ORIGINAL

Niger J Paed 2013; 40 (2): 175 - 178

Shehu UA

Pattern of childhood malignant

tumours in two tertiary teaching

hospitals in Nigeria: comparative

study

Adegoke SA

Abdulsalam U

Ibrahim M

Oyelami OA

Adeodu OO

DOI:http://dx.doi.org/10.4314/njp.v40i2,14

Accepted: 6th June 2012

Abstract Background: Cancer is a

public health problem worldwide

affecting all categories of persons.

It is the second common cause of

death in developed countries and

among the three leading causes of

death in developing countries.

Objective: To compare the patterns

of malignant childhood tumours in

two tertiary hospitals in the north-

Western and South western Nigeria.

Methods: Retrospective studies of

childhood malignancies diagnosed

at Aminu Kano Teaching Hospital

(AKTH), Kano and Obafemi

Awolowo University Teaching

Hospital Complex (OAUTHC) (Ife

Hospital Unit, Ile-Ife and Wesley

Guild Hospital Unit, Ilesa, Osun

state) were undertaken from Janu-

ary, 2001 to December, 2010. The

patterns of childhood cancers in

these hospitals were compared.

Lymphomas were the commonest

type of malignancy in both centers,

which accounted for 47.3% and

59.7% at AKTH and OAUTHC

respectively. Retinoblastoma was

the second commonest tumour at

AKTH constituting 14.9% of all

malignancies followed by nephro-

blastoma and acute leukemias. In

contrast, acute leukemias were the

second commonest malignancy at

OAUTHC accounting for 12.7% of

all malignancies followed by retino-

blastoma and nephroblastoma. Tu-

mours of central nervous system

were observed to be commoner at

AKTH, while bone tumours were

commoner at OAUTHC.

Conclusion: The pattern of child-

hood cancer varies rather little be-

tween different regions in Nigeria,

with malignant lymphomas being

the most common as is the case in

most developing countries.

However, the findings in this study

suggest that there is variation in

prevalence of leukemia, CNS and

bone tumours in northern and

southern Nigeria.

Shehu UA (

)

Abdulsalam U, Ibrahim M

Department of Paediatrics

Aminu Kano Teaching Hospital, Kano

P.M.B 3452

Tel: +2348028503832

E-mail: dr_suak@yahoo.com

Adegoke SA

Oyelami OA, Adeodu OO

Department of Paediatrics and Child

Health, Obafemi Awolowo University

Teaching Hospital Ile-Ife, Osun State,

Nigeria.

Results: Four hundred and ten chil-

dren aged 7 months to 15 years

were admitted at AKTH with ma-

lignancies of which 236 were males

and 174 females with male to fe-

male ratio of 1.4:1. At OAUTHC,

5

68 children aged two months to 15

years were admitted with malignan-

cies over the ten year period. There

were 401 males and 167 females,

with male to female ratio of 2.4:1.

Key words: Childhood, malignant

tumours, pattern, teaching hospitals,

Nigeria

Introduction

Genetic, climatic and other environmental factors often

exert considerable influence on the pattern of malignant

tumours. Even within the same country like Nigeria dif-

ferences have been₂noted in the pattern of childhood

malignant tumours. Understanding of the pattern of

childhood malignancies in different geographical zones

support the hypothesis of environmental factors in the

aetiopathogenesis of cancers in children. In Nigeria,

studies on the differences in the pattern of childhood

malignancies in different geographical zones are few,

and this study is one of the first few attempts to

Childhood cancers represent an important global public

health problem. This is especially so in poorer countries,

where childhood cancer too often is detected too late for

effective treatment and where appropri₁ate treatment is

either not available or not affordable. Many children

are never diagnosed at all, many are diagnosed very late,

and when a₁diagnosis is made the treatment options may

be limited.

1

76

characterise such differences.

With respect to parental social class, majority (79.3%)

of the children with malignancy in AKTH were from

low socio-economic background as against 58.5% in

OAUTHC (Table 5).

This study was therefore undertaken to compare the pat-

tern of childhood malignancy in Kano (North western)

and Ile-Ife/Ilesa (South western) Nigeria.

Table 1: Types of malignancy observed in AKTH and

OAUTH

AKTH

n (%)

OAUTH

n (%)

Materials and Methods

Types of malignancy

A retrospective study of childhood malignancies diag-

nosed at AKTH, Kano and OAUTHC, Ile-Ife was under-

taken from January 2001 to December 2010. Aminu

Kano Teaching Hospital (AKTH) is a tertiary centre

serving Kano and neighboring states in north western

Nigeria. OAUTHC is a multi-centre hospital; Ife Hospi-

tal Unit (IHU) and Wesley Guild Hospital Unit (WGH)

where the study was carried out are the two main refer-

ral facilities of the hospital providing both general and

specialist paediatric care for the semi-urban communi-

ties of the Osun, Ondo and Ekiti states in south-western

Nigeria. Both centres (AKTH and OAUTHC) are fee for

service hospitals equipped with histopathological, hae-

matological, surgical, cytochemical and neuro-imaging

facilities for diagnosis of malignancies.

