Faina Nyirabagwiza, one of several Rwandan women diagnosed with cervical cancer, at her home in the village of Rosiro, near Kibogora, in western Rwanda.

How Rwanda can become one of the first countries to eliminate cervical cancer – The Guardian

IIt’s 10 a.m. Thursday and midwife Patrice Mucarcondo grabs a swab and explains to the packed benches for women and children how they will be tested. There are about 40 women in the Rubona Health Center in Hue District, Rwanda, in the first screening for human papillomavirus (HPV), an infection that can cause cervical cancer. Among them is Olive Ahotsi, 39.

“A woman in my village developed cervical cancer and died. If she had been screened, she would have been saved,” she says.

It is a very dangerous disease. Recognizing them at an early stage is beneficial because they can be addressed later.”

Cervical cancer is the most common type of cancer affecting women in Rwanda. killing 940 women in 2019. But the state is rapidly expanding cervical cancer testing and deploying tens of thousands of community health workers to raise awareness of the disease. Combined with a successful HPV vaccination program for girls as young as 12, which has surpassed other countries – including the UK – in terms of coverage, officials believe Rwanda is on track to become the first country in Africa, and possibly the world, to eliminate Cervical cancer.

“We are among the top candidates,” says Dr. Francois Uwenkindi, director of the department of non-communicable diseases at the Rwanda Biomedical Center, part of the Ministry of Health. “Australia may be the first country that may be able to eliminate cervical cancer.” He adds that Rwanda can get there first.

The human toll from non-communicable diseases (NCDs) is huge and rising. These diseases take nearly 41 million lives out of the 56 million people who die each year – three-quarters of them in the developing world.

Non-communicable diseases are simply; Unlike, say, a virus, you can’t catch them. Rather, they occur due to a combination of genetic, physiological, environmental, and behavioral factors. The main types are cancers, chronic respiratory diseases, diabetes, and cardiovascular diseases – heart attacks and strokes. Approximately 80% are preventable, and all of them are increasing, spreading relentlessly around the world as population aging and lifestyles driven by economic growth and urbanization make unhealthy a global phenomenon.

Non-communicable diseases, once seen as diseases of the wealthy, are now taking over the poor. Illness, disability, and death are perfectly designed to create and widen inequality — and being poor makes you less likely to be accurately diagnosed or cured.

The investment in treating these common and chronic conditions that kill 71% of us is incredibly low, while the cost to families, economies and societies is staggeringly high.

In low-income countries, non-communicable diseases – usually slow and debilitating diseases – see a fraction of the money needed to invest or donate. Attention remains focused on threats from infectious diseases, yet cancer death rates have long exceeded the number of deaths from malaria, tuberculosis, and HIV/AIDS combined for a long time.

A Common Case is a new Guardian series on non-communicable diseases in the developing world: their prevalence, solutions, causes and consequences, and tells the stories of people living with these diseases.

Tracy McPhee, Editor

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The human toll from non-communicable diseases (NCDs) is huge and rising. These diseases take nearly 41 million lives out of the 56 million people who die each year – three-quarters of them in the developing world.

Non-communicable diseases are simply; Unlike, say, a virus, you can’t catch them. Rather, they occur due to a combination of genetic, physiological, environmental, and behavioral factors. The main types are cancers, chronic respiratory diseases, diabetes, and cardiovascular diseases – heart attacks and strokes. Approximately 80% are preventable, and all of them are increasing, spreading relentlessly around the world as population aging and lifestyles driven by economic growth and urbanization make unhealthy a global phenomenon.

Non-communicable diseases, once seen as diseases of the wealthy, are now taking over the poor. Illness, disability, and death are perfectly designed to create and widen inequality — and being poor makes you less likely to be accurately diagnosed or cured.

The investment in treating these common and chronic conditions that kill 71% of us is incredibly low, while the cost to families, economies and societies is staggeringly high.

In low-income countries, non-communicable diseases – usually slow and debilitating diseases – see a fraction of the money needed to invest or donate. Attention remains focused on threats from infectious diseases, yet cancer death rates have long exceeded the number of deaths from malaria, tuberculosis, and HIV/AIDS combined for a long time.

A Common Case is a new Guardian series on non-communicable diseases in the developing world: their prevalence, solutions, causes and consequences, and tells the stories of people living with these diseases.

Tracy McPhee, Editor

Thank you for your feedback.

Community health workers go door to door in villages to warn them of the risks of cervical cancer and encourage women to attend check-ups. That’s how Ahutsi heard about her.

She worries that the test will be painful, but nothing is as bad as childbirth, she says, so she will “persevere.”

Results should take 10 days. If the swab comes back positive, Uhutesi will be contacted either by phone or by a community health worker who will tell her to return to the health center for a thermal curettage, a treatment that uses a heated probe to destroy precancerous cells in the cervix.

