"After our class teacher taught us about the importance of immunization of cervical cancer, I decided to voluntarily vaccinate in order to prevent myself from the deadly disease. The teacher taught us that girls who receive the vaccine at the required early age reduce their risks of suffering from cervical cancer in future."
Those were the words of Shukurani Mbwile, (14), a form four student at Vwawa Secondary School in Songwe region.
Explaining her experience, Mbwile says that after injecting against cervical cancer, she feels different from other girls who are yet to be vaccinated and adds that she feels safe and different from those who are not immunized because the fear of suffering from cervical cancer is reduced.
"The only thing I say at the moment is to encourage young girls to see the importance of this vaccine. Parents should also cooperate with teachers and health service providers to help increase the number of vaccinations," she says.
However, Anna Kibona, (16), narrates a different scenario of how her mother encouraged her to get the vaccine. According to Anna, her mother explained to her just how big the magnitude of the cervical cancer problem was in the country.
Reports from the World Health Organization (WHO) show that Tanzania has one of the highest cervical cancer burdens in the Eastern Africa region, with an age-standardized incidence rate (ASR) of 59.1 cases per 100,000 women, and an age-standardized mortality rate of 42.7deaths per 100,000 women.
Following this, a one year HPV+ project which includes provision of integrated health services such as sexual reproductive health, eye testing and nutrition education to the girls is implemented by Jhpiego in collaboration with the government through the President's Office, Regional Administration and Local Government (PO-RALG) and Ministry of Health, Community Development, Gender, Elders and Children and with funding from UNICEF Tanzania has been introduced.
The HPV+ project aims to strengthen service provision in 200 health facilities across Mbeya and Songwe Regions also includes menstrual hygiene management.
The District Immunization and Vaccination Officer at Songwe hospital, Mr Miraji Kanyonje told Your Health that although some parents have been reluctant to allow their children to be vaccinated, the exercise has been well received by the majority of the population.
"The target is to reach 7,762 primary and secondary school girls this year. We have so far provided the first dose to 2,816 girls (108 percent) and a second dose to 1,912 girls between January and April, 2021. We provide the vaccine to at least 647 girls each month," he said.
In explanation, he says that in order to reach the targeted number, the vaccination campaign will still go on to save a number of girls as cervical cancer kills.
"We could not administer the vaccine to seven girls at Ilolo Secondary School because their parents were not willing. We will continue educating them on the importance of protecting their children from cervical cancer because it is the most common cancer among women," he added.
Immunization and vaccination officer at Faraja dispensary in Tunduma Mr Lunyili Vincent says they have come up with a strategy to involve local government leaders at village and ward levels to help in identifying targeted girls including those out of school as well as those living with HIV/AIDS.
He says they came up with collaborative effort with villagers and local leaders because it was difficult to vaccinate and identify out-of-school girls and girls with HIV/AIDS unlike with school going girls.
According to him, the initiative has helped them to vaccinate four girls living with HIV/Aids. "They were tracked down through our Care and Treatment Clinics (CTC). We track and vaccinate girls living with HIV/AIDS because they are the most vulnerable to cervical cancer," explained Vincent.
He said that HIV infected girls receive three doses of HPV because their body's immunity is low. In Tunduma town, the target is to reach 1,896 girls this year whereas a total of 1,400 school girls have been provided with the first dose
Faraja dispensary immunization and vaccination supervisor in Tunduma, Ms Mary Nyengo said during her outreach services, she visits and provides education to secondary school students four times a year while primary schools are visited two times every year.
Nyengo said that between January and May this year, the centre provided the first dose of HPV to 306 girls (90 percent) and 227 girls for the second; attributing the decrease in numbers of girls going for second dose to various factors including completion of their primary school education, thus it became difficult to trace them.
The centre was trying its best to ensure girls who received first HPV dose get the second dose too, because failure to do so means that they are unable to have complete protection against cervical cancer.
The World Health Organization (WHO) recommends the use of the HPV vaccine as the most cost-effective public health measure against cervical cancer, as part of a comprehensive cervical cancer control strategy.
Globally, the East African region is the leading burden carrier of cervical cancer. Tanzania is amongst the five countries with the highest rates in Africa.
The district immunization and vaccination officer in Chunya Mr Moses Katamba said target population for first and second HPV is to vaccinate 1,796.
According to him, out of the said number already, a total of 1,450 girls have received the first doze vaccination and they plan to provide a second by August this year.
In Chunya, the approach for health practitioners is different from Songwe and Mbeya because they have set cervical cancer as an agenda by speaking to pastoralists, elders and households frequently to build capacity in order to help them track girls who are out of school so that they could be vaccinated.
Health teacher at Chalangwa Primary School in Chunya region, Ms Nuru Mwatujobe says due to cultural beliefs and norms parents were still finding it difficult to allow their children to be vaccinated.
After discovering such challenges, the school introduced a health club for both girls and boys to teach them different health issues. This has proved to be working, response is so far overwhelming and a larger number of girls are aware of the vaccine.
Mwajutobe says from January-Feb this year the school had so far vaccinated 12 children and this was a good sign for school.
"With the support from Jhpiego through this project, we are confident that we will increase community demand for adolescent friendly services and provide cervical cancer immunization to all target groups and also build capacity for the parents," says Mwajutobe.
According to reports, cervical cancer is the most common cancer among women and the leading cause of cancer related morbidity and mortality in women in Tanzania.
Last year, presenting the immunization status for Mbeya, the Regional Immunization Officer Mr. Danford Barnaba said the region attained only 77 per cent of the immunization coverage to girls aged 14 years on the second dose of HPV from the January to October 2020 results.
He said the region faced a number of challenges including the presence of nomadic pastoralist populations in Mbarali and Chunya who normally move, which presents a challenge when trying to reach them.
Other challenges include limited involvement of teachers in school health services, cancellation of outreach services by almost 21 per cent, distance issues and Low immunization coverage of the second doze of HPV vaccine to some councils.
In 2018,Tanzania with the support from WHO and partners became one of the first countries in all of Africa to roll out the HPV vaccine nationwide following only Rwanda, Uganda, Botswana, Mauritius, Seychelles and South Africa.
Globally, cervical cancer is the fourth most common cancer among women with an estimated 570,000 new cases and 311,000 deaths in 2018.
According to the WHO, lack of urgent effort to scale-up cervical cancer prevention services will contribute to increasing the number of deaths to 460,000 deaths by 2040, which is nearly 50 percent over the 2018 levels and nearly 90 percent of these deaths will be in low and middle-income countries.