Recommendations for Cervical Cancer Prevention and Control in Ghana: Public Education and Human Papillomavirus Vaccination

In Ghana, the integration of public education on cervical cancer prevention, human papillomavirus (HPV) vaccination and screening programmes into both medical and public health services is critical, according to this paper. Considering that cervical cancer is the most common cancer among women in Ghana, the paper makes the case for a collaborative approach involving both private and government organisations, health professionals, and the general public.

Evidence from studies conducted in Ghana indicates that knowledge of HPV and other risk factors associated with the development of cervical cancer is limited. A cervical cancer educational programme could be implemented as part of a national cervical cancer control programme. According to the paper, for this to be achieved, the Ministry of Education and Health and the Ghana Health and Education Services will need to work together to develop a specific, structured, targeted, age-related, evidence-based, and culturally appropriate curriculum for adolescent sexual and reproductive health, including cervical cancer education. Teachers, health professionals, social workers, and community members may require further training to deliver sexual and reproductive education. The development of the curriculum should ideally involve individuals with various backgrounds in research on cervical cancer and sexual health. The content of the curriculum needs to include all aspects of sexual and reproductive health, including the causes of cervical cancer, risk factors, signs and symptoms, prevention, HPV vaccination, screening, and available health services. Misconceptions and beliefs about cervical cancer such as a perceived lack of available treatment for the disease should be addressed, as well. A pilot study can be conducted to test the curriculum and make changes when necessary.

As noted here, partnerships with young people are critical in designing and implementing cervical cancer prevention education programmes. The involvement of young people at the onset of a sexual and reproductive education programme can develop trust and help identify some of the challenges (such as lack of youth-friendly services) that need to be improved for adolescent health programmes to be effective. This can build the capacity of young people in the area of advocacy and peer education. Youth networks in Ghana such as The Global Youth Action Network and the Ghana Youth Development Network may be able to train volunteer peer educators to provide education to adolescents and women in the community using various media such as home visits, radio, television programmes, and theatre. The establishment of clubs at schools to discuss adolescent health issues such as HPV infection and the prevention of cervical cancer will also play a role in educating students about the disease.

For individuals out of school, public cervical cancer education can take place at schools, workplaces, churches, mosques, marketplaces, and durbars. Education programmes to reach women in semi-urban and remote areas and those at increased risk of cervical cancer are also needed. Educational information could be disseminated using a variety of media, including: seminars; media channels such as television, radio, newspapers, posters, role-playing and drama; and interpersonal contact with healthcare professionals. The latter personnel could be upskilled to provide education on cervical cancer when they come into contact with women during consultation, family planning, and antenatal and postnatal services. Community health nurses could be trained to provide organised cervical cancer education programmes in the community, to conduct home visits, and to give talks at community festivals.

Also recommended is increased involvement of the media and women who are living with or who have survived the diseases. In addition, the involvement of people with disability and head porter (kayayee) will potentially result in increased coverage among at-risk groups.

Next, the paper outlines a vision for implementation of a national HPV vaccination programme. Because HPV vaccines are effective when given before sexual debut, the age group the paper has in mind for a national cervical cancer policy is young adolescents aged 10-14 years. There are sociocultural issues that need to be considered; because HPV vaccines are associated with sexually transmitted infections (STIs), their acceptance and marketing may be problematic (even though studies have reported no statistically significant increase in sexual behaviour and STIs in adolescents after HPV vaccination). In addition, the stigmatisation of young women with respect to a women-only vaccination programme needs to be avoided.

The paper stresses that education of adolescents and parents is critical in reducing misconceptions about HPV vaccination. Studies are needed to assess the acceptability of the vaccine and any misconceptions among the Ghanaian population. Multiple stakeholders need to be involved at the appropriate stages of advocacy and social communication. Any attempt to implement a national HPV vaccination programme should involve clinicians, parents, teachers, and other relevant stakeholders to obtain widespread support.

According to the paper, a school-based vaccination programme is likely to be the most effective strategy. However, due to low school attendance during later adolescence, particularly for girls, a mixture of services might be employed in Ghana involving HPV vaccine delivery at health facilities and outreach programmes. Both private for profit and not-for-profit health providers need to get involved in cervical cancer education and HPV vaccination programmes. Most sexual and reproductive health services are involved in providing family planning and cervical screening services to women, so it will be important for HPV vaccination programmes to be integrated into these services. HPV vaccination might also be integrated into the Expanded Program on Immunization (EPI), which could involve educating mothers of infants about other vaccines that can be given at various stages of their children's lives.

The Department of Disease Control and Prevention, Ghana Health Service, could be a base for a cervical cancer prevention and control programme in Ghana. Collaboration with the Family Health division is one way proposed here for ensuring high impact and efficiency. Continued evaluation of cervical cancer education and the HPV vaccination programme is likely to be necessary to enhance its effectiveness and ensure that the programme achieves its objectives and reaches the intended population.

In conclusion, addressing high rates of cervical cancer in Ghana requires a coordinated, systematic approach from the government, private agencies, health professionals, and the general population, including young people themselves. The paper recommends a whole-of-government approach involving all the relevant governmental agencies and other key stakeholders to develop an integrated approach for cervical cancer control and prevention in Ghana.