186281 Feasibility of geographic information systems (GIS) technology for esophageal cancer research in western Kenya

Wednesday, October 29, 2008

Robert K. Parker, BS , Tenwek Hospital, Bomet, Kenya
Russell E. White, MD MPH FACS , Tenwek Hospital, Bomet, Kenya
Background: Esophageal cancer (EC) is the fifth most common cause of cancer in developing countries, which account for 80% of EC mortality. EC has an uneven geographical distribution with sharply demarcated high-risk areas. Although an undefined region in Kenya has been proposed as an endemic area, it remains relatively unstudied. Within East Africa, infectious disease has been mapped with GIS, but this is the first use for cancer.

Methods: Diagnosed EC cases were reviewed retrospectively at the two main EC referral institutions within Kenya from 1990-2007. Sex, age, ethnicity, and residence were recorded. By utilizing public domain data from the United States Geological Survey of Kenya which lists GPS coordinates for 29,984 locations, cases were assigned with coordinates based on varying levels of recorded residence. They were then mapped with EpiInfo version 3.4.3.

Results: Coordinates were available for 2727 cases. The maps reveal ethnic/tribal and geographic variations. Demarcated areas are clearly observed. The majority of cases <30 years (4.7%) appear to be located in the Rift Valley region.

Conclusions: The creation of a digital distribution map of EC in Kenya was a feasible and reproducible undertaking conducted in a resource-limited setting with the use of freely available technology. The maps visually define the region of EC risk in Kenya. They may provide a background for comparison with various maps such as geological, climate, socioeconomic, ethnic, and population density maps to assess for risk factors. Screening campaigns could be enhanced by targeting the specific, affected populations.

Learning Objectives:
1. Analyze the implications of geographical information systems (GIS) technology in defining the area of risk for esophageal cancer in Kenya. 2. Recognize and evaluate the potential applications of utilizing publicly available GIS technology in other resource-limited settings.

Keywords: Cancer, Geographic Information Systems

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a fourth year medical student at Indiana University who has taken a year leave for a detached study program in western Kenya, where this specific study has been conducted. I have been involved with a number of research projects while here. Of these, I have presented and/or published on 5 different topics, including presentation at a regional, international conference where I spoke about the epidemiology of esophageal cancer in western Kenya. After conversing with the leading surgeons and researchers in the region who did not know or agree on the area of high risk, I decided to attempt to visually define the area of risk for esophageal cancer by utilizing freely available GIS technology. This research was conducted under the supervision of Dr. Russ White MD, MPH, FACS, an associate professor at Brown University and Chief of Surgery and Endoscopy at Tenwek Hospital.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.