Patient Navigation for Cancer Care in Sub-Saharan Africa: A Scoping Review.

In the current nationwide study, the authors used latent class analysis (LCA) to identify classes of cancer patient navigators (CPNs) and examined whether class membership and 12 indicators were related to navigator role retention. By using data from 460 CPNs in the United States, LCA identified classes (ie, homogenous subgroups) of CPNs with the following indicators: type of CPN (clinical vs nonclinical), education level, area(s) of the cancer care continuum in which the CPN provided patient navigation, region and urbanity where the CPN provided services, organizational work setting, and patient navigation program funding source. The associations of navigator retention with class membership and each indicator were examined using χ2 tests. LCA identified 3 classes of CPNs. Classes 1 and 3 were conceptualized as distinct, homogeneous subgroups of clinical CPNs that appeared to differ mainly on their likelihood of engagement in outreach, survivorship, palliative care, and end-of-life patient navigation. Class 2 was conceptualized as a nonclinical CPN subgroup that was distinct primarily based on their high endorsement of employment in programs, which are at least partially funded by grants and engagement in earlier stages of patient navigation (eg, early detection). The provision of survivorship and treatment patient navigation was related to navigator role retention, with senior CPNs providing these patient navigation services more than novice CPNs. The current study highlights 3 distinct classes of CPNs, provides initial information regarding determinants of navigator retention, and makes several recommendations for future patient navigation research.

Cancer navigation guides patients through cancer care, addressing barriers like late diagnosis, financial constraints, and emotional distress. In Africa, it supports early detection, treatment, and survivorship amid poor infrastructure and limited access. Expanding these programs can reduce mortality and improve outcomes. Cancer cases are rising rapidly in Africa and are expected to double by 2050. Access to care is hindered by limited facilities, few trained oncologists, geographic barriers, cultural stigma, high treatment costs, and lack of screening programs. Most services are urban-centered, leaving rural areas underserved. Financial hardship, poor governance, inadequate research funding, and scarce cancer registries worsen the problem. Coordinated, sustainable efforts are needed to improve cancer prevention, treatment, and care. Patient navigation significantly enhances cancer care in sub-Saharan Africa by addressing barriers to early detection, diagnosis, treatment, and support. Navigators facilitate screening, improve awareness, and coordinate care across healthcare levels. They reduce treatment delays, offer psychosocial support to patients and caregivers, and help with financial, transport, and lodging challenges. Successful programs in South Africa, Uganda, and Nigeria demonstrate improved outcomes, including increased screenings, faster diagnoses, and better treatment adherence, showcasing the transformative impact of navigation on cancer control in resource-limited settings. Strengthening cancer navigation systems is essential, focusing on healthcare infrastructure, workforce training, policy reform, and community engagement. Key strategies include expanding cancer centers, integrating trained patient navigators (both clinical and non-clinical navigators), leveraging telemedicine and AI, and increasing collaborations. Formal navigator certification, education campaigns, and improved health financing are crucial. These efforts aim to improve cancer detection, treatment, and outcomes across Africa's diverse healthcare settings.

Improving child wellbeing and care in Sub-Saharan Africa: The role of social protection

HomeCirculation: Cardiovascular Quality and OutcomesVol. 15, No. 4Fixing the Broken Care Pathway for Acute Myocardial Infraction Care in Sub-Saharan Africa No AccessEditorialRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessEditorialRequest AccessFull TextFixing the Broken Care Pathway for Acute Myocardial Infraction Care in Sub-Saharan Africa Oyere K. Onuma, MD, MSc Oyere K. OnumaOyere K. Onuma Correspondence to: Oyere K. Onuma, MD, MSc, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510. Email E-mail Address: [email protected] https://orcid.org/0000-0003-1186-7104 Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT Search for more papers by this author Originally published18 Mar 2022https://doi.org/10.1161/CIRCOUTCOMES.121.008689Circulation: Cardiovascular Quality and Outcomes. 2022;15This article is a commentary on the followingOne-Year Outcomes and Factors Associated With Mortality Following Acute Myocardial Infarction in Northern Tanzania"Fixing the Broken Care Pathway for Acute Myocardial Infraction Care in Sub-Saharan Africa." Circulation: Cardiovascular Quality and Outcomes, 15(4), pp. e008689–FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.For Disclosures, see page 280.Correspondence to: Oyere K. Onuma, MD, MSc, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510. Email oyere.[email protected]edu

Cancer and palliative care in Africa.

