October 2012

A monthly means to inform and inspire our TEAM

October 2012
Vol. 3, No. 10

The Snowball Effect

Dung beetle in action. Note that the
beetle pushes with its hind legs.

When subjects for a particular research topic are few and/or hard to contact, researchers can employ "snowball sampling". They start with the few they know, and ask each subject to refer others known to them.

The EMBLEM Study held a workshop in September, in Tanzania, on Cancer Research Methods. During a teaching session, one visiting lecturer from the USA was describing "snowball sampling". Then he paused and reflected, "Maybe that term wouldn’t be understood in Africa. We need a different analogy".

"Dungball!" I suggested. "The dung beetle starts with a small ball and as it rolls it gets bigger". Every child learns about the benefits of the task done by these beetles. Without dung beetles, one couldn’t wade through the filth that would otherwise accumulate in cattle-keeping communities. These beetles are often observed rolling balls of this treasured substance that are many times bigger and heavier than they are.

When I asked an African colleague later what he thought the "snowball effect" would mean, he thought it had something to do with throwing a snowball, hitting the target, and the snowball smashing into pieces! No doubt he had seen this done in movies from places with snow. It took me a while to explain about rolling small snowballs into bigger ones, and building snowmen (sorry, snow people).

Dr. Esther Kawira - Editor


Participants at the EMBLEM Cancer Research Methods Workshop in
Mwanza, Tanzania on September 17-20, 2012.

Thirteen BL cases have been enrolled in the study so far (6 females, 7 males). The two sites – Bugando and Shirati - were visited by the study monitors from Uganda during the month. The team also hosted the EMBLEM Cancer Research Methods Workshop in Mwanza which was attended by study staff from the three countries in East Africa and the USA, medical superintendents and other scientific collaborators.


EMBLEM Kenya has spotted 87 cases.  Twenty-two were Burkitt’s lymphoma and 14 have been enrolled in the study (10 males, 4 females).  Five were not eligible and 3 died before enrollment.

Dr. Esther Kawira gives a talk about
Burkitt’s Lymphoma at the EMBLEM
Cancer Research Methods Workshop

Dr. Sam Mbulaiteye, EMBLEM PI, and Ben Emmanuel, EMBLEM Study manager, visited Homa bay, Webuye study sites and EMBLEM Kenya head office in MTRH Eldoret.

Community mobilization is ongoing.  EMBLEM posters were distributed during a community health units review meeting from Asego, North Kanyabala and Katuma community units, Homa bay County.

Twenty staff members from Kenya, including staff from Homa bay district hospital, Webuye district hospital and the R.S.P.O, attended a scientific conference in Mwanza Tanzania on September 17-22, 2012. The Kenya EMBLEM team also visited Shirati (EMBLEM study site) Tanzania.

Following the doctors’ strike in the public hospitals, few cases turned up to seek medical attention in the public hospital and, therefore, few cases were spotted.


Francis Ssebiryo

Case enrollment at Lacor Hospital study site continues with current enrollment figures at 91 (31 females, 60 males). At Kuluva Hospital study site, enrollment figures stand at a total of 17 (4 females, 13 males).

The Ugandan EMBLEM team visited Tanzania to attend the EMBLEM workshop in Mwanza. It was a great experience meeting the EMBLEM teams from the various sites. For many, it was the first visit to Tanzania, Mwanza in particular.

The Lacor EMBLEM team has added a new data manager - Francis Ssebiryo. We welcome him to the EMBLEM team and are sure that his presence will bring great improvement to our data management.


This section will provide a monthly update on how we are doing on reaching project goals, focusing on patient enrollment, control enrollment, specimen acquisition, storage, shipping, and data management. This month we report on BL Patient Enrollment. We aim to enroll 1500 Burkitt’s Lymphoma patients in five years, from three participating countries. It was projected that the rate of enrollment would snowball (or dungball) from the start to the end of the project, as publicity and sensitization about BL and the research project penetrate the communities. One site has been enrolling for almost 2 years. The other 2 sites have been enrolling for about six months each, giving a total enrollment period of three country-years. The total number of cases (almost 150) enrolled to date means that we have enrolled about 10% of the goal for case enrollment. Since we are still in the early phase of enrollment in two of the three countries, we expect the rate of overall enrollment to increase.

EMBLEM Newsletter is a monthly on-line publication based on contributions of the EMBLEM Study staff.
Editor: Dr. Esther Kawira
Reporters: EMBLEM Uganda – Isaac Otim; EMBLEM Kenya – Pam Akinyi Were; EMBLEM Tanzania – Josia Magatti