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A case-control study of Burkitt lymphoma in East Africa: are local health facilities an appropriate source of representative controls?

Sonya Baik1, Mike Mbaziira2, Makeda Williams3, Martin D Ogwang24, Tobias Kinyera2, Benjamin Emmanuel5, John L Ziegler1, Steven J Reynolds6 and Sam M Mbulaiteye57*

Author Affiliations

1 Global Health Sciences, UCSF, San Francisco, CA, USA

2 EMBLEM Study Office, St. Mary's Hospital Lacor, Gulu, Uganda

3 Center for Global Health, National Cancer Institute, Bethesda, MD, USA

4 Department of Surgery, St. Mary's Hospital Lacor, Gulu, Uganda

5 Infections and Immunoepidemiology Branch, National Cancer Institute, Bethesda, MD, USA

6 Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA

7 Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, 6120 Executive Blvd, Executive Plaza South, Rm. 7080, MSC 7248, Rockville, MD 20852, USA

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Infectious Agents and Cancer 2012, 7:5  doi:10.1186/1750-9378-7-5

Published: 13 March 2012



We investigated the feasibility and appropriateness of enrolling controls for Burkitt lymphoma (BL) from local health facilities in two regions in Uganda.


BL case data were compiled from two local hospitals with capacity to diagnose and treat BL in North-west and North-central regions of Uganda during 1997 to 2009. Local health facility data were compiled from children attending four representative local health facilities in the two regions over a two week period in May/June 2010. Age and sex patterns of BL cases and children at local facilities were compared and contrasted using frequency tables.


There were 999 BL cases diagnosed in the study area (92% of all BL cases treated at the hospitals): 64% were from North-central and 36% from North-west region. The mean age of BL cases was 7.0 years (standard deviation [SD] 3.0). Boys were younger than girls (6.6 years versus 7.2 years, P = 0.004) and cases from North-central region were younger than cases from North-west region (6.8 years versus 7.3 years, P = 0.014). There were 1012 children recorded at the four local health facilities: 91% at facilities in North-central region and 9% from facilities in North-west region. Daily attendance varied between 1 to 75 children per day. The mean age of children at health facilities was 2.2 years (SD 2.8); it did not differ by sex. Children at North-central region facilities were younger than children at North-west region facilities (1.8 years versus 6.6 years, P < 0.001).


While many children attend local health facilities, confirming feasibility of obtaining controls, their mean age is much lower than BL cases. Health facilities may be suitable for obtaining young, but not older, controls.