Ness, Anne; Reynolds, Sherrie; Johnson, John L.; Subbiah, Vivek; Bako, Jacob; Wabinga, Henry; Abdallah, Fatuma K.; Meyerson, Howard J.; Whalen, Christopher C.; Lederman, Michael M.; Black, Jodi; Ayers, Leona W.; Ayers, Leona W.; Katongole-Mbidde, Edward; C., Scot; Remick, Scot C.
Purpose Africa is burdened by the AIDS epidemic and attendant increase in HIV/AIDS-related malignancies. Pragmatic approaches to therapeutic intervention could be of great value. Dose-modified oral chemotherapy for AIDS-related non-Hodgkin's lymphoma is one such approach. Patients and Methods The oral regimen consisted of lomustine 50 mg/m2 on day 1 (cycle 1 only), etoposide 100 mg/m2 on days 1 to 3, and cyclophosphamide/procarbazine 50 mg/m2 each on days 22 to 26 at 6-week intervals (one cycle) for two total cycles in HIV-infected patients with biopsy-proven non-Hodgkin's lymphoma. Results Forty-nine patients (21 in Uganda and 28 in Kenya) were treated. The majority of patients were female (59%) and had a poor performance status (63%); 69% of patients had advanced-stage disease; and 18 patients (37%) had access to antiretroviral therapy. In total, 79.5 cycles of therapy were administered. The regimen was well tolerated, had modest effects (decline) on CD4+ lymphocyte counts (P = .077), and had negligible effects on HIV-1 viral replication. Four febrile neutropenia episodes and three treatment-related deaths (6% mortality rate) occurred. The overall objective response rate was 78% (95% CI, 62% to 88%); median follow-up time was 8.2 months (range, 0.1 to 71 months); median event-free and overall survival times were 7.9 months (95% CI, 3.3 to 13.0 months) and 12.3 months (95% CI, 4.9 to 32.4 months), respectively; and 33% of patients survived 5 years. Conclusion Dose-modified oral chemotherapy is efficacious, has comparable outcome to that in the United States in the pre–highly active antiretroviral therapy setting, has an acceptable safety profile, and is pragmatic in sub-Saharan Africa. The international collaboration has been highly successful, and subsequent projects should focus on strategies to optimize combination antiretroviral therapy and chemotherapy and follow-up tissue correlative studies.
Factors associated with carcinoma of the oesophagus at Mulago Hospital, Uganda
(African health sciences, 2008) Ocama, Ponsiano; Kagimu, Magid M.; Odida, Michael; Wabinga, Henry; Opio, Christopher K.; Colebunders, Britt; Ierssel, Sabrina van; Colebunders, Robert
In Uganda, as in many other parts of the world cancer of the oesophagus (CAE) is on the rise. Squamous cell carcinoma and adenocarcinoma are the common subtypes. Risk factors for this cancer have been identified but not studied systematically in Uganda. Identification of these factors would enable establishment of preventive measures. Objective To determine the prevalence, histological features and associated factors for CAE among patients referred to the endoscopic unit of Mulago hospital, Kampala, Uganda. Methods: We performed a 1-year cross-sectional study in 2004 and 2005 of all patients presenting for oesophageal-gastro-duodenoscopy (EGD) at Mulago Hospital. Demographic characteristics, behavioural practices, endoscopy findings and histology results where biopsies were performed were collected using a study tool. Data analysis was done using STATA 8® statistical package Results: Two hundred nineteen patients were enrolled in the study, three were excluded because they could not tolerate the endoscopy procedure. Fifty five (19%) of the 287 had histologically proven CAE. Squamous cell carcinoma was found in 100% of tumours of the upper third, 91% middle third, and 73% lower third of the oesophagus. Four patients had a histological diagnosis of adenocarcinoma of the oesophagus. Factors that were associated with CAE included age (OR 1.63, CI 1.34-1.98, p value <0.001), smoking (OR 3.63, CI 1.82-7.23, p value <0.001) and gender (OR 2.17, CI 1.07-4.41, p value 0.032). Conclusion: Many patients referred for EGD in Uganda had esophageal cancer most of which were.squamous cell type. Smoking, male gender and older age were risk factors. Preventive measures should target stopping smoking.
High-resolution disease maps for cancer control in low-resource settings: A spatial analysis of cervical cancer incidence in Kampala, Uganda
(Journal of Global Health, 2022) Beyer, Kirsten; Kasasa, Simon; Anguzu, Ronald; Lukande, Robert; Nambooze, Sarah; Nansereko, Brendah; Oyana, Tonny; Savino, Danielle; Feustel, Kavanya; Wabinga, Henry
The global burden of cervical cancer is concentrated in low-and middle-income countries (LMICs), with the greatest burden in Africa. Targeting limited resources to populations with the greatest need to maximize impact is essential. The objectives of this study were to geocode cervical cancer data from a population-based cancer registry in Kampala, Uganda, to create high-resolution disease maps for cervical cancer prevention and control planning, and to share lessons learned to optimize efforts in other low-resource settings.
