Mapping Evidence on Management of Cervical Cancer in Sub-Saharan Africa: Scoping Review

Abstract

Cervical cancer (CC) is the most common viral infection of the reproductive tract and in Sub-Saharan Africa (SSA), its morbidity and mortality rates are high. The aim of this review was to map evidence on CC management in SSA. The scoping review was conducted in accordance with Arksey and O'Malley's scoping review framework. The review included studies on different aspects of CC management. The review was also done following the steps and guidelines outlined in the PRISMA-Extension for Scoping Reviews (PRISMA-ScR) checklist. The following databases were searched: PubMed, EBSCOhost, Scopus and Cochrane Database of Systematic Review. A total of 1121 studies were retrieved and 49 which were eligible for data extraction were included in the review. The studies were classifiable in 5 groups: 14 (28.57%) were on barriers to CC screening, 10 (20.41%) on factors associated with late-stage presentation at diagnosis, 11 (22.45%) on status of radiotherapy, 4 (8.20%) on status of chemotherapy and 10 (20.41%) on factors associated with high HPV coverage. High HPV vaccine coverage can be achieved using the class school-based strategy with opt-out consent form process. Barriers to CC screening uptake included lack of knowledge and awareness and unavailability of screening services. The reasons for late-stage presentation at diagnosis were unavailability of screening services, delaying whilst using complementary and alternative medicines and poor referral systems. The challenges in chemotherapy included unavailability and affordability, low survival rates, treatment interruption due to stock-outs as well as late presentation. Major challenges on radiotherapy were unavailability of radiotherapy, treatment interruption due to financial constraints, and machine breakdown and low quality of life. A gap in understanding the status of CC management in SSA has been revealed by the study implying that, without full knowledge of the extent of CC management, the challenges and opportunities, it will be difficult to reduce infection, improve treatment and palliative care. Research projects assessing knowledge, attitude and practice of those in immediate care of girls at vaccination age, situational analysis with health professionals and views of patients themselves is important to guide CC management practice.

Keywords: cervical cancer management; chemotherapy; diagnosis; human papillomavirus vaccine; radiotherapy; screening.

Figure 1

PRISMA flow diagram of the study selection process.

Figure 2

Cervical cancer incidence. Sources: [8,11,38,39,40,41,42].

Figure 3

Cervical cancer mortality rate. Sources: [8,11,40,42,43,44,45].

Figure 4

Cervical cancer survival rate. Source: [13,25,40,46].

Figure 5

HPV vaccine Coverage: Pilot studies. Source: [7,8,9,10,37,47,48].

Figure 6

Prevalence of late-stage cancer presentation at diagnosis. Source: [12,40,41,44,50,54].

Figure 7

CC screening uptake Rates. Source: [1,17,38,45,57,58].