Lymphoma

194 (47.3)

122 (29.8)

46 (11.2)

26 (6.3)

61 (14.9)

60 (14.7)

339 (59.7)

301 (53.0)

13 (2.3)

25 (4.4)

45 (7.9)

Burkitt's lymphoma

Non-Hodgkin's lymphoma

Hodgkin's lymphoma

Retinoblastoma

Acute leukaemia

72 (12.7)

Nephroblastoma

Neuroblastoma

44 (10.7)

21 (5.1)

38 (6.7)

18 (3.2)

Rabdomyosarcoma

Nasophrangeal Ca

CNS tumour

Teratoma

Bone tumours

11 (2.7)

3 (0.7)

5 (1.2)

1 (0.2)

-

17 (3.0)

4 (0.7)

3 (0.5)

24 (4.2)

5 (0.9)

Others (CML,Hepatic tumours)

10 (2.4)

Total

410 (100)

568 (100)

Case files of all children admitted with malignancies in

the two hospitals during the study period were retrieved

and relevant data were extracted and recorded in the

study proforma. Such data included socio-demographic

characteristics (age, sex, socio-economic class), types of

the tumour and parts of the body affected. Patients

whose case files were missing or those with incomplete

data were excluded from the study. The results from

two centres were compared.

Table 2: Types of malignancy in relation to gender

Types of

malignancy

AKT

H

OAU

TH

Male

s

Fe-

males

To-

tal

Males

Fe-

males

Total

Lymphomas:

Burkitt´s lym-

phoma

73

20

21

25

49

26

5

122

46

207

7

94

6

301

13

Non Hodgkin’s

Lymphoma

Results

Hodgkin’s

Lymphoma

26

12

13

25

Retinoblastoma

36

15

61

60

39

16

6

45

38

At AKTH, 442 children aged 7 months to 15 years with

various types of malignancy were admitted over the

study period, which accounted for 2.9% of 15,185 total

paediatric admissions. Two hundred and thirty six were

males and 174 were females, with male to female ratio

of 1.4:1. While at OAUTH, 624 case files of children

aged 2 months to 15 years were admitted with malignan-

cies over the study period, which accounted for 3.1% of

Nephroblastoma 45

16

Leukaemia

Bone tumours

23

-

21

-

44

-

60

18

12

6

72

24

Neuroblastoma

12

2

9

1

21

3

18

3

0

1

18

4

Nasopharyngeal

tumour

Rabdomyosar-

coma

6

5

11

6

17

2

0439 total paediatric admissions. There were 401 males

CNS tumour

Teratoma

Others (CML,

Hepatic tu-

mours)

3

-

6

2

1

4

5

1

10

3

0

4

0

3

1

3

5

and 167 females, with male to female ratio of 2.4:1.

However, 32 and 56 children from AKTH and OAUTH

respectively whose data were incomplete and those

without definitive diagnosis were excluded from further

analysis. Hence, 410 and 568 children from AKTH and

OAUTH were studied.

Total

236

174

410

401

167

568

(57.6) (42.4)

(70.6)

(29.4)

Comparison of the sociodemographic characteristics

between the zones

The sex distributions in both centres were similar with

an overall male preponderance in both centers (Table 2).

Similarly, in both centers majority of the cases fall

within the age range 6 to 10 years (Tables 3 and 4).

1

77

Table 3: Types of malignancy in relation to age group in

AKTH-Kano

Types of malignancy

Types of malig-

nancy

Age

group

Lymphomas were the commonest malignancy observed

accounting for 47.3 percent and 59.7 percent in AKTH

and OAUTHC respectively. Also, Burkitt Lymphoma

was the leading malignancy in both centres. It was re-

sponsible for about one-third of the cases in AKTH and

about one-half of the cases in OAUTHC.

The prevalence of Burkitt’s lymp₂homa in both centres

was not significantly different (X = 6.08, OR – 1.41, p

= 0.014). On the contrary, while Non-Hodgkin Lym-

phoma was not commonly seen in OAUTHC (2.3%), it

accounted for 11.2% of cases in AKTH. Acute leuke-

mias were second commonest malignancy in OAUTHC,

while retinoblastoma was observed to be the second

commonest malignancy in AKTH. Similarly, tumours of

the central nervous system were observed to be com-

moner in AKTH. At OAUTHC, 24 (4.2%) children were

admitted with malignant bone tumour. No cases of ma-

lignant bone tumour were recorded in AKTH (Table 1).

