Burkitt's lymphoma in Ghana: urban-rural distribution, time-space clustering and seasonality

Epidemiological data are summarized from 236 cases of Burkitt's lymphoma (greater than 90% cytologically or histologically confirmed) seen from 1970 through 1975 at Korle Bu Hospital, Accra, Ghana. The rate of referral from rural areas was greater than that from urban areas, despite a probable bias toward referral from urban areas. The distribution of cases in Ghana appeared to be non-random but we attribute this to variable access to medical care and physician interest. Rainfall did not appear to be an important factor. Seasonal variation and time-space clustering were not observed. The incidence here seems lower than that reported in East Africa. We found no evidence of an environmental influence with a short incubation period, as has been postulated for this disease in East Africa. The higher risk among rural patients is consistent with severe malaria being a factor in the etiology of Burkitt's lymphoma.