Distant Health Facilities Challenging Cervical Cancer Screening in Rural Areas

Rural women in Bugesera excited to know more about cervical cancer prevention

Rural women in Bugesera district have indicated that there is still lack of awareness and knowledge on cervical cancer despite the disease claiming more as the second women killer in the country.

The revelation was made during the Saturday end of month community general exercise which focused on creating awareness to combat Non-communicable diseases specifically cervical cancer in Rwanda.

“I don’t know much about cervical cancer but I heard about when they were vaccinating young school girls in the village,” says one Seraphine Mukamam a resident of Bidudu cell, Mwendo sector, Bugesera district.

Her experience is not very different from other rual women in the area, who say they don’t know much (infection and prevention) but have heard of the disease and would love to know much to avoid catching the disease.

Local and security officials participate in Umuganda where they worked on a feeder road connecting Gashora to Mwendo

A research ‘ Knowledge, Barriers and Motivators to Cervical Cancer Screening in Rwanda: A Qualitative Study” published by the National Library of Medicine shows that barriers to uptake cervical cancer screening services in Rwanda are related to poor information about cervical cancer and the importance of screening as well as non-adherence to medical insurance.

“Population sensitization through campaign and community outreach activities could have a positive impact on increasing the usage of cervical cancer screening in Rwanda,” it says.

Launch of the cervical cancer campaign in Bugesera, and this will be taken across the country

Though preventable, nearly all cervical cancers are caused by an infection with certain high-risk types of human papillomavirus (HPV). The disease is commonly among when of birth age but anyone can get HPV from: any skin-to-skin contact of the genital area (especially with unprotected sex).

One (especially women) may lower your risk of developing cervical cancer by doing the following: get vaccinated against human papillomavirus (HPV), practice safer sex, take cancer screening, live smoke-free.

Rwanda has a population of 4.35 million women ages 15 years and older who are at risk of developing cervical cancer- which is currently the second biggest killer of women in Rwanda, next to breast cancer. The disease kills at least 67% of all persons (women and men) diagnosed as positive.

In August 2020, the World Health Assembly adopted a global strategy to eliminate cervical cancer that each country should meet the 90–70–90 targets by 2030, this means that 70% of women will be screened using a high-performance test by the age of 35, and again by the age of 45, 90% of women with pre-cancer will be treated and 90% of women with invasive cancer will be managed.

Rwanda believes that this strategy to eliminate cervical cancer can be achieved by 2027 as almost all public health facilities in 30 districts have been trained in using visual inspection with acetic acid (VIA) to screen for precancerous lesions of cervical cancer.

Available data shows that Rwanda has managed to achieve 95% vaccination, treatment and management at 91%, however there is no current data on screening, though there was a target to screen over one million women by 2024.

Health experts say that to ensure widespread utilization of this service, it is crucial to raise awareness within the community about the importance of cervical cancer screening (which is free) and the availability of VIA screening at these facilities

“There is a need to create more awareness and early screening starting with women of 21 years of age, but even below because this is a killer disease that can be prevented,” said Dr. Wilson Kananga, a medical doctor at Nyamata hospital.

Dr. Wilson Kananga

While Dr. Kananga, a member of My Docta Organisation that creates awareness on cervical cancer; says that increase access to early screening is necessary, women in Bidudu cell say that finding the nearest health post to provide the service is a hurdle as they have to travel more than 50 km to reach the nearest health post in Gashora.

“We have a health post (Bidudu) which has been idle to two years yet the infrastructure is available and equipped,” said Mado Niyizanyibuka, the cell council chairperson.

Niyizanyibuka explained that the challenge was after a private contractor failed to secure a contract to run the health post and now citizens spend Rwf5,000 to take a taxi-moto to reach Gashora.

“We have another health post in the nearby Mwendo cell that has also been idle since 2003. This would be easier to reach if it is also staffed and functional, it would solve the challenges we face,” Niyizanyibuka said.

Aline Tuyishime (left)- Director of Gashora Health center

Aline Tuyishime- Director of Gashora Health center recognizes the challenge of reaching health facilities in the area but also stated cervical cancer numbers are alarming thus the need for early screening.

For example, Tuyishime revealed that they receive 20 women every month received with cases of infection and there is need for earlier diagnosis.

“This service is provided every Friday and we do more tests including breast cancer but there is need to make it more accessible,” she said.

According to data from the Rwanda Health Management Information System (HMIS), only 24% of eligible women in Rwanda have undergone cervical cancer screening in the past five years. Current estimates indicate that every year 1,229 women are diagnosed with cervical cancer and 829 die from the disease.

Cervical cancer campaign month conducted by the ‘My Docta’ organisation

Cervical cancer ranks as the 2nd most frequent cancer among women in Rwanda and the first most frequent cancer among women between 15 and 44 years of age. Data is not yet available on the HPV burden in the general population of Rwanda.

However, in Eastern Africa, the region Rwanda belongs to, about 4.7% of women in the general population are estimated to harbour cervical HPV16 /18 infection at a given time, and 67.9% of invasive cervical cancers are attributed to HPVs 16 or 18.