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Demystifying cervical cancer screening

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MWAKASUNGULA—Screening could make all the difference

At Nsaru Health Centre in Traditional Authority (T/A) Kabudula in Lilongwe, an antenatal clinic is underway.

Every week, women attending antenatal services here are remind of yet another threat to their lives, cervical cancer.

This non-communicable disease accounts for 45.4 percent of all cancers among Malawian women.

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Over 2,300 women develop cervical cancer in Malawi and 1,600 die from the disease every year.

Health workers say early screening and detection of the disease could make all the difference needed in combating the disease.

But not all health workers have the prerequisite knowledge on cervical cancer due to lack of training opportunities and myriad of other duties.

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However, some health officials at Kabudula Community Hospital have received training in the condition.

It is these health workers with support from Women Coalition against Cancer (Wocaca) who have been travelling to various clinics including Nsaru Health Centre, reminding women of the need to get cervical cancer screening.

“The problem is that most women, especially those in rural areas, do not have information regarding this disease and where the information is available, the women are afraid to go for screening because of several misconceptions,” says Cecilia Mkwala, a Matron at Kabudula Community Hospital.

But Ruth Elisa, 43, of Chiwambo Village, T/A Kalolo in the district says she has gone for cervical cancer screening twice in the last two years.

Elisa heard about the importance of cervical cancer screening among women of childbearing age through the radio.

“When I heard such messages, I was eager to go for screening but the long distance we have to travel from where we live to the facility discouraged me, due to this distance, we usually go to the hospital whenever we are really sick,” Elisa says.

Through various interventions aimed at encouraging women to undergo cervical cancer screening and health workers to conduct screening in hard-to-reach areas, Elisa underwent cancer screening.

“That was last year and when the results came, I was happy I did not have the condition but that did not prevent me from undergoing screening this year too,” the mother of five says.

Elisa says, since she started undergoing cervical cancer screening, she has encouraged several of her friends to undergo screening.

“Some came to me asking about misconceptions that health workers use metals to screen cancer to the extent that the woman would feel pain when urinating but I told them that there is no pain.

“I have been telling them that the disease has no cure but, with early screening and detection, it is possible to prevent this disease,” Elisa says.

Like Elisa, Phoebe Nyirongo first heard about cancer screening on radio and from health counsellors at her home in T/A Kabudula.

Nyirongo, who lives at Nsaru Trading Centre, has also undergone cervical cancer screening and says it is not as painful as some say it is.

“I did not feel the pains I feared when I went for cervical cancer screening,” Nyirongo says.

Malawi has the highest cervical cancer incidence and mortality in the world, at a rate of 75.9 and 49.8 per 100,000 populations respectively.

Cervical cancer also accounts for 45.4 percent of all cancers in women in the country and the trend is increasing.

Reports also indicate that, every year, over 2,300 women develop cervical cancer and over 1,600 die from the disease.

High prevalence of HIV, human papilloma virus, late diagnosis, limited access to timely, standard treatment of cancer and palliative care are some of the main risk factors for high cervical cancer incidence and mortality in Malawi.

Non- profit organization Wocaca has been reaching out to women living in the country’s rural areas, especially in Lilongwe, with messages on the importance of cervical cancer screening.

The organisation has also been supporting health workers in terms of transportation and other incentives to promote cervical cancer screening clinics in rural areas in Lilongwe.

It is through such interventions that Elisa and Nyirongo and other women in their community came to know about the importance of cervical cancer screening.

Wocaca Executive Director Maud Mwakasungula says, since the initiative started, the number of women undergoing cancer screening has increased.

“This is a welcome development because screening could make all the difference but it is not about screening alone, it is about providing quality services including psychological support if we are to deal away with all the misconceptions regarding cervical cancer screening and indeed the disease in Malawi,” Mwakasungula says.

But Mwakasungula says cervical cancer is still killing many women in the country’s rural areas.

She says long distances women in rural areas have to walk to access health services is one of the reasons women are still dying from the condition.

According to Mwakasungula, in most cases, by the time the women have decided to go for screening, it is too late.

“The problem in rural areas and indeed in the country is that we do not have that tendency where we can go to a health facility just for a check-up, in most cases, we wait until we are sick to go to the hospital, so what we are doing is reduce the distance that women walk to access medical care by conducting mobile clinics that bring these services closer to the women where they can get help on time,” Mwakasungula says.

Apart from working with health workers, the organisation is also working with traditional leaders so that cervical cancer screening is encouraged from the grassroots level.

“At the end of the day, what we want is to even change mindset to align people, especially women living in the country’s rural areas, to good health practices, we understand that this cannot be done in a day but, with concerted efforts from all players, we are determined to prevent further deaths of women due to cervical cancer,” Mwakasungula says.

Recently, the World Health Organisation (WHO) adopted a Global Strategy on Cervical Cancer Prevention and Control, accelerating the elimination of cervical cancer as a public health problem.

WHO member States adopted the strategy alongside other health resolutions as part of the silence procedure launched after the last World Health Assembly in May.

Local organisations including Wocaca welcomed the strategy, saying it sends a strong signal of worldwide interest in progressing on “these important public health issues, despite the Covid-19 pandemic”.

The new strategy emphasises integrated implementation of services within communities, ensuring equity in access and financial protection for all women.

The cervical cancer elimination strategy and implementation plan ensures that women’s needs and perspectives are well represented.

It further outlines the three pillars of cervical cancer elimination – HPV vaccination, cervical screening and treatment – and provides concrete targets to be achieved by 2030.

The Malawi government has also been actively involved in the fight against cervical cancer.

For example, Ministry of Health has implemented various preventive measures through the HPV immunisation programme since January 2019.

The ‘screen-and-treat’ programme and DNA testing has also been implemented in several health facilities in the country by development partners.

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