Uganda Tests Strategies for Cervical Cancer

Sunday, April 26, 2009

Ugandan health officials are mulling the results of two pilot projects involving the HPV vaccine that test different ways to reach the nation's girls. One project adds the vaccine to existing public health programs; the other is based in schools.

Ugandan girl getting vaccinated

KAMPALA, Uganda (WOMENSENEWS)--In wealthier countries, screening programs to detect cervical cancer in its early stages, when it's more easily treated, are part of routine health care.

But in cash-strapped countries, such as Uganda, women are rarely screened and only go for treatment during the disease's advanced stages, when symptoms are apparent and the chances of saving a woman's life are diminished.

Health activist Claire Judith Achieng is working to bring screenings to rural women, but she said her own mother is an example of how difficult the job can be.

"In my village, my mom told me we lost this prominent woman to stomach cancer," said Achieng, who has conducted numerous workshops in central Uganda about cancer screening. "I told her, 'Mom, it's time you go for screening.' And she said, 'but what if it said I had it?'"

"I'm an activist, and I can't even get my mom to go to a screening," said Achieng.

About 473,000 cases of cervical cancer are diagnosed annually, according to the National Cervix Cancer Coalition, based in West Hills, Calif., with 85 percent of those cases in low-income countries.

The Ugandan Ministry of Health estimates that 85 percent of the nation's women who develop cervical cancer are diagnosed when it is already at an advanced stage.

Uganda has little capacity to treat these women. According to the Ugandan Ministry of Health, the country of 30 million has an estimated 140 obstetricians and gynecologists and 3,400 midwives. Uganda has only one radiotherapy machine to treat cancer patients, according to the director of Mulago Hospital, as the other radiotherapy machine broke down last October.

Protection Through Vaccines

In the past couple of years public health researchers have been intensifying efforts to attract urban women to community-based health clinics for screenings, with good results so far. Drawing upon research they have done in urban areas, the Health Ministry is working on developing screening services in rural communities.

At the same time, public health officials and advocates are beginning to express optimism about stopping the disease before it has a chance to start through vaccination programs.

In a demonstration project in two Ugandan districts that started last year, the country's Health Ministry began to inoculate 9- and 10-year-old girls against human papillomavirus (HPV), a common precursor to cervical cancer. The program was supported by PATH, a Seattle-based nonprofit health advocacy organization, which has received millions of dollars in grants from the Bill and Melinda Gates Foundation for vaccines and fighting HIV-AIDS and neglected diseases.

HPV is the most common sexually transmitted infection in the world. The Atlanta-based Centers for Disease Control and Prevention recommends that girls receive vaccination against this virus between the ages of 9 and 26, preferably before they become sexually active.

Ugandan health officials picked two districts that they considered to be average by health standards, one in the central part of the country and one in western Uganda.

In the first central district, called Nakasongola, health workers who normally deliver vaccinations and de-worming medicine were also given vaccines for HPV to inoculate 9- and 10-year-old girls. This translated into few additional costs, since health workers didn't have to significantly change their routine. However, some health workers said it was difficult to locate all the 9- and 10-year-old girls in the district.

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