ecancermedicalscience

Research

Cervical cancer programme, Kenya, 2011–2020: lessons to guide elimination as a public health problem

25 Aug 2022
Valerian Mwenda, Woki Mburu, Joan-Paula Bor, Mary Nyangasi, Marc Arbyn, Steven Weyers, Philippe Tummers, Marleen Temmerman

Background: Cervical cancer is the leading cause of cancer mortality in Kenya, with an estimated 3,200 deaths in 2020. Kenya has implemented cervical cancer interventions for more than a decade. We describe the evolution of the cervical cancer programme over the last 20 years and assess its performance.

Methods: We searched the Ministry of Health’s archives and website (2000–2021) for screening policy documents and assessed them using seven items: situational analysis, objectives, key result areas, implementation framework, resource considerations, monitoring and evaluation and definition of roles/responsibilities. In addition, a trend analysis was performed targeting screening and disease burden indicators in the period 2011–2020, using data from Kenya Health Information System and the Global Burden of Disease database.

Findings: Policy guidance improved over time, but the implementation of screening was poor. Before 2016, a clear leadership and accountability structure was lacking; improvement occurred after the establishment of the National Cancer Control Program. The main health system gaps included the lack of a trained healthcare workforce and poor data collection. Annual screening coverage varied between <1% and 36% of the target population for the year for HIV-negative women and between <1% and 7% for HIV-positive women, from 2011 to 2020. Test positivity for visual inspection with acetic acid was below 5% for most of the period. Compliance to treatment of precancerous lesions ranged between 22% and 39%. The detection rate of cervical cancer ranged between 0.5% and 1.0%. The burden of invasive cervical cancer did not change significantly: world age-standardised incidence and mortality rates of 26.3–27.4 and 16.6–18.0/100,000 women-years, respectively; disability-adjusted life years of 579–624/100,000 life years.

Conclusion: The Kenyan cervical cancer control programme suffered from inadequate health system strengthening and poor quality implementation. Evidence-based policy implementation and sustained health system strengthening are necessary to move towards cervical cancer elimination as a public health problem.

Related Articles

Julius O Maitanmi, Temidara E Fabiyi, Oluwadara Eniola, Toluwalope O Sansi, Josiah O Blessing, Bukola Maitanmi, Margaret O Ojewale, Abiodun A Dairo, Damilola A Adebiyi, Oluwadamilare Akingbade
Lucky E Tietie, Kehinde S Okunade, Adaiah P Soibl-Harry, Sarah O John-Olabode, Rose I Anorlu
Annie Kanchan Baa, Sameer Rastogi, Sanal Fernandes, Shakti Shrivastava, Rajni Yadav, Adarsh Barwad, Shamim A Shamim, Nihar Ranjan Dash
Jhajaira M Araujo, Andrea C Gómez, Winston Zingg-De Jongh, Jhon Ausejo, Iván Córdova, Luis J Schwarz, Denisse Bretel, Williams Fajardo, Luis G Saravia-Huarca, Joshuan Barboza-Meca, Zaida Morante, Jaun R Guillén, Henry Gómez, Nadezhda K Cárdenas, Lady Hernández, Walter Melo, Cynthia Villarreal-Garza, Christian Caglevic, Carolina Palacio, Héctor García, Gerson Mejía, Claudio Flores, Carlos Vallejos, Joseph A Pinto