Lymphomas Cancer in Nigeria

Lymphomas are a heterogeneous group of neoplasms of lymphoid tissues, each with distinct clinicopathological features that varies to different response to treatment1.  

The finding from the report of Ferlay showed that the cancer rate occurring in Sub-Saharan Africa, Hematolymphoid Malignancies has merged as a major cause of morbidity and mortality with lymphomas and other hemotologic malignancies such as leukemia and multiple myeloma together accounted for 8.7% of incident cancer diagnoses and 9.9% of cancer deaths in 2008. Annual incidence has estimated a rate as low as 30,000 and as high as 278,000 of Non-Hodgkin Lymphoma (NHL) in Sub-Saharan Africa. This has made it one of the most common cancers in the region. Other studies have indicated that in most Nigerian Tertiary Hospitals, Lymphomas, mostly NHL are ranked among the leading cancers2.  

Between the year 1960 and 1975 an estimate of 100 patients with Non-Hodgkin's Lymphoma were admitted to the University College Hospital in Ibadan, Nigeria. The related cases were analysed in respective to the clinical findings, histological classification and response to therapy. Majority of the patients (87%) had reticulum cell sarcoma with a high ratio of men than women (2:1). The applied therapy consisted mainly of single-agent chemotherapy, but a few of the patients had either surgical excision combined with chemotherapy or multiple-agent chemotherapy. The derived results were poor as a result of high default rate, late presentation, inadequate supply of drugs and the lack of radiotherapeutic facilities3.  

“The contemporary management of these neoplasms requires that they are accurately diagnosed, categorized by sub-typing according to the WHO system of classification”4. These classifications are multiparametric approach requiring clinical, morphological, immunological, cytogenetic and molecular techniques. The impact of this can be reflected in the resource-rich settings where treatment of those malignancies is increasingly related with unprecedented rates of long-term cure and control. Diagnosis of lymphomas cancer remains as a big challenge in Sub-Saharan Africa, because of inadequate facilities5.  

Leukemia in Children-Canada

Leukemia is the most commonly diagnosed cancer in children in Canada.

It can take several years to collect and confirm cancer data, so the number of new cancer cases and deaths from recent years may not be available for some time. The most recent data available are provided.

The most recent incidence and mortality statistics for leukemia in children aged 0 to 14 years are from 2009 to 2013.

• 1,445 Canadian children were diagnosed with leukemia.
• 145 Canadian children died from leukemia.
• 1,130 Canadian children were diagnosed with acute lymphoblastic leukemia and 59 died from it.
• 180 Canadian children were diagnosed with acute myelogenous leukemia and 57 died from it.

Children with leukemia and their parents may have questions about prognosis and survival. Prognosis and survival depend on many factors. Only a doctor familiar with a child’s medical history, type of cancer, characteristics of the cancer, treatments chosen and response to treatment can put all of this information together with survival statistics to arrive at a prognosis.

A prognosis is the doctor’s best estimate of how cancer will affect the child, and how it will respond to treatment. A prognostic factor is an aspect of the cancer or a characteristic of the child that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together and they both play a part in deciding on a treatment plan and a prognosis.

Prognostic factors can vary depending on whether the child has acute lymphoblastic leukemia (ALL) or acute myelogenous leukemia (AML)

Canadian Healthcare Funding

The Canadian healthcare system is predominately public, with 70% of healthcare funding coming from the public-sector and the remaining 30% from the private-sector (Canadian Institute for Health Information, 2016). It is estimated that health spending in Canada will be $228.1 billion in 2016, or approximately 11.1% of GDP, the majority of which goes to hospitals (29.5%), drugs (16%) and physicians (15.3%) (Canadian Institute for Health Information, 2016). Since 2005, physician compensation as a portion of total health spending has increased but since 2014, the share has slowed and is now maintaining levels comparable to those of the late 1980s (Canadian Institute for Health Information, 2016).

Spending on healthcare varies across Canada, but on average provinces spend approximately 38% of their total budgets on healthcare (Canadian Institute for Health Information, 2016). Per capita spending in 2016 for all of Canada is projected to be $6,299, but spending by province ranges from $5,822 in Québec to a high of $7,256 in Newfoundland and Labrador (Canadian Institute for Health Information, 2016).

Global Budget is the most common healthcare funding in Canada, where a fixed amount of payment is allocated to a provider (such as the health authority or hospital), which covers the operating expenses for a period of time, usually a year. Most Canadian provinces have their healthcare regionalized-the local or regional health authorities are responsible for the delivery of primary health services. In most province, the government allocates funding to health authorities through a global budget and many health authorities, in turn, use global budgets to fund specific groups of services. In Canada, most hospitals, long-term care facilities, publicly-funded rehabilitation facilities and mental and public health programs are funded under global budgets (Sutherland et al., 2013). Funding amounts are typically based on factors such as historical budgets, inflation and politics, and are provided irrespective of the number of patients or levels of demands on resources (Sutherland & Repin, 2012).

Global budget is an effective means of controlling healthcare expenditure growth by the use of spending "caps". It provides financial predictability for administrators and policy makers (Wolfe & Moran, 1993; Antioch & Walsh, 2004). Its only weakness is the impetus to meet the budget target. Providers may restrict the access to services or limit the number of hospital admissions. Global budgets covers little incentive for innovation or improve the healthcare efficiency (Sutherland & Crump, 2011), since global budgets do not provide opportunities for increased revenue of patient, healthcare providers have no incentive to shorten patient lengths of stay or to discharge patients to lower cost healthcare settings (Sutherland et al., 2013). Global budgets do not promote coordination across service providers in acute and post-acute settings, creating a fragmented healthcare system that is often associated with inefficiencies and reduced quality of care (Sutherland & Crump, 2011; Sutherland & Repin, 2012).

