Vaccine hesitancy and refusal among parents: An international ID-IRI survey.

INTRODUCTION: Although vaccines are the safest and most effective means to prevent and control infectious diseases, the increasing rate of vaccine hesitancy and refusal (VHR) has become a worldwide concern. We aimed to find opinions of parents on vaccinating their children and contribute to available literature in order to support the fight against vaccine refusal by investigating the reasons for VHR on a global scale. METHODOLOGY: In this international cross-sectional multicenter study conducted by the Infectious Diseases International Research Initiative (ID-IRI), a questionnaire consisting of 20 questions was used to determine parents' attitudes towards vaccination of their children. RESULTS: Four thousand and twenty-nine (4,029) parents were included in the study and 2,863 (78.1%) were females. The overall VHR rate of the parents was found to be 13.7%. Nineteen-point three percent (19.3%) of the parents did not fully comply with the vaccination programs. The VHR rate was higher in high-income (HI) countries. Our study has shown that parents with disabled children and immunocompromised children, with low education levels, and those who use social media networks as sources of information for childhood immunizations had higher VHR rates (p < 0.05 for all). CONCLUSIONS: Seemingly all factors leading to VHR are related to training of the community and the sources of training. Thus, it is necessary to develop strategies at a global level and provide reliable knowledge to combat VHR.

Pattern of survival of breast cancer patients in a tertiary hospital in South West Nigeria.

BACKGROUND OF THE STUDY: Breast cancer is the most common cancer among women in both developed and developing nations. The survival of breast cancer is increasing in developed countries with improved treatment modalities, while still very poor in developing countries. In Nigeria, few breast cancer survival data are available. RESEARCH DESIGN: This is a retrospective cross-sectional study. OBJECTIVES: To determine the survival of breast cancer patients and possible factors influencing it. METHODOLOGY: Socio-demographic and clinical variables from treatment records and case notes of breast cancer patients treated from 1 January 2004 to 31 December 2008 at the Department of Radiation Oncology, University College Hospital, Ibadan. The status of patients was determined at 2 and 5 years after diagnosis. The survival of patients with breast cancer was compared using Log Rank test according to socio-demographic and clinical variables. The median survival times were obtained from the Kaplan-Meier survival curve. Cox's proportional hazard model was fitted for those that were statistically significant in the Log Rank test. Missing data were reported as unknown, not documented or missing. RESULTS: A total of 378 patients were analysed. Age ranged between 22.0 and 87.0 years with mean of 47.6 (standard deviation (SD) = 11.2) years. Almost all patients were females (98.4%). More than half (55.3%) presented at stage III, 28.0% had metastasis and the stage was unknown in about 6.6% of the patients. Invasive ductal carcinoma was the most prevalent histology (89.2%). Only 124 (32.8%) patients had their histological grade stated and most of the patients had no immunohistochemistry done. All the patients had radiotherapy, chemotherapy and surgery. About 25.1% of the patients were lost to follow up. The 2- and 5-year survival rates were 56.4% and 37.6%, respectively. The 2- and 5-year survival rates according to stage were stage I (80.0% and 66.7%), stage II (67.7% and 57.6%), stage III (51.4% and 27.9%) and stage IV (37.9% and 13.8%). Median survival time was 41 months (95%CI = 35.0-44.0). The disease-free survival at 2 and 5 years was 66.6% and 60.3%, respectively. Median time for recurrence was 8.0 months. Level of education, height, tumour unilaterality, clinical tumour size, stage at presentation, presence of distant metastases, clinical axillary lymph node metastasis, supraclavicular node metastasis, mode of surgery and axillary clearance were found to have statistically significant association with survival. CONCLUSION: A large number of the patients in our study presented at a young age, late with advanced stage disease which results in poor survival outcome.

Financial Burden of Cancer on Patients Treated at a Tertiary Health Facility in South West Nigeria.

Background: Cancer is a growing health concern in the world. The financial burden of cancer affects not only cancer patients and their families, but also the society as a whole. In Nigeria there is a dearth of information about the financial burden of cancer on patients. Hence, there is need to estimate the cost of cancer treatment and to show the resources being allocated to the problem. Objectives: The aim of this study was to estimate the financial burden of cancer on patients treated at a tertiary heath facility in South West Nigeria. Materials and Methods: The study was a cross-sectional study and patients were interviewed using a set of questionnaires that addresses sociodemographic and economic questions involving medical and nonmedical costs (direct medical costs). Data Analysis: Data obtained were analyzed using the Statistical Package for Social Sciences (SPSS), version 21.0. Descriptive statistics such as frequencies (%), mean, standard deviation, median, range and P-value were used to highlight important and relevant features of the data. For ease of analysis some of the variables such as sociodemographic, medical, and nonmedical costs were grouped or categorized. Results: Two hundred and twenty cancer patients participated in the study. The mean age of the patients was 54.1 (standard deviation [SD] = 13.4) years and majority were females (81.4%). Approximately one-third of the respondents were those with breast (35.9%) and cervical (35.5%) cancers, respectively. Majority perceived financial burden as a result of cancer to be significant (82.7%).The mean annual income of patients was $5,548.7(SD = $7,245.4). The main sources of income for their treatments were from their children (26.8%). The mean total cost incurred by patients with cancer was $5306.9 (SD = $5045.7), with medical costs accounting for the highest percentage $3889.4 (SD = $4372.9); 73.0% and nonmedical costs of $1417.5 (SD = $1085.6); 27.0%. Patients with colorectal cancer incurred the highest cost, whereas cervical cancer patients incurred the least cost. Conclusion: Financing cancer management is a major challenge for both patients and their caregivers. Cancer care also results in a loss of economic income available to the community/country.

Radiotherapy for breast cancer in countries with limited resources: program implementation and evidence-based recommendations.

Radiotherapy is an essential part of the multimodality treatment of breast cancer. Applying safe and effective treatment requires appropriate facilities, staff, and equipment, as well as support systems, initiation of treatment without undue delay, geographic accessibility, and completion of radiotherapy without undue prolongation of the overall treatment time. Radiotherapy can be delivered with a cobalt-60 unit or a linear accelerator (linac). In early stage breast cancer, radiotherapy is an integral part of breast-conserving treatment. Standard treatment includes irradiation of the entire breast for several weeks, followed by a boost to the tumor bed in women age 50 years or younger or those with close surgical margins. Mastectomy is an appropriate treatment for many patients. Postmastectomy irradiation with proper techniques substantially decreases local recurrences and improves survival in patients with positive axillary lymph nodes. It is also considered for patients with negative nodes if they have multiple adverse features such as a primary tumor larger than 2 cm, unsatisfactory surgical margins, and lymphovascular invasion. Many patients present with locally advanced or inoperable breast cancer. Their initial treatment is by systemic therapy; after responding to systemic therapy, most will require a modified radical mastectomy followed by radiotherapy. For those patients in whom mastectomy is still not possible after initial systemic therapy, breast and regional irradiation is given, followed whenever possible by mastectomy. For patients with distant metastases, irradiation may provide relief of symptoms such as pain, bleeding, ulceration, and lymphedema. A single fraction of irradiation can effectively relieve pain from bone metastases. Radiotherapy is also effective in the palliation of symptoms secondary to metastases in the brain, lungs, and other sites. Radiotherapy is important in the treatment of women with breast cancer of all stages. In developing countries, it is required for almost all women with the disease and should therefore be available.