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Community engagement for better uptake of cervical cancer prevention in Uganda

Author: Tapati Dutta, PhD Student, Indiana University Bloomington
15 March 2017
  • Arne Hoel / World Bank

This is part 2 in a series on cervical cancer in Uganda by Tapati Dutta, a socio-behavioral scientist in community health writing about cervical cancer prevention initiatives in the region.

Cervical Cancer Prevention in Uganda

Cervical cancer is a public health imperative in Uganda and is causal for almost 50 to 60 percent of all female malignancies in the country. To effectively address this scourge, the Ministry of Health in Uganda has formulated the Strategic Plan for Cervical Cancer Prevention and Control (SPCCPC), 2010-14. 

Primary prevention for cervical cancer occurs through the administration of the Human Papilloma Virus (HPV) vaccine and its secondary prevention through the screening for oncogenic HPV infections. Both these prevention strategies have been made available for free throughout the country.

The HPV vaccination is recommended for 10 to14 year old girls who are studying in Primary 4 (P4) level. Catch up programs are implemented to reach out and vaccinate those girls who have dropped out of school. As per the policy, cervical cancer screening is recommended among women aged 30 years and above. The recommended administration of the vaccination is once in three years for HIV negative women and annually for women who are living with HIV. Uganda also receives financial and technical support from various donor organisations for the country’s health system strengthening and to support its cervical cancer prevention programs effectively.

Despite such investments, the HPV vaccination uptake rates are particularly low among girls who are either not enrolled in school or have dropped out of school.  In Uganda, many young girls drop out of school upon reaching the age of puberty, which, coincidentally is also the age when the girls should be vaccinated with the HPV vaccine. 

Anecdotally, evidence from sub-national studies from Masaka, in the Central Region of Uganda, highlight screening rates as low as 4 percent. Thus, there is both a huge unmet need for cervical cancer prevention due to high rates of oncogenic morbidities and case fatalities due to the disease.

Perceptions on the HPV vaccine in local communities

Previous research on cervical cancer screening and low update of the HPV vaccine have been linked to misconceptions around the vaccination, including fear of adverse-effects after being vaccinated and low HPV vaccine confidence among local communities. Further, low rates of cervical cancer screening has been linked with both sporadic screening programs in the country and the asymptomatic nature of the disease leading to its late presentation of symptoms.

Advocacy and community engagement for vaccine uptake

The literature reveals that community engagement from policy formulation to program implementation improves the acceptability and utilization of cervical cancer prevention programs, both from a sustainability standpoint and in improved HPV prevention requirements by local communities. 

At the global level, a Working Group for Vaccine Hesitancy has been formed under the WHO Strategic Advisory Group of Experts on Immunization (SAGE), Cervical Cancer Action Coalition and the HPV Vaccine Community of Practice by GAVI, as well as the Practice-based Research Networks of the Agency for Healthcare Research and Quality (AHRQ) of the Centers for Disease Control and Prevention.

At the national level in Uganda, Village Health Teams (VHTs) have been formed to support cervical cancer prevention and outreach programs. VHTs are constituted of local men and women who voluntarily serve as the primary health contact at the village level.  Through regular trainings, VHT members have been empowered to relay basic health information to their neighbours, as well as guide villagers to the services for various levels of health care. 

In a robust country-wide initiative last year, Information Education Communication (IEC) materials were developed and VHT members were trained in cervical cancer prevention. With skill building of the VHT members coupled with a community’s receptiveness, the VHT concept can be a significant means to facilitate cervical cancer prevention in Uganda.

While community-based strategies like VHT in Uganda are comparatively new interventions, additional implementation research studies are recommended to examine the impact of VHTs in increasing knowledge and awareness about cervical cancer prevention among communities. Further research will also help understand ‘if’ and ‘how’ VHTs have impacted cervical cancer prevention outreach services in the country. 

Interested in this topic? Read part I of the series here.

See more articles in Care

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