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July 28, 2008

Costs hindering Cervical Cancer campaign

Birungi Rebecca, Journalist, Mama Radio, Kampala, Uganda

The first Global Cervical Cancer conference was held in London In December, 2006, and Africa was represented by five countries, namely: South Africa, Nigeria, Uganda among others.

The following year, the conference was held in Nigeria and it was the first of its kind on the African continent. The event was supported by Bill and Melinda Gates Foundation and it ran from 24th to 25th of July 2007.

Uganda this year 2008 has hosted the second annual 2nd Stop Cervical Cancer International Conference held in Kampala on the 21st -22nd July 2008, with the theme: “Accelerating access to HPV vaccines to prevent Cervical cancer”, whose aim was to highlight the burden of cervical cancer on the African continent.

While presenting a paper on “Current experience of the introduction of HPV Vaccines in Uganda” The Country Director of PATH an International Non Governmental health Organization, Doctor Emmanuel Mugisha, said that cervical cancer is caused by a sexually transmitted virus known as human papilloma virus (HPV). The doctor added that the virus is responsible for cervical cancer which is the second cause of mortality among women globally. There are different types of HPV, and many do not cause problems but strains of HPV of 16 and 18 cause 70% of cervical cancer cases.

He further said that PATH is leading the way in the fight against cervical cancer in Uganda by using HPV vaccines. Doctor, Emmanuel Mugisha went ahead to reveal that PATH is carrying out a demonstration project to test Cervarix® vaccine delivery in Ibanda and Nakasongola districts.

Statistical data from the World Health Organization [WHO] indicate that cervical cancer affects 500,000 women with 270,000 of deaths recorded annually on all continents.

Records indicate that 85% of women with the burden of cancer are living in poor resource countries, Uganda inclusive, where access to health care is still inadequate particularly in the rural areas. In Uganda, over 80% of women with cancer of the cervix are diagnosed with advanced disease, thereby making it complicated to treat the cancer.

According to the State Minister for Health Doctor Richard Nduhuura, 30% of the gynecological beds are occupied by women in Mulago National Hospital. “Many more women suffer from cervical problem, but don’t go to the health centers, while others try but fail to access treatment and die painfully at home” He adds.

Further more, Doctor Mugisha says cervical cancer is the leading cause of cancer deaths among women in the Uganda. 40% of radiotherapy patients in Mulago hospital are women presenting with cervical cancer.

The development of cervical cancer is very slow and takes up to 20 years from infection with HPV to become cervical cancer. It starts as precancerous condition called dysplasia. The latter describes the appearance of abnormal cells of the cervix. In advanced stages the disease presents with heavy vaginal bleeding after sexual intercourse, vaginal discomfort which may be pale, watery, brown or bloody, and pelvic pain among others. However, severe symptoms may rise in very advanced stages include severe anaemia, fistulae.

Despite the lingering ugly picture, Mugisha says that cervical cancer is preventable by the use of HPV vaccine for girls who are not sexually active, or by screening sexually active women. Given the poor resource settings in Africa, Doctor Hannah Simonds a Consultant with Tygerberg Hospital, Western Cape, South Africa, says,” screening is still one of the cheapest options for detecting cervical cancer among women annually”. However, the ideal situation for the governments would have been vaccination along side screening that will reduce the risk of cervical cancer. Additionally Simonds says Pap smear is one of the oldest methods of cervical screening that has been used to screen pre-cancers and cancer. The “Pap smear technique” collects cells that are shedding off the cervix using a brush. The cells are then put on a glass slide, fixed with alcohol processed and read by a trained person.

In Uganda, Kawempe Health Center IV, Naguru Teenage and Mulago National Hospital are providing free screening services which are apparently located in Kampala and unfortunately the screening services are still in the city centre, leaving rural women at a disadvantage. Doctor Mugisha adds that, “inadequate health services with so many competing health needs, coupled with the high disease burden and high costs are daunting challenges to cervical cancer treatment”.

The screening procedure can costs between 5000, to 20,000 Uganda shillings which is between 3 and 13 United States Dollars. This amount of money is not easy to get due to the fact that a number of women in the country are not bread earners, they depend on their husbands’ income for survival and health services. A few women who are income earners have a big dependency burden that includes taking children to school, looking after relatives and paying rent, etc.

The partnership between PATH cervical cancer project and the government of Uganda has enabled this developing country to engage pharmaceutical companies by signing a deal that has seen the buying of vaccines at 89,000 shillings ($50) at a significant affordable rate, though prices need to be reduced further.

In Uganda, PATH in close collaboration with the Ministry of Health is targeting only girls between the ages of 10-12 years because they have not been exposed to sexual activities. Fortunately the on going the HPV-vaccines are a donation in the country’s two districts, namely Nakasongola and Ibanda. “Vaccination of young girls is the best alternative of protecting them from acquiring cervical cancer.” Path’s country director, adds.

In addition the Commissioner in charge of Immunization with the Ministry of Health Doctor Issa Makumbi says the vaccination of 4,000 girls in the Nakasongola and Ibanda districts is given free of charge. “There are vaccines that can prevent up to 70% of cervical cancer among women. Uganda is using Cervarix® that was found to be effective and safe in preventing cancer”. He argues.

Mugisha adds that a doze for cervical cancer treatment would cost 160,000 shillings ($100), saying a woman with cervical cancer requires three doses which adds up to 500,000 shillings ($323). The good news is that World Health Organization and the Global Alliance for Vaccine will be meeting in the next one or two years to discuss about the price reduction for the vaccines, to enable African countries provide the vaccines to the women at a subsidized price, doctor Mugisha noted.

Ritah not her real name is a prominent business woman and a survivor of cervical cancer. After the birth of her second a child, doctors did a screening test and the test was found to be positive, a clear sign for cervical cancer. Ritah recalls that in 1999,the treatment cost her 200,000 Uganda shillings which was too expensive for her. She appealed to the Ugandan government to set up a cervical cancer clinic that specifically caters for women.

However, Kenya’s Health Minister, Beth Mugo who attended the conference, says that, prohibitive costs are hindrance to cervical cancer treatment, adding that there is a need for a conscious African Union involvement for advocacy and ownership of the problem.

Uganda women Parliamentarians present at the conference assert that, the cost of cervical cancer treatment is a challenge to achieving of the milestones of the Millennium Development Goals (MDGs),in particular goal number five of reducing maternal mortality, given the poverty levels in the country.

The next cervical cancer conference is slated for 21st to 22nd of July 2009 in Cape town South Africa, said Princess Onyeri the founder of the Breast Cancer Foundation of Nigeria.

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