Resumo
There is a dearth of information on the mortality of children with cancer in Nigeria but the few available reports suggest a poor outcome. The objectives of this study were to determine the underlying and immediate causes of death from childhood cancer. The mortality summary cards of all cases of childhood cancer seen at the Department of Paediatrics, University College Hospital, Ibadan between January 1998 and December 2004 were reviewed. Eighty –eight cases of childhood cancer were seen, out of whom 52 (59.1%) died, but only the 48 deaths with complete data were analyzed. These deaths comprised of 37 males and 11 females giving a male: female ratio of 3.4:1. Their ages ranged from 1 to 13 years with a mean of 7.3 +3.4years. The majority (71.4%) of all patients presented with diffuse or metastatic disease at diagnosis and this was associated with increased risk of dying. Of the 48 cases reviewed, 39 (81.3%) died without any remission of the primary tumour including 5(10.4%) with disease progression despite treatment and 15(31.3%) who died before treatment; only 4 cases (8.3%) died from tumour relapse. The immediate causes of death were infections (39.6%), bone marrow suppression (29.2%), treatment-related mortality (27.1%), organ failure (22.9%), bleeding (16.7%) and other metabolic causes (8.3%). Potentially reversible factors such as infections, bone marrow suppression and treatment-related events are the commonest causes of death from childhood cancer in Ibadan. Therefore, early presentation, prompt identification and effective management of these problems may reduce childhood cancer mortality in Nigeria.
Keywords: Cause of death, childhood, cancer, Ibadan
Résumé
IL y a une absence accrue d’information sur la mortalité des enfants ayant le cancer au Nigeria mais quelques rapports suggèrent des faibles résultats. Les objectifs de cette étude étaient de déterminer les causes immédiates de décès chez les enfants ayant le cancer. Les registres de résumé de mortalités vu en département de pédiatrie, Centre Universitaire Hospitalier d’Ibadan entre janvier 1998 à Décembre 2004 étaient revus. Quatre vingt cas étaient vu, 52(59.1%) mourraient et 48 cas de décès ayant les données étaient analysées. Ces décès incluaient 37 males et 11 femelles, d’une proportion de 3.4 : 1. Leurs age variait entre 1 – 13 ans ayant une moyenne de 7.3 +_ 3.4 ans. La majorité (71.4%) des patients avait un mal métastatique diagnostiqués et était associé à un taux élevé de décès. Des 48 cas analysés, 39(81.3%) mourraient sans aucune remissions de la tumeur primaire inclus 5(10.4%) avec la progression de la maladie malgré le traitement et 15(31.3%) qui sont mort avant le traitement ; seulement 4 cas (8.3%) sont mort de la rechute due a la tumeur. Les causes immédiates de la mort étaient les infections (39.6%) , la suppression de la moelle osseuse (29.2%) ; la mortalité liée au traitement (27.1%) ; la destruction des organes (22.7%) ; l’hémorragie et d’autres causes métaboliques (8.3%) ; les facteurs potentiels réversibles tels que les infections, la suppression de la moelle osseuse et les évènement liés aux traitement étaient les causes communes de décès due cancer infantile à Ibadan. Ainsi, une présentation précoce, une identification précise et une gestion effective de ces problèmes peuvent réduire la mortalité due au cancer infantile au Nigeria.
Correspondence: Dr. B.J. Brown, Department of Paediatrics, University College Hospital, Ibadan, Nigeria. Email: biosbrown@yahoo.com
Referências
World Health Organization. Tropical Disease Research Progress 1995-96. Thirteenth Progress Report UNDP/WORLD BANK/WHO Special Programme for Research and Training in Tropical Disease (TDR). 1997.
World Health Organization. Onchocerciasis and its control. Fourth report of the expert committee on Onchocerciasis. WHO. Techn. Rep. Ser. 1995; 852.
World Health Organization. The importance of onchocercal skin disease: Report of the Pan. African study Group on Onchocercal Skin Disease. Document TDR/AFR/RP/95.1. Geneva: WHO. 1995.
World Health Organization. Division of Control of Tropical Diseases (CTD). Progress report. Geneva: WHO. 1998; 115-118.
Boakye DA. A pictorial guide to the chromosomal identification of members of the Simu- lium damnosum Theobald complex in West Africa with particular reference to the Oncho- cerciasis Control Programme area. Trop Med Parasitol 1993; 44:223-243.
