THERE IS NEED TO PREVENT YOUNG GIRLS IN KWALE FROM THE HUMAN PAPILLOMA VIRUS TRANSMISSION

photo by Caroline

BY

 Caroline Katana

Human papilloma virus ( HPV  ) is the leading cause of ano-genital cancers globally with cervical cancer as the top cause of cancer –related deaths in women .

Over 90 percent of these deaths occur in low income and middle  countries  where cancer control  strategies remain inadequate .

HPV  vaccination provides protection against HPV types 16 and 18 which are responsible  for approximately  70 percent of  cervical cancer cases .

The optimal  age of vaccination  is in the early  adolescent period ,before sexual debut with possible HPV infection .

Studies  have shown  that children  residing  in low and middle settlements are at risk of early initiation of sexual activity .

Adolescent vaccination programs  would provide  an avenue to link  other health promotion  strategies targeting this age group that has hitherto been left out of many health interventions  in 2019 .

Kenya introduced HPV vaccine to be given  to 10  year old girls ,intake  has been  sub –optimal with only  33 percent  of targeted population  receiving  the first  dose in 2020  and 16 percent  returning for the  2nd dose .

While disruption of immunization programs  by the COVID -19 pandemic contributed to the low coverage ,other factors  such as low demand fuelled by misinformation  have also  played a role .

HPV  vaccines have been shown to be effective in preventing  HPV infection  when administered in young boys and girls  before their  sexual debut .

In countries with high vaccine coverage like Australia which reported  a HPV vaccine coverage of 80 percent in females and 76 percent in males in 2019 ,a significant decline in vaccine  type –HPV infection and high grade precancerous  cervical lesions has been reported  with a  substantial impact on cervical cancer incidence expected in the coming years .

Adolescent  vaccination  is one of the strategies toward implementing  the life course immunization  approach set out in the immunization agenda 2030 .

This approach expands  the coverage  of routine immunization  to other age groups outside  infancy and also seeks to improve coverage in under-served population under the mantra  reaching everyone ,everywhere .

Since 2020 , 30 percent of girls of 10 years  in Kwale county   received HPV 1 vaccine , while 26 percent completed  the two  doses  PHV 1 and 2 vaccine  that are administered at an interval of six months .

During an exclusive interview in Kwale health headquarters ,Kwale county Immunization Coordinator Mgallah Samson said the ongoing  PHV  vaccine exercise  is implemented  using  stakeholders approach  between  facility ,community and schools  so as to reach many girls   .

“ We are  working closely with different partners ,community influencers ,county and national government to sensitize  community  and teachers  to understand the importance of the PHV vaccine to their children ,we believe  teachers are  good mobilizers of parents  once they get the clear concept of the vaccine  they can translate the message well to the young girls and parents ,”Said Mr Samson . 

Study has shown that average age  sexual debut is 10 years ,saying there is need  for the  the two PHV  vaccine doses  to be ministered   before  they  are exposed to sex ,Said the coordinator .

“In Kwale the sexual debut is 9 years so there is need to prevent young girls from the  Human Papilloma  virus  that is carried by men whom then  transmit the virus to women during sexual intercourse ,so before young girls are exposed to sex ,it’s good take PHV vaccine for their safety ,” Added  mr Samson .

Mr. Samson said  Kwale county health department  is adapting the national  government  health  system of paradigm shift   to prevent  virus  transmissions  .

“ We are now moving from curing to prevention ,this is a  game changer for cancer ,we want to have firm health structures  and vibrant community health promoters at the grassroots levels linked to a community unit that is attached to a facility and every  CHP  to attend at least ten households per month, this means will mean  good health  system at the community levels ,and this will give us room  to sensitize , detect  and cure early stage of cancer , “ Said the Coordinator .

The health officer said they are focusing on Primary Care Network system in  all  health facilities in Kwale county for easy access of health services  to the community  .

“ We are decentralizing  special health services at the grass root level whereby patients with special health problem will no longer  travel long distances looking for health services at the referral hospitals , instead our health experts will attend  patients  at the health facilities at the grass root level ,”Said the officer .

Mr. Samson  confirmed  health department  to have initiated sexual education programs in schools to counter  sexual intercourse among teenage girls  and avoid contaminating  Human Papilloma Virus .

“ Lack of sexual education is the cause of many teenage girls engaging in sex without protection  ,outdated traditions and cultures of not discussing  matters sex with children are also to be blamed for the current predicament ,” Said Mr .Samson 

Schools are considered better for vaccination programs targeting school –age children and adolescents ,there is increased  acceptability among parents  and caregivers as teachers are seen as trusted custodians of children and schools as safe havens for the welfare of children .

Teachers knowledge and attitude  about vaccination therefore plays a majo

r role in ensuring success of school based vaccination programs ,  whereby  over  three  hundred  girls  of 9 to 14 years  in Kwale primary school received HPV vaccine  ,confirmed  teacher  Phyllis Koki .

