Mapping Evidence on Management of Cervical Cancer in Sub-Saharan Africa: Scoping Review

Abstract

Cervical cancer (CC) is the most common viral infection of the reproductive tract and in Sub-Saharan Africa (SSA), its morbidity and mortality rates are high. The aim of this review was to map evidence on CC management in SSA. The scoping review was conducted in accordance with Arksey and O’Malley’s scoping review framework. The review included studies on different aspects of CC management. The review was also done following the steps and guidelines outlined in the PRISMA-Extension for Scoping Reviews (PRISMA-ScR) checklist. The following databases were searched: PubMed, EBSCOhost, Scopus and Cochrane Database of Systematic Review. A total of 1121 studies were retrieved and 49 which were eligible for data extraction were included in the review. The studies were classifiable in 5 groups: 14 (28.57%) were on barriers to CC screening, 10 (20.41%) on factors associated with late-stage presentation at diagnosis, 11 (22.45%) on status of radiotherapy, 4 (8.20%) on status of chemotherapy and 10 (20.41%) on factors associated with high HPV coverage. High HPV vaccine coverage can be achieved using the class school-based strategy with opt-out consent form process. Barriers to CC screening uptake included lack of knowledge and awareness and unavailability of screening services. The reasons for late-stage presentation at diagnosis were unavailability of screening services, delaying whilst using complementary and alternative medicines and poor referral systems. The challenges in chemotherapy included unavailability and affordability, low survival rates, treatment interruption due to stock-outs as well as late presentation. Major challenges on radiotherapy were unavailability of radiotherapy, treatment interruption due to financial constraints, and machine breakdown and low quality of life. A gap in understanding the status of CC management in SSA has been revealed by the study implying that, without full knowledge of the extent of CC management, the challenges and opportunities, it will be difficult to reduce infection, improve treatment and palliative care. Research projects assessing knowledge, attitude and practice of those in immediate care of girls at vaccination age, situational analysis with health professionals and views of patients themselves is important to guide CC management practice.

Poor Cervical Cancer Knowledge and Awareness among Women and Men in the Eastern Cape Province Rural Community

“…Overall, this study finds that both women and men in rural Eastern Cape, South Africa had limited knowledge and awareness about cervical cancer, its risk factors, and prevention methods even though they reported having heard of cervical cancer. Similar findings have been reported elsewhere [13][14][15][16][17][18][19][20][21][22][23][24]26,27,31,32]. It was apparent that the level of knowledge about cervical cancer decreased with increasing age among rural community women and men.…”

“…Among the general South African population, limited awareness and knowledge about cervical cancer, its risk factors, and the available prevention measures contribute to low screening coverage and high cervical cancer burden [13][14][15][16][17][18][19][20][21][22]. This is not only limited to the South African population but seems to be the norm in other sub-Saharan countries where knowledge about cervical cancer has similarly been reported to be poor [23,24]. It is common for men to have poor knowledge of and misperceptions about cervical cancer prevention and other women's health issues; yet, men in sub-Saharan Africa control the economic resources and make most health-related decisions for their families and population [25][26][27][28].…”

Epidemiology and Clinical Signs of Gynecological Cancers in an African Country South of the Sahara: Case of the Republic of Benin in 2022

“…Geriatrics is still embryonic and systematic consultation is not developed. According to the study by Zibako, et al, in sub-Saharan Africa, the reasons for the delay in diagnosis were: the unavailability of screening services, delay related to self-medication and weakness of the referral system [22]. Although the physical examination made it possible to establish the diagnosis of the progressive stage, the positive diagnosis of cancer is histological.…”

Precancerous cervical lesions and associated factors among women on antiretroviral therapy at Dukem Health Center, Central Ethiopia: A cross‐sectional study

“…In Sub‐Saharan African countries, about 80% of cervical cancer are detected in advanced stages when very little can be done to treat the disease 15 . In Ethiopia, annually 6294 new cervical cancer cases and 4884 deaths are estimated in 2018 16 .…”

“…7,8,14 In Sub-Saharan African countries, about 80% of cervical cancer are detected in advanced stages when very little can be done to treat the disease. 15 In Ethiopia, annually 6294 new cervical cancer cases and 4884 deaths are estimated in 2018. 16 Smoking, high parity, longterm hormonal contraceptive use, and co-infection with HIV have been identified as cofactors of precancerous cervical lesions.…”