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Iseme-Ondiek R, Abuodha J, Ngugi A, Abayo I, Saleh M. Insights Into Cancer Awareness and Health Practices in Rural Kenya: A Cross-Sectional Study of Esophageal, Breast, Prostate, Cervical, and Colorectal Cancers. JCO Glob Oncol 2025; 11:e2400421. [PMID: 40344548 DOI: 10.1200/go-24-00421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Revised: 03/14/2025] [Accepted: 04/01/2025] [Indexed: 05/11/2025] Open
Abstract
PURPOSE In sub-Saharan Africa (SSA), there has been an epidemiologic transition from infectious diseases to noncommunicable diseases, including a projected doubling in incidence of cancer. Understanding the underlying factors driving this surge is crucial for designing effective strategies to mitigate the cancer burden. This study focuses on assessing knowledge, attitudes, screening practices, and health behaviors related to five most prevalent cancers in SSA: prostate, breast, cervical, esophageal, and colorectal-among a predominantly rural coastal population in Kenya. MATERIALS AND METHODS We used a cross-sectional study design targeting 1,500 adult respondents randomly selected from an existing community health and demographic surveillance system. Face-to-face interviewer-administered questionnaires were used to collect data. RESULTS One thousand four hundred fifty-two adults participated in the final survey. Breast cancer awareness was highest (69.1%), while awareness of colorectal cancer was lowest (34.6%). Given a list of possible risk factors and symptoms, most respondents (>50%) could only recognize one to two per cancer type. Perceptions of survival from colorectal cancer were particularly pessimistic, with <70% recognizing early detection as a means to improve survival outcomes. In terms of cancer-associated risk factors, more men engaged in tobacco and alcohol use (20.5% and 22.4%, respectively). Additionally, fewer than 10% of eligible participants had ever undergone cancer screening. CONCLUSION This study addresses a gap in population-level Knowledge, Attitudes, and Practices studies in rural SSA, offering insights crucial for cancer prevention, early detection, and treatment. The low awareness and knowledge levels and unhealthy behaviors emphasize a need for targeted educational campaigns at community level and enhanced understanding of barriers to uptake of screening if we are to effectively combat the growing cancer burden in this region.
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Affiliation(s)
- Rosebella Iseme-Ondiek
- Department of Population, Medical College, Aga Khan University, University Centre, Nairobi, Kenya
| | - Joseph Abuodha
- Department of Haematology-Oncology, Medical College, Aga Khan University Cancer Centre, Nairobi, Kenya
| | - Anthony Ngugi
- Department of Population, Medical College, Aga Khan University, University Centre, Nairobi, Kenya
| | - Innocent Abayo
- Department of Haematology-Oncology, Medical College, Aga Khan University Cancer Centre, Nairobi, Kenya
| | - Mansoor Saleh
- Department of Haematology-Oncology, Medical College, Aga Khan University Cancer Centre, Nairobi, Kenya
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Cooper S, Schmidt BM, Jama NA, Ryan J, Leon N, Mavundza EJ, Burnett RJ, Tanywe AC, Wiysonge CS. Factors that influence caregivers' and adolescents' views and practices regarding human papillomavirus (HPV) vaccination for adolescents: a qualitative evidence synthesis. Cochrane Database Syst Rev 2025; 4:CD013430. [PMID: 40232221 PMCID: PMC11998976 DOI: 10.1002/14651858.cd013430.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2025]
Abstract
BACKGROUND Human papillomavirus (HPV) vaccination in adolescents provides a powerful tool for preventing cervical cancer in women and other HPV-associated diseases in people of all genders. HPV vaccines have been progressively introduced in many countries. However, worldwide, many adolescents do not receive HPV vaccination, for various reasons. The HPV vaccine might be costly or unavailable, healthcare systems might lack capacity for its delivery, or adolescent health might not be prioritised. Some caregivers and adolescents may not accept available HPV vaccines and vaccination services. We currently lack a comprehensive understanding of the factors that influence HPV vaccination views and practices, and why some caregivers and adolescents may be less accepting of the vaccine. Qualitative research can contribute to this understanding and help inform policy and practice, including the development of more relevant, acceptable and effective interventions to promote public acceptance and uptake of HPV vaccination in adolescents. This qualitative evidence synthesis supplements a Cochrane review of the effectiveness of interventions to improve uptake of adolescent vaccination, including HPV vaccination. OBJECTIVES The objectives of the review are to identify, appraise, and synthesise qualitative studies that explore caregivers' or adolescents' views, experiences, practices, intentions, decision-making, acceptance, hesitancy, or nonacceptance of HPV vaccination; to gain an understanding of the factors that influence caregiver and