“ At first it was not easy  there was a lot of resistance from parents  ,there was a lot of fear that the HPV vaccine is meant for family planning  hence exposing young girls to early  sex  but after sensitizing them on the importance of the HPV vaccine atleast 90 percent  gave concept for their girls to be vaccinated and  the progress is good  ,” confirmed  the teacher  .

The teacher called upon the national government through the ministry of health to ensure constant distribution of the HPV vaccine so as to reach as many young girls as possible by 2030 .

Angelina Peter  is  among the young  girls  in Kwale whom  received two doses of HPV vaccine applauding  the effort of the national government for the golden opportunity to link young adolescents into promotive and preventive health services .

“ I want to applaud the ministry of health for this initiative,  I don’t take it for granted ,it means a lot for our future lives , I have witnessed cancer patients  in my village  worried because  cancer treatment is very expensive ,they wish they would get the PHV vaccine earlier to  save their lives and money  ,” Said ms peter .

Ms Peter  confirmed to be inspired by her parents to take the HPV vaccine   is now challenging  her peers  to end  outdated cultures and traditions of not taking the HPV vaccine terming it  to be harmful to their health  .

“HPV vaccine has no side effects in our bodies ,it is safe for us ,the vaccine is not for family planning  but to prevent us from human papilloma virus that cause cervical cancer ,” Said Ms Peter .

She urged the ministry of health to ensure there is no shortage of HPV vaccine so as to ensure the targeted group benefit by 2030 .

Her sentiments were echoed by  her peer Mejumaa Ramadhan whom completed her two HPV vaccine doses after getting advices from teachers and nurses ,called upon her peers who took single dose to ensure they go for the second dose  .

Behavior change 

Promoting behavior change as a lone strategy  for preventing sexually  transmitted infections has been shown to be ineffective in reducing  transmission and would hence not be effective for prevention of HPV infection as well .

Behavior change must be linked to other prevention  strategies  such as condom use ,vaccination and screening .

HPV vaccines are licensed for use in both boys and girls between 9 and 26 years of age ,with the optimal age of administration being 9- 14 yeas of age ,this is considered to be the most appropriate age for vaccination as most of the children  have not had any sexual encounters by then and therefore unlikely to have acquired HPV infection .

The Centre  for Behavior Change and Communication CBCC in collaboration with UNICEF  has been actively engaging various communities through multiple community radio stations to promote  the acceptance of routine child vaccinations .

The Ministry of Health’s National Vaccine and Immunization program has identified  several key vaccines ,including BCG for Tuberclusis ,OPV and IPV for Poliomyelitis ,Rotavirus for rotavirus and Diarrhea ,DPT for diphtheria ,whooping cough and tetanus as well as measles ,rubellaand HPV for cervical cancer among others .

This extensive campaign has specifically targeted  caregivers and teenagers in 31 counties such as Mombasa ,Lamu ,Taita Taveta ,Meru ,Tharaka Nithi , Embu ,Kitui ,Machakos ,Makueni ,Nyandarua  ,Nyeri among others 

Challenges surrounding HPV vaccine in Kwale county 

Kwale county is not exceptional of  misinformation  about HPV vaccine , so  parents did not allow their 10 year old girls to administer  the vaccine ,among their claims  were doubts about safety and efficacy ,some parents believed that allowing their young girls to take HPV vaccine was giving them free reign to engage in pre-marital sex since the vaccine is meant for family planning .

The top 5 cancer cases  in Kwale county 

Since June  2022  to  June 2023  ,Prostrate cancer  is leading with   19.7 percent  ,followed by  Cervical cancer 14.1 percent ,Breast cancer 9.9 percent ,OEsophageal  and Lymphomas  cancer 7 percent .

Kwale county  health executive  Francis Gwama  said HPV vaccine  is available and administration exercise is ongoing  in schools and health centers  so as to reach the targeted group .

“ We had few doses of the HPV vaccines but we are expecting  more to come ,preventive measures such as HPV vaccines play a crucial role in reducing  the risk of cervical  cancer ,however the uptake of these vaccine is still low but measures are in place  to reach many girls ,” Said the CEC 

The CeC confirmed Kwale county to be among the counties in Kenya  that  witness high cases of cancer ,saying plans to open Kwale Oncology center that  cost a total of million 60  are in place .

“ We are in the process of licensing the oncology center  and make it officially operational , currently the center offers screening  services  but  chemotherapy services will  also be available when  licensed ,” Said Cec .

In Kenya  as in many other countries  the reasons  for the waning vaccine  confidence  are highly  context specific and should therefore not be addressed in a uniform approach .

HPV vaccine introduction in Kenya continues to be a learning point for all immunization  stake holders  on how  to ensure successful uptake of new vaccines and especially where  a new cohort is involved .

Despite having done a lot of prior social mobilization and advocacy ,confidence in the HPV vaccine was severely compromised by rumors and misconception .

It became evident that continuous engagement and public multi-stakeholder dialogue should  be employed at all stages of vaccine introduction .