Histopathological patterns and biological characteristics of ameloblastoma: A retrospective cross-sectional study
(Journal of Taibah University Medical Sciences, 2022) Bwambale, Phenehas; Yahaya, James J.; Owor, Geraldine; Wabinga, Henry
This study aims to determine the histopathological patterns and biological characteristics of ameloblastoma.This was a cross-sectional retrospective laboratory-based study using 82 formalin-fixed paraffin-embedded tissue blocks from patients diagnosed histologically with ameloblastoma. Information regarding age, sex, anatomical location of the lesion, histopathologic type, and biological behaviour or characteristics of the types of ameloblastoma was obtained from laboratory request forms. Categorical and continuous variables were summarized in percentage and mean ± standard deviation, respectively. The cohort was conducted on Ugandan patients diagnosed between 2016 and 2019.Most patients (66.3%) were clinically presenting a painless jaw swelling, and a follicular pattern was common (39%) followed by the plexiform pattern (12.2%). All the ameloblastoma cases (100%) were benign, with the majority (76.8%) cases being non-recurrent while the remaining (23.2%) were recurrent, and the plexiform pattern was the commonest recurrent histopathological pattern.This study reports a relatively significant rate of recurrence in almost a quarter of the study population. The plexiform histopathologic type was the dominant type in recurrence cases. Therefore, this finding provides insightful information to clinicians to ensure close follow-up for patients diagnosed with such a variant to prevent possible relapse of the disease.
Immunohistochemical and other prognostic factors in B cell non Hodgkin lymphoma patients, Kampala, Uganda
(BMC Clinical Pathology, 2009) Tumwine, Lynnette K.; Agostinelli, Claudio; Campidelli, Cristina; Othieno, Emmanuel; Wabinga, Henry; Righi, Simona; Falini, Brunangelo; Piccaluga, Pier Paolo; Byarugaba, Wilson
Non Hodgkin lymphomas are the most common lymphomas in Uganda. Recent studies from developed countries have shown differences in survival for the different immunophenotypes. Such studies are lacking in Africa where diagnosis is largely dependent on morphology alone. We report immunohistochemical and other prognostic factors in B cell non Hodgkin lymphoma patients in Kampala, Uganda. Methods: Non Hodgkin lymphoma tissue blocks from the archives of the Department of Pathology, Makerere University College of Health Sciences, Kampala, Uganda, from 1991-2000, were sub typed using haematoxylin and eosin, Giemsa as well as immunohistochemistry. Using tissue micro array, 119 biopsies were subjected to: CD3, CD5, CD10, CD20, CD23, CD30, CD38, CD79a, CD138, Bcl-6, Bcl-2, IRTA-1, MUM1/IRF4, Bcl-1/cyclin D1, TdT, ALKc, and Ki-67/Mib1. Case notes were retrieved for: disease stage, chemotherapy courses received and retrospective follow up was done for survival.
Infection-related and Lifestyle-related Cancer Burden in Kampala, Uganda: Projection of the Future Cancer Incidence up to 2030
(BMJ open, 2022) Asasira, Judith; Lee, Sanghee; Mpamani, Collins; Wabinga, Henry; Park, Yikyung; Cho, Hyunsoon
In Uganda, infection-related cancers have made the greatest contribution to cancer burden in the past; however, burden from lifestyle-related cancers has increased recently. Using the Kampala Cancer Registry data, we projected incidence of top five cancers, namely, Kaposi sarcoma (KS), cervical, breast and prostate cancer, and non-Hodgkin’s lymphoma (NHL) in Uganda.
p53 Expression in Colorectal Carcinoma in relation to Histopathological Features in Ugandan Patients
(African health sciences, 2008) Rambau, Peter F.; Odida, Michael; Wabinga, Henry
It has been shown that colorectal carcinoma is increasing in incidence in African countries. This could be due to change in life style. Molecular pathogenesis of colorectal cancer commonly involves mutation in p53 gene which leads to expression of p53 protein in tumor cells. Expression of p53 protein has been associated with poor clinical outcome and reduced survival in patients. This was a retrospective laboratory based study carried out in the Department of Pathology Makerere University, Kampala, Uganda. The aim of the study was to evaluate the expression of p53 protein in colorectal carcinoma in Ugandan patients, specifically its association with histological types, degree of differentiation, sites of the tumor and demographic characteristics of the patients. Immunohistochemistry was carried out on 109 patient\'s paraffin embedded tissue blocks of colorectal carcinoma diagnosed in the Pathology Department, Faculty of Medicine Makerere University Kampala during the period 1995 to 2005. The indirect immunoperoxidase method using monoclonal antibody p53 DO-7 and Envision + Dual link system-HRP to detect p53 expression was used. Haematoxylin and eosin stain was used for evaluation of histological types and degree of differentiation of the tumors. Topography of the tumors and demographic data were obtained from accompanying histological request forms. Out of 109 patient\'s tissue blocks that were studied, 61 cases (56%) expressed p53 protein in the nucleus of malignant cells. Right sided colonic tumors were commoner (53.2%) than left sided colonic tumors (46.8%). p53 protein was expressed more in left sided colonic tumors with a significant difference (p<0.05), it was also expressed more in well differentiated tumors and non mucinous adenocarcinomas but with no significant difference (p>0.05). p53 expression was not affected by age or sex. Frequency of p53 protein expression in Ugandan patients did not differ from that reported in the other parts of the world. It was expressed more in the left sided colonic tumors and this could support the hypothesis that right and left colonic tumors could have different pathogenesis and probably also responsible for difference in prognosis in these two topographic sites.