Child Mortality Rate in Nigeria

About 10% of new born deaths in the world occurred in Nigeria in the year of 2017, a new report of the United Nations Children Fund, according to UNICEF.  

The report states that five countries are accounted for half of all new-born deaths within the year, inclusive with Nigeria as the third country in the list. India had 24%, Pakistan 10%, Nigeria 9%, the Democratic Republic of Congo 4% and Ethiopia 3%. Most new-born deaths occurred in Southern Asia of 39 per cent and Sub-Saharan Africa 38%.  The report indicated that 15000 children died globally at the age of 5 in the year of 2016, with at least 46% of deaths within the first 28 days of life.  

WHO issued a press conference in 2017 stating that there is a new study “Levels and Trends in Child Mortality”, revealing, although the number of children dying before the age of 5 is at a new low-5.6 million in 2016, compare to that of 9.9 million in 200. The proportion of under-five deaths in new-born increased from 41 to 46 per cent during the same period.  

The UNICEF Chief of Health, Stefan Peterson, said “though the lives of 50 million children under-five have been saved since 2000 through increased level of commitment by governments and development partners to tackle preventable child deaths, more still needs to be done to stop babies from dying the day they are born, or days after their birth”. “We have the knowledge and technologies that are required – we just need to take them where they are most needed.” 

According to the report released by UNICEF, the World Health Organization, the World Bank and the Population Division of UNDESA, which make up the Inter-agency Group for Child Mortality Estimation (IGME), at current trends, 60 million children will die before their fifth birthday between 2017 and 2030, half of them new-born. 

The Nigerian Minister of Health, Isaac Adewole, had earlier this year described the high mortality rate of under-five in the country as unacceptable. “He said the government has however made significant progress in reducing the rate of new-born deaths in the country as it has declined from 201/1000 live births to 128/1000 live births in 2013”. 

Nigeria loses a total of 2,300 under-five year olds and 145 women of child bearing age per day, making the country the second largest contributor to under-five and maternal mortality rate in the World. Latest reports states that many lives would be save on the circumstances of decrease in global inequalities.  

If all countries achieved the average mortality of high-income countries, 87 per cent of under-five deaths could have been averted and almost 5 million lives could have been saved in 2016. 

Tim Evans, Senior Director of Health Nutrition and Population at the World Bank Group said “it is unconscionable that in 2017, pregnancy and child birth are still life-threatening conditions for women, and that 7,000 new-borns die daily”. 

“The best measure of success for Universal Health Coverage is that every mother should not only be able to access health care easily, but that it should be quality, affordable care that will ensure a healthy and productive life for her children and family". 

“We are committed to scaling up our financing to support country demand in this area, including through innovative mechanisms like the Global Financing Facility (GFF)”, he said. “Pneumonia and diarrhoea top the list of infectious diseases which claim the lives of millions of children under-five globally, accounting for 16 per cent and eight per cent of deaths, respectively”.

Health Crisis in Syria

According to WHO, attack rate on the health sector in Syria has continued to increase over the past years. There has been 67 verfied attacks on the health facilities, workers and infrastructure within the first two of 2018, and about 50% of verified attacks in the year of 2017.  

Dr. Tedros Adhanm Ghebreyesus General Director of WHO, stated that “this health tragedy must come to an end”. “Every attack shatter communities and ripples through health systems, damaging infrastructure and reducing access to health for vulnerable people. WHO calls on all parties to the conflict in Syria to immediately halt attacks on health workers, their means of transport and equipment, hospitals and other medical facilities.” 

The attacks on the health system occurs in the most needed places for medical attention. An estimate of 2.9 million Syrians is living in the UN-declared hard-to-reach and besieged locations, with the collaboration of the World Health Organization providing health services to the areas that lacks access to healthcare.  

About 400,000 individuals are living under siege for half a decade in East Ghouta, running out of the most basic health supplies in the area, with at least 1000 people in urgent need of medical evacuation. “It is unacceptable that children, women, and men are dying from injuries and illnesses that are easily treatable and preventable,” said Dr Tedros. 

70% of health supplies provided by the WHO aimed to reach East Ghouta were restrained by the authorities and sent back to the warehouse of the World Health Organization. The confiscated items were desperately needed to save the lives of the population, as well as decrease the suffering rate. The medical supplies are also routinely removed from the inter-agency convoys to the hard-to-reach and besieged locations.  

Seven years of conflict has affected the healthcare system in Syria. At least half of the country’s public hospitals and healthcare centres are shot down or in bad conditions to function. More than 11.3 million people are seeking for the immediate health assistance possible, with 3 million injured and disabled people.  

WHO ensures that the people in Syria have access to the essential supplies, life-saving healthcare and has delivered more than 14 million treatments and medications in the country, which includes cross-border and cross-line services.  

“The suffering of the people of Syria must stop. We urge all parties to the conflict to end attacks on health, to provide access to all those in Syria who need health assistance, and, above all, to end this devastating conflict,” said Dr Tedros. 

Health Crisis in Syria