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Public Health Marketing Strategy Sub-Saharan Africa

Public Health Marketing Strategy Sub-Saharan Africa (SSA)

It would take less than $10 US per woman screened to significantly decrease the cervical cancer related deaths that will occur in Sub-Saharan Africa over the next 10 years.

High incidences of cervical cancer are reported in Africa at rates exceeding 50 per 100,000 populations and age- standardized mortality sometimes exceeding 40 per 100,000 populations. For example, between 1981 and 1990, data from Nairobi hospital records showed that cervical cancer accounted for 70%–80% of all cancers of the genital tract and 8%–20% of all cancers.

Cervical cancer remains a major public health problem in developing countries, especially in Africa where an estimated 53,000 women die of the disease every year.

The World Health Organization (WHO) estimates HPV infections cause approximately 68,000 cases of cervical cancer each year in Africa. However, these figures likely represent a conservative estimate due to the health challenges in health information systems and cancer registries in the Region.

Rates of cervical cancer incidence and mortality have declined greatly in Western countries since the introduction of screening, yet in Africa screening programs remain rudimentary or nonexistent. With the changing population dynamics that will occur globally over the next 50 years, a fourfold increase in the number of cervical cancer deaths will be seen in middle aged women.

Situational Overview; Current State of Cervical Cancer & STD’s Sub-Saharan Africa

“There are more than 200 dialects spoken in Africa, but most of them have no word for ‘cancer’, and this despite the fact that the disease kills more people worldwide than AIDS, tuberculosis and malaria combined, and the burden is particularly acute in the developing world”.

The Guardian/June 2011

85 % of the more than 50,000 new cases of cervical cancer and the 27,000 resulting deaths that occur worldwide each year occur in developing countries. In Africa, it is the most common type of cancer found in women, and frequently results in a near 100% mortality rate in the absence of healthcare facilities equipped to deal with it.

In Africa, 34 out of every 100,000 women are diagnosed with cervical cancer and 23 out of every 100,000 women die from cervical cancer every year. This figure compares with 7 out of every 100,000 women being diagnosed with cervical cancer and 3 out of every 100,000 women dying of the disease every year in North America. In Africa, most of these women are diagnosed at advanced stages of cancer, if at all, which of course is associated with very unfavorable outcomes.

A Disease State in Crisis; The High Price of Cervical Cancer & STD’s SSA

Cervical cancer is the leading cause of cancer morbidity and mortality in women in sub-Saharan Africa (SSA), accounting for about 50,000 deaths annually. Until recently, cytology was the gold standard for screening and prevention of cervical cancer. This method of screening has not been successful in SSA due to a lack of human, financial and material resources and poor health care infrastructure.

Vaccine. 2013 Dec 29;31 / Trials and projects on cervical cancer and human papillomavirus prevention in sub-Saharan Africa.

þÿRates of cervical cancer incidence and mortality have declined greatly in Western countries since the introduction of screening, yet in Africa screening programs remain rudimentary or nonexistent. With the changing population dynamics that will occur globally over the next 50 years, a fourfold increase in the number of cervical cancer deaths will be seen in middle aged women.

Researchers have been challenged to examine promising, inexpensive strategies where screening for cervical cancer screening is limited but the burden of this preventable disease remains unacceptably high

Cervical cancer is a preventable disease. Yet it is the most common cause of cancer in the African Region where it accounts for 22% of all female cancers and 12% of all newly diagnosed cancer in both men and women every year.

In Africa, 34 out of every 100,000 women are afflicted with cervical cancer and 23 out of every 100,000 women die from cervical cancer every year.

This figure compares with 7 out of every 100,000 women being diagnosed with cervical cancer and 3 out of every 100,000 women dying of the disease every year in North America. In Africa, most of these women are diagnosed at advanced stage of cancer which is associated with negative outcomes.

The following cervical cancer risks and challenges are faced in the African Region.

