ANNOTATED BIBLIOGRAPHY OF ORAL CANCERS IN AFRICA: 1965-2008

Title of Paper ANNOTATED BIBLIOGRAPHY OF ORAL CANCERS IN AFRICA: 1965-2008
Authors Otoh EC (Ed)
Year of Publication/Presentation 2010
Publication Details/Conference Venue ICOH/AFRO/273/1.2010. ISBN: 978-188-079-3. 2010.
Research Area Oral Cancers
AIMS: To document publications from researches on oral cancer, conducted in the different countries in Africa, and analyze the trends.
OBJECTIVES: (a) To highlight the various areas of oral cancer research in the different geographic groups; (b) to make an overview and summarize each of these research areas; (c) to determine the level of progress, if any, in the area of oral cancer research; (d) to make specific recommendations for improvements in oral cancer research, where required.
SOURCES OF INFORMATION: Information for the bibliography was obtained from the following sources: PubMed; African Journals OnLine (AJOL); Dissertations submitted to the West African College of Surgeons in the Faculty of Dental Surgery; Dissertations submitted to the National Postgraduate Medical College of Nigeria in the Faculty of Dental Surgery.
ANALYSIS OF TREND OF RESEARCHES ON ORAL CANCERS IN AFRICA
Johnson (1991) described the global epidemiology, highlighted risk factors and recommendations by the World Health Organization (WHO) for future researches on oral neoplasms 3. The WHO- recommendations highlighted were broadly classified into general and specific recommendations. The general recommendations emphasized the need for standardization of researches in the areas of data collection, outcome, statistical and evaluation measures; the emphasis on multi-centre approach to research studies, and, where possible, the desirable need for international collaborations. While the general recommendations (researches on epidemiology and aetiology, specifically for countries where information on habits like tobacco/alcohol use in relation to cancer is not available and on the roles of viruses and nutrition in oral cancers; pathology, primary prevention, early detection, treatment, management of oral complications of treatment) served as a yardstick for assessing the quality of the research, the specific recommendations served as a guide in the collation of publications for this annotated bibliography. A total of ninety-three (94) publications from researches on oral cancers were published between 1965 and 2008, with the following distribution: (i) epidemiological studies 40(42.5%), (ii) case reports 6(5.1%), (iii) aetiological studies 10(10.5%), (iv) gene expression studies 13(13.8%), (v) risk-factor studies 10(10.5%), (vi) cancer diagnosis studies 4(4.3%), (vii) cancer management studies 6(5.1%), (viii) post-treatment rehabilitation studies 2(2.1%), (ix) cancer education studies 1(1.1%) and (x) cancer control studies 2(2.1%) (Fig. 1). In order to better appreciate the trends of researches, items (ii) – (vii) were broadly classified as “follow-up studies” as shown below (Fig. 2)

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Pub_Otoh_2
There were a relatively greater number of publications from epidemiological surveys in the West African sub-region, especially from Nigeria. In Nigeria, there was no national epidemiological survey conducted, but multiple regional surveys were conducted which tended to overlap each other as regards the periods of study. Relative to epidemiological studies, follow-up studies in the region was the least and this trend could be attributed to factors ranging from the dearth of facilities to the lack of needed experience for conducting experimental and clinical follow-up researches in oral cancers. Other published oral cancer research studies include case reports and their “follow-up studies” such as case management studies, post-treatment rehabilitation studies and quality of life (QoL) studies, and their trend is as shown below in Figs. 3 & 4.

Issues Highlighted
Manpower Issues: In the West African sub-region, over 2500 dentists were produced from dental schools in Nigeria from 1971 till date. Over 170 specialists from dentistry sub-specialty produced by the West African College of Surgeons alone from 1980 to 2008 4. The foundation for conducting qualitative researches in the training institutions is questionable; but this could be improved during the residency training and by adequate mentoring in research. Mentoring could be enhanced during the residency training by the sustenance of the compulsory one-year clinical attachment in developed countries as part of the residency training programme, during which the trainee is mentored in both clinical and experimental research. Infrastructures for cancer research are not available, or at best inaccessible to the researcher in oral cancers, where these are available in other government institutions. This predicates the need for collaborations at various levels, i.e. inter-agency, inter-institutional and inter-country collaborations, as demonstrated by the Sudan in Central Africa.
Policy issues: Globally, the priority status of oral cancer or any health problem often determines the level of funding for researches into it. In Africa, Oral Cancer is on the top priority list of oral health problems, according to the WHO/AFRO Regional Oral Health Strategy for 1998-2008 1, but not on the priority list of health problems in most countries in the West African sub-region. The West African situation could be attributed to the dearth of data on the true position of the oral cancer problem in the sub-region. In the Sudan (Central Africa), Republic of South Africa (South Africa), oral cancer is a priority problem and this can be attested to by the levels of experimental and clinical researches conducted and the establishment of preventive programmes by the government of these countries.
Conclusions and Recommendations
Reversing the trend of researches on oral cancers in most Sub-saharan African countries would require a greater commitment on the part of governments towards recognizing oral cancer as a high priority health problem. Qualitative, rather than quantitative researches would go a long way in improving government commitment and attracting collaborations and funding. To this end, the following are recommended: (i) the re-training of available oral health practitioners in research methodologies/techniques through workshops and short courses is highly critical; (ii) the incorporation of a mandatory clinical attachment into residency training programmes, during which specialists in training could be trained and mentored in clinical and experimental research. Inter-governmental collaborations could help realize this recommendation; (iii) standardization of data collection, outcome measures through the development of minimum datasets for oral cancers in the sub-region is recommended; and (iv) sustained collaborations with institutions, agencies and research institutes would enhance researches into WHO-recommended specific areas of oral cancer research.