African Region (AFR)

This course is accredited by theAfrican Palliative Care Association, and was developed in partnership with experts from the region, supported by VUCCnet, Cardiff University, the University of Cape Town and several other contributors.

“We hope that these modules will help you to improve your practice and skills, so that patients in Africa and beyond can get good-quality palliative care,” says Dr Emmanuel Luyirika, Executive Director of the African Palliative Care Association.

The twenty modulescoveran essential range of topics; from pain management and specific symptoms, to spiritual care and the grieving process, these modules provide an excellent education on all aspects of palliative care.

The course offers a supportive learning environment, helpful quizzes, learning assessments, and certificates for completing each module. Each module is only an hour long, and can be paused and repeated at any time, allowing for flexible learning. For participants with slower internet connections, ecancer offers a text-based course as well.

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

Noncommunicable diseases (NCDs) have traditionally been associated with affluent of

lifestyles in developed nations. However, at the dawn of the new millennium, NCDs now

pose a huge health challenge in Africa, and Swaziland is no exception. It calls for urgent

action from both the Government of Swaziland and non-state actors to address the risk

factors for NCDs and their determinants. While Swaziland finds itself facing an increase

in NCDs, maternal and child morbidity and mortality, HIV and AIDS, TB and malaria also

remain a huge public health concern.

A social determinant of health approach reveals that the health outcomes of individuals,

families and communities are influenced by the social and economic conditions in which

people are born, grow, live, work and age, and the systems put in place to deal with illness,

disability and premature death. This case study was conducted to identify how actions of

various sectors could be harnessed to address key determinants of noncommunicable

diseases including their risk factors.

A secondary analysis of government policy papers, strategic plans and WHO guidelines

was conducted in addition to key informant interviews. The study examined the presence

of intersectoral actions across progragrammes and sectors namely, health in all policies,

good governance for health, leadership and stewardship roles, adequate financing,

health literacy and community empowerment. The key findings are that there is an

unnoticed, unrecorded and unabated increase of noncommunicable conditions mainly

diabetes mellitus, cardiovascular disease, hypertension, respiratory problems and HIVrelated

cancers like Kaposi’s sarcoma. The associated major risk factors are alcohol and

tobacco consumption, physical inactivity and unhealthy diet. It is concluded that a rise in

noncommunicable conditions in Swaziland requires an intersectoral approach to ensure

effective and sustainable prevention and control.