  • Lack of integrated cervical cancer control policy, strategies and comprehensive screening
  • Lack of recent and comprehensive data
  • The intensive economic and psychosocial impacts of unchecked and untreated disease
  • Insufficient knowledge of and lack of accurate information, and testing and treatment skills
  • Prohibitive cost of immunization against HPV
  • Unaffordability / Unavailability of secondary prevention resources and therapeutic resources
  • Geographical inaccessibility to tertiary prevention
  • Lack of collaboration and coordination of interventions

The Cost of Doing Nothing vs. The Benefit of Doing Something

According to the World Health Organization (WHO), there is growing evidence that the African Region is facing a major public health challenge due to the rising burden of cancer. It is projected, for example, that by 2030, Africa will bear some 1.6 million new cancer cases with 1.2 million deaths. The most common cancers in the Region are cancers of the cervix, breast, liver, prostate, Kaposi’s sarcoma and non-Hodgkin’s lymphoma.

Beyond World Cancer Day: Raising Awareness, Dispelling Myths About Cancer/ WHO Regional Office for Africa

Save a Woman Initiative (Sawi), is a group that aims to raise awareness about cervical cancer in Uganda and organises information sessions in churches, schools, universities and markets. “We make women understand the disease and give them time to volunteer for screening,” says Kyomugisha. “By the end of the meetings, most of them want to be screened.”

“The main obstacle”, says Kyomugisha, “is that women cannot afford to go to big

hospitals. Private hospitals are very expensive and we don’t really have screening centers and we lack trained personnel to do the tests”.

With the peak age of cervical cancer being 35-45 years of age, it claims women in the prime of their lives as it relates to raising children, caring for family and contributing to the social and economic life of their communities. It is estimated that the average life years lost to cervical cancer is 25.3 years. The burden of this illness is not only devastating for the women who develop the cancer, but of course also has significant impact on their children, families and

communities.

Cervical cancer never diagnosed or diagnosed at advanced stages in African women aged 30 to 69 years has devastating physical, psychological and social impact on patients, their families and the community. A 1993 World Bank analysis estimates that the cost of screening a cervical cancer case every five years is $ 100 US per disability-adjusted life year (DALY) gained, compared with $ 2600 US per DALY for treatment and palliative care of invasive cancer. According to the International Federation of Gynecology and Obstetrics, it would take less than $10 US per woman screened to significantly decrease the cervical cancer deaths that will occur in Sub-Saharan Africa over the next 10 years.

Strategies to increase screening coverage that utilize a community focus should include: (1) listening to and learning from the community; (2) involving community members in program development and implementation; and (3) responding in a way that addresses the needs of the community. Strategies should be designed to increase and sustain frequency of screening and treatment, and to improve the quality of services, thereby resulting in an ever increasing participation in screening and compliance with treatment recommendations.

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Cervical Cancer Screening and Preventative Therapy (CCS&PT) is a four-year project that seeks to improve reproductive health outcomes for women, with regard to cervical cancer. Their implementation strategy is summarized below.

Community Education: In collaboration with existing health care services such as the Community Health Volunteers, Village Health Teams, Community Health Extension Workers and Peer Educators, awareness of cervical cancer prevention is promoted in communities through one-on one chats and small or large group talks.

Integrated Outreach Services: We conduct community outreach activities where information on cervical cancer is shared and cervical cancer screening services are provided. The outreach activities target women at high risk of cervical cancer (30-49 years), by providing them with relevant information and services. Prior to the outreach sessions, community mobilization is done together with Peer Educators, Community Health Volunteers and Village Health Teams – all of whom have received comprehensive training on cervical cancer awareness and prevention information.

Training: Member Association clinics have qualified trained health professionals and volunteers, including collaborators from the respective government and private facilities that provide quality health services to the communities.

Implementation Ideas for Effective Program Understanding/ Incorporation

Dr. Jean-Marie Dangou, the Regional advisor for cancer control stresses “Prevention, Prevention, Prevention! WHO recommends that cancers can be reduced and controlled by implementing evidence-based interventions and strategies for cancer prevention, early detection and management. Many cancers have a high chance of cure if detected early and treated adequately. Indeed, scientific knowledge, gathered over many decades, indicates that at least one-third of all cancer cases can be prevented.

WHO Regional Office for Africa

Implementing screening and vaccinations in Africa could result in preventing 50,000 cervical cancer deaths by the end of the century. However, since vaccines only protect against 70% of HPV, and are only effective for those who have not yet been exposed to the virus, an entire generation of women can be helped by screening with SelpPap™.

