Oesophageal cancer (EC) is a common cause of cancer mortality. Evidence on the burden, risk factors and treatment outcomes is limited in low-income and middle-income countries. This study aimed to describe the features of EC cases and determine associated factors among patients attending surgical and oncology clinics in Garissa County Referral Hospital (GCRH).
We conducted a case–control study in which cases were patients with EC and positive histological confirmation and controls were patients admitted to GCRH for other diseases. Data on exposures were extracted from patient files. Data on tobacco and alcohol use were based on current or past use as documented in the records; hot tea intake referred to habitual consumption. Mixed-effect logistic regression model was used to determine EC-associated factors.
141 cases and 282 controls were recruited. Of the 141 cases, 59 (42%) had cancer in the lower third of the oesophagus, whereas 72 (51%) and 10 (7%) had cancers in the middle and upper thirds, respectively. EC was associated with tobacco use (adjusted OR (AOR), 21.02, 95% CI 5.41 to 81.69), consumption of hot tea (AOR 59.87, 95% CI 5.45 to 657.35), chewing khat (miraa, AOR 9.94, 95% CI 3.59 to 27.52), gastro-oesophageal reflux disease (GERD) (AOR 54.12, 95% CI 24.48 to 119.62), gastritis (AOR 17.89, 95% CI 2.94 to 108.989) and peptic ulcer disease (PUD) (AOR 69.31, 95% CI 14.09 to 340.9). Among the case group, 95 (65%) had surgery or gastrostomy tube placement as treatments for EC.
The study findings highlight modifiable risk factors for EC, including tobacco use, hot tea consumption, chewing miraa, GERD, gastritis and PUD. Targeted screening of high-risk patients may improve early detection and outcomes.
Sepsis and antibiotic resistance constitute a deadly synergy, causing the loss of millions of lives across the world, with their economic and developmental consequences posing a threat to global prosperity. Their impact is disproportionately felt in resource-limited settings and among vulnerable populations, especially children. A key challenge is prompt diagnosis and timely commencement of appropriate antibiotic therapies. These challenges are compounded in low-income and middle-income countries by a lack of comprehensive epidemiological data, with Nigeria being one such country for which it is lacking. Kaduna is the third largest state in Nigeria, with over 10 million inhabitants, of whom more than half are children under 14 years old. While bacterial sepsis and antimicrobial resistance (AMR) are recognised as a growing problem in the state, there are huge gaps in the current understanding of their aetiology. This project employs a cross-sectional design to investigate the clinical and haematological markers of paediatric sepsis, alongside determining the bacterial cause and prevalence of AMR at four high-turnover hospitals in Kaduna State, Nigeria. Further, whole-genome sequencing of isolated bacterial pathogens will be performed to determine the genetic features of resistance. This project represents the largest surveillance study of paediatric sepsis in Kaduna to date. Additionally, we aim to use the clinical, haematological, microbiological and genomic data to derive predictive models for sepsis causes, treatment strategies and patient outcomes.
This is a hospital-based, cross-sectional study that will recruit up to 461 children with bacterial sepsis who were admitted at the two teaching and two general hospitals in Kaduna State, Nigeria. Children presenting with features of fever, subnormal temperature and body weakness would be recruited into the study and have their blood samples collected. The blood samples will be used for culture, complete blood count, HIV and malaria testing. Accordingly, we will capture clinical presentation, haematological characteristics, causative pathogen from blood culture and patient outcomes. Nutritional status, known congenital immunosuppressive diseases, HIV infection and malaria infection will also be determined and documented. The bacterial isolates will be phenotypically characterised for AMR and genotypically following whole genome sequencing. Known and potential confounders to the outcomes of bacterial sepsis would be assessed in all participants, and adjustment for confounding would be performed using logistic regression and/or stratification±Mantel-Haenszel estimator where applicable.
Ethical approvals were granted by the University of Birmingham (ERN_2115-Jun2024), the Ahmadu Bello University Teaching Hospital (ABUTHZ/HREC/H45/2023), Barau Dikko Teaching Hospital, Kaduna (NHREC/30/11/21A) and the Kaduna State Ministry of Health (MOH/AD M/744/VOL.1/1110018). The study will be conducted using the international guidelines for good clinical practice and based on the principles of the Declaration of Helsinki. The results will be disseminated via oral and poster presentations in scientific conferences and published in peer-reviewed journal articles.