The Zimbabwe National Cancer Registry (ZNCR) was established in 1985 as a result of a collaborative research agreement between the Ministry of Health and Child Care (MHCC) and the International Agency for Research on Cancer (IARC) of the World Health Organisation (WHO). This followed the acknowledgement and realisation by the MHCC that cancer had become an important cause of morbidity and mortality, and therefore a serious public health problem in Zimbabwe.
The ZNCR is conveniently located in the Parirenyatwa Group of Hospitals complex, a large government tertiary referral centre, which provides most of the cancer management services for the northern part of the country and is one of the 2 teaching hospitals of the University of Zimbabwe College of Health Sciences. The activities of the ZNCR are overseen by a constituted multidisciplinary advisory committee. The Registrar is responsible for the day-today management of the institution under the guidance of the Medical Director. The ZNCR is supported by the Ministry of Health and Child Care, the AFCRN and other organisations.
Over the years the ZNCR has been providing technical support to registries in the sub-Saharan region of Africa at the request of the International Agency for Research on Cancer (IARC), WHO/AFRO, the International Atomic Energy Agency (IAEA) and the African Cancer Registry Network (AFCRN). The Registry is a voting member of the International Association of Cancer Registries (IACR) and is also one of the founding members of the East African Registry Network (EARN) which became the African Cancer Registry Network (AFCRN) in 2011. The ZNCR was privileged to host the 2nd Annual Review Meeting of the AFCRN at the resort town of Victoria Falls in January 2014.
Mr Eric Chokunonga
Registrar, Zimbabwe National Cancer Registry
Parirenyatwa Group of Hospitals
Post Basic School of Nursing Building
P.O. Box A449
Tel: +263-4-794445, 791631
Professor Margaret Z Borok (Medical Director)
Mr Eric Chokunonga (Registrar)
Ms Marygorret Zvarevashe (Executive Assistant)
Mrs Rosemary Rukainga (Health Information Assistant, Harare)
Mrs Romalda D Chireshe (Health Information Assistant, Harare)
Mr Tongai Tapera (Health Information Assistant, Bulawayo)
Mrs Sukoluhle Mguni (Health Information Assistant, Bulawayo)
(Picture left) ZNCR staff standing from left to right: Rosemary Rukainga (Health Information Assistant), Romalda Chireshe (Health Information Assistant), Marygorret Zvarevashe (Executive Assistant) and seated is Eric Chokunonga (ZNCR Registrar). (Picture right) Bulawayo staff from left to right: Tongai Tapera (Health Information Assistant), Sukoluhle Mguni (Health Information Assistant), Eric Chokunonga (ZNCR Registrar) and Samukeliso Vuma (Bulawayo Radiation Oncologist).
(Picture left) AFCRN 2nd Review Meeting: Dr. Portia Manangazira (Director of Epidemiology and Disease Control in the Ministry of Health and Child Care) flanked by Dr. Max Parkin (AFCRN Co-ordinator) and Professor Margaret Borok (ZNCR Director) officially opening the meeting at the Zimbabwean resort town of Victoria Falls in January 2014. (Picture right) Some of the participants at the AFCRN 2nd Review Meeting at the Kingdom Hotel in Victoria Falls.
Geographical location of Zimbabwe
Although at inception the ZNCR targeted the population of the Capital City of Harare it did not exclude cancer cases from other parts of the country. After achieving complete reporting and coverage of Harare in 1990, the ZNCR has since been aiming to achieve complete reporting for the entire population of Zimbabwe. Great strides have been made in this direction following the successful revival of the Bulawayo Cancer Registry in 2011. The Zimbabwe Cancer Prevention and Control Strategy (2014-2018) unveiled by the Ministry of Health and Child Care in February 2014 envisages the strengthening of the ZNCR by extending registration to other parts of the country.
The population of Harare according to the national population census of 2012 is 1 468 767 inhabitants comprising 706 918 males and 761 849 females respectively. The national population is 12 973 808 consisting of 6 234 931 males and 6 738 877 females.
