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Innovative Approaches to Cancer Training in Africa First-of-Its-Kind Course Trains Nigerian Pathologists on Cancer Diagnosis

Sub-Saharan Africa is experiencing an unprecedented growth in cancer burden commensurate with the economic growth the continent has experienced over the past several decades. This African cancer crisis is particularly acute in Nigeria, the most populous country in the region, where the number of cancer patients is set to double by 2040 to more than 225,000 new cases per year.

An accurate and timely diagnosis of cancer can mean the difference between survival and death. Late diagnosis of cancer is tragically common in Africa, partly due to the lack of trained pathologists and other laboratory professionals. In many sub-Saharan countries, there is only one pathologist for every one million patients, a ratio approximately 50 times lower than the average across high-income countries.

Through the African Access Initiative (AAI), BIO Ventures for Global Health (BVGH) is addressing Africa’s cancer crisis by gathering data through hospital needs assessments to design data-driven programs that improve clinical and research capacity, access to medicines, and healthcare infrastructure. Under the purview of AAI and the Partners for Cancer Diagnosis and Treatment in Africa, BVGH and the American Society for Clinical Pathology (ASCP) have united to improve the capacity of students and practicing pathologists to accurately diagnose cancer patients.

In 2018, BVGH and ASCP jointly organized a three-day pathology workshop in collaboration with the Lagos State University Teaching Hospital (LASUTH). This training workshop improved participants’ knowledge of key concepts in pathology for cancer diagnosis, but it also illuminated the need for additional, sustained training.

Participants and trainers at the BVGH-ASCP pathology training workshop at LASUTH in 2018

In response to this identified need, BVGH and ASCP collaborated with the Ahmadu Bello University Teaching Hospital (ABUTH) in Zaria, Nigeria to design an innovative training course for pathologists across Nigeria. The curriculum for this course was developed in consultation with Professor Yawale Iliyasu at ABUTH to reflect the realities and serve the needs of the many pathologists practicing in Nigeria. BVGH, ASCP, and ABUTH opted for a virtual training format, which would open this learning opportunity to participants from across Nigeria, especially in light of travel restrictions necessitated by the COVID-19 pandemic.

"The virtual training program has been a boon for my institution, where we diagnose more than 1,800 cancer patients each year. The training course will enable my colleagues and me to correctly diagnose difficult cancer cases, thereby ensuring those patients are offered the most appropriate treatment option." – Professor Yawale Iliyasu of ABUTH

A Novel Approach

The Nigeria Virtual Pathology Course was taught by leading cancer pathology experts over weekly video webinars. The novel virtual format allowed Nigerian pathologists across experience levels and regions to participate in the multi-week course, a feat not possible with an in-person workshop. In total, 85 participants from 35 hospitals across Nigeria participated in the training program.

Course participants' home institutions in Nigeria

The course covered 12 topics prioritized by Nigerian pathologists and oncologists – and illuminated in the AAI Hospital Needs Assessment data – relevant to the diagnostic pathology of cancer, including histopathology of common cancers, immunohistochemistry for advanced diagnosis, and synoptic reporting. Eight expert trainers from elite American institutions delivered lectures that were recorded and then posted online, so participants could watch the lectures live or at their leisure. Participants completed internet-based homework assignments and knowledge assessments to gauge their knowledge before and after the sessions.

Based on the interests and needs expressed by the course participants, BVGH and ASCP held one webinar focused on business and fiscal planning for the laboratory – skills that are not typically taught during medical training but that are critical for increasing access to and affordability of laboratory services for patients. The content taught in this session aligns with BVGH and ASCP’s ongoing efforts to assist African laboratories in improving their operations, services, and efficiencies.

Course statistics

The nine-week course culminated in a virtual graduation ceremony that was attended by trainers, participants, and organizers. Nigeria’s Federal Minister of Health, Dr. Osagie Ehanire presided over the graduation ceremony with a speech delivered by Dr. Okpako Okpikpi, the Director of the National Cancer Control Program. Professor Ahmed Hamidu, the Chief Medical Director of ABUTH also delivered his congratulations and encouraging remarks to the graduates. Among the participants, 58 people completed the requisite assignments to receive ten continuing medical education credits from the West African Division of the International Academy of Pathology.

Attendees of the Nigeria Virtual Pathology Course graduation ceremony

Sustained Impact

As a result of this course, Nigerian pathologists now have the tools and know-how needed to diagnose challenging cancer cases and budget for the consumables and reagents that will empower them to make the precise diagnoses necessary to use targeted cancer therapies.

“The priority of the place of training and retraining cannot be overemphasized. Moreover, government cannot do it alone. Hence [the partnership with BVGH and ASCP] in this respect is apt, well-conceived, and very much appreciated… This training has further equipped pathologists and oncologists to diagnose and manage cancers more effectively and efficiently, making for better prognosis.” – The Honorable Federal Minister of Health, Dr. Osagie Ehanire

The training doesn’t stop after the course graduation ceremony though; the knowledge exchange between the Nigerian participants and ASCP pathology experts will be sustained via BVGH’s virtual mentorship program platform. This innovative program will enable course participants to continue sharing knowledge and experience and build lasting mentorship linkages amongst themselves and with the international pathology experts.

Nigeria’s improved diagnostic capacity – combined with increased access to affordable, high-quality cancer drugs and technologies through AAI – will lead to better patient outcomes, increased survivorship, and a brighter future for cancer patients across the country.

BVGH and ASCP are grateful to ABUTH and all course participants across Nigeria - for their contributions to the success of the course - and to AAI's program partners, Takeda Pharmaceutical Co., Ltd., Johnson & Johnson, and Faber Daeufer and Itrato PC.

Credits:

Paweł Czerwiński