Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E Young Dr S, Los Angeles, CA 90095, United States.
African Institute for Development Policy, P.O Box 31024, Lilongwe, Malawi.
J Cancer Policy. 2022 Jun;32:100321. doi: 10.1016/j.jcpo.2021.100321. Epub 2022 Jan 1.
Cervical cancer is a major public health challenge in Africa. We analyzed the presence and content of policies for the primary, secondary and tertiary prevention of cervical cancer in Africa, to identify areas of opportunity for policy strengthening in the region most affected by cervical cancer globally.
We searched for publicly-available policy documents among countries in Africa. Using a data extraction form, we gathered data from these policies about key elements of primary, secondary and tertiary prevention approaches and activities based on World Health Organization (WHO) guidelines. We also contacted key stakeholders in each country to confirm these details. We summarized each country's policy details (summed score for each prevention stage and overall), and compared these scores across individual countries and groups of countries based on economic, policy and public health characteristics.
Most countries had at least one policy addressing some aspect of cervical cancer prevention. Primary and secondary prevention were more commonly addressed, and certain details like age of vaccination, screening age/interval and method, were frequently mentioned in these policies.
Countries with high HIV burden and relatively more donor financing for health had more comprehensive cervical cancer policies; there was no apparent association with cervical cancer mortality, female representation in government, or economic indicators (poverty prevalence or income inequality).
There is room to improve cervical cancer policy comprehensiveness in Africa, and to bring these policies in line with evidence and expert recommendations. This analysis is timely given upcoming monitoring of the WHO Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem. These findings suggest some improvements in African cervical cancer policy, including increased inclusion of vaccination, but many topics remain under-specified. The influence of internal and external factors on policymaking should also be considered.
宫颈癌是非洲面临的重大公共卫生挑战。我们分析了非洲在宫颈癌一级、二级和三级预防方面的政策现状和内容，以确定在全球宫颈癌发病率最高的地区加强政策的机会领域。
我们在非洲国家中搜索了公开的政策文件。我们使用数据提取表，根据世界卫生组织（WHO）指南，从这些政策中收集了关于一级、二级和三级预防方法和活动的主要内容。我们还与每个国家的主要利益相关者联系，以确认这些细节。我们总结了每个国家的政策细节（每个预防阶段和总体的总分），并根据经济、政策和公共卫生特征对个别国家和国家群体的这些分数进行了比较。
大多数国家都有至少一项政策涉及宫颈癌预防的某些方面。一级和二级预防更为常见，这些政策中经常提到某些细节，如疫苗接种年龄、筛查年龄/间隔和方法。
高艾滋病毒负担和相对更多的卫生保健捐赠资金的国家制定了更全面的宫颈癌政策；宫颈癌死亡率、政府中女性代表比例或经济指标（贫困发生率或收入不平等）与这些政策之间没有明显的关联。
非洲在宫颈癌政策的全面性方面还有改进的空间，并且需要使这些政策与证据和专家建议保持一致。鉴于即将对世界卫生组织全球加速消除宫颈癌作为公共卫生问题的战略进行监测，这项分析是及时的。这些发现表明，非洲宫颈癌政策有所改善，包括增加了疫苗接种的纳入，但许多主题仍未得到明确规定。还应考虑内部和外部因素对决策制定的影响。
