Challenges of Setting up the First Stem Cell Transplant Centre in a Developing Country (Nigeria)

Abstract

Hematopoietic Stem cell Transplantation (HSCT) is an approved therapy by the World Health Organization (WHO) for non-malignant and malignant disorder. This is readily assessable and available in developed countries. In 2006 a total of 50,417 first HSCT was recorded worldwide and majority was done in Europe (48%) and the America’s (36%). While only 2% in East Mediterranean and Africa.In a global perspective study the first factor for the low HSCT in poor resource country was Government health care expenditure representing 77.33% of the variance. Second factor was team density and the third Gross National Income (GNI) per capital which added another 4.41% explanation. The first HSCT in Nigeria was done in September 2011 with several challenges in setting up a functioning unit. The challenges range from inadequate manpower compounded by brain drain of health workers. Only a Hematologist, two Nurses, two Laboratory scientists and a Hematopathologist trained for HSCT was available in Hospital. With respect to the challenges of infrastructure and equipment, a four bed isolation unit was constructed with HEPA-filtration and High-pressure machine, an Aphaeresis and platelet storage machine. Most of the supportive, diagnostic unit in the laboratory and Radio-imaging technique are below international substandard. There is need for improved laboratory culture especially for fungal and viral infections. In selecting patients we started with a seven years old child who had severe Sickle Cell disease from a 14 years sibling donor. Also supportive care with parentheral nutrition, blood support (irradiate products), and procurement of rare drugs was a huge challenge. The cost of the first patient transplant patient was paid for by the hospital and is beyond the reach of most Nigerians. The health insurance policy of the nation is still ineffective. Challenges in setting up the first HSCT unit in Nigeria are enormous but with a good political will from government and improved health insurance policy. HSCT could be made available, assessable and affordable to Nigerians who will require this form of therapy.