Background: Malawi is a densely populated developing country in Sub-Saharan Africa. With a population of 15 million, Malawi suffers from a high burden of HIV/AIDS, with an estimated HIV prevalence of 15% for those aged 15 to 49. This high prevalence has resulted in an increase in HIV-associated malignancies. Kaposi’s sarcoma and cervical cancer are the most common cancers in males and females, respectively.1 Contributing to the challenge is a paucity of data on the matter which has been attributed to the lack of diagnostic capacity and inadequate cancer services at different levels and disciplines throughout the country. In addition to inadequate infrastructure, only three pathologists and three oncologists are available to serve the entire nation. The nation also lacks adequate support staff including laboratory technicians, pharmacists, and nurses with expertise in cancer care.
Intervention: Motivated by the lack of capacity in cancer service delivery, in 2010 the University of Malawi applied for and received a Medical Education Partnership Initiative (MEPI) award. The goal was to use the MEPI award to expand physical resources for cancer diagnosis and treatment and assemble a limited group of trained Malawian doctors, scientists, and personnel to strengthen the diagnosis, treatment, epidemiologic surveillance, and research on HIV-associated malignancies in Malawi.
Eighteen individuals were identified to pursue specialized training in various disciplines in cancer service delivery, including anatomical pathology, histotechnology, epidemiology, oncology nursing, and palliative care. In addition to increasing human resources for health, there was the need to renovate cancer wards and establish chemotherapy preparation rooms and anatomical pathology laboratories at the country’s two major referral hospitals—Queen Elizabeth Central Hospital (QECH) and Kamuzu Central Hospital (KCH).
Outcomes: Five oncology nurses, four palliative care nurses, one histotechnologist, and one epidemiologist have completed their specialized training and are now working in Malawi. In addition, there have been several in-house trainings for clinicians in colposcopy and for pharmacists, clinicians, and nurses in the handling of chemotherapeutic agents. The QECH cancer ward has also been renovated, and a chemotherapy preparation room has been established at KCH. Two functional anatomical pathology laboratories have been established, and a retired pathologist has been called back into service. Three technologists who plan to undergo specialized training are working in these laboratories, and one technologist is in training in Uganda. Two doctors are training in anatomical pathology in South Africa and are expected to finish in 2016, while one physician is preparing to attend a master’s program in public health.
Comment: We anticipate improved surveillance, timely diagnosis, and treatment of HIV-associated malignancies. The oncology and palliative care nurses and clinicians are all working in Malawi. The majority of cancer patients present in late stages and are benefiting from additional palliative care services. Previously, Malawi had only one pathology laboratory with one histotechnologist. The establishment of the two new laboratories and recruitment of technologists has significantly decreased specimen turnaround times from more than six months to less than two weeks. Beyond the pilot phase, the long-term goal is to create a sustainable program having a high likelihood of success in attracting resources to care for cancer patients and conduct independent research into HIV-associated cancers. It is expected that the trained personnel will take a leading role in this research. The Malawi Ministry of Health has included cancer in its noncommunicable disease strategic plan with the goal of improving cancer service delivery at all levels.
Acknowledgments: The author would like to thank Drs. Johnstone Kumwenda, Newton Kumwenda, and Steve Kamiza for their tremendous dedication and support on the project; all the beneficiaries of the various trainings for their enthusiasm and hard work; and Jim Scott for editing the manuscript.
1. Msyamboza K, Dzamalala C, Mdokwe C, et al. Burden of cancer in Malawi; common types, incidence and trends: National population-based cancer registry. BMC Res Notes. 2012;5:149