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



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.



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.



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.
Department of Family Medicine, University of Kansas Medical Center, Kansas City, USA. Skessler2@kumc.edu.
Sarah
S
Finocchario-Kessler
Department of Family Medicine, University of Kansas Medical Center, Kansas City, USA.
Catherine
C
Wexler
Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu, Kenya.
May
M
Maloba
Department of Family Medicine, University of Kansas Medical Center, Kansas City, USA.
Natabhona
N
Mabachi
Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, USA.
Florence
F
Ndikum-Moffor
Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu, Kenya.|Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.|Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya.
Elizabeth
E
Bukusi
D000328:Adult; D000349:Africa; D005260:Female; D006801:Humans; D032541:Mass Vaccination / Q000592:standards; D027383:Papillomaviridae / Q000472:pathogenicity; D053918:Papillomavirus Vaccines / Q000494:pharmacology / Q000627:therapeutic use; D011315:Preventive Medicine / Q000379:methods / Q000592:standards*; D011634:Public Health / Q000379:methods*; D011788:Quality of Life / Q000523:psychology; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control* / Q000628:therapy*
D053918:Papillomavirus Vaccines
Africa; Cervical cancer; Feasibility challenges; Prevention; Quality of life; Systematic review; Treatment