Challenges Of Cervical Cancer Prevention And Care In Africa 

By: Adebowale Bello, Freelance Health Writer. With medical review and editorial support by the Datelinehealth Africa Team

 

A group of African women standing in a row. Click image to enlarge.

 

 

Key Takeaways

• The burden and crude death rates for cervical cancer are highest among women in Africa. For example the occurence of the disease is reported to be as high as 36 per 100,000 women in Southern Africa, compared with a rate of 6 per 100,000 women in North America and 7 per 100,000 in Western Europe. ^{(1, 2)}

• 85-90% of cervical cancer deaths globally occur in low resource nations in Africa, Latin America and South East Asia. 

• Cervical cancer is eminently treatable and preventable yet African women with this condition face severe challenges.

• Healthcare and health system inadequacies as well as socioeconomic factors like poverty, low education and health literacy as well as high unemployment are some of the major challenges facing African women.

• African governments need to collaborate with other stakeholders in respective countries to spearhead policies and programs that will lower the burden, death and disability rates associated with cervical cancer in African women.

 

Introduction

Ngozi, a mother of two children lives in a village in Eastern Nigeria where she diligently tends to her farm. Every day, Ngozi checks on her growing crops but recently she has felt some pain in her lower abdomen and has noticed that after short walks, she gets tired quickly.

Having little money and even less food, she believed the pain would go away after a few days but it didn't.

Over the next couple of weeks, the pain persisted and one chilly morning, she woke up with unbearable pain and swollen legs. 

Thoughts of going to the nearest health centre for screening crossed her mind but they quickly vanish as it's about 7km away. With the rising transportation cost, the little savings she had would not conveniently cover her transport to and fro and the possible medications she might have to buy.

As she laid in bed contemplating a decision, Ada, her seven year old daughter ran in crying "Mummy, I'm hungry," with eyes looking up to her sole providing parent and there, Ngozi's decision had been made for her. 

The health centre can wait.

 

African women, especially those in rural areas face difficulty accessing quality healthcare. Sometimes, treatment is shelved in the battle for daily survival and providing for the home.

Though cervical cancer is eminently treatable, the African terrain tells a different story as 85-90% of global cervical cancer deaths occur in low and middle income countries (LMIC) like in sub-Saharan Africa because of several challenges peculiar to the regionn. ^{(1, 2)}

This article aims to highlight some of the challenges that make the occurence and death rate of cervical cancer in Africa to be so high and proffer practical solutions that can be implemented to lower them.

 

The Challenges

1. Low level of Awareness

Kofi Annan, a former Secretary General of the United Nations, said in part, "Knowledge is power." This statement glaringly highlights one of several issues facing African women living with cervical cancer. 

The seeming low level of awareness and health literacy among African women has proved to be a formidable challenge in reducing the death and disability rates associated with cervical cancer.

This could be because of limited access to accurate information in the language that they understand, especially among women who reside in rural areas.

This has allowed several myths and misconceptions, such as the idea that cervical cancer is brought about by witchcraft or as a spiritual attack, to take root and grow in their hearts while passing down from one generation to the next.

Due to its conservative nature, the African culture doesn't encourage open discussions about reproductive health leading to many women enduring pain and suffering in silence. This taboo makes it harder to pass life-saving medical information to those who need it.

2. Limited Access to Screening and Vaccination

A functional health sector is crucial in preventing and treating cervical cancer but lives are at risk in countries where health infrastructure is inadequate.

The unequal distribution of resources limits access to quality healthcare and there are notable contrasts in health outcomes in urban and rural areas in countries of sub-Saharan Africa.

Limited health infrastructure and personnel contribute to the inadequacy in cervical cancer screening in sub-Saharan Africa. This is more so in rural locations, where a hospital offering screening and vaccination programs is located several miles away in another town or village and the long distance discourages women from going for checkups.

When combined with a low level of awareness, women in many communities in sub-Saharan Africa see no urgent need to visit the health facilities until their subtle symptoms have progressed to an advanced stage.

Hospitals and other health facilities also grapple with funding constraints and have limited budgets, which are stretched thin and might only be able to prioritize preventive measures like screening and vaccination programs with external financial backing.

3. Role of Human Papillomavirus

The human papillomavirus is a joint group of viruses with at least 100 strains, though many estimates suggest there are about 150 to 200 strains.

Amongst this, 14 specific strains are classified as high-risk HPV and two of these 14; HPV 16 and 18, are responsible for almost all HPV-related cancers. ⁽³⁾

In 2017, the worldwide prevalence of HPV was 11.7%, while in Africa, that figure more than doubled to 24%. This translates to a rough estimate of 1 in 4 women living with this potentially deadly virus. ⁽⁴⁾

There are several reasons why HPV is prevalent in Africa and some of them include;

• Early exposure to sexual activity: Many women are engaged in sexual activity before age 19 and studies have shown that these women are more likely to have HPV 16. ⁽⁵⁾

• Multiple sexual partners: Having more than one sexual partner has been shown to increase your chances of HPV. A high-risk strain, HPV 18, has been linked with women who have multiple sexual partners. ⁽⁵⁾

• Lack of sexual education: Sexual needs are normal but in trying to satisfy those needs, many people throw caution to the wind and do not take adequate precautions.

