By Kuda Pembere
When the world locked down due to COVID-19 disruptions in 202o, most health interventions were put on hold. Immunization and vaccination activities were the most affected. This has resulted the rising incidence of vaccine preventable diseases in most low income countries.
In Zimbabwe, most girls aged 10 to 14, the eligible group for the Human Papiloma Virus (HPV) vaccine, missed the opportunity to get their doses due to disruptions caused by COVID-19. According to data, Zimbabwe shed 24 percent of its Human Papillomavirus (HPV) coverage which was 91 percent in 2019 to 67 percent in 2021.
A study conducted in 2023 shows that Zimbabwe has one of the highest incidence rates of cervical cancer in the world – 61.7 per 100,000 women. To protect young girls against cervical cancer, the government of Zimbabwe introduced bivalent HPV vaccine with a 0,12 month schedule to all 10–14 year old girls using a pulsed-campaign approach in May 2018 (dose 1) and May 2019 (dose 2).
For Itayi Mteliso (25), however, fortune knocked twice on her door. Having missed the routine Human Papillomavirus (HPV) vaccinations in school by surpassing the age limit when it was done in her area, Makonde District, she longed to get some form of intervention to guard herself from cervical cancer and HPV.
She had an HPV DNA test sample collected last month at Umbowe Clinic which is close to her area of residence.
“I am happy having been screened for HPV. I always wanted this form of protection from HPV. I missed that chance for my age was past the required limit. I always wished to have this programme close to me so I could access the services,” she told this reporter on the sidelines of a visit of the clinic by a delegation of World Health Organization (WHO) officials who came to Zimbabwe from Geneva, the headquarters of the organization.
Fortunately, Itai’s religion is health-friendly encouraging congregants to seek health services.
“I was tested for HPV and I accepted my results. The nurses and village health workers advised me on what to. They told me about not disclosing the results and how to take care of myself when negative or positive. I belong to the Mugodhi Apostolic Faith church. Our church encourages us to visit health facilities understanding that we can be helped by trained medical professionals instead of dying indoors.”
She states the screening process was unoffending and painless adding the results came earlier than expected.
“The testing process was painless. I arrived at the clinic where the nurse gave me a stub with a red end to hold. We both washed our hands and holding that red end I inserted the stick into the vagina and roll the end of the stub four times. The nurse took the stub and the results came in less than two weeks,” Itai said.
Due to the hard work and dedication of health workers stationed at Umbowe clinic, she got to know of this cervical cancer screening offered to women aged between 25 and 49.
“I encourage a lot of people to seize every opportunity to get screened for cervical cancer because dying without knowing about the disease or trying to seek treatment later when the disease has progressed is not good,” she said.
“It is important to get screened for cervical cancer because you get to know the state of your health. If you get screened or tested early, treatment is timeously easy.”
As from October 2023, when Umbowe started the cervical cancer screening program, they collected 166 samples where 140 tested HPV DNA negative with 21 testing positive. The positive had the Visual inspection with acetic acid and cervicography (VIAC) where eight tested negative and five still await their results and the other five had invalid results which have to be recollected.
At Umbowe clinic, there is one registered general nurse midwife, two primary care nurses and two village health workers who were trained in screening cervical cancer cases. They wish they had more nurses familiar with gynecological issues.
“So there are three nurses. One is a registered general nurse midwife and two are primary care nurses. And then we’ve got other ancillary staff, that is an environmental health technician, general nurse aide, In general, we have nurse aides as well as primary care counsellors who test HIV. So, generally that is staff, but nurses, we think there is a shortage of nurses. If we are about five or so, it works well because we are heavily loaded with duties,” said Josephine Matare, the registered nurse who specialized in midwifery said.
While villages have to travel over 14 kilometres to access health services at Umbowe rural clinic, other setbacks bedeviling the rural facility include dilapidated infrastructure as the clinic was built in the 70s. They clinic needs a vehicle for outreach programmes.
When cases are complex for the primary health care service providers, Zimbabwe has a referral system where patients are referred to the district hospital, on to the Provincial Hospital ending at the Central Hospital.
At the Central Hospital where specialist services are offered, it seems there is nothing much to offer at Parirenyatwa Group of Hospitals has its own set of problems hindering quality oncology service provision.
There are few pathologists for oncology services and one specialist gynecology oncology specialist in the country alongside the ever non-functiononal radiotherapy machines. The Hospital has had to rely on chemotherapy intervention which at times faces stock-outs of medicines.
Insofar as Zimbabwe has been hailed for its intensive HPV vaccination exercise where since 2018 a total of 2 175 977 first and second doses have been administered, much needs to be done regarding the early diagnosis of cervical cancer as specialists bemoan how women are presenting late for treatment.
“No, it’s bad. We have to be honest about that. It’s the fourth most badly impacted in the world and in the African region. So I’m very, very happy that the Honourable Minister and the government is so strong and really want to do something for the women.
“And the country is doing the right thing, both having very aggressive politics in vaccination. So of course that is the solution for the long run. But also at the same time we need to see screening happening so we can stop the very, you know, severe cancers coming up. Because if we screen we can treat before it develops to a heavy cancers,” said WHO Director for Non-communicable Diseases Dr Bente Mikkelsen.
She added, “And if I could add one more thing, if you could, you know, come into a situation where you can screen and treat for the early cancers, which is not really cancers, but the early development in the decentralized facilities, that would be the way to go.
“And to achieve that, we need to integrate, you know, in the HIV services, but not only that. As you do here with the schools, for advocacy and awareness, but also into other non-communicable disease programs.
“So the integration to be able to offer this at the lowest level of the healthcare system in the facility is very, very important and it’s the way to go.”
The Minister of Health and Child Care Dr Douglas Mombeshora noted that the availability of HPV DNA testing is dependent on financing to be rolled out nationwide.
“We listed only two centers which can do DNA testing that is Parirenyatwa and Chinhoyi. We are rolling out we would like to roll out a comprehensive program for elimination of of cervical cancer. And part and part of the program would involve the testing. DNA testing is a better method, but we are using other methods. So currently, for us to be able to do the most effective testing, which is the DNA, we need to invest more money in that.
“But that will come with time because at the moment the resources that we have, we cannot have the DNA testing throughout the whole country. The other issue that will affect us also is availability of personnel, trained personnel to be able to interpret those results.
“So I cannot say we are rolling out that particular type of test, which is the DNA testing, as a test on its own. No. We are continuing with the processes that we are doing at the moment, but as we get more resources, we will then want to shift to the DNA testing.
“We are looking at using other equipment that have been used for DNA testing in HIV so that we integrate those tests together with HPV DNA testing. But still, as you know, we have not covered the whole country with the equipment that can do DNA testing for HIV. Therefore we are still a bit behind,” he said.
According to the Global Cancer Observatory’s 2022 report, Zimbabwe’s cervical cancer incidence stands at 68.2 per 100,000 women, with a mortality rate of 47.9.