In Huye, in southern Rwanda, the screening and treatment initiative started last year, reaching 13,377 women out of a total of 63,953 eligible. According to Owenkindi, just over half of health facilities in Rwanda have functional screening services. “Two years from now, we should cover all utilities,” he says.

According to the World Health Organization (WHO) Cervical cancer is the fourth most common type of cancer in women all over the world. About 90% of deaths from the disease occur in low- and middle-income countries.

Faina Nyirabagwiza, one of several Rwandan women diagnosed with cervical cancer, at her home in the village of Rosiro, near Kibogora, in western Rwanda.
Faina Nyirabagwiza, one of several Rwandan women diagnosed with cervical cancer, at her home in the village of Rosiro, near Kibogora, in western Rwanda. Photo: Ben Curtis/Associated Press

Cervical cancer usually takes 15 to 20 years to develop. It can take five to ten years in women with weakened immune systems, such as those with untreated HIV.

“We know that cervical cancer is a preventable cancer, and it can also be cured if we can diagnose it early enough,” says Dr. Princess Nothemba Semelela, Assistant Director-General for Family, Women, Children and Adolescents at WHO. “Women continue to die needlessly from this cancer.”

The greatest burden in AfricaShe adds, because access to public health services is limited and disease screening and treatment has not been widely implemented.

The World Health Organization has sought to mobilize efforts to tackle the disease. In 2020, she adopted Global strategy to eliminate cervical cancer By 2030. To eliminate cervical cancer, all countries must reach and maintain an incidence rate of less than four per 100,000 women. In Rwanda, the rate in 2020 was 28.2. In Eswatini it was 84.6 – one of the highest in the world. Meanwhile, in the UK, the rate was 9.9 and in Australia 5.6.

To achieve this goal, states must ensure that 90% of girls are fully vaccinated with the HPV vaccine by age 15; 70% of women should be screened by age 35, and again by age 45; 90% of women with cancer should be treated while 90% of women with invasive cancer should be treated.

In 2011, Rwanda became the first African country to launch a national HPV vaccination campaign, offering vaccinations to all 12-year-old girls in schools. Since its inception, the program has consistently achieved over 90% coverage. More than 1.2 million girls and women have been fully vaccinated with two doses.

Before introducing the vaccine, teachers told the students about the importance of the vaccine and the threat posed by cervical cancer. Community health workers went from house to house explaining the benefits of the vaccine and dispelling myths, such as the links with infertility.

Coverage has plummeted over the past two years as the Covid-19 pandemic has forced schools to close. Dr. Hassan Sibomana, who works for Rwanda’s Ministry of Health and is responsible for coordinating vaccination programmes, says catch-up campaigns are underway.

But eliminating cervical cancer is not cheap. The HPV vaccine program is funded by the Rwandan government and Gavi, a global vaccine alliance.

“Gavi covers more than 80% of the cost of vaccines, so you realize that it is not easy to maintain this program,” Sibomana says.

Examination is also expensive. The HPV test is $25 (£20). Part of the cost is covered by the Rwandan government, Uwenkindi says, and the rest comes from the Clinton Access to Health Initiative, Health Partners, and the World Bank.

Uwinkindi has plans to include the screening program in the Rwanda Community Health Insurance Scheme, which costs $3 per person for a year.

Similela, of the World Health Organization, acknowledges that these “costs [of preventing and identifying cervical cancer] Banned,” although that is being worked on to change. She wants to see the vaccine, testing and device industry move to Africa.

She believes the costs are too high because cervical cancer affects women, not men. “I think if this was a cancer that affected men the way it affects women, we would have a different conversation,” she says. Advocacy and resource allocation will be a completely different ball game.

She adds: “What I see? [worldwide] is that women get a lot of attention when they’re pregnant, but then there’s really nothing in the women’s public health system.”

Midwife Patrice Mucarcondo holds a swab as she explains the HPV test.
Women wait until they are screened for cervical cancer. Photo: Sarah Johnson/The Guardian

Rwanda seems to contradict this narrative. “In our culture, we consider women to be the heart of the family,” Owenkindi says. “We know that if you empower women, you empower the family and the whole community.”

The state provides chemotherapy and radiotherapy for cervical cancer, and gynecologists can learn to perform advanced procedures through the fellowship program. Owenkindi admits that some women with cervical cancer are “lost to follow-up.”

Similila realizes that Rwanda is the “favorite candidate” on the path to eliminating cervical cancer and is an example for others to follow. She adds that the Gambia and Malawi are doing well.

She says she believes Rwanda could be the first country to eliminate cervical cancer. “[I feel it] Very strongly, because of their political leadership, the commitment you see when you talk to them and the conviction of their efforts.”

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