6-10 yrs >10 yrs

To-

tal

<

1yr

1

-5 yrs

Lymphomas:

BL

-

13

-

89

16

31

20

10

26

7

122

26

HL

NHNBL

4

46

Acute Leukae-

mias

Retinoblastoma

22

60

-

56

29

5

-

61

44

Nephroblastoma

4

11

Bone tumour

-

Neuroblastoma

3

-

14

3

4

6

-

21

11

Rhabdomyosar-

coma

Nasopharyngeal

Ca

2

-

1

2

3

CNS Tumour

-

3

1

7

2

-

5

Teratoma

Others

Total

-

1

-

3

10

7

141

190

72(17.6) 410

(1.7) (34.4)

(46.3)

Discussion

Table 4: Types of malignancy in relation to age groups in

OAUTH- Ife

Lymphomas were the most prevalent childhood malig-

nancy observed in both study centers with Burkitt’s lym-

phoma being the most common childhood cancer consti-

tuting 29.8% and 53.0% of the total malignancies in

AKTH and OAUTHC respectively. This finding₃_-₁₀was

Types of malignancy

Age

group

1-5

<

1yr

6-10

yrs

>10

yrs

Total

yrs

similar to reports from most centers in Africa,

but

Lymphomas:

BL

different from reports from developed countries where

leukem₁₁ias and intracranial tumou₁r₂s predominate in chil-

dren. However, Ojesina et al from Ibadan has ob-

served a significant relative decline in the frequency of

Burkitt’s lymphoma which was ascribed the relative

decline to the improved living conditions and greater

control of malaria. In AKTH, retinoblastoma was found

to be the second commonest tumour (14.9%) in this

study, followed by nephroblastoma and acute leukemias.

This finding is similar to reports from other centers

where retinoblas₃t_,o₁₂m_,₁a₃ and nephroblastoma were rela-

-

85

7

172

12

7

44

6

301

25

HL

NHNBL

-

6

13

Acute Leukaemias

Retinoblastoma

-

13

26

19

10

40

-

72

45

9

Nephroblastoma

Bone tumour

-

25

-

13

5

-

38

24

19

Neuroblastoma

-

18

1

-

18

17

tively common.

In contrast, acute leukemias were

Rhabdomyosarcoma

8

the second common₁e₄st malignancy in OAUTHC; similar

to report from Jos north central Nigeria where acute

leukemia constitute a major childhood cancer. This find-

ing suggests that there are variations in prevalence of

retinoblastoma and leukemia in different parts of Nigeria

or that leukemia is now more common even₁₃in Nigeria

where it had earlier been reported to be rare.

Nasopharyngeal Ca

CNS Tumour

-

1

-

2

3

-

4

3

Teratoma

-

1

3

Others

Total

2

180

2

251

1

128

(22.5)

5

568

9(1.6)

(31.7) (44.2)

The prevalence of nephroblastoma, neuroblastoma and

rhabdomyosarcoma was similar in both centers. There is

higher prevalence of CNS tumours observed in AKTH

and was relatively rare in OAUTHC. Higher prevalence

of CNS tumours was equally reported by other workers.

Table 5: Parental social class

AKTH

OAUTH

n(%)

Social class

n(%)

1

5

In this study, malignant bone tumours were not ob-

I

II

III

18(4.3)

22(5.5)

38(10.9)

49(8.6)

60(10.5)

127(22.4)

served in AKTH. This was probably because, until re-

cently all cases of bone tumours were directly referred to

a national orthopaedic hospital in the state. Ethnic and

geographic variations in the distribution of different

IV

V

Total

94(22.9)

231(56.4)

410(100)

185(32.6)

147(25.9)

568(100)

1

78

types of childhood malignancies may be attributed to the

interplay of varied causative factors such as exposure to

ultraviolet light, chemical carcinogens, oncogenic vi-

ruses, genetic fac₁t₆ors and cultural practices among vari-

ous populations.

background and 58.5% from OAUTHC. This was ab₈ove

1

the national average poverty rate of 71% and 43% for

the north-western and south western Nigeria respec-

tively. The socioeconomic statuses of most parents in

general paediatric population in both centres are low

with few of the patients coming from middle and higher

socioeconomic background. However, families of chil-

dren with malignancy experience more financial diffi-

culties

associated with prolong hospital stay, cost of treatment

including drugs and investigations. This contributes to

late presentation, high default rates and poor compliance

to treatment and eventual high morbidity and mortality.

In this study, it was observed that majority of children

with malignancy were within the age group 6 to 10

years. This is not surprising because, Burkitt’s lym-

phoma is most frequent in the age bracket 5 to 9 years.

There was also male preponderance in the prevalence of

childhood cancer in both centers in this study; this f₅in_,₇d_,₁-₄

ing is also similar to reports from other centers.

Cancer treatment is generally expensive and often times

requiring prolonged hospital stay. The parents of these

patients have to bear all the costs of treatment including

drugs, diagnostic investigations, meals and hospital stay.

Therefore, many families of children with cancer experi-

ence financial difficulties. In developed countries, for

many patients a portion of the medical expenses is paid

by their health insurance plan. For individuals without

health insurance or who need financial assistance to

cover care costs, resources are available, including gov-

ernment sponsored progr₁a₇ms and services supported by

voluntary organizations. On the other hand, in

Conclusion

Childhood cancer is common in the north western and

south western Nigeria; with malignant lymphomas the

most common. There is however, variation in the preva-

lence of retinoblastoma, acute leukemias and CNS tu-

mours. Free treatment is what is required as majority of

the patients particularly in north western Nigeria come

from very poor families.

resource poor countries where health insurance and re-

sources to help families with children with malignancies

through financial difficulties are virtually nonexistent.

Majority of the patients from both centres came from

very poor families with 79.3% of parents of these

Conflict of interest: None

Funding: None

children in AKTH from low socio-economic

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