adolescent views and practices regarding HPV vaccination for adolescents; and to explore how the findings of this review can enhance our understanding of the related Cochrane intervention review. SEARCH METHODS We searched MEDLINE, Embase, CINAHL, PsycInfo, and Scopus for eligible studies (February 2023). We updated this search in October 2024, but these results have not yet been fully incorporated. SELECTION CRITERIA We included studies that utilised qualitative methods for data collection and analysis; focused on caregivers' or adolescents' views, practices, acceptance, hesitancy, or refusal of HPV vaccination for adolescents aged 9 to 19 years of age; and were from any setting globally where HPV vaccination is provided. DATA COLLECTION AND ANALYSIS We used a prespecified sampling frame to capture a sample of eligible studies that were from a range of geographical and income-level settings, were conceptually rich in relation to the review's phenomenon of interest, and included HPV vaccination for diverse genders. We extracted contextual and methodological data from each sampled study. We used a thematic synthesis approach to analyse the evidence. We assessed methodological limitations using a list of criteria used in previous Cochrane reviews and originally based on the Critical Appraisal Skills Programme quality assessment tool for qualitative studies. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each review finding. We integrated the findings of this review with those from the related Cochrane review of intervention effectiveness (by Abdullahi and colleagues), by mapping whether the trial interventions reflected or targeted the factors identified by this review as influencing caregivers' or adolescents' views and practices regarding HPV vaccination. MAIN RESULTS We included 206 studies in the review and sampled 71 of these for our synthesis. Of these, 35 studies were conducted in high-income countries, 26 studies in middle-income countries, 8 studies in low-income countries, and 2 studies in multiple-income settings. Studies came from all six World Health Organization (WHO) regions and included urban and rural settings. We downgraded our confidence in several findings, mainly due to concerns about how the studies were conducted (methodological limitations), concerns about perspectives lacking from some types of participants or in some settings (relevance), or because of variability in the data or insufficient evidence to support all aspects of a review finding (coherence). Many complex factors were found to influence caregivers' and adolescents' HPV vaccination views and practices, which we categorised into eight overarching themes: 1) A lack of biomedical knowledge; 2) Perceptions of a range of interrelated risks and benefits (or lack thereof) associated with HPV vaccination; 3) Routine responses to vaccination generally or more specific views or experiences of other vaccines and vaccination programmes; 4) Complex nuclear familial decision-making dynamics; 5) Extended familial and social relations and networks, particularly extended family members, peers, traditional or religious leaders, and the media; 6) Interrelated socio-cultural beliefs and practices regarding adolescence, sexuality, gender, parenting and health; 7) Trust or distrust in the institutions, systems or experts associated with vaccination, most particularly teachers and the school, the pharmaceutical industry, government, science and biomedicine, and healthcare professionals; and 8) Access to, and experiences of, HPV vaccination programmes and delivery services, such as the convenience (or lack thereof) of HPV vaccination services, the cost of the vaccine, language barriers, the feminisation of HPV vaccination programmes and procedural aspects of school-based vaccination delivery. We did not identify any major differences in the occurrence of these overarching themes between subgroups. However, for various subthemes certain differences emerged in relation to place, gender and socio-economic status, and between caregivers and adolescents. The interventions tested in the related Cochrane review of intervention effectiveness most commonly targeted caregivers' and adolescents' lack of biomedical knowledge and their perceptions of the risks and benefits of HPV vaccination, with the other influencing factors identified by our review being underrepresented. AUTHORS' CONCLUSIONS Our review reveals that caregivers' and adolescents' HPV vaccination views and practices are not only influenced by issues related to individual knowledge and perceptions of the vaccine, but also an array of more complex, contextual factors and meanings: social, political, economic, structural, and moral. Successful development of interventions to promote the acceptance and uptake of HPV vaccination for adolescents requires an understanding of the context-specific factors that influence HPV vaccination views and practices in the target setting. Through this, more tailored and in turn more relevant, acceptable, and effective responses could be developed. The eight overarching themes that emerged from our review could serve as a basis for gaining this understanding.