Wilson MD and Post RJ. Integration Morphometric, Cytogenetics and Molecular Techni- ques: A case study of Simulium damnosum. In The identification and Characterization of Post Organisms (DL. Hawkworth ed.) Willingford: CAB International. 1994; 215-224.
World Health Organization. 20 Years of Onchocerciasis Control programme in the Volta River Basin Area from 1974-1994: 1994;175.
Duke BOL and Anderson J. A comparison of the lesions produced in the cornea of the rabbit eye by microfilariae of the forest and Sudan savanna strains of Onchocerca volvulus from Cameroon. I.The clinical picture.Z Tropenmed Parasitol. 1972; (4):354-468.
Anderson J and Fuglsang H. Ocular onchocerciasis. Trop Dis Bull. 1977; 74(4):257-272.
Unnasch TR and Meredith SEO. The use of degenerate primers in conjuction with strain and species oligonucleotides to classify Onchocerca volvulus. :Meth Mol. Biol. 1996; 50: 293-303.
Buck AA. Onchocerciasis: symptomatology pathology diagnosis. Geneva: World Health Organization. 1974.
Campbell WC . Ivermectin: An update. Parasitology Today. 1985;1:10-16.
Vajime C G and Dunbar R W. Chromosomal identification of eight species of the subgenus Edwardsellum near and including Simulium (Edwardsellum) damnosum Theobald (Diptera: Simuliidae). Tropenmed. Parasitol 1975; 26(1):111-138.
Vajime CG and Danbar RW. The chromosomal identification of Simulium magnese new species. Parasitologia. 1977;19: 95–102.
Mafuyai H B, Post R J, Vajime C G and Molyneux D H. Cytotaxonomic identification of the Simulium damnosum complex (Diptera: Simuliidae) from Nigeria. Trop Med Inter Hlth. 1996;1:775-785.
Higazi T B, Boakye D A, Wilson M D,Mahmoud BM, Baraka OZ, Mukhtar MM and Unnasch TR. Cytotaxonomic and molecular analysis of Simulium (Edwardsellum) damnosum sensu lato (Diptera: Simuliidae)from Abu Hamed, Sudan. J. Med. Entomol. 2000;37(4):547-553.
Traore-Lamizana M, Somiari S, Mafuyai HB, Vajime CG and Post RJ. Sex chromosome variation and cytotaxonomy of the onchocerciasis vector Simulium squamosum in Came- roon and Nigeria. Med. Vet. Entomol. 2000: 115(2): 219-223.
Post R J, Flook PK, Millest A L, Cheke R A, McCall PJ, Wilson MD, Mustapha M, Somiari S, Davies JB, Mark PA, Geenen, P, Enyong P, Sima A and Mas J. Cytotaxonomy, morp- hology and molecular systematics of the Bioko form of Simulium yahense {Diptera: Simu- liidae}. Bull Entomol Resh. 2003; 93:145-157.
Grams R. Use of morphological characters in the study of Simulium damnosum s.l popu- lation in West Africa. Tropenmedizin Parasitologie 1978; 29: 483-491.
Dang PT and Peterson BV. Pictorial keys to the main species and species group within the S. damnosum Theobald complex occurring in West Africa (Diptera: Simuliidae). Tropenmed- zin Parasitologie. 1980; 31:117-120.
Grams R, Cheke RA, Vajime CA and Sowah S. The occurrence and movements of different members of the Simulium damnosum complex in Togo and Benin Zeitschrift fur Angewandta Zoologie.1982;69, 219-236.
Grams R and Zillman U. Morphological identification of Simulium santipauli and Simu- lium yahense in Liberia and comparison of results with those of enzyme eletrophoresis. Tropenmodein Parasitologie. 1984;35:217-220.
Baker RHA, Guillet P, Seketeli A, Poudiougou P, Boakey D, Wilson MD and Bissan Y. Pro- gress in controlling the reinvasion of wind borne vectors into the western area of onchocercia- sis control programme of West Africa. Phil Trans Roy Soc Lond. 1990; B328:731-750.
Wilson M D, Post R J and Gomuiski L M. Multivariate morphotaxonomy in the identifi- cation of adult females of the Simulium damnosum Theobald complex (Diptera: Simuliidae) in the Onchocerciasis Control Programme area of West Africa. Ann Trop Med Parasitol. 1993;87(1):65-82.
