Page 0129

implemented. The Framework Convention on Tobacco

Control10 needs ratification. HIV infection control efforts

have led to a reduction in incidence of some HIV-associated

tumours such as Kaposi sarcoma.11 However, there is a need

for more awareness about prevention of Hepatitis B.

Vaccination against the liver cancer-causing virus is included

in the pentavalent vaccine for children and coverage was

more than 80% in 2010. As for prevention of cervical cancer,

Zimbabwe now has funding from the Global Alliance for

Vaccines and Immunisation (GAVI) to carry out HPV vaccine

pilot projects on young girls in two selected, high

immunization coverage districts, commencing in 2014. These

demonstration projects will guide the national

implementation of HPV vaccination. On-going bilharzia

control to prevent bladder cancer, focusing on school

children in endemic areas commenced in 2013. It is also

critical that any anti-cancer programmes and interventions

integrate control of chronic infections and noncommunicable diseases within primary care. This would

optimize cost-effective usage of the available limited

resources.

Early detection

Early detection comprises both screening in asymptomatic

but at-risk populations and early diagnosis in symptomatic

populations. The problem is that in Zimbabwe the majority of

patients, even with potentially curable cancers, present at an

advanced stage.9 Early clinical diagnosis can only be

implemented through increased public and health workers'

awareness of cancer symptoms and signs and of available

cancer programmes. The work force needs to be adequate,

empowered, well trained in primary care and able to

promptly recognize and refer people with suspected signs

and symptoms for early diagnosis and treatment. Equally,

health services need to be equipped with the necessary

infrastructure to support diagnosis and treatment. Lack of

access to early detection services and general lack of

awareness currently leads to late presentation which is costly

to manage and leads to poorer outcomes.

Priorities to improve early detection of cancers in

Zimbabwe include formal assessment of the reasons for

delays in early detection, scaling up of provision of early

detection services at all levels accompanied by a sound

referral system, i.e. referral centres need to have the capacity

to take up the referred cases. Additionally, access to cancer

screening services should be improved through increased

availability of cost-effective screening services. Screening by

Visual Inspection with Acetic Acid and Cervicography (VIAC)

has been introduced at tertiary and some secondary centres.

This has been selected as the screening method for

Zimbabwe because it places less demand on the limited

numbers of available pathologists, provides immediate

results, the simplicity of the procedure and the potential for

immediate treatment of lesions and its cost-effectiveness for

both the woman and the health system. Plans are on-going to

make VIAC available for primary care and all other levels.

Diagnosis and treatment

Diagnosis is the first step in cancer management. Once the

diagnosis is confirmed, staging to evaluate the extent of

disease is essential. Treatment will obviously depend on the

type of cancer, the tissue of origin and stage of the disease.

The aims of treatment will also vary according to the

circumstances, from cure, to prolonging useful life and

improving the quality of life.2

The diagnostic infrastructure in Zimbabwe is limited. Early

diagnostic facilities are available mainly in the two largest

cities: Harare and Bulawayo. However, a critical shortage of

diagnostic facilities in public institutions leads to diagnostic

delays of up to three or more weeks.

The three major modalities of cancer treatment namely

surgery, radiotherapy and chemotherapy are both costly and

inadequate in the country, in terms of personnel, medicines

and equipment. Tumours which are detected early can be

managed surgically but shortage of oncology-trained

surgeons compromises care. Multidisciplinary teams are

essential but currently a lack of trained specialists such as

paediatric oncologists, haematologists and oncology nurses

compromises this. Priority should be given to coordinate the

fragmentary existing paediatric surgical and oncology

services to improve care given to children with cancer.

Facilities at the existing radiotherapy centres have recently

been upgraded but are still inadequate for the population.

Affordable and accessible chemotherapy and palliative care

medicines should be available in public institutions.

REGIONAL INITIATIVES

128 CANCER CONTROL 2014

Early detection comprises both

screening in asymptomatic but at-risk

populations and early diagnosis in

symptomatic populations

Index

  1. Page 0001
  2. Page 0002
  3. Page 0003
  4. Page 0004
  5. Page 0005
  6. Page 0006
  7. Page 0007
  8. Page 0008
  9. Page 0009
  10. Page 0010
  11. Page 0011
  12. Page 0012
  13. Page 0013
  14. Page 0014
  15. Page 0015
  16. Page 0016
  17. Page 0017
  18. Page 0018
  19. Page 0019
  20. Page 0020
  21. Page 0021
  22. Page 0022
  23. Page 0023
  24. Page 0024
  25. Page 0025
  26. Page 0026
  27. Page 0027
  28. Page 0028
  29. Page 0029
  30. Page 0030
  31. Page 0031
  32. Page 0032
  33. Page 0033
  34. Page 0034
  35. Page 0035
  36. Page 0036
  37. Page 0037
  38. Page 0038
  39. Page 0039
  40. Page 0040
  41. Page 0041
  42. Page 0042
  43. Page 0043
  44. Page 0044
  45. Page 0045
  46. Page 0046
  47. Page 0047
  48. Page 0048
  49. Page 0049
  50. Page 0050
  51. Page 0051
  52. Page 0052
  53. Page 0053
  54. Page 0054
  55. Page 0055
  56. Page 0056
  57. Page 0057
  58. Page 0058
  59. Page 0059
  60. Page 0060
  61. Page 0061
  62. Page 0062
  63. Page 0063
  64. Page 0064
  65. Page 0065
  66. Page 0066
  67. Page 0067
  68. Page 0068
  69. Page 0069
  70. Page 0070
  71. Page 0071
  72. Page 0072
  73. Page 0073
  74. Page 0074
  75. Page 0075
  76. Page 0076
  77. Page 0077
  78. Page 0078
  79. Page 0079
  80. Page 0080
  81. Page 0081
  82. Page 0082
  83. Page 0083
  84. Page 0084
  85. Page 0085
  86. Page 0086
  87. Page 0087
  88. Page 0088
  89. Page 0089
  90. Page 0090
  91. Page 0091
  92. Page 0092
  93. Page 0093
  94. Page 0094
  95. Page 0095
  96. Page 0096
  97. Page 0097
  98. Page 0098
  99. Page 0099
  100. Page 0100
  101. Page 0101
  102. Page 0102
  103. Page 0103
  104. Page 0104
  105. Page 0105
  106. Page 0106
  107. Page 0107
  108. Page 0108
  109. Page 0109
  110. Page 0110
  111. Page 0111
  112. Page 0112
  113. Page 0113
  114. Page 0114
  115. Page 0115
  116. Page 0116
  117. Page 0117
  118. Page 0118
  119. Page 0119
  120. Page 0120
  121. Page 0121
  122. Page 0122
  123. Page 0123
  124. Page 0124
  125. Page 0125
  126. Page 0126
  127. Page 0127
  128. Page 0128
  129. Page 0129
  130. Page 0130
  131. Page 0131
  132. Page 0132
  133. Page 0133
  134. Page 0134
  135. Page 0135
  136. Page 0136
  137. Page 0137
  138. Page 0138
  139. Page 0139
  140. Page 0140
  141. Page 0141
  142. Page 0142
  143. Page 0143
  144. Page 0144
  145. Page 0145
  146. Page 0146
  147. Page 0147
  148. Page 0148
  149. Page 0149
  150. Page 0150
  151. Page 0151
  152. Page 0152
  153. Page 0153
  154. Page 0154
  155. Page 0155
  156. Page 0156

powered by PageTiger