HPV is the most common sexually transmitted disease and can be transmitted through tiny wounds during sexual intercourse and this is not limited to penetrative sex alone. Non-penetrative sex also carries the same risk of HPV transmission.

If you're sexually active as a female, it would be wise to encourage regular use of barrier contraceptives between you and your partner.

4. Role of HIV/AIDS

A 2023 United Nations fact sheet on AIDS reports that an estimated 25.8 million Africans live with HIV/AIDS which is 66% of the global population of people living with the condition. African women and girls make up 63% of people living with AIDS in Africa. ⁽⁶⁾

HIV/AIDS is known for weakening and suppressing the immune system and this increases a person's chances of other infections-based conditions such as cervical cancer.

The immune system is capable of killing the human papillomavirus but when suppressed, the viral cells have a free license to thrive, thereby causing cellular changes which progress to cervical cancer.

Women living with HIV/AIDS are also more likely to be infected by multiple HPV strains and this diversity leads to rapidly growing cancer cells that increases their chances of developing cervical cancer.

5. Social determinants

There are many social factors that play roles in health outcomes in sub-Saharan Africa. Among these are poverty, health literacy, high out-of-pocket spending for healthcare and lack of social health insurance.

Like Ngozi at the beginning of this article, many African women live in low income households and have meagre income that prevents them from accessing quality healthcare.

High school level education at the minimum would be expected to provide women with better knowledge about cervical cancer for making well informed health decisions on their health. Many African women in rural communities are lacking in this level of education.

High out-of-pocket costs and lack of social health insurance are well known factors within many sub-Saharan African communities that discourage especially rural women from access to screening, diagnostics and treatment for cervical cancer. 

Also, for families that depend on a daily income, the opportunity cost of taking a day or two off to visit the medical centres may prove extremely challenging.

 

The Solutions: Practical Ways To Reduce Cervical Cancer Burden and Deaths In African Women

Reducing cervical cancer burden, deaths and disability among African women require a multi-faceted approach that addresses the various challenges highlighted above. There are some practical common sense ways to tackle these issues. These include:

1. Promoting Education and Awareness

• Implement public health educational campaigns using written and visual materials that focus on cervical cancer, its risk factors, symptoms and the importance of early detection are needed. These campaigns should be presented in local languages for better understanding and insights.

• Promote regular community dialogues among stakeholders in health within local communities to address misconceptions, myths and taboos related to cervical cancer, thus encouraging open conversations.

• Integrate sexual and reproductive health education into school curricula at appropriate levels to ensure that young girls receive accurate information about cervical cancer and preventive measures.

2. Increasing Access to Healthcare Services

• Establish and provide resources for mobile clinics or community health centers in underserved areas to provide screenings, vaccinations and information about cervical cancer.

• Provide affordable or free cervical cancer screenings and HPV vaccinations to overcome financial barriers and encourage regular preventive care.

• Train more community level health workers to provide culturally sensitive care and encourage women to prioritize their health.

3. Enhancing HPV Vaccination Coverage

• Implement regular national HPV vaccination campaigns targeting school-aged girls to prevent HPV infections and reduce the risk of cervical cancer later in life.

• Community engagement: Public health managers should engage with schools, parents and community leaders to ensure widespread awareness and participation in vaccination programs.

4. Improving Women's Economic Empowerment

Providing economic opportunities for women to improve their financial independence will in turn enable them to access healthcare services and take time off for medical appointments without financial constraints. This should be a priority for the government.

5. Partnerships with NGOs and International Organizations

Collaborations with non-governmental organizations (NGOs) and international health organizations to leverage resources, expertise and funding for comprehensive cervical cancer prevention programs are vital especially in the prevailing resource limitation existing in most communities in sub-Saharan Africa.

 

Wrap Up

Challenges abound in sub-Saharan Africa for women with cervical cancer. Reducing its burden is imperative and calls for a comprehensive, co-production approach among all stakeholders.

By combining education, accessible healthcare programs and empowerment strategies, African public health managers can make significant strides in reducing the impact of this preventable disease on women. 

Collaborative efforts involving governments, communities, NGOs and international organizations are crucial to achieving tangible progress in the fight against cervical cancer, ultimately ensuring brighter and healthier futures for African women across the continent.

 

References

1. International Agency for Research on Cancer. GLOBOCAN: Cancer Today. Available at: https://gco.iarc.fr/today/home. August 2022. Accessed August 25, 2023.

2. World Health Organisation. Cervical Cancer. Last updated February 22, 2022.  Accessed August 25, 2023.

3. National Cancer Institute. HPV and Cancer. Last updated April 4, 2023. Accessed August 25, 2023.

4. Pan American Health Organisation. Human Papillomavirus (HPV) Vaccine. (n.d.). Accessed August 25, 2023.

5. Itarat Y, Kietpeerakool C, Jampathong N, Chumworathayi B, Kleebkaow P, Aue-Aungkul A, Nhokaew W. Sexual behavior and infection with cervical human papillomavirus types 16 and 18. Int J Womens Health. 2019 Aug 26;11:489-494. doi: 10.2147/IJWH.S218441. 

6.  UNAIDS. Global HIV & AIDS statistics — Fact sheet. (n.d.). Accessed August 25, 2023.

 

 

Related: Cervical Cancer: What African Women Need to Know

 

 

Published: October 8, 2023

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