Eritrea: Cervical Cancer Prevention and Control Program Implementation in Eritrea

Cervical cancer occurs when the cells of the cervix grow abnormally and invade other tissues and organs of the body. When it is invasive, this cancer affects the deeper tissues of the cervix and may have spread to other parts of the body. Cervical cancer is caused through acquisition of HPV virus (Human Papillomavirus) when a woman is sexually active and the virus has been acquired. Some women then develop pre cancer lesions but in about 66% to 70% of these women, the body normally clears it away. However, cervical cancer is slow-growing, so its progression through precancerous changes provides opportunities for prevention, early detection, and treatment

Eritrea had recently developed guidelines for national cervical cancer prevention from the 24th February to the 2nd April 2019, training was conducted for the country to implement the program, through organized national cervical cancer screening and treatment of pre-cancer stages.

The purpose of screening is to detect women who have pre cancer lesion using as screening method called visual inspection with acetic acid (VIA). Following that, if VIA is positive, cryotherapy treatment is to be provided. It is a procedure, where one uses a cooling gas to freeze the cervices, which has the pre cancer lesion, and then the body gets rid of it. The approach used was to train the trainers, so that the trained healthcare providers will cascade the training to all the regions of the country, to ensure that screening can be conducted with VIA and treatment where possible, with cryotherapy.

Using the VIA method, once the person does the test, results are available within five minutes. Therefore, if a woman is tested in a health facility and found positive, the health worker trained in cryotherapy is able to 'see and treat', in a single visit approach (SVA). This approach is crucial in that the woman is able to get screened, have her results and treatment within one day unlike other methods.

Another method of screening which is available at Orotta hospital is called pap-smear. In this method, the woman has to visit the hospital several times before she gets results of the screening. Also it involves many steps and people. For example, the nurse takes the paps, then staining the paps is done by cytologist or pathologist. Then, the results are taken back to the hospital where the paps smear was done, for the woman to come back for her results after three months.

The workshop covered presentations and discussions on many aspects, including in-depth review of the cervical cancer situation analysis in Eritrea; program implications for comprehensive cervical cancer prevention and control; rationale behind investing in cervical cancer; anatomy and physiology of the cervix; visual inspection with acetic acid; concept of cryotherapy and concept of see and treat/single visit approach.

This was followed by plenary discussions of the various sections with inputs from the participants. Participants were composed of gynecologists, oncologists, senor midwives, MOH program manager, biomedical engineer, M and E (HMIS) persons and pharmacist. They made recommendations and identified key challenges going forward, such as the need for expansion of equipment, like cylinder and carbon dioxide. They also thanked WHO for its financial as well as technical support. In addition, they urged for continuous support. Overall, 49 patients were screened during the training, four were found positive and three suspected. The training involved pre and post screening counseling, infection prevention as well as how to diagnose the cervix.

The WHO Representative to Eritrea, Dr Josephine Namboze explained that cancers of the cervix, breast and prostate are the most common reproductive organ cancers in Eritrea. The prevalence and incidence of these diseases can be reduced through primary prevention, early detection and early treatment.

The participants discussed around community mobilization plan; to reach as many people as possible, the general community must be targeted and educated on the importance of early diagnosis and treatment. They highlighted that health care providers should pass on clear and consistent messages in a language that is understood by audience.

MOH recommends that information and education strategies should be directed towards persons who have never been screened before, and towards their partners and family members who can encourage them to solicit screening and comply with follow-up instruction. These discussions were then consolidated into an implementation plan, with a draft produced for finalization.

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