Cervical cancer prevention and treatment research in Africa: a systematic review from a public health perspective

Abstract

Background: Women living in Africa experience the highest burden of cervical cancer. Research and investment to improve vaccination, screening, and treatment efforts are critically needed. We systematically reviewed and characterized recent research within a broader public health framework to organize and assess the range of cervical cancer research in Africa.

Methods: We searched online databases and the Internet for published articles and cervical cancer reports in African countries. Inclusion criteria included publication between 2004 and 2014, cervical cancer-related content pertinent to one of the four public health categories (primary, secondary, tertiary prevention or quality of life), and conducted in or specifically relevant to countries or regions within the African continent. The study design, geographic region/country, focus of research, and key findings were documented for each eligible article and summarized to illustrate the weight and research coverage in each area. Publications with more than one focus (e.g. secondary and tertiary prevention) were categorized by the primary emphasis of the paper. Research specific to HIV-infected women or focused on feasibility issues was delineated within each of the four public health categories.

Results: A total of 380 research articles/reports were included. The majority (54.6 %) of cervical cancer research in Africa focused on secondary prevention (i.e., screening). The number of publication focusing on primary prevention (23.4 %), particularly HPV vaccination, increased significantly in the past decade. Research regarding the treatment of precancerous lesions and invasive cervical cancer is emerging (17.6 %), but infrastructure and feasibility challenges in many countries have impeded efforts to provide and evaluate treatment. Studies assessing aspects of quality of life among women living with cervical cancer are severely limited (4.1 %). Across all categories, 11.3 % of publications focused on cervical cancer among HIV-infected women, while 17.1 % focused on aspects of feasibility for cervical cancer control efforts.

Conclusions: Cervical cancer research in African countries has increased steadily over the past decade, but more is needed. Tertiary prevention (i.e. treatment of disease with effective medicine) and quality of life of cervical cancer survivors are two severely under-researched areas. Similarly, there are several countries in Africa with little to no research ever conducted on cervical cancer.

Keywords: Africa; Cervical cancer; Feasibility challenges; Prevention; Quality of life; Systematic review; Treatment.

Fig. 1

PRISMA flow diagram of the number of searches yielded, excluded, and reviewed

Fig. 2

Geographic Distribution of Cervical Cancer Research within Africa. Figure 2 is a map of Africa illustrating the geographic distribution of cervical cancer research. The map represents individual countries only and does not clearly illustrate some of the smaller African countries. Fifty articles reporting on a geographic region were excluded (Excluded articles reported on the following geographic regions: Middle East/North Africa (2); 3 GAVI-eligible countries (3); Global (6); LMIC countries/developing countries (14); Africa/Sub-Saharan Africa (25). Image modified from: Tourbillon (Own work) [Public domain], via Wikimedia Commons, available at https://commons.wikimedia.org/wiki/File:Colored_map_of_Africa.png#