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

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.Infection with Epstein-Barr virus (EBV) [1-3] and Plasmodium falciparum malaria [4-9] have been implicated in endemic Burkitt lymphoma (BL), a B cell non-Hodgkin lymphoma (NHL) described in African children by Denis Burkitt fifty years ago [10]. Significant associations between EBV and BL have been reported in case-control [7,8] and prospective [2] studies, and the EBV can be detected, as clonal episomes, integrated DNA, or early EBV Early RNA prot