Parish level social factors predict population-based cervical cancer incidence in Kampala, Uganda, 2008–15: an ecological study
(The Lancet Global Health, 2022) Beyer, Kirsten M M; Kasasa, Simon; Anguzu, Ronald; Nambooze, Sarah; Amulen, Phoebe Mary; Nansereko, Brendah; Zhou, Yuhong; Lukande, Robert; Wabinga, Henry
The burden of cancer in Africa is growing. Although cancer outcomes are understood as the product of influences at multiple socioecological levels, population-based studies of geographical factors and cancer outcomes in Africa are scarce. The objective of this study was to identify parish-level social factors associated with cervical cancer incidence in the Kampala Cancer Registry catchment area, using a novel linkage between population-based cancer registry data and small-area census data from Uganda. Kampala Cancer Registry cervical cancer records (2008–15) were augmented to add the parish of residence at diagnosis. Parish-level population and housing profile data (2014) were obtained from the Uganda Bureau of Statistics and linked to Kampala Cancer Registry records. Stepwise forward Poisson regression modelling was used to estimate incidence ratios (IR) assessing associations between social factors and incidence. Housing tenure, infrastructure, gender equality, economic status, and employment were examined, controlling for population density. The significance level was set at α=0·05. Factors related to higher incidence included a higher girl-to-boy ratio of 6–12-year-olds not attending school (IR 1·33 [95% CI 1·15–1·54]; p<0.001), a higher percentage of 10–17-year-olds ever married (IR 1·22 [95% CI 1·06–1·40]; p=0·006) and a higher percentage of households receiving remittances (IR 1·03 [95% CI 1·00–1·06]; p=0·026). Factors associated with lower incidence included a higher percentage of household owner occupancy (IR 0·95 [95% CI 0·92–0·98]; p=0·002) and a higher percentage of households with piped water (IR 0·97 [95% CI 0·95–0·99]; p=0·009). Interpretation Parish-level social factors predict cervical cancer incidence in Uganda. Communities most at risk are characterised by inequity in educational access for girls, higher prevalence of child marriage, low home ownership, inadequate infrastructure, and financial dependence. These communities would benefit from HPV vaccination and screening campaigns to prevent and control cervical cancer. Investments should be made to enhance population-based cancer surveillance and census data collection in Africa to offer new strategies and targets for cancer prevention and control.
Patient Delay in Accessing Breast Cancer Care in a Sub Saharan African Country: Uganda
(British journal of medicine and medical research, 2014) Galukande, Moses; Mirembe, Florence; Wabinga, Henry
To assess patient delay differences between early and late stage breast cancer among women in Uganda. Study Design—A retrospective analytical study. Place and Duration of the Study—A study conducted at a tertiary teaching hospital. Selected patients’ data available for the period between 2008 and 2011 were included in this study. Methodology—We included 201 women with histologically confirmed breast cancer. The variables analysed included age, residence, histological subtype, stage at presentation and time delays. Ethical approval was obtained. Results—The mean age for the early and late presenters was 49 and 46 years respectively (p=0.065). Rural women were more likely to present late. Triple negative breast cancer (TNBC) and HER2+ were the majority cancer subtypes for the late presenters. On average women waited for 29 months before they presented for specialized cancer treatment (median 12 months; range 1-120 months). The duration of symptoms didn’t differ between the two groups (p=0.295) and 75% of early stage presenters, reported at least 6 months after noticing symptoms. Only 9% of the TNBC patients presented under 3 months in comparison to 14 % for HER2+, 33% for Luminal B and 36% for luminal A. Overall 23% (39/168) presented with early stage disease. Conclusion—Delay in seeking appropriate breast cancer care in Uganda was excessive, a sign of a neglected disease. Tumor biology factors seem to play a role in late stage presentation. Research in factors that lead to prolonged delay in accessing care in a resource poor context are needed urgently.

Browsing by Author "Wabinga, Henry"

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