In addition to engaging with Community Health Volunteers, Village Health Teams, Community Health Extension Workers and Peer Educators, SelpPap™ Implantation Recommendations include:

  • Government health agencies

  • Postal Service

  • Government operated hospitals and clinics

  • Doctors Offices

  • Pharmacies & Dispensaries

  • State Clinics & Dispensaries

  • Community Education Centers & Schools

  • University Health Centers

  • Social Services Programs

  • Economic Welfare Programs

  • Women’s Health Advocacy Programs

  • Planned Parenthood Federation

  • Religious Organizations such as churches, mosques and synagogues

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In developing countries, barriers to cervical cancer screening programs include a lack of knowledge about the disease, lack of familiarity with the concept of preventative healthcare, geographic and economic inaccessibility to services, poor quality of services, and lack of support from families and communities.

Focusing on the local community and maximizing local resources in developing strategies for implementing, cervical cancer screening programs is vital because a woman’s ability to make an informed decision and to act on the decision to receive screening is determined not only by her own beliefs, but also by those of her existing social networks and of her community.

We now have effective tools that offer unprecedented opportunities for preventing this cancer that devastates families: an efficient, low-cost screening approach that is suitable for low-resource/geographically challenged areas and that are efficacious in detecting infections and precancerous changes that can lead to cervical cancer. We know we have a problem and SelpPap™ presents a solution that is cost effective, efficient and relatively simple to adopt locally and globally.

SelpPap is a complete customizable solution with competencies far reaching in the global women’s health space. Not only can SelpPap be deployed for cervical cancer prevention and detection, but also for a myriad of diseases and conditions. With the onset of fungal and bacterial illnesses impacting women in the region, the cytology for SelpPap can be easily designed to screen for other critical illnesses using the same sample.

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Numerous SSA based organizations have proven strategies to increase screening coverage. Strategies designed to increase and sustain frequency of screening and treatment, and to improve the quality of services, thereby resulting in an ever-increasing participation in screening and compliance with treatment recommendations. By blending SelfPap with ongoing ground operations distribution and adoption of this innovative health solution can occur swiftly and efficiently.

Global NGO’s and governmental organizations have taught us much on how to mobilize for women’s health treatment & prevention.

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Positively Impacting Regional and State Economies

Arguably, medical technology such as SelfPap™ has a broad range of social and economic benefits. It enables women to live healthier, longer, and enjoy a more active and possibly productive life. It also contributes to the productivity of the local healthcare systems, and to efficient, cost-effective and sustainable service delivery. However, the issue of population health and economic outcomes is particularly acute in sub-Saharan Africa. With the highest burden of the four curable STIs (syphilis, gonorrhea, chlamydial infection and trachomatis) in adults aged 15–49 each year, the impact on human welfare as an instrument for raising income levels, is profound.
There are a number of mechanisms through which health can affect income. Health effects worker productivity, children’s education, savings, investment, and demographic structure. In addition to the impact of a current infection, health may have large effects on prospective lifespans and life cycle behavior. The low cost of some health interventions – such as the introduction of SelfPap™ – will have large‐scale effects on the population and makes health investments a promising policy tool for growth in developing countries. In addition, placing a higher priority on the widespread prevalence of STIs and HPV infections with low mortality burdens that are not priorities from a pure health perspective, has a substantial effect on productivity.
The first is the role of health in the economy is labor productivity. A rapidly deployed, self-administered, cost effective, cervical cell collection system such as SelfPap™ – empowering women to manage their own HPV and Pap tests, STD screening, along with a myriad of other tests – enables workers to lose less time from work due to ill health and are more productive when working. The second role is the effect on health education. Childhood health can have a direct effect on cognitive development and the ability to learn as well as school attendance. In addition, because adult mortality and morbidity (sickness) can lower the prospective returns to investments in schooling, leveraging SelfPap™ to improve adult health can raise the incentives to invest in education. SelfPap™ also positively impacts the third effect on health, which is savings. A longer prospective lifespan can increase the incentive to save for retirement, generating higher levels of saving and wealth, and a healthy workforce can increase the incentives for business investment. In addition, health care costs can force families to sell productive assets, forcing them into long‐term poverty. And lastly, SelfPap™ contributes to the effect of population health on population numbers and age structure. The aggregate output of a population is directly correlated to that populations overall health and age structure.

