By Hailegebriel Endeshaw
(Communications Officer – NIPN/EPHI)
…A Monitoring, Evaluation, and Research Steering Committee (MER SC) meeting, sponsored by the National Information Platform for Nutrition (NIPN-Ethiopia) held in Dire-Dawa City, was a favorable platform for Dr. Haji to express his concern over the prevalence of EC in the country. Dr. Haji, with long years’ experience in nutrition and esophageal cancer, has stressed that although the government is doing its level best to prevent the non-communicable diseases including cancer, “esophageal [has been] left in the dark”…
Non-communicable diseases (NCDs) have become the leading cause of mortality in developing countries. Sources indicate that in recent years, NCDs, such as cardiovascular diseases, diabetes, chronic obstructive pulmonary diseases, and cancer, have become “an emerging pandemic globally with disproportionately higher rates in developing countries”. The World Health Organization estimated that the global burden of NCDs would increase by 17% in the next ten years and in the African Region by 27%.
Like any other developing nations, NCDs have also been a health threat to Ethiopia. Esophageal cancer (EC) is among these NCDs that have gone rampant in the country. Researchers have made official the remarkable increase in the incidence of esophageal cancer in many parts of Ethiopia. Dr. Haji Aman, an assistant professor of Human Nutrition, is working as an instructor and researcher on nutritional problems, metabolic syndromes, and cancer at Adama Hospital Medical College. He has conducted research on EC.
A Monitoring, Evaluation, and Research Steering Committee (MER SC) meeting, sponsored by the National Information Platform for Nutrition (NIPN-Ethiopia) held in Dire-Dawa City, was a favorable platform for Dr. Haji to express his concern over the prevalence of EC in the country. Dr. Haji, with long years’ experience in nutrition and esophageal cancer, has stressed that although the government is doing its level best to prevent the non-communicable diseases including cancer, “esophageal [has been] left in the dark”.
According to available sources, EC occurs in the esophagus, which is a long, hollow tube that runs from the throat to the stomach. A person with EC will have a swollen throat tube that clogs the food passage. “There are two major tissue types: Squamous cell carcinoma and Adenocarcinoma. Squamous cell carcinoma develops in the esophageal epitheliumand is common in developing countries, while adenocarcinoma develops in the esophageal glands and is prevalent in developed countries”.
Dr. Haji Aman said in an exclusive interview he had with the NIPN communications officer in Dire-Dawa City that the Arsi and Bale Zones in Ethiopia were known as EC endemic areas along Africa’s EC belt. “The data taken from local areas such as Adama, Asella, and Goba Hospitals also indicated that it is the 2nd most prevalent cancer next to breast cancer, as opposed to the cancer distribution patterns in other regions of Ethiopia.”
Dr. Haji said, mentioning a study carried out in ten rural hospitals in Ethiopia, that esophageal cancer is the third most prevalent cancer of all forms of cancer. It is the second most common cancer in males, next to prostate cancer, and the third most common cancer among females, next to breast and cervical cancer. “In that study, the largest proportion of patients were from Aira Hospital in West Oromia Region. Other studies show that esophageal cancer accounts for 15% of all cancers in Addis Ababa and the southern part of the country, 7.4%, and 4.9% in Amhara and other regional states, respectively”.
Studies indicate that 92.3% of the affected compatriots are farmers in rural areas. What is alarming is that researchers are observing EC among the younger population below 19 years of age. “In my study, 7.1% of patients were ≤ 39 years of age; the youngest male and female patients were 19 and 25 years old, respectively. Only 9.6% reported a family history of cancer. The median survival time after diagnosis is six months. The majority (about 80%) of EC patients presented at advanced stages (stages III and IV),” Dr. Haji said.
Expressing the seriousness of the disease, Dr. Haji recounted the story of a lady who lost 13 of her relatives due to esophageal cancer. “During my PhD research, I went to one of the districts in the Arsi Zone to gather local evidence related to the disease burden. A 52-year-old female participant involved in the focus group discussion told me that 13 of her relatives died of esophageal cancer, and another four of her neighbors were diagnosed with it during that time,” he said.
What the EC patients say while getting treatment can clearly show how grave the problem is. Dr. Haji said that patients who come to health facilities usually request their care providers to help them swallow their saliva at least once before they die. These patients don`t ask for remedies or medications that relieve their pain. They rather request the health professionals to enable them to swallow their saliva. One can see how tough it is for the patients to dine and swallow, Dr. Haji said.
Speaking of the causes of the disease, Dr. Haji noted that there is no conclusive evidence regarding the reasons for the clustering of cases in specific geographical areas. He, however, mentioned a few studies that testify about the cause of EC. Accordingly, the consumption of false bananas (Kocho), salty diets, inadequate vegetable intake, chewing khat, drinking very hot coffee, too much intake of coffee, very hot porridge, hasty consumption of hot food, alcohol drinking, and tobacco use are the most common factors associated with esophageal cancer in Ethiopia.
The researcher, Dr. Haji, said that the causes of esophageal cancer are multifactorial. The notable geographic dispersion of esophageal cancer in Ethiopia suggests a complex phenomenon that cannot be handled by a single institution or person. “The problem is massive, and we have to pull knowledge, skills, and resources together to prevent the disease, provide care, and support the affected communities,” he said.
Currently, there are efforts being made by scholars, universities, researchers, clinicians, and prominent individuals to find solutions for this deadly disease. Dr. Haji said that activities are underway to make the disease an agenda for policymakers and many stakeholders. The other major achievement is reportedly the establishment of a multi-sectoral and multidisciplinary task force that comprises the Ministry of Health (MoH), Oromia Health Bureau (OHB), Arsi University, Madda Walabu University, Adama Hospital Medical College, Negelle Arsi General Hospital Medical College, professional associations, and community leaders.
Dr. Haji said that two national conferences were organized in Asella and Addis Ababa, in which high- level officials, members of professional associations, research institutions, prominent public figures, and government officials from OHB and MoH participated. “We developed an endoscopy training curriculum for upper gastro-intestine (UGI) endoscopy and biopsy in Ethiopia in collaboration with MoH, OHB, and Saint Paul Millennium Medical College. We trained health professionals on UGI endoscopy for Asella and Goba teaching and referral hospitals that couldn't render endoscopy services, despite having the equipment (endoscopes). Now all facilities are rendering UGI endoscopy and biopsy services which fundamentally will improve access to diagnostic services and facilitate better detection and treatment of cases in the area,” Dr. Haji said.
Every stakeholder in the health sector is expected to play a role in preventing this fatal disease. The Ethiopian Public Health Institute (EPHI) has also been called upon to support the initiative. Dr. Haji said that technical support and collaboration are needed from national and international organizations. “Therefore, I would kindly ask EPHI and its partners to assist our efforts. We want to work on the magnitude of the disease and contributing factors and develop appropriate preventive measures. I hope the Armauer Hansen Research Institute (AHRI), EPHI, the Africa Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), the International Agency for Research on Cancer (IARC), and other researchers will [positively] respond to our call,” Dr. Haji said.
(Findings, and conclusions or recommendations expressed here above reflect only views of the researcher.)
