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30.01.2020 Health

Ending Cervical Cancer In Ghana: A Call To Action

By Joycelyn Cudjoe, PhD, RN || Nurse Research Scientist
Ending Cervical Cancer In Ghana: A Call To Action
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Cervical cancer is preventable and can be treated when detected early. Human papillomavirus (HPV), a sexually transmitted infection, is the known cause of cervical cancer. Other risk factors include smoking, immune system deficiency, multiple childbirth and having multiple sex partners.

Cervical cancer only affects women, but HPV infections are not specific to females. Men who contract HPV can also develop penile, oral and anal cancers.

A Pap smear is a simple procedure where a health practitioner uses a long swab to take cells from a woman’s cervix (the long narrow opening of the womb), and test for the presence of abnormal cells. The Pap smear allows for early cervical cancer detection.

The HPV vaccine (e.g., Gardasil) protects individuals from contracting HPV. The vaccine is most effective when administered before sexual debut and exposure to HPV.

Cervical cancer is killing Ghanaian women

In Ghana, over 8.5 million females, comprising 30% of the overall population, are at risk of developing cervical cancer. In 2019, a report from the International Agency for Research on Cancer (IARC) showed that HPV infections more common in Ghana compared to the entire West African region. Cervical cancer is also the second leading cause of cancer-related deaths among Ghanaian women. Out of 3,052 Ghanaian women diagnosed with cervical cancer each year, over 2,119 die from the disease.

In 2013, the Ministry of Health and Ministry of Education received sponsorship from GAVI, an organization that provides access to vaccines in low-income countries, to set up a 2-year, HPV vaccination demonstration program in Ghana. The primary objectives of the program were to help the government: (1) Procure expensive HPV vaccines ($30 to $100 per dose) at affordable rates (less than $5 per dose); and (2) demonstrate capacity to vaccinate 50% of girls between ages 9 to 11 years (approximately 6,212) living in two average sized districts between 2013 and 2015. After 2 years of successful implementation of the demonstration program, Ghana would be eligible to receive further support from GAVI to set up a national HPV vaccination program.

2019 marked exactly 6 years since the program’s initiation. Our reviews indicate that there are no published reports available on the current progress of the vaccine program in Ghana. Neither are there available reports on the number of girls who have been vaccinated through the program. Components of the program that are producing desired outcomes, as well as implementation challenges have also not been reported.

Cervical Cancer Prevention is a Human Right

Women are powerful drivers of economic growth and form the backbone of many thriving families and resilient communities. It is nearly impossible for Ghana to achieve its national goals and aspirations without addressing cervical cancer, a debilitating disease that rids many Ghanaian women of their psychological, physical and emotional wellbeing.

Cervical cancer prevention is a basic human right! As we celebrate a new decade, I am calling the government, NGOs and the general public to action. It is time to ensure that every woman has access to adequate cervical cancer screening services, and every girl is protected from HPV infection through vaccination. It is our duty as a nation, to look for innovate ways to harness the tools, expertise and best practices we already have, to address cervical cancer. Some recommendations include:

School-based vaccine programs work: Ghana has a primary education program that enrolls a high percentage of girls of school going age, making a school-based program the most efficient HPV vaccine delivery method to implement in the country. A school-based program also has the potential to serve as a critical platform for health education, as well as increase vaccine access for hard-to-reach adolescent populations.

Integrate HPV vaccine with routine immunization: The cost of delivering HPV vaccines to adolescent girls is lowered vaccination is integrated into existing immunization programs. Ghana has successfully immunized children against infectious diseases like polio and measles. We can use similar strategies to successfully scale up HPV vaccination to the national level without re-inventing the wheel.

Public education and buy-in is important: Raising public awareness through culturally relevant health education is a vital step to cervical cancer prevention. We have been successful in educating the masses about HIV prevention and care; similar strategies can be adapted to cervical cancer prevention.

Data is powerful: Although the current morbidity and mortality rates of cervical cancer in Ghana are alarming, it is likely that these numbers are still a gross underestimation. Ghana lacks a national cancer registry. Therefore, studies on cervical cancer often include small sample sizes, which are not representative of the Ghanaian female population.

A successfully implemented cervical cancer prevention program will require concerted efforts from healthcare providers, public health researchers, healthcare and academic institutions to tackle important aspects of the program.

Such aspects include program planning and logistics, feasibility assessment, data collection and surveillance, program management, as well as program monitoring and evaluation. We have individuals with the skillset, knowledge, and expertise right here in our country.

We have the power to eradicate cervical cancer in Ghana. It is time we used our resources, however, limited, to champion this cause for the sake of the girl child, for the sake of women and for the sake of our nation. The time to act is now. We cannot wait until another life is lost to this preventable and treatable disease.

Written by Joycelyn Cudjoe, Ph.D., RN

Dr. Joycelyn Cudjoe is a graduate of The Johns Hopkins University School of Nursing. She currently works as a Nurse Research Scientist at Inova Health System in Falls Church, Virginia. Her research interests include cancer prevention and management, health disparities, global health and implementation science.