Wilson MD, Mafuyai HB and Post RJ. Morphological identification of sibling species of Simulium damnosum (Diptera: Simuliidae) complex from Nigeria, Cameroon and Bioko. Proceedings of the Section Experimental and Applied Entomology of the Netherlands Ento- mological Society (N.E.V). 1994;5:131-135
Mafuyai HB, Wilson MD and Post RJ. Morphological differentiation of adult female of the Simulium damnosum complex from Nigeria. Med Vet Entomol. 1996;10:190-192.
Meredith SEO and Townson L. Enzymes for species identification in Simulium damnosum complex from West Africa. Tropenmedzin Parasitologie. 1981;32: 123-129.
Thomson MC, Renz A and Davies JB. A new PGM eletromorph diagnostic for S squamosum from Sierra Leone and Togo but not found in S. Sqamosum from Cameroon. Acta Ledensia 1990;59:303-305.
Phillips A, Wash JF, Molyneuax DH, Milligan P and Ibrahim G. Identification of adults of Simulium damnosum complex using hydrocarbon analysis. Trop. Med. Parasit. 1985; 36: 97-101.
Mafuyai HA, Phillips A, Molyneux DH and Milligan P. Identification of the larvae of the Simulium damnosum complex from Nigeria by analysis of cuticular hydrocarbons. Trop. Med. Parasitol. 1994; 45(2):130-132.
Flook PK, Wilson MD and Post RJ. The use of repetitive DNA probes in the analysis of natural population of insects and parasite. In; Gene in Ecology Ed RJ berry, TJ Crawford and GM Hewitt Blackwell Scientific Publications Oxford 1992; 484-486.
Tang J, Toel, Back C, Zimmermau PA, Pruess K and Unnasch TR. The Simulium
damnosum Species complex : phylogenetic analysis and molecules identification based upon mitochondrially encoded gene sequences: Ins. Mol. Bio. 1995;4: 79–88.
Tang J, Toè L, Back C and Unnasch TR. Intraspecific heterogeneity of the rDNA internal transcribed spacer in the Simulium damnosum (Diptera: Simuliidae) complex. Mol. Biol. Evol. 1996;13(1):244-252.
Brockhouse CL, Vajime CG, Martin R and Tanguay RM. Molecular identification of oncho- cerciasis vector sibling species in blackflies (Diptera: Simuliidae). Biochem Biophy Resh Comm. 1993;194:628-6324.
Dumas V, Herder S, Bebba A, CadouxBarnabe C, Bellec C and Cuny G. Polymor- phic micro-satellites in Simulium damnosum s.l. and their use for differentiating two savannah populations: implications for epidemiological studies. Genome. 1998; 41 (2): 154-161.
Kruger A, Gelhaus A and Garms R. Molecular identification and phylogeny of East African Simulium damnosun s.l. and their relationship with West African species of the complex (Diptera: Simuliidae). Insect Mol. Biol. 2000; 9(1):101-108.
Cook GC. Manson´s Tropical Diseases 20th edition. English language book society Ballirere Tindall, London 1998;1338-1354.
Wilson MD, Cheke RA, Flasse SP, Grist S, Osei –Ateweneboana MY, Tetteh-Kumah A, Fiasorgbar G K, Jolliffe F R, Boakye D A, Hougard J M, Yamego L and Post R J. Deforestation and Spatio – temporal distribution of Savannah and forest members of the Simulium damnosum complex in Southern Ghana and South Western Togo. Trans Roy Soc Trop Med Hyg. 2002; 96(6): 632-639.
Post RJ, Flook PK and Millest AL. Methods for the preservation of insects for DNA studies. Biochem System Ecol. 1993:21;85 – 92.
Awolola T.S. Studies on dynamics of transmission of human onchocerciasis in selected rain forest and savannah foci in Nigeria. PhD Thesis University of Ibadan 1994. After childhood cancer: implications for cure. BMJ 1994; 309:162-166.
Stokes D N. The tumour lysis syndrome: intensive care aspects of paediatric oncology. Anaesthesia 1989; 44:133-136.
Keengwe I N, Stansfield F, Eden O B, Nelhans N O, Dearlove O R, and Sharples A. Paediatric oncology and intensive care treatments: changing trends. Arch Dis Child 1999; 80:553-555.