Cervical cancer has been noted to be a disease that affects the poor more, and this is all the more obvious in low socioeconomic countries, where cervical cancer rates are the highest.  Some might argue that this is a disease of inequity, given that cervical cancer’s high prevalence amongst African women places them at an increased disadvantage.1  Nigeria has about 50.3 million females aged 15 years and older who are at risk of cervical cancer, the impact of which is estimated at around 14,089 new cases and 8,000 deaths annually.  To put things in perspective, cervical cancer is the second leading cause of female death from cancer in Nigeria and is also the 3rd most common cause of death from cancer in women aged 12-44 years.2

 

Unfortunately, cervical cancer mortality is high and the survival rates are poor in Sub-Saharan Africa due to a number of factors, including poor access to medical facilities, co-morbid conditions, late presentation with the disease, high rate of loss to follow-up, and poverty, in addition to the limited availability of facilities for treatment.3  This makes implementing effective prevention strategies imperative in these countries with very low survival rates. Cervical cancer prevention strategies have been found to be life-saving and very cost effective.1,4,5

Being a woman in Nigeria comes with a lot of challenges. These include a very high chance of dying during childbirth, having to bear the greater burden of the HIV/AIDS epidemic, and being encumbered with different cancers such as breast, cervical and endometrial cancers which are amongst the highest killers of women in Nigeria.6,7,8  Screening programs have been found to be effective in the prevention of cervical cancer. It is estimated that organized screening programs can reduce deaths from this particular type of cancer by over 70%, prevent the associated costs of treating the advanced disease and other associated morbidities, and in many cases, ensure a more enjoyable reproductive life.9  Currently there is no organized national screening program in the country.

Human Papilloma Virus (HPV) is the infectious viral organism responsible for the occurence of cervical cancer and it is transmitted through sexual intercourse.10 In Nigeria, HPV is not perceived by the government as a significant public health problem.  Requisite research has not been adequately funded to know the distribution of the prevalent HPV subtypes that are in the country which will in turn enable the government to know the applicability of the current vaccines to the populace.11,3  A 2013 Global Alliance for Vaccine Initiative (GAVI) document showed that Nigeria, amidst other Sub-Saharan African nations, had not applied to GAVI for support in introducing a national program on HPV vaccination.12  At present, HPV vaccines, despite being licensed in the country, are priced beyond the reach of most of the population at a cost between N9,000 and N15,000 in private and public health facilities.13

One of the significant challenges to prevention programs is the low level of awareness about the importance of protecting against HPV.  A qualitative study carried out in two areas in the north and south of Nigeria found that there was limited knowledge of the importance of screening in preventing cervical cancer.14  Other impediments to cervical cancer prevention include poor health consciousness, inadequate spread of health centers with screening facilities, a poor referral system, and absence of a national prevention program.15,3,16

Tackling the scourge of cervical cancer requires active involvement from all stakeholders in the society.  Premium should also be placed on increasing the awareness of cervical cancer and on effective prevention methods among women in the country.  In addition, increased social marketing of female condoms will empower more women to make decisions when it comes to using protection during sexual intercourse.

Nigeria should also work towards securing support from GAVI to include the HPV vaccine in the national immunization program.  The integration of HPV vaccination into the routine immunization program will be cost effective as evidence from Rwanda, Uganda, and Tanzania shows that delivery costs drop significantly if the vaccine is delivered through existing health frameworks.17

Again, through task shift policies, the government needs to train and equip community health workers and other allied staff so that they can carry out visual inspection techniques.  This will allow women in rural areas and other underserved locations to access this prevention service, the introduction of health insurance programs will also help more women to finance and seek prevention services as and when they are due.

Cervical cancer severely impacts the reproductive lives of women in Nigeria, and it puts them at an increased disadvantage among the population.  It is imperative that the government and relevant bodies perceive the scourge as a public problem and come up with plans and policies for an effective cervical cancer prevention program.  This will go a long way in working towards gender equity and female empowerment.

 

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