Cervical cancer in Tanzania: A systematic review of current challenges in six domains

Abstract

Cervical cancer is the most common cancer in Tanzania. After excluding human immunodeficiency virus, lower respiratory infections, malaria, diarrheal diseases, and tuberculosis, cervical cancer kills more women than any other form of illness in the country. Unfortunately, Tanzania has a low doctor-to-patient ratio (1:50,000) and nearly 7000 women die each year from this disease. The clinical problem is further magnified by the country's lack of resources and prevailing poverty, sporadic cervical cancer screening, prevalence of high-risk oncogenic human papillomavirus subtypes, and relatively high rates of human immunodeficiency virus co-infection. In recent years, addressing the cervical cancer problem has become a priority for the Tanzanian government. In this systematic review of 39 peer-reviewed publications that appeared in the PubMed/MEDLINE (NCBI) database from 2013 to 2018, we synthesize the growing body of literature to capture current trends in Tanzania's evolving cervical cancer landscape. Six domains were identified, including risk factors, primary prevention, barriers to screening, treatment, healthcare worker education, and sustainability. In addition to traditional risk factors associated with sexual behavior, acetowhite changes observed during visual inspection of the cervix with acetic acid, lower education, rural setting, and HIV positivity also have a noteworthy clinical impact.

Burden of cervical lesion in Ethiopia: Systematic review and meta-analysis

“…This finding is higher than from a study done in Tanzania (systematic review) in which the overall prevalence of cervical lesion was 9.2% (68) and Zaria state Nigeria in which the overall prevalence of cervical lesion was 4.8 (69). Another study done in Kwara State, Nigeria (urban community) showed that 5% of study participants had cervical lesion (70).…”

Cervical cancer in low and middle‑income countries (Review)

“…Similarly to other low-income, developing countries, the rates of HPV infection are high in Tanzania; this has led to the Tanzanian Ministry of Health to initiate a school-based HPV vaccination program (44). Other factors that contribute to the high incidence of cervical cancer in Tanzania include; resource allocation (in term of distribution of trained personnel, funds and equipment in urban and rural areas nationwide), lack of resources to fulfil the needs of the entire population, sociocultural influence and a lack of political will (where leaders do not prioritise healthcare programmes and choose to divert funds and resources from screening and treatment programmes) (45). Sociocultural factors such as folklore and myths around cervical cancer screening influence the willingness of people to undergo screening (41).…”

“The best thing is that you are doing it for yourself” – perspectives on acceptability and feasibility of HPV self-sampling among cervical cancer screening clients in Tanzania: a qualitative pilot study

“…The major burden of disease is partly due to poor coverage (4-6%) of cervical screening programs [6,7] and those women who do attend screening often come when symptoms are present and the disease has progressed to advanced stages [8]. A recent systematic review of cervical cancer in Tanzania found that this is due to a number of factors including fear, stigma, unawareness of screening options as well as costs related to screening [9,10]. Therefore, innovative ways of how to improve cervical cancer screening attendance is needed.…”