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Uganda: High Costs Hinder Fight Against Cervical Cancer
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New Vision (Kampala)
21 July 2008
Posted to the web 22 July 2008
Irene Nabusoba
Kampala
UGANDA is hosting the second annual international cervical cancer conference. The two-day meeting, which started yesterday, is running under the theme "Stop Cervical Cancer in Africa: Accelerating access to HPV vaccines."
The international cervical cancer conference was launched in Nigeria last year to fight against cervical cancer. Dr. Emmanuel Mugisha says cervical cancer, which is caused by the human papilloma virus (HPV), is the second leading cancer among women worldwide.
Mugisha is the country director of PATH, a non-profit global health organisation pioneering the fight against cervical cancer in Uganda.
Cervical cancer affects 500,000 women with 270,000 of them succumbing to the disease. Nearly 85% of these women live in low-income countries, like Uganda, where access to routine health care is limited.
In Uganda, over 80% of women with cervical cancer are diagnosed with advanced disease that is difficult or impossible to treat, making it the leading cause of cancer deaths in the country.
Women with cervical cancer account for over 40% of radiotherapy patients in Mulago Hospital.
Symptoms
The disease often presents with heavy bleeding, a thick smelly discharge, pelvic pain and pain when urinating. It is slow growing, providing room for interventions.
Prevention
Cervical cancer is preventable by the use of the HPV vaccine or by screening sexually active women for pre-cancerous lesions and treating them early.
In developed countries, women are encouraged to go for a pap smear every after two to three years. During the check-up, a sample of cells from the cervix is checked for abnormalities. The procedure has helped reduce cervical cancer remarkably.
Hindrances
Mugisha says high costs and inaccessibility of services have weighed down the fight against cervical cancer.
"Cervical cancer screening is not yet widely available. We have a few centres like Naguru Teenage Health Care Centre, Kawempe Health Centre IV and Mulago Hospital where there are free screening services, but all these centres are in Kampala," Mugisha says.
More so, the procedure goes for sh5,000 to sh20,000, which is unaffordable to many women.
"The cost makes it hard for women to go for screening, especially when they are not sick," he adds. There is also lack of awareness among the populace. Voluntary screening is still unpopular in Uganda because the Government has not invested in this public health care aspect.
Sarah Nyombi, the MP of Ntenjeru North County, notes that: "Many cervical cancer cases occur because standard screening services such as pap smears are technically difficult and too expensive for widespread adoption in developing countries." Nyombi also heads the Association of African Women Ministers and Parliamentarians which voices women's reproductive health concerns.
Low-tech visual inspection methods, for example the use of acetic acid (vinegar), which is applied to the cervix and abnormalities show white, could be the cheapest alternative. However, health professionals argue that many lower cadre care providers, who form the bulk in upcountry clinics, have not been exposed to its use.
Vaccination
"Vaccination is the best option in preventing and managing the disease," Mugisha argues.
Dr. Issa Makumbi, the officer in charge of immunisation at the health ministry says having many sexual partners and engaging in early sex is one of the causes of cervical cancer. "That is why we are considering vaccination of 10 to 12-year-old girls before they become sexually active," Makumbi says.
He says there are vaccines that can prevent up to 70% of cervical cancers among vaccinated women.
"In Uganda, we will use an HPV vaccine known as Cervarix®, which was found to be safe and effective in preventing cervical lesions, which, when not treated, may lead to cancer."
However, the vaccines are currently unaffordable in low-income countries. The three doze regiment goes for $360 (about sh640,800) in developed countries.
"Developing countries striked a deal with the pharmaceutical companies and we are buying at $50 (about 89,000), which is still high. The vaccines we are using in Ibanda and Nakasongola are a donation," he reveals.
Without broad access to HPV vaccines and effective, low-cost screening tools, researchers project that by 2050, more than a million women will suffer from cervical cancer annually.
Will this conference provide a platform to reduce health inequities between the rich and the poor?
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Well like they say, optimists see the rose but pessimists see the thorns. It depends on where you lie.
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