ABSTRACT
BACKGROUND/AIMS: Burkitt's lymphoma is the most common childhood oral maxillofacial tumor in Africa and some studies have reported seasonal variation. MATERIALS AND METHODS: All Burkitt's cases diagnosed from 1969 to 2006, from all over Uganda, at the Makerere University's Department of Pathology, were analyzed, to determine seasonal variation. This was done by evaluation of monthly and rainy versus dry season prevalence. STATISTICAL ANALYSIS: The Wilcoxon test was used in both cases, to assess the statistical significance of differences in the diagnostic rates of Burkitt's lymphoma, in comparison to nonspecific chronic inflammation, using the total as the denominator. Yearly variation in prevalence was examined by a Chi-square test for linear trend. Mann-Whitney tests were done to compare the climatic regions. Multivariate analysis of variance (MANOVA) was used to test for differences when gender, seasons and climatic regions were factored in. RESULTS: Although monthly frequencies varied considerably over the period, none of the differences were statistically significant (Pearson's 15.199, degrees of freedom df = 11, P = 0.174). Likewise, there was no statistically significant difference in the total number of Burkitt's and nonspecific chronic inflammation biopsies handled at the Department during the rainy and dry seasons. CONCLUSION: Although the 38-year period gave us sufficient numbers to use the Edward's method for seasonality, it also meant that a lot of seasonal changes that occurred during the period were not taken into consideration. We hence feel that a review of this data with weather experts, so as to group the biopsies into accurate rainfall and dry patterns, would yield a more authoritative publication.
ABSTRACT
PROJECT GOAL: To adapt a successful Canadian health-promoting school initiative to a Ugandan context through international partnership. RATIONALE: Rural children face many health challenges worldwide; health professionals in training understand these better through community-based learning. Aboriginal leaders in a Canadian First-Nations community identified poor oral health as a child health issue with major long-term societal impact and intervened successfully with university partners through a school-based program called "Brighter Smiles". Makerere University, Kampala, Uganda (MUK) sought to implement this delivery model for both the benefit of communities and the dental students. KEY STEPS/HURDLES ADDRESSED: MUK identified rural communities where hospitals could provide dental students with community-based learning and recruited four local schools. A joint Ugandan and Canadian team of both trainees and faculty planned the program, obtained ethics consent and baseline data, initiated the Brighter Smiles intervention model (daily at-school tooth-brushing; in-class education), and recruited a cohort to receive additional bi-annual topical fluoride. Hurdles included: challenging international communication and planning due to inconsistent internet connections; discrepancies between Canadian and developing world concepts of research ethics and informed consent; complex dynamics for community engagement and steep learning curve for accurate data collection; an itinerant population at one school; and difficulties coordinating Canadian and Ugandan university schedules. ACCOMPLISHMENTS: Four health-promoting schools were established; teachers, children, and families were engaged in the initiative; community-based learning was adopted for the university students; quarterly team education/evaluation/service delivery visits to schools were initiated; oral health improved, and new knowledge and practices were evident; an effective international partnership was formed providing global health education, research and health care delivery.
