Cervical cancer is the uncontrolled growth of cells of the uterine cervix following a longstanding infection with oncogenic high-risk human papilloma virus (HPV).
What is Cervical Cancer?
Cervical cancer is the second most common cancer in women living in less developed regions but in Kenya it is the most common cause of deaths from cancer. Over 500 000 women are newly diagnosed with cervical cancer worldwide every year.
The age-standardized incidence rates for cervical cancer are highest in eastern Africa, averaging 42.7/100000 women per year and reaching over 50/100000 in some countries of sub-Saharan Africa, including Malawi (75.9/100000) and Tanzania (54/100000).
Over 60 000 women per year die of cervical cancer in sub-Saharan Africa, in other words every 9 minutes a woman in Africa dies of the cervical cancer. In Eastern Africa cervical cancer is the leading cause of cancer death among women.
Cervical cancer can be prevented by protecting against HPV infection or by regular monitoring for HPV infection or precancerous lesions.
Health Workforce crisis
In sub-Saharan Africa live 12% of world population who carry 24% of global burden of disease. Only 3% of the global health work force serve in sub-Saharan Africa. 0.3% of worldwide medical expenditure is available. In sub-Saharan Africa 48% of the population live on 1.25 USD or less/day.
Globally sub-Saharan Africa ranks lowest in density of physicians (on average 2.5/10000 (range 0.1-8/10 000)), number of specialist especially oncologists, radiation oncologists, pathologists, diagnostic and treatment facilities (radiotherapy units and CT) and availability of cancer drugs and palliative drugs (painkillers).
HIV/AIDS has become a manageable disease, the once deadly infection can now successfully be controlled by antiretroviral medication given lifelong.
These benefits have also been translated to resource-poor settings in Africa where the prevalence is highest on a global scale.
The unprecedented public health endeavor of offering treatment in rural and remote areas is also a huge challenge for already overstretched health infrastructures. Uninterrupted availability of drugs, clinical and laboratory monitoring services for patients and overall monitoring of these continually extending programs are major preconditions for successful implementation.
19 Million people who are infected with HIV do not yet know their HIV status and will not benefit from ART, but continue to spread the virus. (prevention!)
Tuberculosis remains a global health challenge with nearly 9 Million new infections annually (2012) and a high mortality rate of over 1 Million. Most infections occur in resource-limited settings, and especially in populations where HIV is prevalent. Case detection and provision and monitoring of effective treatment that has to be taken for a minimum of 6 months are important tasks of any health facility in high prevalent areas.
200 Million symptomatic malaria cases occur globally on an annual basis (2013) with the heaviest burden in sub-Saharan Africa where over 90% of all 600 000 malaria death occur, mostly among young children. While modern treatment is short (3 days) and effective, in endemic areas an average of 30% of all outpatient clinic visit are for malaria and a high proportion (20-50%) of hospital admissions are a consequence of malaria.
The digital revolution has reached even the poorest and most remote areas in the world, exemplified by wide extension of information technologies and the dense cell phones coverage in Africa. Modern digital devices offer an enormous benefit regarding clarity, storage, access, sharing of medical data and information. Appliances have become flexible and operator-friendly and work in on/off mode make it possible to use the system where power or networks are unreliable. These developments can be used beneficially to overcome to build organized, sustainable screening programs.
Digitalization of health records -widely applied in industrialized countries- is still scarcely used in resource-poor settings where health care resources are limited, skills are scarce and infrastructures are unreliable. The current status of electronic health recording in SSA is still very diverse especially regarding extent to health facility level, choice of services for which data is collected, degree of centralization and evaluation of data .
The recent, large and fast scale-up of anti-retroviral therapy in many sub-Saharan countries has shown the need for urgent upgrading of health data recording in order to achieve accurate and efficient program monitoring and evaluation.
We have developed in collaboration with SAP, a worldwide renown software company, an electronic data system which links multi-directionally data sources from communities, health facilities and laboratories. Data is collected and received on PC-tablets using app-based and web-based applications and remote cloud-based storage.