This study examines breast and cervical cancer screening uptake in a cancer education and patient navigation (PN) program for residents of rural and border counties in Texas by level of participation (education only, PN only, or education and PN). Data collected from March 1, 2012, to November 5, 2016, included 6663 follow-up surveys from participants aged 21-74. Logistic regression models assessed program participation on the odds of completing breast or cervical cancer screening. For women aged 40-74years (N = 4942; mean age = 52years), 58.4% reported a mammogram within 6months on average from initial contact. In the breast cancer screening model, women who only received PN (OR: 6.06, CI: 4.87-7.53) or who participated in both the education plus PN program (OR: 3.33, CI: 2.77-4.02) had higher odds of mammogram screening compared to women who only received education. For women aged 21-64years (N = 6169; mean age = 46years), 37.7% received a Papanicolaou (Pap) test within 6months on average from initial contact. In the Pap screening model, both education and PN (OR: 3.23, CI: 2.66-3.91) and PN only (OR: 2.35, CI: 1.88-2.93) groups had higher odds of screening for cervical cancer compared to those only receiving education. Graphed predicted probabilities examined significant interactions between race/ethnicity/language and program participation (P < 0.0001) for both screenings. PN, solely or in combination with education, is an effective strategy to increase screening for breast and cervical cancer, beyond educational outreach efforts alone, among un-/underserved, racially/ethnically diverse women in rural and border Texas counties.

It is projected that by 2050, around 40% of all births, and about 40% of all children, will be in Africa, up from about 10% in 1950. Consequently, this trend will cause an increase in noncommunicable diseases in children, such as congenital and rheumatic heart diseases. The current state of pediatric cardiac care in sub-Saharan Africa is dire with some countries without cardiac surgical services at all. The purpose of this review is to highlight those components needed to build a sustainable model for a pediatric cardiac care center in sub-Saharan Africa. Review of the literature reveals that capacity-building for pediatric cardiac care in sub-Saharan Africa can be a challenging entity. Several factors must come into play to lay the foundation for a successful cardiac program. Key among them are early diagnosis of heart disease, human resources, financing cardiac care, and political commitment. The burgeoning pediatric population in sub-Saharan African lends itself to an increase in the incidence of pediatric heart disease. The need for sustainable, patient-centered cardiac centers is pressing. Establishing such pediatric cardiac care models will require the essential components of early diagnosis, increasing human resources, financing cardiac care, and political commitment. VIDEO ABSTRACT: http://links.lww.com/HCO/A59.

Surgical burn care in sub-Saharan Africa: A systematic review

IntroductionSub-Saharan Africa has the highest rate of adolescent pregnancy in the world. While pregnancy during adolescence poses higher risks for the mother and the baby, the utilisation of maternity care to mitigate the effects is low. This review aimed to synthesise evidence on adolescent mothers’ utilisation of maternity care in Sub-Saharan Africa and identify the key determinant factors that influence adolescent mothers’ engagement with maternity care.MethodA systematic review of scholarly literature involving seven databases: ProQuest, PubMed, EMBASE/Elsevier, SCOPUS, PsycINFO, CINAHL and Infomit was conducted. Studies published in English between 1990 and 2017 that examined Sub-Saharan adolescent mothers’ experiences of utilising biomedical maternity care during pregnancy, delivery and the post-partum period were included.ResultsFrom 296 relevant articles 27 were identified that represent the experience of adolescent mothers’ maternal health service utilisation in Sub-Saharan Africa. The review indicates that maternal health service utilisation in the majority of Sub-Saharan African countries is still low. There is also a wide discrepancy in the use of maternity care services by adolescent mothers across countries in Sub-Saharan Africa.ConclusionsThe review reveals that a significant number of adolescents in Sub-Saharan Africa do not access and use maternity services during pregnancy. Several factors from individual to systemic levels contributed to low access and utilisation. This implies that interventions targeting the women, their partners, healthcare professionals, communities and the organisations (local to national) are necessary to improve adolescent mother’s engagement with maternity care in Sub-Saharan Africa.

