Oesophageal and other cancer patterns in four selected districts of Transkei,Southern Africa: 1985-1990

New data regarding the incidence of oesophageal and other cancers during the period 1985-1990 are reported for all clinics and hospitals in four selected districts of Transkei, Southern Africa i.e Kentani, Butterworth, Lusikisiki and Bizana. Active and passive methods were used to obtain the hospital-based cancer registry data. The mean annual number of cancer cases recorded for the period 1985-1990 was 292. Age-standardized incidence rates (ASIIR, African Standard) for all recorded cancers were 81.4 and 52.6/100,000 for males and females, respectively. Histopathogical examination of 52.6% of recorded tumours revealed that 67.3% were squamous carcinomas, 21.7% adenocarcinomas and the remainder non-epithelial neoplasms. Cancer of the oesophagus (EC) was the most frequently recorded cancer and accounted for 46.5% of the cases with mean ASIR of 46.7 and 19.2/100,000 for males and females, respectively. The male/female ratio was 2:4:1. The highest mean ASIR per annum for OC in males (55.6/100,000) occurred in Kentani and in females (22.3/100,000) in Lusikisiki, whereas the lowest rates in both sexes (37.0 and 11.7/100,000 respectively) occurred in Bizana. Comparison of the OC rates in the four districts of Transkei during 1985-1990 with previously reported trends, confirms a consistently high rate in the south-western district of Kentani during the past 35 years and progressively increasing rates in the north-eastern districts of Bizana and Lusikisiki. These results have profound implications for further epidemiological and aetiological studies on OC in Transkei, but need to be corroborated by data from other sources such as statistics on histologically diagnosed cancer in Transkei by district in the South African National Cancer Registry. The second most frequently recorded cancer among males was liver cancer with a mean annual ASIR of 6.0/100,0000 and a male: female ratio of 3:1. The most frequently recorded cancer with a mean annual AISR of 20.9/100,000 followed by OC (19.2/100,000) and breast cancer (5.8/100,000).     

Oesophageal and other cancer patterns in four selected districts of the Transkei, Southern Africa:1985-1990

New data regarding the incidence of oesophageal and other cancers during the period 1985-1990 are reported for all clinics and hospitals in four selected districts of Transkei, Southern Africa i.e. Kentani, Butterworth, Lusikisiki and Bisana. Active and passive methods were used to obtain the hospital-based cancer registry data. The mean annual number of cancer cases recorded for the period 1985-1990 was 292. Age-standardised incidence rates (ASIR, African standard) for all recorded cancer were 81.4 and 52.6/100,000 for males and females respectively. Histopathological examination of 52.6% of recorded tumors revealed that 67.3% were squamous carcinomas, 21.7% adenocarcinomas and the remainder non-epithelial neoplasm. Cancer of the oesophagus (OC) was the most frequently recorded cancer and accounted for the 46.5% of the cases with mean ASIR of 46.7 and 19.2/100,000 for males and females respectively. The male/female ratio was 2.4:1. The highest mean ASIR per annum for OC in males (55.6/100,000) occurred in Kentani and in females (22.3/100,000) in Lusikisiki, whereas the lowest rates in both sexes (37.0 and 11.7/100,000 respectively) occurred in Bizana. Comparison of the OC rates in the four districts of Transkei during 19985-1990 with previous reported trends, confirms a consistently high rate in the south-western districts of Kentani during the past 35 years and progressively increasing rates in the north-eastern districts of Bizana and Lusikisiki. These results have profound implications for further epidemiological and aetiological studies on OC in Transkei, but we need to be corroborated by data form other sources such as statistics on histologically diagnosed cancer in Transkei by districts in the South African National Cancer Registry. The second most frequent recorded cancer among males was liver cancer with a mean annual ASIR of 6.0/ 100,000 and male:female ratio of 3:1. The most frequent recorded cancer among females was cervical cancer with a mean annual ASIR of 20.9/100,000 followed by OC (19.2/100,000) and breast cancer (5.8/100,000).     

