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Cancer Epidemiol. 2018 Dec;57:45-52. doi: 10.1016/j.canep.2018.09.006. Epub 2018 Oct 6.

Cancer epidemiology fieldwork in a resource-limited setting: Experience from the western Kenya ESCCAPE esophageal cancer case-control pilot study.

Author information

1
School of Public Health, College of Health Sciences, Moi University, Eldoret, Kenya. Electronic address: dianamenya@gmail.com.
2
University Health Services, University of Eldoret, Eldoret, Kenya.
3
Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
4
School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
5
School of Dentistry, College of Health Sciences, Moi University, Eldoret, Kenya.
6
National Affirmative Action Fund, Ministry of Gender, Government of Kenya, Nairobi, Kenya.
7
School of Public Health, University of Haifa, Haifa, Israel.
8
Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France.
9
Section of Genetics, International Agency for Research on Cancer, Lyon, France.

Abstract

BACKGROUND:

Case-control studies remain an important study design for aetiologic research on cancer, particularly when cohorts are not available. In addition to the potential biases inherent in this design, conducting fieldwork in settings with weak health care and information systems for cancer, such as in sub Saharan Africa, confer additional challenges which we present here with the aim to share experience to guide future studies.

METHODS:

We undertook a hospital-based case-control study of squamous cell esophageal cancer at the Moi Teaching and Referral Hospital in Eldoret, West Kenya. Cases were recruited at endoscopy and controls from hospital wards, age and gender frequency-matched to cases. Urine, toenails, blood and tumour biopsy were collected and a questionnaire administered.

RESULTS:

During this pilot phase, 143 cases and 155 controls were successfully recruited. Complete questionnaire data was obtained through e-data collection. Biospecimen collection was possible with support of an already existing equipped laboratory. We introduce changes made in the main study phase, including on expansion of the control groups to allow to consideration of selection bias.

CONCLUSIONS:

Extra attention and funding to train and monitor data quality and biospecimen collection and collaboration of a large group held together by strong leadership are essential. We recommend studies based on regional treatment centres with their more defined catchment areas rather than in the capital cities as referral routes in multi-level health care systems are severely attrition prone.

KEYWORDS:

Case-control study; Esophageal cancer; Fieldwork; LMICs

PMID:
30300838
PMCID:
PMC6289835
[Available on 2019-12-01]
DOI:
10.1016/j.canep.2018.09.006
[Indexed for MEDLINE]
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