Health seeking behavior among cancer patients attending Ocean Road Cancer Institute; Tanzania

Objectives: To characterize cancer patients and to determine the associated health seeking behaviours. Methods: Between September 2005 and February 2006; we collected data using structured and semi-structured interviews among new cancer patients attending the ORCI. Findings are summarized using univarite and bivariate analyses. Results: There were 330 cancer patients during the study period. The mean age was 48 (SD = 13.5) years ranging between 21 and 84 years. The majority; 205 (62.1); were females. More than two thirds of all patients; that is 225 (68.2); presented at the ORCI at advanced stages of disease. Many patients reported to have neither heard; 193 (58.5); nor to know cancer symptoms; 203 (61.5). Only 185 (56.1) of all patients reported their willingness to disclose and a freedom to talk about the disease. Risk factors for cancer staging were sex; patient's education status; awareness and knowledge of disease symptoms. Conclusions: Interventions targeted to improve health care seeking behaviour among cancer patients need to include health education and sensitization specifically of cancer disease; establish a strong referral mechanisms at primary health level and to start a population cancer registry for monitoring and evaluation purposes

Risk factors for HIV infection in gynaecological inpatients in Dar es Salaam, Tanzania, 1988-1990.

A prevalence of 12.8% for anti-HIV-1 and a prevalence of 16.8% for anti-syphilis antibodies was found in 359 gynaecological inpatients admitted in the Department of Gynaecology and Obstetrics, Muhimbili University College of Health Sciences from 1988 to 1990. The highest HIV prevalence (17.3%) was observed in the youngest age group (14-20 years), whereas the highest syphilis prevalence (22.2%) was found in the oldest age group (> 45 years). Infections with HIV and syphilis were both significantly associated with variables related to sexual behaviour, such as marital status, age at first intercourse and number of sexual partners in the past ten years. After adjustment for these common risk variables linked to sexual behaviour, syphilis infection was still associated with a more than twofold higher risk of HIV infection (odds ratio (OR) = 2.60, p = 0.02) and trichomonas vaginalis infection with a nearly threefold higher risk (OR = 2.96, p < 0.001). These data characterize patients at risk for HIV infection among inpatients of a gynaecological department in East Africa, and indicate that effective measures to prevent sexually transmitted disease may reduce HIV transmission.

Human papillomavirus (HPV) infection, HIV infection and cervical cancer in Tanzania, east Africa.

The presence of HPV-DNA was determined in tumor biopsies of cervical-cancer patients and in cervical swabs of non-cancer patients from Tanzania, East Africa, by Southern blot hybridization and/or PCR. HPV types 16 and 18 were detected in 38% and 32%, respectively, of 50 cervical-carcinoma biopsies. A consensus primer PCR capable of detecting a broad spectrum of HPV types revealed the presence of HPV-DNA in 59% of 359 cervical swabs of non-cancer patients. Type-specific PCR showed that types 16 and 18 accounted for 13.2% and 17.5%, respectively, of all HPV infections. Therefore we concluded that HPV 18 is more prevalent in Tanzania than in any other geographical location so far reported. The strongest risk factors for the presence of any HPV-DNA in the 359 female non-cancer patients were young age and HIV infection. The epidemiology of HPV types 16 and 18 was found to differ from that of other HPV types, being associated in univariate analysis with trichomonas vaginalis infection, martial status (single/divorced), age at first intercourse, and young age at menarche. However, young age at menarche accounted for most of the effects of all other, variables in multivariate analysis. Of the non-cancer patients, 12.8% had antibodies against HIV I (no patient being severely symptomatic), and HIV infection was highly correlated with the presence of HPV-DNA, especially types 16 and 18. While HPV-DNA of any type was detectable 1.4-fold more often in HIV-positive patients than in HIV-negative patients, evidence of an infection with HPV types 16 or 18 was found 2.2-fold more often in the HIV-positive patients. The HIV-positive women did not show an increased rate of cervical cytological abnormalities as assessed by PAP staining of a single cervical smear, the overall rate of abnormalities being 2.8%. Furthermore, the age-adjusted prevalence of HIV antibodies was found to be considerably lower in 270 cervical-carcinoma patients (3% HIV-positive) in comparison with non-cancer patients. Thus there was no association observable between the prevalence of HIV infections and the frequency of cervical cytological abnormalities or cervical cancer in the setting of this cross-sectional study.

