Cancer Management in Sudan: Current Status and Future Perspectives

Introduction: Sudan is one of the developing countries that face a great challenge with cancer management. About 5700 cases had been seen during year 2007 in Radiation and Isotope CenterKhartoum (RICK) and Institute of Nuclear medicine, Molecular biology, and Oncology (INMO) Wadmedani which are the only cancer centers in Sudan. Purpose: Aim of this work is to highlight the difficulties of cancer management in Sudan and to propose possible solutions. Methods: This paper evaluates the current situation of cancer management in Sudan through reviewing of data available in cancer centers and reports from the Sudan national bureau of statistic. Suggestions are also made for cancer control plan in Sudan having the current situation in mind and guided by the published international data on cancer control. Results: The preliminary analysis of the available data reveals that Sudan has very limited resources available to deal with cancer and the service provided is not evenly distributed. Conclusion: Establishment of new centers is extremely needed with special attention to good distribution of services. To achieve such a goal training of more staff and upgrading of the existing centers is mandatory to manage all types of cancer. Cancer registry is the right way to plan for cancer control in Sudan.

ancer is an immense problem facing the whole world and a notorious human being killer.According to World Health Organization (WHO) and international association against cancer (UICC); 12.5% of all deaths in world are due to cancer (more than malaria, TB, and AIDS together).There were 10.9 million cancer cases worldwide in 2002 and more than 16 millions are estimated for year 2020.Correspondence to:E.mail:abuidris@yahoo.comAbout 60% of cancer cases in 2020 are going to be in developing world.Eighty to ninety percent of cancer cases in developing countries present late and advance.Thirty percent of cancer cases can be cured if it presents in early stage 1,2 .Sudan is the largest state in Africa with a population exceeding 40.000.000(Est.july2005) 1 .It has endured civil wars for more than 23 years; this made its limited resources even worse.On the other hand, the oil production may boost its economy especially when joined with the end of civil wars.One third of people in Sudan live centrally however, the remaining two thirds scattered all across this large country (about one million mile squire).Health service planning is so difficult because of people distribution, nomadic nature of some people and country limited recourses.

C
Forty percent of the population is under poverty line and the unemployment exceeds 18% 2 .Most of the professionals are working in Khartoum, Sudan Capital, and this is another challenge for health service authority.Till recently, cancer use to be the least health problem and most of efforts are towards tropical and infectious diseases.Now, cancer is an obvious health problem which drew the attention of both the health professionals and public due to increasing numbers of new cases and deaths caused by cancer 3 .Although only less than 6000 cases had been treated in year 2007 in Sudan cancer centers but this may be the tip of the iceberg (Table 1).Many cases are hidden, probably undiagnosed, or couldn't find their way to the limited-health facilities.Another problem is the late presentation of the majority of cases, partly due to lack of good quality health service particularly in the periphery of Sudan, this goes together with the major issues of ignorance and poverty.Sudan needs nearly eight centers according to WHO statement (one center for each 5 million population).This work focused on the existing cancer service capabilities and suggested the needs for cancer control in the whole country.

Methodology of this study:
The authors are health professionals working in the two cancer centers in Sudan.All data is collected from the available resources in the cancer centers by looking into hospital annual reports and direct contact with the administrative and staff members.RICK was established in 1967.The second center, INMO, was established in Wadmedani in 1999.Data about the population estimation and country demography were obtained from the Sudan Central Bureau of statistic in Wadmedani branch.Other information sources include the international internet network and some scientific papers.
The study presents all available useful data to through light on the existing service available in Sudan and the needs for the future planning of cancer service in the country.The main input of authors was on providing these facts to public and decision makers and to make use of the available international literature for how to improve situation in Sudan and probably other similar countries.

Results: Facts about present situation in Sudan: (personal communication RICK &I&MO STAFF-2007) •
There are only two centers for cancer in Sudan.

Future perspectives
To improve the current situation of cancer control in Sudan the following steps are needed: Firstly: Increasing cancer treatment centers by making use of International Atomic Energy Agency (IAEA) multi partner program of action for cancer therapy (PACT) 4 .
Establishing centers in strategic cities (according to location and population density), which have good medical service infrastructure and back up.Upgrading of the existing centers by providing more new machines, rising staff training chances and increasing the inpatient facilities is mandatory.

Table 2 :
quality of service available in cancer centers

Table 3 :
Sudan regions and distribution of population, site and service