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Evaluation of implementation and outcomes in a community-based gastric cancer prevention in Bhutan

Bhutan

Gastric cancer is characterized by rapid progression and a high case-fatality rate when diagnosed at an advanced stage. It is a deadly disease, especially in low- and middle-income countries.

Project contact

  • Yoshio Yamaoka

Background

It is the most frequent cause of cancer death in Bhutan, and the gastric cancer–related mortality rate in Bhutan is the second highest worldwide. In Bhutan, most gastric cancers are detected at a very late stage. Furthermore, the number of gastric cancer cases is likely to increase based on the high prevalence of Helicobacter pylori infection. This warrants immediate action to reduce the risk of death from gastric cancer.

Aims

This collaborative study aims to conduct a H. pylori eradication program and early gastric cancer detection via endoscopy in communities under one Basic Health Unit catchment area in one of the districts.

Project plan

A successful gastric cancer prevention program should focus on the eradication of H. pylori (primary prevention) and early detection of gastric cancer by endoscopy (secondary prevention). However, the predicted effectiveness of these preventions differs greatly from reality. One prevention strategy is gastric cancer screening in the general population. Although a pilot study indicated that there were no antibiotic-resistant strains of H. pylori in Bhutan, the overall cure rate was only 51.9%, which suggests poor treatment compliance.

Secondary prevention via endoscopy is also important to detect gastric cancer at the early stage. The researchers aim to introduce endoscopy training via e-learning and on-site approaches. Researchers also aim to analyse the evidence–practice gap for eradication therapy in Bhutan using communication tools such as pamphlets and education campaigns.

If this community-based “screen-and-treat” pilot project is successful, it will be used to guide the implementation of a nationwide H. pylori-associated gastric cancer control program to eliminate gastric cancer–related deaths in Bhutan. The proposed program will help greatly in preventing gastric cancer and will thus massively reduce healthcare costs.

Principal investigators

  • Yoshio Yamaoka Oita University Faculty of Medicine, Japan

  • Kinzang P. Tshering Khesar Gyalpo University of Medical Sciences of Bhutan, Bhutan

  • Sithar Dorjee Khesar Gyalpo University of Medical Sciences of Bhutan, Bhutan

Team members

  • Sonam Wangchuk Ministry of Health, Bhutan

  • Dhakal Guru Prasad Jigme Dorji Wangchuk National Referral Hospital, Bhutan

Funding organisations

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