Childhood cancers  – A child health priority for MENA

Childhood cancers – A child health priority for MENA

  by Hedieh Mehrtash The current, and soon to be expired Millennium Development Goal 4 (MDG 4), is to reduce childhood mortality in under-fives by two thirds. In the past decade, global efforts to reach this goal have focused on scaling up access to childhood vaccines, oral rehydration salts, malaria treatment and prevention, and prevention of mother to child transmission of HIV in Southern Asia and sub-Saharan Africa. Since the inception of the MDGs there has been increasing recognition of the burden of non-communicable diseases (NCDs) globally, not just as diseases of high-income countries. The post-2015 development agenda seeks to accommodate this shift as articulated in roadmaps such as the WHO Global Action Plan for NCDs. This blog post looks at where child health and NCDs intersect in the MENA region, with a specific focus on the burden and available treatment for childhood cancers. The unique epidemiological characteristics of childhood cancers make a strong case for studying them separately from adult cancers. The most striking difference perhaps is that cancer is generally a rare disease among children – annual incidence of all cancer in children under 5 years of age in developed countries is only 0.5% (1). Moreover, adult cancers are associated with modifiable risk factors, whereas childhood cancers are not. Consequently, population based screening and prevention programs are not the best recourse for pediatric cases, which benefit instead from accurate early diagnosis and effective treatment (10). When the data on pediatric cancer is stratified by geographic location, the highest incidence of childhood lymphomas occur in North Africa and the Middle East, while leukemia accounts for a quarter of childhood cancers in the...
Questions asked: Experiences of an Iranian at an oncology ward in Malawi

Questions asked: Experiences of an Iranian at an oncology ward in Malawi

  by Hedieh Mehrtash As members of a globalized world, our communities are increasingly connected by the shared burden and challenge of non-communicable diseases, cancer one of chief among them. My personal experience with family members plagued by cancer has driven a personal commitment to the global cancer care arena and #closingthecancerdivide. [1] After several observational experiences of cancer care in Iran, France and the United States, it is clear that cancer is a disease where finding the appropriate care and treatment is a global challenge. The next step in my journey led to me to Malawi this summer to work on my MPH summer practicum through Global Oncology, an NGO in Boston, and its ongoing collaboration with the oncology ward at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi.    Arriving in Malawi     “What have I done?”  Having landed at the “fun-sized” airport, without the fancy jet bridges one sees elsewhere, and having completed the paper work, I was on my way to Blantyre city. As we passed through all the villages on the way, I was shocked by the degree of visible poverty, worried and ready to turn back. Questions kept running through my head: should I really be here? Would my presence as a foreigner be accepted? Will I be able to communicate with people? Once I arrived at the lodge, things took off as I met other students and my coworkers at the hospital; my fears soon forgotten.   Oncology ward 2A at QECH     Here I was, at one of the only public referral hospitals that consult cancer patients in the country....
Improving cancer registries in the Middle East

Improving cancer registries in the Middle East

  Hedieh Mehrtash It is ironic when looking at modern cancer registries in the Middle East that cancer detection and registration can be traced back to papers from 2600 BC Egypt, citing Imhotep’s discovery of breast cancer cases . Today however, numerous barriers exist to dissemination of information regarding the burden of cancer in the region. In order to coordinate effective cancer care, a country must be able to identify its cancer burden and then use the data to act accordingly. A national cancer registry is the first step to achieving this. A systematic collection of data on cancer and tumors, cancer registries is a crucial tool that provides detailed information about cancer patients and the treatments they receive, thus informing requirements for infrastructure, medical supplies, and other health system inputs. The WHO highlights that cancer registries allow for better early detection programs, palliative care services, and the improvement of diagnosis and treatment. Regional information on cancer epidemiology in the region is available via Globocan, WHO’s International Agency for Research on Cancer, and the Middle East Cancer Consortium, a collaborative center with the US National Cancer Institute. The estimates from these international and regional databases are pooled from various national sources that are not readily available to the public. With no access to the disaggregated data, questions remain over the reliabilty and vaildity of the data e.g. what populations were captured during data collection, and whether or not clinical diagnosis was classified correctly. WHO guidelines specify “dissemination of results and free access to data” as a core role of population-based cancer registries, an undertaking that would address the ambiguity around regional cancer...

Exploring non-communicable disease risk factors among Middle Eastern adolescents

The Middle East and North Africa edition of The Global Burden of Disease, Generating Evidence, Guiding Policy identifies dietary risks, high blood pressure, high body mass index, and smoking as the leading risk factors for premature death and disability in the region. These risk factors can be attributed to health behaviours that are adopted during childhood and adolescence, with the burden of disease extending and worsening into adulthood.  Hence, adolescence is an opportune time for targeted interventions promoting healthy, protective behaviours. Several studies published this month aim to quantify the prevalence and predictors of these risk factors among cohorts of youth and recommend policy for intervention: Time trends of cigarette and waterpipe smoking among a cohort of school children in Irbid, Jordan, 2008 -2011 in the European Journal of Public Health Results synopsis: The longitudinal study documents patterns of tobacco use among school children according to age, gender, and tobacco use method. Boys reported higher smoking rates than girls for both cigarettes and waterpipe smoking, and girls generally displayed a 2-year delay in smoking acquisition compared to their male counterparts. Smoking patterns were characterized by “a predominance of waterpipe smoking and steeper age-related increase in cigarette smoking”. Based on these findings, the authors suggest that youth are initially introduced to smoking and tobacco use through waterpipe smoking, which later facilitates tobacco dependence and cigarette smoking. As such tobacco-control strategies should target waterpipe initiation and use at early ages. Physical activity and perceived barriers among highschool students in Muscat, Oman in Eastern Mediterranean Health Journal Results synopsis: This cross-sectional survey studying the patterns and determinants of physical activity among secondary school students...