The Central Business District (CBD) of Harare City
Methods of registration and data management
The ZNCR uses a combination of active and passive methods of case-finding. In order to register cases ZNCR staff visit institutions within the healthcare delivery system in Harare that are involved in the management of cancer patients. The Bulawayo branch of the registry reports to the ZNCR those cases recorded in the southern region of the country. Regular routine visits to the inpatient wards of the 3 government referral hospitals (Parirenyatwa Group of Hospitals, Harare Central Hospital and Chitungwiza Central Hospital) are made by ZNCR staff. Patient interviews are conducted in order to record patient demographics accurately. Oncology outpatient clinics, medical records departments and the Radiotherapy Department are also visited regularly. In addition, the staff visit the two municipal hospitals in Harare (Beatrice Road Infectious Diseases Hospital and Wilkins Infectious Diseases Hospital) as well as the three major private hospitals (St. Anne’s Hospital, Avenues Clinic and West End Hospital). The other important sources of information are (a) public and private pathology laboratories (b) Radiology department at Parirenyatwa Hospital (c) Haematology department (d)Oral Health Centre of the University of Zimbabwe College of Health Sciences and (e) Harare Death Registry. Similar methods of data collection are employed by the Bulawayo Cancer Registry which reports its cases to the ZNCR.
Variables collected on each patient include patient demographic data: names, date of birth/age, sex, race and usual residential address. Hospital and patient numbers, date of diagnosis, method of diagnosis, primary site, histological type, extent and stage of disease are also collected. Basic data on initial treatment and follow-up are collected as is HIV status when it is available. The data is recorded on an abstract form.
The International Classification of Diseases for Oncology (ICD-O-3) is used for coding topography (tumour site) and morphology (histology). The ZNCR observes the IARC/IACR rules on multiple primary cancers.The CanReg4 cancer registration software developed by the IARC is used for data processing and arrangements are underway to migrate to version 5 of the software.
Use of Data
Apart from national cancer prevention and control activities of the Ministry of Health and Child Care, ZNCR data is extensively used by indigenous and international researchers. It is also used by conference participants, lecturers, students and local organisations involved in health education. This justifies the existence of the Registry.
NMSC = NON-MELANOMA SKIN CANCER
Publications and Reports
The ZNCR has made 4 successive contributions to the ‘Cancer Incidence in 5 Continents’ series (Volumes 7-10) and has also contributed data to other international publications, including volume II of the ‘’International Incidence of Childhood Cancer ‘’ (IARC Scientific Publication No. 144), ‘’Cancer in Africa: Epidemiology and Prevention” (IARC Scientific Publication No. 153) and ‘’Cancer Survival in Africa, Asia and the Caribbean and Central America (IARC Scientific Publication No. 162). The ZNCR also publishes annual reports. Below is the full list of publications:
- Bassett, M.T., Levy L.M., Chetsanga, C.J. and Chokunonga, E., Zimbabwe National Cancer Registry Summary Data 1986-1989. Centr. Afr. J. Medicine. 38, 91-94 (1992).
- Bassett, M.T., Chokunonga, E., Levy, L., Mauchaza, B.G., Ferlay, J. and Parkin, D.M., Cancer in the African Population of Harare, Zimbabwe, 1990-1992. Int. J. Cancer, 63, 29-36 (1995).
- Bassett, M.T., Levy, L., Chokunonga, E., Mauchaza, B., Ferlay, J. and Parkin, D.M., Cancer in the European Population of Harare, Zimbabwe, 1990-1992. Int. J. Cancer, 63, 24-28 (1995).
- Bassett, M.T., Chokunonga, E., Levy, L. and Mauchaza, B., in Cancer Incidence in Five Continents Vol. VII, eds. D.M. Parkin, S.L. Whelan, J. Ferlay, L. Raymond and J. Young. IARC Scientific Publication No. 143, Lyon, 1997.
- Watts, T., Siziya, S. and Chokunonga, E., Cancer of the Skin in Zimbabwe: an analysis based on the Cancer Registry 1986 to 1992. Centr. Afr. J. Medicine. 43, (7): 181-4 (1997).
- Chokunonga, E., Bassett, M.T., Levy, L.M., Mauchaza, B.G., Abayomi, A. and Chitsike, I., in International Incidence of Childhood Cancer Vol. II, eds. Parkin, D.M., Kramarova, E., Draper, G.J. IARC Scientific Publication No. 144, Lyon, 1998.
- Chokunonga, E., Levy, L.M., Bassett, M.T., Borok, M.Z., Mauchaza, B.G., Chirenje, Z.M. and Parkin, D.M., Aids and Cancer in Africa: The Evolving Epidemic in Zimbabwe. AIDS, 13, 2583-2588 (1999).
