The Registro de Cancro de Beira was founded in 2005, after Dr Ferro had undertaken training in Lyon and Goiania (Brazil).
Hospital Central de Beira
Av Martires de Revolução 727
PO Box 1613
Director- Dr Josefo Ferro
Location of cancer registry
- The registry occupies an office in the department of pathology, within the Hospital Central (Clinical Director: Dr Elvira Xavier and General Director: Augusto César Macome)
- It is well equipped with office equipment, storage and a well-functioning desk top computer
- The registry does not have access to its own transport
Staffing of cancer registry:
Apart from the Director, at present there is only one staff member- the cancer registrar (Telma Sande) who has been with the registry for 13 months, and is working half time. The previous staff members (Dr Helder Rassolo) who attended the IARC summer school in 2012 has tranferred to Nampula and Anuario Alfai has moved to Human Resources Department.
Source of finance:
In the past, the registry has benefitted from staff positions funded through the Hospital Central. It seems that the salaries for these posts ceased to be available when the staff left. A grant from IARC in 2008 is still supporting salaries in the registry. This also serves to pay for equipment purchase and replacement, and all running expenses. There have been some contributions from government for indirect costs, office supplies and internet access.
- The registry covers the district of Beira, one of 13 of Sofala Province, one of the 11 provinces of Mozambique. Beira district comprises 23 bairros
- The most recent census was in 2007. Male 225629; female 217741; total 443369.
- Annual population estimates (by age and sex) are available from the statistics section of the Provincial Health Department. The estimate for 2013 is male 230599; female 227201; total 457799.
- Ethnic/religious etc. composition: The predominant ethnic group in Beira is Bangwe, which originated by the mixture of Machangas, Matewes and Podzos from the Zambezi valley. The majority of the population is Christian, with a minority of Muslims and Hindus.
Sources of information for the registry:
- The only public hospital in Beira is the Hospital Central. It is the referral hospital not only for the province of Sofala, but for the 3 other provinces in the central region (Manica, Tete and Zambezia). The hospital has some 733 beds (officially) and all specialties are present. Currently there is no oncologist. There is one haematologist (Dr Almary-Cuban) who deals with diagnostic and clinical haematology (but does not do any bone marrow examinations – leukemia diagnosis is based on blood smear +/- histopathology. Cases of KS are treated by chemotherapy in the department of dermatology (or on an outpatient basis in the Day-hospital) in registry area.
- The archive service acts only as a store for medical records. There is no patient index. Tracing the records of returning patients requires them to recall when they were last at the hospital (there is a register of admitted/outpatients in chronological sequence).
- The hospital statistics department is currently only compiling censuses of numbers of admissions/deaths by department.
- There is one private hospital in Beira (Hospital Avicenna). It has limited beds at present (~12) but is expanding. It has good diagnostic and consulting facilities and an operating theatre. All cytology and histopathology is done by the lab at HCB.
- The only pathology laboratory is in HCB (no private work, no specimens sent elsewhere). There are 3 pathologists (Dr Ferro and 2 Cuban pathologists). The lab is well equipped for basic diagnostic work. Fine needle aspirations take place in the lab (there is ultrasound for abdominal/thoracic work). The lab does about 2500 biopsies and 2200 cytologies/year
- Death registration is mandatory. The bodies of all who die in Beira district must be brought to the mortuary at HCB – deaths at home pass via the Emergency department and receive a request form to take to the mortuary. For hospital deaths, a death certificate is completed in the relevant service (and accompanies the body). It contains all details on the deceased, including “direct” and “Basic” cause of death, completed by a physician. For non-suspicious/violent deaths at home, the certificate is completed by the statistical office in the mortuary, the cause data based on documents brought by the family, and questions (a sort of verbal autopsy). Violent deaths are autopsied and the forensic pathologist completes the certificate. The relatives keep one part, one goes to the Registo Civil, and the third copy remains in the mortuary (in the books). In fact, the hospital statistics department is creating a computer file of all hospital deaths (since 2011), using some locally created software. It can produce some standard tables, and an EXCEL file of all variables. Unfortunately, the latter does not include the name of the deceased, and only the Province of residence.
Methods of registration
- The registry is based in the pathology laboratory and this is the main data source. The registrar uses the printed report forms on cancer cases, sorted for her by the pathologists. Unfortunately the request/report forms does not have place of residence (and only patients for FNA actually come to the lab). The registrar generally contacts the patient themselves immediately (in the service, or by phone) to collect additional biographic information – including on duration of residence.
- For the Hospital Central, the registrar makes a daily round of visits, scheduling the different services according to yield of cases, and completes the registration form (Annex) then and there.
- Death certificates – the registrar visits the mortuary registry and Registro Civil to check for death certificates with a mention of cancer.
- Actually, it is possible to generate a list of cancer deaths in hospital, from the database in the statistics department (see Annex 3). However, it will be necessary to trace the relevant certificates.
- Coding of diagnosis (site/histology) in ICD-O 3 is done by Dr Ferro. Place of residence, and source of information is not coded.
- The data are being entered using simple EXCEL spreadsheets, one for each year. Several items – for example, place of residence, source of information, are entered as abbreviations (Annex 2)
- There are no quality control procedures, or duplicate checks performed
- The registry prepares an internal report each year.
- The great majority of patients are included in the registry with basis of diagnosis histology or cytology. There are very few clinical only cases – 2% in 2011 (suggesting under-ascertainment of cases in clinical services), and no cases based on death certificate information only.