Stefan Daniela Cristina, Dangou Jean-Marie, Barango Prebo, Mahamadou Issimouha Dille, Kapambwe Sharon
Institute of Global Health Equity Research Rwanda, University of Global Health Equity, 0000 Kigali, Rwanda.
World Health Organization Regional Office for Africa, P.O. Box: 06, Brazzaville, Republic of Congo.
Ecancermedicalscience. 2022 Oct 7;16:1454. doi: 10.3332/ecancer.2022.1454. eCollection 2022.
Africa is home to many countries with the highest incidence of cervical cancer in the world. It is encouraging to see that the efforts to prevent and manage this disease are intensifying across the continent. The World Health Organization (WHO) has, in the last years, led a world-wide initiative to eliminate cervical cancer as a public health problem, starting by setting clear targets for 2030.
To assist those African countries with the largest burden of cervical cancer, to reach the set targets, as a first step, WHO initiated a baseline capacity assessment in African high burden countries. We present and discuss the results thereof in this paper.
The countries selected for the baseline evaluation were Eswatini, Guinea, Malawi, Rwanda, Uganda and Zambia. The data were collected by a mailed questionnaire in English, with 129 questions, most of them with preset answer options. It was answered by national coordinators of non-communicable diseases, cancer control or reproductive health programmes in the ministries of health and by the WHO country representatives. Based on the answers, suggestions were made towards optimising the efforts for cancer control.
Except for Eswatini and Guinea, vaccination against the human papilloma virus (HPV) has reached between 74% and 98% of girls in the age bracket. The main method for cervical screening is still inspection with acid acetic. HPV testing, recommended by WHO, is being introduced slowly. The numbers of women screened are not yet nearing the required levels. Between 30% and 70% of the cervical cancers diagnosed are being treated with palliative intent. A deficit of personnel was reported for all professions involved in cervical cancer care.
Guinea will need assistance to implement HPV immunisations and expand screening. In all six countries surveyed, steps should be taken to introduce or scale up the more precise HPV screening instead of acid acetic inspection of the cervix, to replace the current cryoablation of the preinvasive lesions of the cervix with thermal ablation and to increase the capacity for screening. Solutions need to be found for covering the dearth in gynaecological oncologists and radiotherapy installations and personnel.
非洲有许多国家是世界上宫颈癌发病率最高的国家。令人鼓舞的是，整个非洲大陆预防和管理这种疾病的努力正在加强。世界卫生组织（WHO）在过去几年中牵头开展了一项全球倡议，旨在消除宫颈癌这一公共卫生问题，首先为2030年设定了明确目标。
为帮助那些宫颈癌负担最重的非洲国家实现既定目标，作为第一步，WHO在非洲高负担国家启动了基线能力评估。我们在本文中展示并讨论评估结果。
选定进行基线评估的国家有斯威士兰、几内亚、马拉维、卢旺达、乌干达和赞比亚。数据通过一份英文邮寄问卷收集，问卷有129个问题，大多数问题有预设答案选项。由各国卫生部非传染性疾病、癌症控制或生殖健康项目的国家协调员以及WHO国家代表作答。根据答案，提出了优化癌症控制工作的建议。
除斯威士兰和几内亚外，人乳头瘤病毒（HPV）疫苗接种率在该年龄段女孩中达到了74%至98%。宫颈癌筛查的主要方法仍然是醋酸检查。WHO推荐的HPV检测正在缓慢引入。接受筛查的女性人数尚未接近所需水平。确诊的宫颈癌患者中有30%至70%正在接受姑息治疗。据报告，参与宫颈癌护理的所有专业人员都存在短缺。
几内亚在实施HPV免疫接种和扩大筛查方面需要援助。在所有六个接受调查的国家，应采取措施引入或扩大更精确的HPV筛查，而不是宫颈醋酸检查，用热消融取代目前对宫颈浸润前病变的冷冻消融，并提高筛查能力。需要找到解决妇科肿瘤学家以及放疗设备和人员短缺的办法。
