In Nigeria where cervical cancer is said to be one of the major killers of women

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In Nigeria where cervical cancer is said to be one of the major killers of women, many cases of deaths are said to go on unreported because the country lacks a cancer registry. However, the case of Lara Sonoiki, the CEO of Dress Sense, a popular fashion outlet on Allen Avenue in Lagos is one of the few reported cases. It would be recalled that Sonoiki recently celebrated her 40th birthday when she lost the battle to the terminal illness.
Another Nigerian woman who was said to have lost her life to the scourge was Prof. Dora Akunyili, the former DG NAFDAC and  former Minister for Information. Though her husband would later come out to deny the claim of her dying of cervical cancer, saying she died of a rare type of cancer.
The import of her story goes to discredit the age long belief that cervical cancer is a disease for white women since many celebrities in Europe and America have been known to die from the disease. Nigeria reportedly has the 10th highest number of deaths from cervical cancer globally.
In January 2014, the Society for Family Health (SFH), reported that cervical cancer killed about 9,659 women in the country. Mr. Bright Ekweremadu, Managing Director was quoted in a report which said most women get Human Papilloma Virus (HPV), infection at least once in 50 years. He said it is only a few of them that develop cervical cancer. According to him, next to breast cancer, cervical cancer, which claims the life of about 9,659 women annually, is the second most frequent cancer among women in Nigeria.
Another thing which makes the situation more pathetic is that the country has been rated the first nation in Africa and the fifth in the world with the highest cervical cancer deaths. This is according to a new report released in May last year by the Cervical Cancer Free Coalition, titled “Crisis Card.” The report stated that cervical cancer has reached a crisis level in Nigeria with 9,659 women dying of the disease every year.
Although a deadly disease, cervical cancer is  99 per cent preventable with a vaccine and also 97 per cent treatable when detected early through screening. This is why developed countries seem to have an upper hand in controlling it because women have access to vaccine and they get information about regular screening.
Another worrying dimension in the upsurge of the death of cervical cancer is the fact that young women between ages 20-30 are also coming down with the disease. This has led to many stakeholders advocating for a government to subsidize vaccine for women and also put in place a firm national policy on cancer.
Reacting to the question whether it is not an exaggeration that one woman dies in an hour of cervical cancer in Nigeria, Dr. Femi Olaleye, the founder of Optimal Cancer care foundation said it is not.
“It is not. That is over 20 women in a day. That is about 8-10 thousand in a year. Most people think cervical cancer is a rare disease but it is not. It is common. In the bible, the woman with issue of blood that Jesus Christ healed, that was cervical cancer (laughs). You know we doctors diagnose based on symptoms so it is not an assumption. It is just that people cover it up.”
Dr Olaleyemi also asserted that the prevalence of cervical cancer is not taken seriously because of the lack of a cancer registry in the country.
“The question to ask is where is the cancer registry in Nigeria? We need a national cancer registry so that all cases of cancer can be reported. That way you will know that it is not a rare disease. We don’t report our cancer cases. Some of them don’t even come to the hospitals-they blame their neigbours and families in the village out of ignorance. Women are dying from cervical cancer quietly. It is the number one killer of Nigerian women. The good news is that it is a disease that can be prevented when detected early which means that all that are at risk, that is, women that have had sex must go for screening.”
Prevention
Cervical cancer can be prevented through a primary prevention which is vaccination for those who have not had sex and a secondary prevention of screening for those who are sexually active. For women who are already sexually active, once they take the vaccine, they are protected for a subsequent number of years.
To prevent cervical cancer from killing more women in Nigeria, Dr Olaleye advocates that pre-sexually active teenagers should be provided with free vaccines.
“Government should make vaccination free for young girls so that we can give it to them from schools. But because government is not responsible for the diagnosis and care of patients who have cervical cancer, there is no pressure on them to prevent it. If there was a burden on the national government to treat women with cervical cancer, they would want to prevent it. This is why they make screening and vaccination free for young girls in other countries but our women don’t have such privileges, ” the gynaecologist opined.
At a Global Cervical Cancer Prevention forum held in Malaysia in 2013, stakeholders who spoke at the conference identified cost of the HPV vaccine and poor commitment from governments where this disease is rampant as reasons why more women are dying from cervical cancer.
Although the cost of the HPV vaccine given to girls and women to prevent the cancer which was formerly pegged at about N20, 800 has been reduced to about N15, 000, many Nigerian women still cannot afford to pay to get vaccinated.
A donor agency known as GAVI Alliance, which receives funding support from Bill and Melinda Gate foundation is already providing subsidy for the vaccine in some selected African countries.
The fact that Nigeria is one of the countries with the highest number of prevalence notwithstanding, the CEO of Gavi Alliance, Dr. Seth Berkley said at the conference that Nigeria would be excluded from benefiting from the globally subsided vaccines due to poor vaccination system and poor coverage.
“The immunisation coverage in Nigeria is just above 40 per cent. For this programme to be effective, we are only giving it to countries that have demonstrated that they have the capacity, infrastructure and human resources to get the HPV vaccines administered effectively.
“We are not giving it to countries where we can see that their cold chain storage system is not effective and vaccines cannot be stored appropriately or where vaccines would not get to the end users because they do not have the human resources or facilities. Nigeria has not met these criteria,” Berkley was quoted to have said in a media report.
Although denied of the privilege, this is not to say that Nigeria as a country cannot make provision for subsidized vaccines for its women without support from international organisation.
“Government is not taking vaccination for cervical cancer serous because they are thinking of how much money it will cost them. The reason why they think it is a lot of money is because nobody is counting the cost of the women that are dying. If the cost of women that are dying daily in this country is counted and government can see it as a loss, then they can now see the need to pay attention to prevention.
“The vaccine is about N4-5, 000 per dose which is about N15, 000 per person. But the cost of a woman’s death from cervical cancer is probably more than 15, 000 naira to the society and the whole country. The vaccination can be spread over a 10 year period; it is not something you do at once. You can vaccinate only 16 years old in a particular year, and take another age group in another year. The fund remains the same and everybody will be covered,” Dr Olaleye stated.
He further advised that government can carry out free vaccination in partnership with faith based organisations and corporate organisations who can donate a certain percentage of the profits to vaccinate young girls as a form of CSR.
Disagreeing with international agencies who refused to fund vaccine subsidy for Nigeria  on excuse of  cold chain storage facility, he stated:
“Some international organisations are deferring from giving vaccine subsidy to Nigerians based on the claim that we don’t have the cold chain, which is false.
“It depends on the infrastructure you set up and I give almost about 300 vaccines a month here so I get a lot of people relaying on making sure I keep my cold chain continuous. Question is can you be sure of the person who is wholesaling, of course the person who is retailing the vaccine has a huge  cold room and that is where they store their vaccines. GSK who imports from their French/Belgium European counterparts also ensure that when the vaccines arrive the Murtala Muhammed airport, it’s easily transferred to a cold room. And then when I’m taking it to a remote area, I put them in freezer bags with the same thing to ensure it is cold.  It is a challenge but we can surmount it, he affirmed.”
In trying to control the spread of cancer, stakeholders in the health centre have made case for a government policy in cancer management. Citing the case of the seriousness with which the Ebola case was treated, Dr. Olaleye said that with a policy from government that is backed up with a budget, then government can be taken more seriously on the fight against cancer.

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