African Region (AFR)

Context.

—

This report presents the proceedings of the

African Pathologists Summit, held under the auspices of

the African Organization for Research and Training in

Cancer.

Objectives.

—

To deliberate on the challenges and

constraints of the practice of pathology in Sub-Saharan

Africa and the avenues for addressing them.

Participants.

—

Collaborating organizations included the

American Society for Clinical Pathology; Association of

Pathologists of Nigeria; British Division of the International

Academy of Pathology; College of Pathologists of East,

Central and Southern Africa; East African Division of the

International Academy of Pathology; Friends of Africa–

United States and Canadian Academy of Pathology

Initiative

;

International Academy of Pathology; Interna-

tional Network for Cancer

Treatment and Research;

National Cancer Institute; National Health and Laboratory

Service of South Africa; Nigerian Postgraduate Medical

College; Royal College of Pathologists; West African

Division of the International Academy of Pathology; and

Faculty of Laboratory Medicine of the West African

College of Physicians.

Evidence.

—

Information on the status of the practice of

pathology was based on the experience of the participants,

who are current or past practitioners of pathology or are

involved in pathology education and research in Sub-

Saharan Africa.

Consensus Process.

—

The deliberations were carried out

through presentations and working discussion groups.

Conclusions.

—

The significant lack of professional and

technical personnel, inadequate infrastructure, limited

training opportunities, poor funding of pathology services

in Sub-Saharan Africa, and their significant impact on

patient care were noted. The urgency of addressing these

issues was recognized, and the recommendations that

were made are contained in this report.

(Arch Pathol Lab Med.

doi: 10.5858/arpa.2013-0732-CC)

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Costs, effects and cost-effectiveness of breast cancer control in Ghana.

Zelle SG1, Nyarko KM, Bosu WK, Aikins M, Niëns LM, Lauer JA, Sepulveda CR, Hontelez JA, Baltussen R.

Author information

Abstract

OBJECTIVE:

Breast cancer control in Ghana is characterised by low awareness, late-stage treatment and poor survival. In settings with severely constrained health resources, there is a need to spend money wisely. To achieve this and to guide policy makers in their selection of interventions, this study systematically compares costs and effects of breast cancer control interventions in Ghana.

METHODS:

We used a mathematical model to estimate costs and health effects of breast cancer interventions in Ghana from the healthcare perspective. Analyses were based on the WHO-CHOICE method, with health effects expressed in disability-adjusted life years (DALYs), costs in 2009 US dollars (US$) and cost-effectiveness ratios (CERs) in US$ per DALY averted. Analyses were based on local demographic, epidemiological and economic data, to the extent these data were available.

RESULTS:

Biennial screening by clinical breast examination (CBE) of women aged 40-69 years, in combination with treatment of all stages, seems the most cost-effective intervention (costing $1299 per DALY averted). The intervention is also economically attractive according to international standards on cost-effectiveness. Mass media awareness raising (MAR) is the second best option (costing $1364 per DALY averted). Mammography screening of women of aged 40-69 years (costing $12,908 per DALY averted) cannot be considered cost-effective.

CONCLUSIONS:

Both CBE screening and MAR seem economically attractive interventions. Given the uncertainty about the effectiveness of these interventions, only their phased introduction, carefully monitored and evaluated, is warranted. Moreover, their implementation is only meaningful if the capacity of basic cancer diagnostic, referral and treatment and possibly palliative services is simultaneously improved.

Increased awareness of cancer as a health crisis facing less developed healthcare systems has led to recent calls for increased investment in cancer care infrastructure in low resource settings. However, operational descriptions of well-functioning cancer care systems in resource-constrained settings are limited. AMPATH-Oncology is the result of collaboration between North American, European, and Kenyan partners to develop a comprehensive cancer care model that supports screening services, cancer treatment, and palliative care. This article describes the approach taken by the AMPATH-Oncology program to deliver cancer care in a resource-constrained setting. A review of other ‘high-income – low-income’ collaborative models identifies successful strategies to implement cancer care in low resource environments.

Keywords: Africa, Cancer, Kenya, International, Health care, Treatment, HIV/AIDS, Program development, Research, Chemotherapy