The Implications of STIs

Sexually transmitted infections (STI), including those caused by HIV types 1 and 2, remain a major public health problem in Africa, causing death through AIDS, cervical cancer, congenital syphilis and ectopic pregnancy, as well as significant morbidity in terms of HIV-related illness, disseminated syphilitic infection and multiple reproductive tract sequelae. Published estimates, available from the Joint United Nations Program on HIV/AIDS (UNAIDS) and the WHO, indicate that Africa remains the continent worst affected by HIV/STI.

STI Epidemiology

As a result of the implementation of syndromic management and poorly functioning or non-existent national microbiological surveillance programs, there are few recent or reliable data on the prevalence of individual STI pathogens in Africa. In 2008 the WHO estimated there are 92.6 Million new cases of the four curable STIs (syphilis, gonorrhoeae, chlamydial infection and trachomatis) in adults aged 15–49 years occur each year within the WHO African Region – comprising of 46 countries with a 2008 estimated population of 384.4 million adults between the ages of 15 and 46. This alarming prevalence of annual new cases represents 1 out of 5 new cases reported globally.

Challenges & Opportunity

Many of the key advances in STI/HIV research have been reported from Africa, and several have been translated into daily clinical practice. However, a key challenge for the region is to scale up successful interventions, which requires sustainable funding, adequate infrastructure and a well-trained workforce. The continued success of syndromic management is currently being challenged by a number of issues. First, the emergence and spread of antibiotic-resistant gonorrhea within the African region, which requires on-going and close monitoring. Second, it has to be appreciated that syndromic management is a tool to treat symptomatic STI in a cost-effective manner and therefore has little impact on the larger burden of asymptomatic infections. Although the use of cheap and easy-to-use point-of-care rapid syphilis tests is now being implemented in many African countries, similar rapid tests are still urgently required to enable the detection of those asymptomatic STIs that have important health sequelae, such as gonorrhea and chlamydial infection. Third, in many countries, healthcare workers remain unable to provide quality STI services for CSW and MSM populations due to discriminatory legislation. Finally, poor quality partner notification remains the ‘Achilles heel’ of STI control programs worldwide, and further health systems research is required to demonstrate the potential benefit of introducing expedited partner notification strategies in the African setting.

The traditional doctor’s office setting and speculum has been replaced with a streamlined patented cylinder design and the SelfPap™ speculum can be easily inserted into the vagina with a smooth, non- traumatic entry, making the cell collection simple, comfortable, and easy to perform. The guide head automatically positions the cervix, allowing the collection brush to retrieve the cell samples. With five rotations of the brush holder the sample is collected, placed in a container with fixative, and sent to the laboratory for screening.

Industry frequency standards:

Major health organizations, including the American College of Obstetricians and Gynecologists, the American Cancer Society, and the U.S. Preventive Services Task Force, agree that women benefit from regular cervical cancer screening.

These groups have published recommendations on testing options and timing:

Major health organizations, including the American College of Obstetricians and Gynecologists, the American Cancer Society, and the U.S. Preventive Services Task Force, agree that women benefit from regular cervical cancer screening.

These groups have published recommendations on testing options and timing:

  • Women between the ages of 21 and 29 should have a Pap smear every three years

  • A Pap smear for women younger than 21 is not recommended because the incidence of cancer in this age group is very low

  • For women aged 30 to 65, screening with a Pap smear and an HPV test every five years is preferred

  • The groups advise against screening women over the age of 65 who have had negative results on prior screening tests

“CDC: Too Many Women Go Unscreened for Cervical Cancer.” Labtestsonline. 20 Nov. 2014.

Web. 7 Dec. 2015.

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SelfPap™ crosses social, economic, cultural and religious barriers and empowers women’s health by in- creasing accessibility and affordability of testing.

SelfPap’s™ affordability and accessibility will allow for unprecedented penetration into all markets, including small towns, socioeconomically challenged, and highly rural areas. With the availability of the Self-Pap™ kit, governments, groups and institutions will be able to offer self-screening to women. In the developed world this translates to reduced costs and in- creased access to women’s cervical cancer.

The need for regular Pap test screening for adult women cannot be stressed strongly enough. SelfPap™ can be an important tool in saving lives and families with early, convenient, efficacious detection.

 

ADDITIONAL RESOURCES

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http://www.afrox.org/

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http://ww w.ippfar.org/

þÿhttp://ww w.nih.gov/

þÿ http://ww w.who.int/en/

þÿ  https://w ww.unic efu sa.org/

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þÿ http://www.paho.org/ http://www.gavi.org/

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