- Chokunonga, E., Levy, L.M., Bassett, M.T., Mauchaza, B.G., Thomas, D.B., and Parkin, D.M. Cancer Incidence in the African Population of Harare, Zimbabwe: Second Results from the Cancer Registry 1993-1995. Int. J. Cancer. 85, 54-59 (2000).
- Chokunonga, E., Levy, L.M., Bassett, M.T. and Mauchaza, B.G., in Cancer Incidence in Five continents Vol. VIII, eds. D.M. Parkin, S.L. Whelan, J. Ferlay, L. Teppo and D.B. Thomas. IARC Scientific Publication No. 155, Lyon, 2002.
- Bassett, M.T. and Chokunonga, E. in Cancer in Africa, Epidemiology and Prevention. Eds. D.M. Parkin, J. Ferlay, M. Hamdi-Cherif, F. Sitas, J. Thomas, H. Wabinga and S. Whelan. IARC Scientific Publication No. 153, Lyon.
- Chokunonga, E., Ramanakumar, A.V., Nyakabau, A.M., Borok, M.Z., Chirenje, Z.M., Sankila, R. and Parkin, D.M. Survival of cervix cancer patients in Harare, Zimbabwe, 1995-1997. Int. J. Cancer, 109, 274-277 (2004).
- Adam Gondos, Eric Chokunonga, Hermann Brenner, Donald Maxwell Parkin, Risto Sankila, Margaret Borok, Z. Michael Chirenje, Anna M. Nyakabau and Mary Travis Bassett, Cancer Survival in a Southern African Urban Population. Int. J. Cancer, 112, 860-864 (2004).
- A. Gondos, D.M. Parkin, E. Chokunonga and H. Brenner. Calculating age-adjusted cancer survival estimates when age-specific data are sparse: an empirical evaluation of various methods. Br. J. Cancer 94, 450-454 (2006).
- Chokunonga, E. et al, Pattern of Cancer in Zimbabwe: Zimbabwe National Cancer Registry Annual Reports. (1990-2011).
- E. Chokunonga, M.Z. Borok, Z.M. Chirenje, A.M. Nyakabau and D.M. Parkin. Trends in the Incidence of cancer in the black population of Harare, Zimbabwe 1991-2010. Int. J. Cancer, 133 (3), 721-9 (2013).
- Karima Chaabna, Freddie Bray, Henry R. Wabinga, Eric Chokunonga, Margaret Borok, Phillipe Vanhems, David Forman and Isabelle Soerjomataram. Kaposi sarcoma trends in Uganda and Zimbabwe: a sustained decline in incidence? Int. J. Cancer, 133 (5), 1197-203 (2013).
- E. Chokunonga, M.Z. Borok, Z.M. Chirenje, A.M, Nyakabau and R. Makunike-Mutasa. Cancer Incidence in Harare: Triennial Report 2010-2012. (2013)
- E. Chokunonga, M.Z. Borok, Z.M. Chirenje and A.M. Nyakabau. In Forman D, Bray F, Brewster DH, Gombe Mbalawa C, Kohler B, Piñeros M, Steliarova-Foucher E, Swaminathan R and Ferlay J eds. (2013). Cancer Incidence in Five Continents, Vol. X (electronic version) Lyon, IARC. http://ci5.iarc.fr
- E. Chokunonga, M.Z. Borok, B.G. Mauchaza, Z.M. Chirenje and A.M. Nyakabau. In: Curado. M.P., Edwards, B., Shin. H.R., Storm. H., Ferlay. J., Heanue. M and Boyle. P., Eds. (2007) Cancer Incidence in Five Continents, Vol. IX, IARC Scientific Publications No. 160, Lyon, IARC.
- R. Masanganise, S. Rusakaniko, R. Makunike, M. Hove, E. Chokunonga, M.Z. Borok, B.G. Mauchaza, M.Z. Chirenje, V.N. Masanganise and T. Magure. A historical perspective of registered cases of malignant ocular tumours in Zimbabwe (1990-1999). Is HIV infection a factor? Cent. Afr. J. Med. Vol. 54, (5/8) (2008).
- Chokunonga E, Borok M.Z., Chirenje AM, Nyakabau AM and Parkin DM, Cancer Survival in Harare, Zimbabwe, 1993-1997. In R. Sankaranarayanan and R. Swaminathan. Eds. (2011). Cancer survival in Africa, Asia, the Caribbean and Central America. IARC Scientific Publications No. 162, Lyon, IARC