Eight out of ten children with sufficient access to healthcare stand a chance to survive childhood cancer due to progress in the field of medicine and treatment of this disease. But in Africa, it is a different picture altogether.
"Children in developing countries – especially in Africa – are not yet sharing in the successes that saw the survival rate rising from 0% in 1950 to almost 80% today," says Prof Mariana Kruger, a paediatric oncologist and head of the Department of Paediatrics and Child Health at Stellenbosch University's Faculty of Medicine and Health Sciences (FMHS).
The reason is that access to treatment is not always available in developing countries. "Almost 80% of children in these countries don't have adequate access to the necessary medication and expertise, resulting in children being diagnosed at a late stage, which complicates treatment," Kruger says.
In terms of the availability of treatment, expertise and other resources, South Africa is much better off than most other African countries. "And yet we are still diagnosing only half of the expected number of childhood cancers. It is thus essential that researchers and clinicians contribute to the improvement of primary and secondary healthcare services to enable early diagnosis of childhood cancer."
Kruger attributes late or inaccurate diagnosis to healthcare practitioners who are not sensitised adequately to pick up on the early signs of childhood cancer.
The treatment of childhood cancer is further complicated by poverty. Parents often cannot afford to take their children for treatment to public sector childhood cancer facilities, which in South Africa are mainly situated at tertiary hospitals in the big cities. The only two units offering cancer therapy to all children in the Western Cape and parts of the Eastern and Northern Cape are the Tygerberg Children's Hospital and the Red Cross War Memorial Children's Hospital. The Tygerberg Unit is also the point of referral for childhood cancer patients from Namibia.
Poverty also contributes to insufficient nutrition and malnutrition, which can increase complications with treatment. "One can't administer highly toxic drugs to malnourished children, and we are therefore investigating adapted treatment protocols. We are also attempting to match the intensity of chemotherapy with the supportive care that existing staff and facilities can provide in the cancer care units in the rest of Africa," says Kruger.
Kruger and the team of paediatric oncologists at the FMHS focus on affordable drugs and treatment available in South Africa. Working with the rest of the country's oncologists, they are actively involved in the development of national treatment protocols, based on outcomes-based and highly effective therapy.
The unit also undertakes outreach projects to Baptist hospitals in Cameroon, where it supports and trains local healthcare workers to offer affordable, customised treatment in the local environments.
Typical symptoms of childhood cancer include the following:
- Persistent fever with unknown origin.
- Sudden weight loss.
- Persistent pain in the bones, joints, back or legs.
- A lump such as a gland in the armpit, groin or neck, or a larger mass in the abdomen that doesn't disappear.
- A whitish spot behind the pupil.
- Excessive bruising or abnormal bleeding such as bleeding of the gums or severe nosebleeds, or rash-like tiny red dots under the skin (petechia).
- Headaches with early morning nausea and vomiting.
- Paleness and tiredness.
- Changes in behaviour, posture and manner of walking.
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