Malawi is a part of the African Cancer Registry Network (AFCRN). In 1989 a national cancer registry was established; it was initially based in the pathology department of Blantyre’s Queen Elizabeth Hospital, which has an oncology department and is where people go for terminal cancer treatment.
In 1993 a population-based component for Blantyre District was added to the registry, covering the urban area of Blantyre and the rural area around Blantyre. Registration is carried out by a programme of regular visits by cancer registrars and data clerks to all hospitals (government, Christian and private) in the District, with data recorded on cases of cancer from hospital records departments and clinical services, where cases might have been diagnosed or treated. There is no comprehensive system of death registrations in Malawi, and thus death certificates are not routinely used as a source of information. Cancer diagnoses are coded according to the International Classification of Disease for Oncology (ICD-O). The CANREG system provided by IARC is used for the recording of cases; this includes checks at data entry for potential duplicates as well as for impossible or unlikely codes or combinations of codes, and provides automatic code conversions to ICD-10. Between 1994 and 1998, there were 400-500 cancer cases per year recorded in the registry. The registry was scaled up in 2000-2001 to include more case-finding investigations in rural hospitals, as well as cancer in out-patient clinics and departments of larger hospitals. Case reports increased to around 735 per year (Parkin, 2003).
Currently, records are transferred to the registry by two staff members who visit each hospital once a month for one day, resources-permitting.
Even though we have some information on the burden of cancer in Malawi, any registry is limited by the quantity and quality of data contained within it. There is evidence that the Blantyre Cancer Registry lacks much specific data, such as on stage of disease. Thus, we do not know how much of this registry information is accurate, especially given the increase in case finding in the years that the registry was scaled-up and on the fact that the registry may not include case data from Queen Elizabeth Hospital.
Data on the underlying population-at-risk came from two sources. Population estimates for Blantyre for 1996 and 1997 were estimated via linear interpolation by sex and age based on census information for the years 1987 and 1998, whereas more recent population data (for 1999 to 2005) were available by sex and age from the tables of national population projections for 1999-2025 produced by the National Statistical Office of Malawi (NSO).
The Blantyre Cancer Registry covers 15 hospitals. They are:
- (A) Queen Elizabeth Central Hospital (Government Central Hospital)
- (B) Blantyre Adventist Hospital (Private Hospital)-B
- (C) Mwaiwathu Private Hospital
- (D) Chitawira Private Hospital
- (E) Mtengoumodzi Private Hospital
- (F) Mlambe Mission Hospital
- (G) Malamulo Hospital (Amina, Mission Hospital)
- (H) Welmatt Private Hospital
- (I) Malmed Private Clinic and Laboratory (Private Hospital)
- (J) Admarc Hospital (Company Hospital, Now MASM Medi Clinic)
- (K) Nguludi Hospital (Mission Hospital)
- (L) Chiradzulu District Hospital (Government District Hospital)
- (M) Malamulo Makwasa Hospital (Mission Hospital)
- (N) Thyolo District Hospital (Government District Hospital)
- (O) Zomba Central Hospital (Government Central Hospital)
The population of Blantyre District (urban and rural) was 809,000 in 1998 and slightly more than 1 million in 2008. The data extracted and analysed restricted to the population of Blantyre, with residential status defined as persons who have lived in Blantyre for at least six months. About 10% of registrations are incomplete due to missing ages. Incidence data were extracted from the registry database by cancer site, sex and age group and year of registration (1996-2005).
Blantyre Registry Cancer Notification Form
Banda LT, Parkin DM, Dzamalala CP, Liomba NG. Cancer incidence in Blantyre,
Malawi 1994-1998. Trop Med Int Health. 2001 Apr;6(4):296-304.