PIP: Southern blot hybridization and/or PCR was used to examine tumor biopsies of 53 women with cervical or vaginal cancer at Ocean Road Hospital in Dar es Salaam, Tanzania, and the cervical swabs of 359 women with no cancer at the gynecologic clinic at Muhimbili University College of Health Sciences in Dar es Salaam. Tanzanian and German scientists wanted to determine whether an association existed between human papillomavirus (HPV) infections and HIV, and whether the high prevalence of HIV infection was matched by a high prevalence of HPV infections, cervical dysplasias, and cervical cancer in HIV-positive cases. 59% of the noncancerous women had HPV-DNA. Young age and HIV infection were the greatest risk factors for HPV-DNA in these women (p .0001 for age and HPV-16/18; p = .08 for other HPVs; and p = .03 for HIV). 13.2% and 17.5% of all HPV infections were HPV types 16 and 18, respectively. Tanzania had the highest prevalence of HPV 18 ever reported. HPV-16/18 risk factors included: Trichomonas vaginalis infection (odds ratio [OR] = 2.23; p = .04), single status (OR = 2.55; p = .01), 16 years old or less at first intercourse (OR = 2.1; p = .03), and young age at menarche (OR = 6 for or=12 years old; p = .02 and OR = 3.25 for or=13 years old and or=16 years old; p = .05). Yet, the multivariate analysis revealed young age at menarche had the greatest effect (OR = 6.2 for or= 12 years old, p = .03; OR = 3.73 for or=16 years old, p = .08). 12.8% of noncancerous women tested positive for HIV-1, but none of them were obviously symptomatic. These HIV-positive women had a higher OR if they had HPV-16/18 than if they had other HPV types (4.25 vs. 2.02). Further, they did not have more cervical cytological abnormalities than did the HIV-negative women (overall cervical cytological abnormality rate - 2.8%). The HIV-positive rate for cancerous patients was only 3%. In conclusion, no association existed between HIV infection and cervical cytological abnormalities or cervical cancer.

Histochemical profile of mouse hepatocellular adenomas and carcinomas induced by a single dose of diethylnitrosamine.

In continuation of earlier studies on murine neoplastic liver lesions, we characterized by histochemical methods the phenotype of hepatocellular adenomas and carcinomas induced by single injections of diethylnitrosamine (1.25, 2.5, or 5.0 micrograms/g of body weight) in 15-day-old C57BL/6 x male C3H F1 mice. The hepatocellular adenomas were composed predominantly of basophilic cells but stored excessive amounts of fat and glycogen in large portions of the tumors. Irrespective of the carcinogenic dose, the adenomas showed a consistent histochemical pattern. Glycogen synthase and phosphorylase were highly active in the hepatocytes that stored glycogen. In cells poor in, or free of, this polysaccharide, these enzymes were only moderately active or even inactive. In glycogen-storing parts of the adenomas, the activity of adenylate cyclase was reduced compared with normal liver parenchyma, but in fat-storing portions it was elevated. In a few adenomas, uniform increase in adenylate cyclase activity could be encountered. The levels of ATPase, acid phosphatase, and glucose-6-phosphatase were either increased or decreased. Glucose-6-phosphate dehydrogenase and glyceraldehyde-3-phosphate dehydrogenase showed an increased activity in all adenomas compared with preneoplastic foci, which in turn exhibited a higher glucose-6-phosphate dehydrogenase and glyceraldehyde-3-phosphate dehydrogenase activity than the surrounding parenchyma or the liver of untreated controls. The hepatocellular carcinomas showed remarkable histochemical changes compared with adenomas. The levels of fat and glycogen and the activities of glycogen synthase, phosphorylase, and in most cases also that of glucose-6-phosphate dehydrogenase, were reduced significantly. In contrast, adenylate cyclase, glucose-6-phosphatase, glyceraldehyde-3-phosphate dehydrogenase, and also alkaline phosphatase showed a striking elevation in developing carcinomas. Similar, although more pronounced, histochemical changes were seen in the advanced hepatocellular carcinomas. These observations indicated that progression from adenomas to hepatocellular carcinomas was associated with a change in the activity of several enzymes involved in cell membrane function, glycogen metabolism, the oxidative pentose phosphate pathway, and glycolysis.