The correct diagnosis of children affected by cancer is a global priority. In Togo, the development of oncopediatrics and pathological anatomy departments at the Lomé University Hospital is a major step.
Pediatric oncology is a relatively young medical specialty but which has experienced particularly rapid development throughout the last decades. This is due in particular to the very significant progress made in the care of these children and the considerable improvement in recovery rates observed over the past thirty years.
However, this progress has only affected a portion of the world's children, mainly in Europe and North America, leaving aside 80% of the world's pediatric population, including that of the African continent in particular. While it is now 80% in high-income countries, the cure rate in low- and middle-income countries remains at 10-40%, with exact figures difficult to know.
Each year, it is estimated that 400 children are affected by cancer worldwide, but while only 000% of them escape diagnosis in Europe and North America, this figure reaches 3% in West Africa. In other words, of the 57 to 6 million children likely to be affected by cancer between 7 and 2015, 2,9 million of them, many of them in Africa, will die for lack of being diagnosed.
Different cancers depending on the population
Leukaemias, lymphomas and tumors of the brain and bone marrow are the most common cancers worldwide in children under 16 years of age.
However, this distribution varies according to the country, depending in particular on the number of cancers actually diagnosed (technical platform often insufficient in the countries of the South) and genetic and environmental factors (example of Burkitt's lymphoma, endemic in Africa and rather sporadic in the countries of the North).
Clearly, the fight against childhood cancers is now a real challenge for low- and middle-income countries, and more specifically for many African countries: 22 of the 25 poorest countries in the world are in Africa and have an average GDP per capita of €558 (for comparison, GDP per capita in France is €39 in 500). In Togo, for example, total health expenditure was evaluated in 2021 at around 2012 million euros per year, or around €210 per year per inhabitant; in France, in 40, it was estimated at 2019 billion euros per year, or €208 per year per inhabitant.
How to improve these results and ensure that "African children can be treated successfully in their country by African teams", as Professor Jean Lemerle, founder of the Franco-African Pediatric Oncology Group (GFAOP) proclaimed in 2000? ? An improvement in the service offer, in clinical, diagnostic and therapeutic terms, is essential.
Improve reception and training
It presupposes an improvement in the training of medical and paramedical personnel, so that dedicated units and real multidisciplinary teams are created, which are essential for effective care of children.
It also involves better reception conditions, easier access to specific drugs (chemotherapy), to radiotherapy, to oncological surgery, but also to therapies related to supportive care, palliative care and pain. Finally, it requires support for community communication and social mobilization programs in favor of early diagnosis of children.
In 2018, WHO launched the Childhood Cancer Initiative (cureall) to provide technical assistance to governments to strengthen and maintain quality programs to combat this disease. This initiative can be linked to other actions carried out by various organizations such as the GFAOP or the AMCC (World Alliance against Cancer).
The latter, for example, has developed since 2016 a program to fight retinoblastoma, by training doctors in the early diagnosis and treatment of this disease in several African countries. The GFAOP, for its part, has been involved since the 2000s in the development and gradual structuring of more than 20 pediatric oncology units in French-speaking Africa.
He first worked on financing cancer drugs for the five most common cancers in Africa (Burkitt's lymphoma, nephroblastoma, retinoblastoma, acute leukemia and Hodgkin's lymphoma). Then between 2014 and 2018, he created in Rabat (Morocco) a DIUOP (Interuniversity diploma in pediatric oncology) for the training of paediatricians, then the Jean Lemerle Institute in Dakar (IAFOP, African Institute for training in pediatric oncology) to paramedics. In addition, in 2019, it set up an early diagnosis program aimed at combating diagnostic delays in French-speaking African countries affiliated to the GFAOP.
Adapt to local specificities
All these programs, implemented on a multinational scale, are all essential actions for the development of pediatric oncology in Africa. They were supplemented as close as possible to the field by sharing experience between French and African pediatric oncology teams, in particular through pairings developed from 2015 by the GFAOP.
These twinnings are indeed one of the best ways to identify the specificities of each African country, and to take into account both the needs and expectations of each country but also its capacities and priorities in terms of health. In any case, this is what we learned from the collaboration set up in 2017 between the pediatric oncology team of the CHU Sylvanus Olympio in Lomé and that of the CHU in Angers.
The two teams succeeded in drawing up, with all the institutional managers concerned, a five-year plan for the development of pediatric oncology taking into account the Togolese realities, not only in terms of health, but also in economic and political terms.
This collaboration has enabled the rehabilitation of the Pathological Anatomy laboratory of the CHU Sylvanus Olympio, an essential step in obtaining quality diagnoses. It is in this laboratory that operated tumors are studied under the microscope so that pathologists can make a precise diagnosis. This then makes it possible to offer patients the most appropriate treatments.
Other actions exist, such as the setting up of joint medical meetings (monthly videoconferences) to discuss patient care, the modernization of Internet connections, the training of doctors and paramedical staff, or the empowerment to obtain essential drugs.
All of them are part of the actions carried out by the Togolese government within the framework of the National Health Development Plan which, in the long term, should make it possible to significantly increase the population's health coverage.
There is a long road to the WHO target of a survival rate of at least 60% for all children with cancer by 2030. However, we believe this can be achieved if that high-income States truly realize their responsibilities vis-à-vis low- and middle-income countries, and especially African countries.
But, as Thomas Sankara pointed out, it would probably be necessary, at the same time, to move away from the principle of development aid in order to establish "genuine collaboration, so that all the actions undertaken constitute relevant actions […] and not permanent aid with which the populations can live only thanks to them”.
Pr. Isabelle Pellier (PU-PH) and Dr. Stéphanie Proust (PH), from the pediatric onco-haemato-immunology unit of the CHU of Angers, also contributed to the design of this article as well as to its proofreading.
Audrey Rousseau, Professor in Pathological Anatomy – Physician teacher-researcher at the CHU d'Angers, University of Angers; Adama Dodji GBADOE, Full Professor of Pediatrics, and Koffi Mawuse GUEDENON, Assistant Professor of Pediatrics at the University of Lomé