Maximizing the Impact of Voluntary Medical Male Circumcision for HIV Prevention in Zambia by Targeting High-Risk Men: A Pre/Post Program Evaluation.

A well-documented barrier to voluntary medical male circumcision (VMMC) is financial loss due to the missed opportunity to work while undergoing and recovering from VMMC. We implemented a 2-phased outcome evaluation to explore how enhanced demand creation and financial compensation equivalent to 3 days of missed work influence uptake of VMMC among men at high risk of HIV exposure in Zambia. In Phase 1, we implemented human-centered design-informed interpersonal communication. In Phase 2, financial compensation of ZMW 200 (~ US$17) was added. The proportion of men undergoing circumcision was significantly higher in Phase 2 compared to Phase 1 (38% vs 3%). The cost of demand creation and compensation per client circumcised was $151.54 in Phase 1 and $34.93 in Phase 2. Financial compensation is a cost-effective strategy for increasing VMMC uptake among high-risk men in Zambia, and VMMC programs may consider similar interventions suited to their context.

A review of bladder cancer in Sub-Saharan Africa: A different disease, with a distinct presentation, assessment, and treatment.

Background: Cancer of the bladder is the ninth leading cause of cancer in developed countries. It is the second most common urological malignancy. Transitional cell carcinoma (TCC) is the most common histological subtype in developed countries. In most of Africa, the most common type is squamous cell carcinoma (SCC). Cancer of bladder guidelines produced by the European Urological Association and the American Urological Association, including the tumor, node, and metastasis staging is focused on TCC of the bladder. Objectives: The purpose of the study is to review the pathogenesis, pathology, presentation, and management of cancer of the bladder in Africa and to use this information to propose a practical staging system for SCC. Methods: The study used the meta-analysis guideline provided by PRISMA using bladder cancer in Africa as the key search word. The study collected articles available on PubMed as of July 2017, Africa Online and Africa Index Medicus. PRISMA guidelines were used to screen for full-length hospital-based articles on cancer of the bladder in Africa. These articles were analyzed under four subcategories which were pathogenesis, pathology, clinical presentation, and management. The information extracted was pooled and used to propose a practical staging system for use in African settings. Results: The result of evaluation of 821 articles yielded 23 full-length papers on hospital-based studies of cancer of the bladder in Africa. Cancer of the bladder in most of Africa is still predominantly SCC (53%-69%). There has been a notable increase in TCC in Africa (9%-41%). The pathogenesis is mostly schistosoma-related SCC presents late with painful hematuria and necroturia (20%). SCC responds poorly to chemotherapy or radiotherapy. The main management of SCC is open surgery. This review allowed for a practical organ-based stage of SCC of the bladder that can be used in Africa. Conclusion: Bladder cancer in Africa presents differently from that in developed countries. Guidelines on cancer of the bladder may need to take account of this to improve bladder cancer management in Africa.

RésuméContexte: Le cancer de la vessie est la neuvième cause de cancer dans les pays développés. C'est le deuxième plus fréquent urologique malignité. Le carcinome à cellules transitionnelles (TCC) est le sous-type histologique le plus commun dans les pays développés. Dans la majeure partie de l'Afrique, le plus le type commun est le carcinome épidermoïde (SCC). Lignes directrices sur le cancer de la vessie produites par l'Association européenne d'urologie et American Urological Association, y compris la tumeur, le nœud, et la mise en scène de la métastase est axée sur le TCC de la vessie. Objectifs: Le Le but de l'étude est d'examiner la pathogenèse, la pathologie, la présentation et la gestion du cancer de la vessie en Afrique et d'utiliser cette information pour proposer un système de mise en scène pratique pour SCC. Méthodes: L'étude a utilisé la ligne de méta-analyse fournie par PRISMA en utilisant le cancer de la vessie en Afrique comme le mot clé de recherche. L'étude a recueilli des articles disponibles sur PubMed à partir de juillet 2017, Africa Online et Africa Index Medicus. Les directives PRISMA ont été utilisées pour dépister des articles hospitaliers complets sur le cancer de la vessie en Afrique. Ces articles ont été analysés sous quatre sous-catégories qui étaient la pathogenèse, la pathologie, la présentation clinique et la gestion. le les informations extraites ont été regroupées et utilisées pour proposer un système de mise en scène pratique à utiliser dans les contextes africains. Résultats: Le résultat de l'évaluation sur 821 articles, 23 articles complets ont été publiés sur les études hospitalières sur le cancer de la vessie en Afrique. Cancer de la vessie dans la plupart des L'Afrique est toujours principalement SCC (53% -69%). Il y a eu une augmentation notable du TCC en Afrique (9% -41%). La pathogenèse est principalement la SCC liée au schistosome se manifeste tardivement par une hématurie douloureuse et une nécroturie (20%). SCC répond faiblement à la chimiothérapie ou la radiothérapie. La gestion principale de SCC est la chirurgie ouverte. Cette revue a permis un stade pratique de la CEC de la vessie qui peut être utilisé. en Afrique. CONCLUSION: Le cancer de la vessie en Afrique présente différemment de celui des pays développés. Lignes directrices sur le cancer de la vessie Il faudra peut-être en tenir compte pour améliorer la gestion du cancer de la vessie en Afrique.