Linkage to care following a home-based HIV counselling and testing intervention in rural South Africa

Introduction

Efforts to increase awareness of HIV status have led to growing interest in community-based models of HIV testing. Maximizing the benefits of such programmes requires timely linkage to care and treatment. Thus, an understanding of linkage and its potential barriers is imperative for scale-up.

Methods

This study was conducted in rural South Africa. HIV-positive clients (n=492) identified through home-based HIV counselling and testing (HBHCT) were followed up to assess linkage to care, defined as obtaining a CD4 count. Among 359 eligible clients, we calculated the proportion that linked to care within three months. For 226 clients with available data, we calculated the median CD4. To determine factors associated with the rate of linkage, Cox regression was performed on a subsample of 196 clients with additional data on socio-demographic factors and personal characteristics.

Results

We found that 62.1% (95% CI: 55.7 to 68.5%) of clients from the primary sample (n=359) linked to care within three months of HBHCT. Among those who linked, the median CD4 count was 341 cells/mm³ (interquartile range [IQR] 224 to 542 cells/mm³). In the subsample of 196 clients, factors predictive of increased linkage included the following: believing that drugs/supplies were available at the health facility (adjusted hazard ratio [aHR] 1.78; 95% CI: 1.07 to 2.96); experiencing three or more depression symptoms (aHR 2.09; 95% CI: 1.24 to 3.53); being a caregiver for four or more people (aHR 1.93; 95% CI: 1.07 to 3.47); and knowing someone who died of HIV/AIDS (aHR 1.68; 95% CI: 1.13 to 2.49). Factors predictive of decreased linkage included the following: younger age – 15 to 24 years (aHR 0.50; 95% CI: 0.28 to 0.91); living with two or more adults (aHR 0.52; 95% CI: 0.35 to 0.77); not believing or being unsure about the test results (aHR 0.48; 95% CI: 0.30 to 0.77); difficulty finding time to seek health care (aHR 0.40; 95% CI: 0.24 to 0.67); believing that antiretroviral treatment can make you sick (aHR 0.56; 95% CI: 0.35 to 0.89); and drinking alcohol (aHR 0.52; 95% CI: 0.34 to 0.80).

Conclusions

The findings highlight barriers to linkage following an increasingly popular model of HIV testing. Further, they draw attention to ways in which practical interventions and health education strategies could be used to improve linkage to care.     

Evaluating the utility of national‐scale data to estimate the local risk of foot‐and‐mouth disease in endemic regions

Knowledge of the distribution of foot‐and‐mouth disease (FMD) is required if control programmes are to be successful. However, data on the seroprevalence and incidence of affected villages in developing countries with endemic disease are scarce. This is partly due to resource constraints as well as the logistical challenges of conducting intensive surveys and diagnostic testing in remote locations. In this study, we evaluated the performance of low resolution national‐scale data against high resolution local survey data to predict the FMD serological status of 168 villages in the Mandalay and Sagaing Regions of central Myanmar using both logistic regression and random forest modelling approaches. Blood samples for ELISA testing were collected from approximately 30 cattle per village in both the 6 to 18 month age range and in the over 18 month age range to distinguish between recent and historical exposure, respectively. The results of the animal level tests were aggregated to the village level to provide the outcome of interest (village positive or not positive for FMD), and three explanatory data sets were constructed: using only nationally available data, using only data collected by survey and using the combined survey and nationally available data. The true seroprevalence of FMD at the village level was 61% when only young animals were included, but increased to 87% when all animals were included. The best performing model was a logistic regression model using the combined national and survey data to predict recent infection in villages. However, this still incorrectly classified 40% of villages, which suggests that using national‐level data were not reliable enough for extrapolating seroprevalence in regions where conducting detailed surveys is impractical. Other methods for collected data on FMD such as the use of local reporting should be explored.     

An evaluation of the objectivity and reproducibility of shear wave elastography in estimating the post-mortem interval: a tissue biomechanical perspective

International Journal of Legal Medicine - Cadaveric rigidity—also referred to as rigor mortis—is a valuable source of information for estimating the time of death, which is a...