Reduced cervical cancer burden in Nigeria

Hannah Anthony

Immunization of adolescent girls across Nigeria has given hope for a healthier future and directly reduces the burden of cervical cancer it would shoulder in the coming years.

Folake Abiona didn’t understand the magnitude of the sore that extended to the opening of her mom’s cervix and the pain she endured until the day her organs began to shut down.

 “While she lays helpless on the bed at the Lagos State Teaching Hospital – emergency ward, I looked into her eyes, tears dripped down my face uncontrollably. She stared back at me with her dimming eyes. The dead silence spoke volumes, pierced my soul, and tore my heart apart. In no time, my world shattered when my mom shut her eyes, finally, to cervical cancer at exactly 11:50 pm on the 2nd of March 2020, at age 57. It hurts,” she recalls.

The painful passing of Abiona’s mother made her ask questions about protection against cervical cancer and vowed to protect herself and daughter. “Now, my adolescent daughter and I are vaccinated against cervical cancer. The Nigerian government made it possible,” she said.

For decades, the impact of the Human Papillomavirus infection

has been a public health concern in Nigeria and nations worldwide as a result of its role in leading to 8-genital cancer types. With over a hundred variants, HPV types16 and 18 are responsible for about 70% of cervical cancer.

Globally, cervical cancer ranks as the 4th death-causing disease among women ages 15 and older. In Africa, according to a report,  there is a yearly estimate of about 76,745 million cervical cancer-related deaths and diagnoses of 117,316 women with the disease, making it rank the 2nd most death-causing disease.

In Nigeria, however, cervical cancer stands 3rd, with about “3.5% in the general population of 60.9 million women, estimated to carry cervical HPV-16 and18 infections,” the Human Papillomavirus and Related Cancers, Fact Sheet 2023 reported, “especially in lower-middle and low-income settings.”

Since 2009, the World Health Organisation has recommended HPV vaccines in countries’ immunization routines. The vaccines have been demonstrated to be effective against cervical cancer-causing HPV infection types. Since 2014, a two-dose schedule of a dose for those aged 9 to 14 has been in use worldwide.

In a milestone that deserves accolades, the Federal Government of Nigeria, in collaboration with the WHO, Gavi, the Vaccine Alliance, and other key stakeholders welcomed HPV vaccination into its routine immunization system in October 2023 for girls aged 9 to 14.

The goal is to “vaccinate 7.7 million girls” before they become sexually active “in the largest single round of HPV vaccination across 16 states and the Federal Capital Territory, Abuja while the second phase of the vaccination was scheduled to start in May 2024 in 21 states, after which the vaccine would then be incorporated into immunization schedules in all health facilities across the states, according to UNICEFin a press release.

With a unified synergy across the education sector, primary health centers, and health communication key players across the country, a five-day mass vaccination campaign in schools and communities was carried out during the inaugural rollout in the states. HPV health communication fliers were sent on social media and school platforms shared among parents and caregivers.

On 24th of October 2023, girls in various schools and communities across the 16 states began receiving their free shots of the HPV vaccine upon the consent of their parents.

Public and private schools within the states were one target anticipated because adolescent girls can easily be found in large numbers.

 “I saw a flier on my daughters school platform and she also came home with a consent card asking for parents’ permission for the vaccination of their daughters with the HPV vaccine as health workers would be sent to their school to give them the first shot ,” Mrs Tella a parent said.

Since the introduction, many adolescent girls have benefitted from the free vaccination and their parents expressed their joy. Tomisin Fatokun,10, is one of the adolescent girls whose future is secured against cervical cancer when she received a shot of the HPV vaccine. ” I am very happy with the vaccination, my daughter is vaccinated. My heart is at peace for the future,” said Mrs. Fatokun, a book publisher in Olambe, Ogun State.

A primary school head teacher at Solomon Treasure International School, Lagos, Mrs Esther Ogunnaike said: “90% of our parents allowed their daughters to be vaccinated with HPV vaccine.

“My daughter also was vaccinated, I don’t want to lose any of my loved ones to cervical cancer. Not even me. I would rather prevent cervical cancer using vaccines than go through the pain of looking for treatments and eventual loss,” she added.

The high-level advocacy of engagement of all partnerships across sectors where target adolescents can be found contributed to the awareness of the benefits and parents acceptability of the HPV vaccine uptake in various states. “We were able to vaccinate a commendable number of girls during our visitation to schools within Lagos,” ” said Mrs Kikelomo Amao, health worker at the Lagos teaching hospital, immunization and Disease Control Center.

However there are indications that the worrisome rise in burden is a reflection of “gaps in access to vaccination, early screening, diagnosis, and treatment,” according to Dr Nathan Bakyaita, WHO Representative to Zambia, at the African Regional Immunization Technical Advisory Group (RITAG),  where “less than 1% of the vaccines needed by Africans are produced in Africa, creating a significant health safety threat while  hundreds of millions to billions of doses of vaccines requires the vaccine-manufacturing capacity of the entire world.

Imagine the rate of wellness a cervical cancer-free nation would bring to millions of families and the relief to the public health institutions in Africa.

Image credit-Dr Abdu

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