The number of people needing palliative care is rapidly increasing in sub-Saharan Africa (SSA). Healthcare systems in SSA are heterogenous, so broadly defining and operationalizing primary palliative care is a major obstacle to achieving Universal Health Coverage. We aimed to conceptualize and operationalize primary palliative care in SSA by developing an evidence-based logic model and consensus definition. We purposively sampled expert participants in a workshop in Harare, Zimbabwe. They collaboratively developed a logic model using the Centers for Disease Control and Prevention's guide for developing and using logic models and a consensus definition using modified nominal group technique. Twenty-four primary palliative care experts comprised of researchers (70.1%) , physicians (37.5%) and nurses (29.2%) from 8 countries (7 in SSA) participated. Twenty (83.3%) participants fell into multiple role categories. Primary palliative care essential resources (i.e., medications, funding, health workers), activities (i.e., clinical guidelines and referral pathway development, education), outputs (i.e., care pathways, cost-benefit ratios), and outcomes (i.e., improved quality of life, skilled primary palliative care workforce, reduced health-related suffering) relevant for countries in SSA were identified. To define primary palliative care in SSA, participants identified and ranked crucial components, including holistic care (provided by health workers with role-appropriate training) , culturally congruent delivery of care, and accessibility at the entry point of healthcare systems. The definition highlights that "primary" pertains to how people access care, rather than who or where it is provided. The identified essential components of primary palliative care address the region's specific context, challenges and strengths. Training the existing primary healthcare workforce in palliative care and providing necessary support and resources must be prioritized in order to improve outcomes in SSA.

There has been significant progress in maternal health outcomes in the sub-Saharan African region since the early 1990s, in part due to digital and mobile health interventions. However, critical gaps and disparities remain. Mobile phones in particular have potential to reach underserved, hard-to-reach populations with underdeveloped infrastructure. In spite of the opportunities for mobile phones to address maternal mortality in the region, there is no extensive mapping of the available literature on mobile phone interventions that aim to improve access of maternal care in sub-Saharan Africa. The proposed scoping review aims to map literature on the nature and extent of mobile phones interventions designed to improve maternal care health services in the region. Conduct of this scoping review will be guided by the Joanna Briggs Institute approach. Literature searches will be conducted in multiple electronic databases, including MEDLINE, Embase, CINAHL, APA PsycInfo, Cochrane Central Register of Controlled Trials, Global Health, African Index Medicus, Web of Science, and Applied Social Sciences Index & Abstracts. Grey literature will also be identified. Keyword searches will be used to identify articles. Two reviewers will independently screen eligible titles, abstracts and full articles with a third reviewer to help resolve any disputes. We will extract data on general study characteristics, population characteristics, concept, context, intervention details, study results, gaps and recommendations. Understanding use of mobile phones among underserved, hard-to-reach populations with underdeveloped infrastructure to address maternal mortality in developing countries is very critical to informing health systems on potential effective strategies. This review will complement the evidence base on utilisation of mobile phone interventions to improve the delivery of maternal health services in sub-Saharan Africa.

PURPOSETo evaluate the scope and types of cancer research projects in sub-Saharan Africa (SSA) to identify research gaps and inform future efforts.METHODSThis retrospective observational study summarized information on cancer research projects in SSA from the International Cancer Research Partnership (ICRP) between 2015 and 2020, alongside 2020 cancer incidence and mortality data from the Global Cancer Observatory. SSA cancer research projects were identified as led by investigators in SSA countries, or by investigators in non-SSA countries with collaborators in SSA, or in database keyword searches. Projects from the Coalition for Implementation Research in Global Oncology (CIRGO) were also summarized.RESULTSA total of 1,846 projects were identified from the ICRP database, funded by 34 organizations in seven countries (only one, Cancer Association of South Africa, based in SSA); only 156 (8%) were led by SSA-based investigators. Most projects focused on virally induced cancers (57%). Across all cancer types, projects were most frequently related to cervical cancer (24%), Kaposi sarcoma (15%), breast cancer (10%), or non-Hodgkin lymphoma (10%). Gaps were observed for several cancers with higher incidence/mortality burden in SSA; for example, prostate cancer accounted for only 4% of projects but 8% of cancer-related deaths and 10% of new cases. Approximately 26% were dedicated to etiology. Treatment-related research declined over the study period (14%-7% of all projects), while projects related to prevention (15%-20%) and diagnosis/prognosis (15%-29%) increased. Fifteen CIRGO projects were identified; seven were relevant across multiple cancer types, and 12 focused either wholly or partially on cancer control (representing 50% of the total research effort).CONCLUSIONThis analysis shows notable discrepancies between cancer burden and research projects and identifies opportunities for future strategic investments in cancer care in SSA.

