Clinical importance of cervical cancer prevention and education in Zambia and Sub-Saharan Africa
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INTRODUCTION: Cervical cancer exists as the second most common cancer among women world wide, and in numerous countries is the leading type of female cancer. Specifically, Zambia has one of the highest mortality rates and cervical cancer incidence rates. The goal of this study is to analyze the published literature on preventative techniques for cervical cancer in resource-deprived areas of sub-Saharan Africa by focusing on the correlation between the Human Papilloma Virus (HPV), Acquired Immunodeficiency Syndrome (AIDS), and cervical cancer; the accuracy and feasibility of “screen and treat” clinics; and socio-economic and geographical barriers. RESULTS: Correlations exists between the prevalence of HIV, HPV, and cervical cancer in sub-Saharan Africa, and a clear association exists between HPV and cervical cancer. The deliverance of HPV vaccines as well as educational programs has helped to improve this medical problem. Main screening methods for cervical cancer include the Pap smear, naked eye visual inspection of the cervix after the application of either diluted acetic acid (VIA), Lugol’s iodine (VILI), or with a magnifying device (VIAM), colposcopy, and tests for HPV markers. Studies indicate that the VILI screening test has the highest level of sensitivity with the LEEP method also of importance. The procedure is relatively low cost and is easy to implement when excising lesions. Major risk factors and determinants of cervical cancer can help to explain the underlying barriers of access to care. Women’s misconceptions regarding cervical cancer, gender inequality in African nations, socio-economic status, and foreign aid all play major roles the cervical cancer screening process. A lack of proper education, especially among women in sub-Sahara Africa, has led to misconceptions about the causes of cervical cancer. Studies have found that some women associated cervical cancer with prostitution, a Satanic curse, and other bad behavior. Gender inequality also plays a significant role since the Zambia government had reported that a husband would have absolute rights over children and reproductive rights over his wife once he had made payments for a bride. Geographical barriers also exist as the terrain in Zambia is swamp-like and heavy flooding throughout the year is common. After flooding occurs, communities become physically separated. Furthermore, there are correlations between high incidence rates of cervical cancer and high poverty as it has been shown that the largest number of people living on less than $1.25 dollars per day is that of sub-Saharan Africa. DISCUSSION: Studies have indicated that virtually all of cases of cervical cancer are caused by HPV, implying that HPV testing and detection would largely prevent the progression of lesions. Ultimately, this would reduce the high incidence rate of cervical cancer in Zambia and in other Sub-Saharan African countries. In areas where cytology programs are either non-existent or not efficient, HPV testing approaches should be evaluated and implemented, and they should be based off of the HIV/AIDS infrastructure that has already been established. In regards to the screening approaches, VIAM and VIA are the only two tests that are also practical, affordable, and available. Affordability is the major concern when implementing screening programs in sub-Saharan Africa; for this reason, either VIAM and VIA would arguably be the best options as long as they were effective. VIA would be considered the most appropriate method in terms of screening procedures as the method has the advantage of giving immediate results that can be applied to large populations. Lastly, the lack of proper education, including sex education, has in part led to drastic misconceptions about the causes of cervical cancer. Women hold negative beliefs about cervical cancer since they associate it with being unclean and view it as a reflection of bad behavior. Geographical barriers also play a role; the physical inaccessibility of the clinic discourages women to come to the clinic for screenings. Home visits by physicians and/or the utilization of community health workers may help to eliminate this particular barrier of access. This strategy would be especially beneficial to residents of rural areas since they are more likely to live farther away from institutionalized clinics and screen and treat facilities and are also more likely to be in a state of extreme poverty.
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