Francis Kokutse, in Accra, Ghana
Francis Kokutse is a journalist based in Accra and writes for Associated Press (AP), University World News, as well as Science and Development.Net. He was a Staff Writer of African Concord and Africa Economic Digest in London, UK.
Some deaths should not happen, because they can be prevented. Unfortunately, across Africa, some barriers have been preventing people from seeking care early enough for some conditions. A recent study has identified barriers that have contributed to the death of Ghanaian women who suffer from cervical cancer. Given what is happening in Ghana, one wonders what the situation is with women in other parts of Africa. For this reason, healthcare practitioners and policy makers across the continent must find a way of breaking down all the blocks that have been identified, to help women seek early care.
Though the condition has become a source of worry globally, early screening has been found to be a good way to fight it. Unfortunately, the authors found that some women in Ghana have never been screened for cervical cancer because of the lack of knowledge about the condition.
According to the World Health Organisation (WHO), cervical cancer is a type of cancer that occurs in the cells of the cervix, or lower part of the uterus that connects to the vagina. Nearly all cases are caused by oncogenic strains of human papillomavirus (HPV), specifically two strains, HPV-16 and HPV-18, both of which account for about 70 percent of all cervical cancer cases.
When people are exposed to HPV such as through sexual activity, the virus can be transmitted through skin-to-skin contact and body fluids. Women who are HIV-positive are five times more likely to develop invasive cervical cancer and the progression from pre-cancer to cancer takes a much shorter time.
Across sub-Saharan Africa, the International Agency for Research on Cancer (IARC) reports that in 2018, there were 111,632 new cases of cervical cancer, according to figures provided by the WHO. The IARC says though country-specific data is limited, this figure indicates the significant burden of cancer in the region, and added that, in the same year 68 percent of women in the region died from the disease.
In their study, “Perceptions of barriers and facilitators for cervical cancer screening from women and healthcare workers in Ghana: Applying the Dynamic Sustainability Framework,” published in PLOS Global Public Health journal last month, the authors said, screening for the condition has reduced cervical cancer-related mortality by over 70 percent in countries that have achieved high coverage.
“In Ghana, although cervical cancer is the second most common cancer in women, there is no national-level screening programme, and only 2–4% of eligible women have ever been screened for cervical cancer,” the authors wrote.
The study identified among other things, long clinic waiting times as impacting greatly on screening. Women with lower educational backgrounds do not even know of the existence of places to obtain screening services.
They also found that over two-thirds of married women surveyed in the study said they needed permission from their spouses before scheduling a doctor’s appointment. There is also the problem of inadequately staffed facilities, as well as culturally sensitive issues being a barrier to screening uptake, including patient shyness.
In order to overcome these barriers, the authors suggested the use of self-collected samples for HPV testing, to mitigate barriers such as time spent travelling to and waiting at a healthcare clinic. “It might also provide a more culturally sensitive option for screening to address cultural norms since it does not require the assistance of healthcare providers,” the authors added.
The study said a cross-sectional design was adopted to investigate the barriers and facilitators of cervical cancer screening in women aged 30 years and over in Ghana. It consisted of women presenting at two urban facilities of the Ghana Health Services (GHS) CERVICARE programme (Pap smear VIA, and cryotherapy for treating precancerous cervical lesions) and one peri-urban facility in the Ashanti Region of Ghana.
Despite the gloomy picture that has been painted in the study, it is gratifying to note that the world has not abandoned Africa. The WHO said two years ago that an initiative to support better access to breast and cervical cancer detection, treatment and care services is being piloted in three African countries, Côte d’Ivoire, Kenya, and Zimbabwe, to provide cancer care services over the next three years.
In a statement, the WHO said “breast and cervical cancer currently constitute over half the cancer burden for women in sub-Saharan Africa. Between 60%–70% of women in African countries are diagnosed at a late stage, and only one in two women diagnosed with breast cancer in an African country will survive five years. Breast cancer five-year survival rates in high-income countries exceed 90%.”
The initiative in the three countries includes health promotion, screening, early diagnosis, and treatment, as well as general primary care and screening for other noncommunicable diseases. In addition, early detection services will be integrated into existing cervical cancer screening clinics to ensure both old and new systems are unified. The aim is to provide an integrated and holistic system of health care that will contribute to addressing the burden of breast and cervical cancer in the African region.
“Early detection is a key contributor to better cancer treatment outcomes. With this approach, we aim to bolster the role of primary health care services to help avert excess mortality of African women from preventable cancers,” said Matshidiso Moeti, WHO regional director for Africa. “The health of women will always be reflected in the health of our nations, and we are proud to take these steps to tackle these treatable diseases, for the good of women, our communities and our countries.”
The new initiative being rolled out in the three African countries will also seek to increase health care worker’s ability to provide cancer care within communities through training and will supply and deliver the necessary equipment and essential supplies to support women at primary health care level.
In February this year, there was further good news that researchers, led by the Africa Centres for Disease Control (Africa CDC), will establish three Centres of Excellence in Rwanda, Morocco, and Zambia to gather evidence and accelerate efforts to end cervical cancer in Africa by 2030. This decision was made during a consultative meeting on cervical cancer elimination, held from November 27-29 last year, in Addis Ababa, with technical partners, donors, academia, and civil society organisations in attendance.
Rwanda was chosen for reaching a 90 percent HPV vaccination coverage rate since 2011. It decentralised treatment across 22 districts and 350 health centres. Morocco was selected for leading in the provision of primary health care, school-based vaccination, and accessible treatment by establishing regional cancer centres. Zambia, which has screened over 1.9 million women and introduced advanced treatment technologies, was also selected to host a Centre of Excellence.
“[There will be] the establishment of a Technical Working Group and Centres of Excellence to ensure sustainability and peer learning across the continent,” said Adelard Kakunze, lead, non-communicable diseases, injuries and mental health at Africa CDC.
The Technical Working Group will provide technical guidance for cervical cancer elimination in Africa, ensure that the agenda and priorities set are adopted and executed effectively at the continental, regional, and national levels, and support joint advocacy activities at both the regional and continental levels.
The WHO has a ‘Global Strategy for the Elimination of Cervical Cancer as a Public Health Problem,’ which provides a roadmap through the 90-70-90 targets for 2030. It states that 90 percent of girls should be fully vaccinated with HPV vaccine by the age of 15 years, 70 percent of women should be screened with a high-performance test by 35 and again by 45 years, and 90 percent of women identified as having cervical disease should receive treatment.
Majority of African countries have started implementing the single-dose schedule for the HPV vaccine in line with the WHO Strategic Advisory Group of Experts on Immunization’s recommendation that one dose is as effective as two doses. Results from a Cervical Cancer Prevention Capacity survey carried out by Africa CDC support this approach.
Zainab Shinkafi Bagudu, chairperson of First Ladies Against Cancer (FLAC) and president-elect of the Union for International Cancer Control, said Africa CDC should take the lead in engaging leaders so that the organisation can secure more resource allocation. “It remains a resource problem, so to build those partnerships and the financial models that allow us to run programmes in all African countries, we need credible leaders to help eliminate cervical cancer,” she said.
I cannot agree more with Dr. Bagudu, and hopefully, the leaders will listen to her.
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