BackgroundBreast cancer mortality rates in the U.S. remain relatively high, particularly among ethnic minorities and low-income populations. Unequal access to quality care, lower follow up rates, and poor treatment adherence contribute to rising disparities among these groups. Healthcare empowerment (HCE) is theorized to improve patient outcomes through collaboration with providers and improving understanding of and compliance with treatment. Patient navigation is a health care organizational intervention that essentially improves healthcare empowerment by providing informational, emotional, and psychosocial support. Patient navigators address barriers to care through multilingual coordination of treatment and incorporation of access to community services, support, and education into the continuum of cancer care.MethodsUtilizing survey and qualitative methods, we evaluated the patient navigation program in a Northern California safety-net hospital Breast Clinic by assessing its impact on patients’ experiences with cancer care and providers’ perspectives on the program. We conducted qualitative interviews with 16 patients and 4 service providers, conducted approximately 66 hours of clinic observations, and received feedback through the self-administered survey from 66 patients.ResultsThe role of the patient navigator at the Breast Clinic included providing administrative assistance, psychosocial support, improved knowledge, better understanding of treatment process, and ensuring better communication between patients and providers. As such, patient navigators facilitated improved collaboration between patients and providers and understanding of interdisciplinary care processes. The survey results suggested that the majority of patients across all ethnic backgrounds and age groups were highly satisfied with the program and had a positive perception of their navigator. Interviews with patients and providers highlighted the roles of a navigator in ensuring continuity of care, improving treatment completion rates, and reducing providers’ workload and waiting time. Uncertainty about the navigator’s role among the patients was a weakness of the program.ConclusionsPatient navigation in the Breast Clinic had a positive impact on patients’ experiences with care and healthcare empowerment. Clarifying uncertainties about the navigators’ role would aid successful outcomes.

Background: Although morbidity and mortality rates are low compared to other types of cancer, cervical cancer remains a high priority for the following reasons: 1) invasive cervical cancer is a disease that could be prevented in nearly all cases, with greater use of the Pap test; 2) the Pap test is a well-established, low cost, widely available screening test that should present minimal barriers to its use; and 3) despite our ability to prevent and treat cervical cancer, the burden of cervical cancer morbidity and mortality continues to be higher among low-income women with limited education, many of whom reside in rural areas. Despite public health recommendations for cervical cancer screening and follow-up of abnormal Pap test results, adherence is still low among rural Appalachian women in Kentucky. In response to this concern, the University of Kentucky Prevention Research Center is implementing a National Cancer Institute-funded project that is integrating patient navigators (PN) in cervical cancer screening programs in several rural health departments. Goal: To reduce the disproportionate burden of cervical cancer experienced by rural Appalachian women in Kentucky. Objectives: To: 1) improve our understanding of the barriers to follow-up; 2) recruit, train, and utilize lay health workers as PNs in cervical cancer screening programs; 3) increase the proportion of women who adhere to recommended follow-up; and 4) evaluate the efficacy of the intervention. Method: Intervention activities are as follows: 1) nurse case managers refer patients with abnormal pap tests to PNs in selected local health departments in Big Sandy, Lake Cumberland, and Kentucky River Area Development Districts; 2) PNs enroll patients in the study; 3) study participants complete a baseline interview; 4) PNs provide navigation services including outreach, education, and support; 5) PNs conduct follow-up interviews; and 6) PNs document follow-up recommendations, barriers, patient needs, and specific actions taken to ensure adherence to follow-up recommendations. Evaluation: To assess the efficacy of the intervention, outcome data will be collected from health department records in intervention and control counties. Findings: The total number of referrals to date is 600. Among the referrals: 82 (14%) were ineligible (patient less than 18 years, refused services, dropped by health department for non-compliance, or lost to follow-up); 379 (63%) were offered enrollment; and enrollment is pending for 139 (23%). Among those offered enrollment, 297 (78%) agreed to participate in the study. Additional preliminary findings will be presented including reason for referral, characteristics of women enrolled, patient needs, adherence to follow-up, etc. Conclusions: The program creates a unique opportunity to support rural cervical cancer screening programs, ensuring women obtain their recommended follow-up care through the support of PNs. Citation Information: Cancer Prev Res 2010;3(1 Suppl):B30.

As the importance of quality in health care provision is increasingly recognised, it is opportune to consider quality care as a key link between clinical and public health approaches to human immunodeficiency virus (HIV) infection in developing countries, especially in sub-Saharan Africa. This region has the lion's share of the global epidemic and the least resources to respond. Looking at health problems using a 'quality lens' may help bridge the gaps between clinical care and public health, the current and desired standard of care, and prevention and treatment. Quality care, with prompt diagnosis and effective treatment, of people with HIV infection is crucial for good individual health outcomes, public health outcomes (in terms of decreased HIV transmission) and societal outcomes (increased productivity and decreased costs of health provision for HIV-related care). A spotlight on quality care can bring clinicians and public health practitioners together in working towards universal access to quality HIV care and prevention - one of the greatest health challenges faced in developing countries in Africa today.