Akure, 28 October, 2022 - When Mrs Olawale Damilola, a 40 years old lecturer, heard that the health facility in her locality was offering screening to detect early signs of cervical cancer, her mind flashed to stories of women whom she had heard died of the disease. 

She immediately booked for  screening at the health facility, one of the ten Primary Health Care (PHC)  centres offering cervical cancer secondary prevention program services in Ondo State, South-west Nigeria. 

“I had gone to the Comprehensive Health Centre at Ilara- Mokin, Ondo State, for a family planning service when the nurse informed me about the screening and immediately knew I had to check my status. I seized the opportunity because I had always wanted to check my status, but the price for a pap smear is high as N25 000. 

Once she was lying on the examination bed in the screening room, the nurse explained the simple process - Visual Inspection with acetic acid (VIA) - which involved applying dilute acetic acid – a component of ordinary vinegar – to the cervix and observed by the health worker with naked eyes. 

The health care provider then looks for abnormalities on the cervix, which will turn white when exposed to vinegar. 

Before the screening, the nurse counselled her about cervical cancer saying it was preventable if detected early. 

“Though my result was negative, I started raising awareness about the screening in my community because I overheard the health workers complaining of a low turnout of women”. So far, five women from my office have presented themselves for screening, she said.

A global strategy 

cancer is the fourth most common cancer among women globally, with an estimated 604 000 new cases and 342 000 deaths in 2020.

In 2020, the World Health Assembly adopted the Global Strategy for cervical cancer elimination. Achieving that goal rests on three key pillars and their corresponding targets: 

• Vaccination: 90% of girls are fully vaccinated with the HPV vaccine by the age of 15; 
• Screening: 70% of women screened using a high-performance test by the age of 35, and again by the age of 45; 
• Treatment: 90% of women with pre-cancer treated and 90% of women with invasive cancer managed.

To achieve the goal, the World Health Organization (WHO), with funding from Susan Thompson Buffet Foundation, is providing catalytic support to Ondo, Kebbi, Niger, Ekiti and Ondo states for cervical cancer screening and treatment. The target is to screen at least 5 000 women in the first phase of the programme. 

The disease is preventable through regular screening with either VIA, Pap smear and human papillomavirus (HPV) tests to find any pre-cancers and treat them. The disease is also vaccine-preventable. 

In Ondo state, the state government in collaboration with WHO and Clinton Health Access Initiative (CHAI) have been raising awareness on cancer among the populace by implementing a cervical cancer secondary prevention programme to increase cancer prevention, screening, treatment and the need to support cancer patients.

The screening service is being implemented in 10 PHC centres in Ondo state. It started on 22 July and as of 30 September, 2 239 women have been screened for cervical cancer, and 9% were placed on treatment. 

High turnout 

 Mrs Ilemobayo Wuraola,  a health worker at Arakale health centre, one of the PHCs where the service is offered said the centre has been recording a high turnout of women due to the awareness campaigns by the health workers. 

“In September, we screened 182 women using the VIA procedure, and 36 had suspected cervical cancer cases and were referred to the University of Medical Sciences Teaching Hospital (UNIMEDTH) Akure for further consultations. 

All the process is free. I usually take advantage of the family planning programme and ante-natal and post-natal days to raise awareness about cervical cancer screening” she said.

Path to  elimination

Meanwhile, the Ondo State Commissioner for Health, Dr Banji Ajaka said, “the cervical cancer campaign is a deliberate effort to ensure that our people (especially the vulnerable women and girls) know about the disease, are screened and those positive are treated.  

The figures recorded in the past three months are encouraging. We are optimistic that the state would supersede the 5,000 women targeted for cervical cancer screening within six months ( July to December),  he said.

Emphasizing the importance of the intervention,  Dr Kelias Msyamboza of WHO, noted that the intervention is crucial to reducing the burden of cervical cancer in the country. 

Nigeria records an estimated 12, 075 cervical cancer cases and 7,968 deaths annually. 

WHO has supported the Ondo state government with equipment and supplies, tools for monitoring and evaluation and  training of 100 health care workers for the implementation of the programme. The trained health workers include eight  LGA Health educators and 92 community mobilisers trained on demand creation for cervical cancer screening, he said. 

To raise awareness about the programme, WHO is supporting the airing radio jungles on cervical cancer screening in media houses across  the state. WHO also provides technical support for data validation as well as  supervisory assistance to the state to monitor and evaluate the screening activities across the 10 healthcare facilities.  

Technical Contact:
Dr Kelias Msyamboza; msyambozak [at] who.int (msyambozak[at]who[dot]int)