Further Discussions Regarding Causes of Mortality In BL Patients

There is very little information about the incidence and mortality rates in BL in African countries. Our own experience has suggested that not only do patients frequently fail to reach a center capable of effective care of patients with this disease (and are not registered), but a significant fraction of patients die prior to the initiation of therapy. The lack of registration systems, suggests that many patients have found the hospital, but failed to find an individual who can tell them where to go. Remarkably, in one case, the patient had been sleeping in the hospital for some weeks before his presence became known. He was finally found by a visitor to the hospital and admitted for treatment. Not surprisingly, he died from the complications that result from extensive BL.

It would seem that patient navigation systems within African hospitals are likely to be lacking. Even if there are signs pointing the way to different parts of the hospital, illiterate patients or family of patients glean nothing. The frequency of these events is unknown, but physcians in charge of the hospital need to ensure that proper registraton and prompt examination by a competent physician followed by the implementation of a care plan for each patient are early and essential steps which without which it is impossible to establish organized programs that lead tto maximum treatment benefiits for patients.

This would suggest two additional elements to the algorithm - 1. Sufficient concern in the eyes of the patient or parent to attempt to reach a doctor - whether primary care provider or hospital doctor (ranging from district hospital to tertiary care hospital. 2. A system of registering all patients who enter the hospital and completion of a registration form. 3. AT THE TIME of ENTRY, sufficient concern on the part of the Doctor to examine the patient carefully with respect to the presence of shortness of breath, serous effusions, abdominal masses or mass lesions at one or more sites. A characteristic feature of BL is jaw tumours, which occur predominantly in the maxilla but often involve all 4 jaw quadrants.

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