According to the Centers for Disease Control and Prevention, about “93% of cervical cancers are preventable.” Unfortunately, however, the rates for cervical cancer, as well as the number of deaths from it, continue to remain high in many of the poorest areas of the world. This is especially the case in sub-Saharan Africa, most notably in East Africa. In order to reduce incidences of cervical cancer in sub-Saharan Africa, targeted human papillomavirus (HPV) vaccine rollouts are necessary.

Cervical Cancer Rates in Sub-Saharan Africa

Sub-Saharan Africa notes a significant number of cervical cancer cases. In East Africa specifically, cervical cancer is “the leading cause of cancer-related morbidity and mortality, with one of the incidence rates above 40 cases per 100,000 of the population,” according to a study based on surveys conducted between 2014 and 2017. The World Health Organization (WHO) reports that, in 2018, Africa accounted for 19 of the 20 countries with the highest rates of cervical cancer.

A study published in 2020 by Elima Jedy-Agba and others says cervical cancer is also “the most common cancer in half (23/46) of the countries of sub-Saharan Africa,” with women in these countries noting the highest cervical cancer incidences and mortality rates globally. The cervical cancer survival rate is also very low in sub-Saharan Africa as only about 33% of those with this form of cancer survive five years after diagnosis. Additionally, cervical cancer was responsible for 21.7% of all cancer deaths in women in sub-Saharan Africa in 2018, “making it the most common cause of cancer death in the region.”

Cervical Cancer Risk Factors

Cervical cancer rates are high in sub-Saharan Africa primarily due to a prevalence of various risk factors, many of which tend to be associated with poverty. University of Cape Town gynecology professor Lynette Denny asserts that the increased risk of cervical cancer in sub-Saharan Africa has “a very strong connection with poverty, with high numbers of people living in unsatisfactory conditions, as well as fragile health care systems that tend to focus on curative rather than preventative interventions…”

Denny also cites women’s lack of access to health care and successful screening programs in Africa as other potential causes. This lack of access contributes to 90% of deaths from the illness.

Lower levels of education, which ties to poverty, also play a role. In a study published in July 2021, Abila and others found that among a group of participants from Uganda, Burundi, Rwanda, Kenya and Tanzania, “having a complete secondary education was associated with the lowest number of risk factors for cervical cancer compared with women with no education” in each country.

Furthermore, most of the respondents in the study “started sexual intercourse at 17 years or younger with the highest proportion among women from Uganda (72.38%) and the lowest among women from Burundi (52.3%).” The women also first gave birth at tender ages, with the mean ages ranging from 18.67 in Uganda to 21.71 in Rwanda.

HIV and HPV Risk Factors

Such trends are common in poor regions as various studies in Africa reveal that “poverty is a risk factor for early sexual debut.” For instance, sub-Saharan African countries typically note higher rates of transactional sex (exchanging sexual acts for basic necessities such as food and money) among young women due to economic insecurity.

Although these young women can meet certain short-term needs by engaging in transaction sex, this practice typically involves multiple sexual partners, which increases the risk of contracting HPV and/or HIV, both of which cause a bulk of cervical cancer cases globally. This shows how poverty in sub-Saharan Africa can directly result in higher rates of cervical cancer.

Treatment Options/HPV Vaccinations

Expanding access to HPV vaccinations is a solution that could greatly reduce the incidence of cervical cancer in sub-Saharan Africa. According to a research article by Christine Muthoni Karanja-Chege, “HPV vaccination provides protection against HPV types 16 and 18 which are responsible for approximately 70% of cervical cancer cases.”  Karanja-Chege also notes that the best age for vaccination is during the early adolescent years before an individual’s first sexual encounter as children in developing countries are more prone to becoming sexually active at an early age.

Karanja-Chege cites Australia as an example of a country in which widespread HPV vaccination has succeeded. As of 2019, 80% of Australian females eligible for the HPV vaccine have received it, which has greatly reduced HPV infection in the country. Furthermore, this increase in HPV vaccination rates is expected to reduce the cervical cancer rate in the country in the near future. The example of Australia demonstrates that nations can achieve considerable success in preventing a major risk factor associated with cervical cancer, which is what African nations such as Kenya hope to do.

HPV Vaccination Rollout in Kenya

Kenya has also attempted to deter cervical cancer through HPV vaccination. In 2019, Kenya’s Ministry of Health rolled out a “routine HPV vaccination” program for 10-year-old girls in the country. With the support of Gavi, the Vaccine Alliance, public health organization John Snow, Inc. (JSI) helped introduce the vaccine in Kenya.

Despite these efforts, vaccine misinformation spread throughout the country, discouraging many parents from bringing their daughters for vaccinations. Furthermore, the COVID-19 pandemic disrupted health care services in the country and forced the government to delay many immunization campaigns, including the HPV immunization campaign.

Nevertheless, the introduction of the HPV vaccine in Kenya has seen some success. The 2019 program also provides valuable lessons that health ministries in Africa can take into account to ensure greater success in future programs. JSI notes that “HPV vaccine introduction requires tailored approaches to reach preadolescent/adolescent girls. Countries that are introducing HPV vaccine are learning that these lessons also offer an innovative blueprint for future life-course vaccinations.”

– Adam Cvik

Photo: Flickr