The Pattern of Urological Cancers in Zambia

Objective: To examine the pattern of urological malignancies; particularly cancer of the bladder; seen at the University Teaching Hospital (UTH) in Lusaka and to compare the findings with previous studies on the same parameters done at UTH. Material and Methods: A retrospective study of urological cancers in Zambia was performed; based on histopathology reports of specimens reviewed at the UTH Pathology Laboratory in Lusaka; Zambia; between January 1990 and December 2005. The parameters studied were the histological type of the cancer; patient age and trends over a 15-year period. Results: In total; 8829 cancers were diagnosed during the study period; of which 749 (8.5) were urological malignancies affecting the kidney; bladder; prostate; testis or penis. The maleto- female ratio of the urological cancers was 10.7 to 1. Cancer of the prostate was the most common urological malignancy (54.6); followed by bladder cancer (21.1) and penile cancer (18.6). The histological type of bladder cancer was mainly squamous cell carcinoma (46.2); transitional cell carcinoma (23.4) and adenocarcinoma (22.2); other types (8.2) included rhabdomyosarcoma; small cell carcinoma and lymphoma. The majority of patients (79) with bladder cancer were between 56 and 65 years of age. Whereas 20 years ago prostate cancer comprised only 26of urological malignancies; it accounted for 55of urological cancers diagnosed in Zambia between 1990 and 2005. In contrast; cancer of the penis; kidney and testis have shown no change in frequency distribution compared to 20 years ago. Conclusion:Over the last 15 years there has been an increasing proportion of cancer of the prostate and squamous cell carcinoma of the bladder. This is associated with high levels of schistosomiasis; cystitis (some of which is HIV-related) and bladder stones. It may also be due to the extension of urological services and the diagnostic armamentarium (PSA; cystoscopy and histological diagnosis) to indigent rural populations; where the incidence of squamous cell carcinoma is likely to be higher than in affluent urban populations

The Changing Pattern of Urological Cancers in Zambia

The university teaching hospital Lusaka (UTH) is the main reference hospital and national reference laboratory in Zambia it has a referral areas of 1.3 million people objectives :the purpose of the study was to examine the pattern of urological malignancies seen at the UTH in Lusaka .in particular the pattern of cancer of the bladder. Method :A retrospective study of urological cancers in Zambia was done ; which the IDC(10) classification .Results: a total 8829 cancers were diagnosed over the 15years study period; 749(8.4) were urological maligical cancer was 10.7 to 1. cancer of the prostate was the most common urological malignancy (54;6) ; followed by cancer of the bladder (21;1) and cancer of the penis (18.6) the histological type of bladder cancer was squamous celle carcinoma (46.2); transitional cell carcinoma (23.4); adenocarcinoma (22;2) and other types (82) . the majority of patients (79) with bladder .cancer were between and 65years of age .There was an increasing incidence of squamous celle cancers of the bladder over last 15 tears.Conclusion:twenty years ago prostate cancer comprised only 26of urological malignancies ;it now makes up 55of the urological cancers diagnosed in Zambia over the last 15 years.In contrast; cancer of the penis; kidney and testis have shown so change in frequency distribution compared to 20 years ago.There has been has an increase in squamous cell type of bladder observed over the last 15 years