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Affiliation(s)
- Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Bey-Marrié Schmidt
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Ngcwalisa A Jama
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Jill Ryan
- Equality Unit, Stellenbosch University, Stellenbosch, South Africa
| | - Natalie Leon
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Edison J Mavundza
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Rosemary J Burnett
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | | | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Vaccine Preventable Diseases Programme, World Health Organization Regional Office for Africa, Brazzaville, Congo
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Kullin BR, Gitome S, Happel AU, Pidwell T, Lefevre M, Madikida A, Wekesa P, Mahlangu K, Ochieng J, Awili L, Agolla W, Otieno R, Mutharimi A, Ganief Y, Daniels R, Chicken A, Welp K, Livingstone H, Swanepoel C, Claassen-Weitz S, Kanyoka P, Ravel J, Humphrys M, Bilski L, Mulder N, Bekker LG, Gill K, Jaspan H, Bukusi EA, Passmore JAS. Vaginal Microbiome Research Consortium for Africa: study protocol of a multicentre prospective clinical study to evaluate temporal vaginal microbial composition associated with maintenance of reproductive health in women in South Africa and Kenya. BMJ Open 2025; 15:e090938. [PMID: 39987010 PMCID: PMC11848679 DOI: 10.1136/bmjopen-2024-090938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 02/03/2025] [Indexed: 02/24/2025] Open
Abstract
INTRODUCTION The Vaginal Microbiome Research Consortium for Africa (VMRC4Africa) study is a multicentre observational cohort study. We aim to enrol parallel cohorts of 100 women from two sites in two African countries (N=200) (Desmond Tutu HIV Centre [DTHC], South Africa; Kenya Medical Research Institute [KEMRI], Kenya) to evaluate detailed temporal fluctuations in vaginal microbiota in young, generally healthy women from Southern and Eastern Africa. METHODS AND ANALYSIS Cohorts in Kenya and South Africa will be followed up twice a week for 10 weeks to create detailed profiles of vaginal microbial community state types (CSTs; by 16S rRNA gene sequencing) and fungal communities (by internal transcribed spacer (ITS) sequencing) and to identify women with stable Lactobacillus crispatus-dominated microbiota, with no evidence of genital inflammation, as assessed by the measurement of inflammatory cytokines. DISCUSSION Through the establishment of this African vaginal sample biorepository, the intention will be to cultivate Lactobacillus isolates to create a biobank from which to ultimately select geographically diverse Lactobacillus strains with health-promoting characteristics that can be co-formulated into live biotherapeutic products (LBPs) to treat bacterial vaginosis (BV) for women in sub-Saharan Africa. ETHICS AND DISSEMINATION The VMRC4Africa study has been granted ethical approval by the Human Research Ethics Committees in South Africa (UCT HREC: 611/2022) and Kenya (KEMRI Scientific and Ethics Review Unit: SERU No. 4569). Deidentified microbial community compositional data will be made available on public databases. Results of the study will be published in peer-reviewed journals.
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Affiliation(s)
- Brian Ronald Kullin
- Department of Pathology, UCT Institute of Infectious Disease and Molecular Medicine, Cape Town, Western Cape, South Africa
- Centre for the Aids Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
| | - Serah Gitome
- Kenya Medical Research Institute, Nairobi, Nairobi County, Kenya
| | - Anna-Ursula Happel
- Department of Pathology, UCT Institute of Infectious Disease and Molecular Medicine, Cape Town, Western Cape, South Africa
| | - Tanya Pidwell
- Department of Pathology, UCT Institute of Infectious Disease and Molecular Medicine, Cape Town, Western Cape, South Africa
| | - Mellissa Lefevre
- University of Cape Town Desmond Tutu HIV Centre, Cape Town, Western Cape, South Africa
| | - Anda Madikida
- University of Cape Town Desmond Tutu HIV Centre, Cape Town, Western Cape, South Africa
| | - Pauline Wekesa
- Kenya Medical Research Institute, Nairobi, Nairobi County, Kenya
| | - Karabo Mahlangu
- University of Cape Town Desmond Tutu HIV Centre, Cape Town, Western Cape, South Africa
| | - James Ochieng
- Kenya Medical Research Institute, Nairobi, Nairobi County, Kenya
| | - Lydia Awili
- Kenya Medical Research Institute, Nairobi, Nairobi County, Kenya
| | - Winnie Agolla
- Kenya Medical Research Institute, Nairobi, Nairobi County, Kenya
| | - Rhoda Otieno
- Kenya Medical Research Institute, Nairobi, Nairobi County, Kenya
| | - Amos Mutharimi
- Kenya Medical Research Institute, Nairobi, Nairobi County, Kenya
| | - Yacoeb Ganief
- Department of Pathology, UCT Institute of Infectious Disease and Molecular Medicine, Cape Town, Western Cape, South Africa
| | - Rezeen Daniels
- University of Cape Town Desmond Tutu HIV Centre, Cape Town, Western Cape, South Africa
| | - Anika Chicken
- Department of Pathology, UCT Institute of Infectious Disease and Molecular Medicine, Cape Town, Western Cape, South Africa
- Centre for the Aids Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
| | - Kirsten Welp
- Department of Pathology, UCT Institute of Infectious Disease and Molecular Medicine, Cape Town, Western Cape, South Africa
- Centre for the Aids Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
| | - Hannah Livingstone
- Department of Pathology, UCT Institute of Infectious Disease and Molecular Medicine, Cape Town, Western Cape, South Africa
- Centre for the Aids Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
| | - Caleb Swanepoel
- Department of Pathology, UCT Institute of Infectious Disease and Molecular Medicine, Cape Town, Western Cape, South Africa
- Centre for the Aids Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
| | - Shantelle Claassen-Weitz
- Department of Pathology, UCT Institute of Infectious Disease and Molecular Medicine, Cape Town, Western Cape, South Africa
- Centre for the Aids Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
| | - Pride Kanyoka
- Department of Pathology, UCT Institute of Infectious Disease and Molecular Medicine, Cape Town, Western Cape, South Africa
- Centre for the Aids Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
| | - Jacques Ravel
- Department of Microbiology and Immunology, University of Maryland Institute for Genome Sciences, Baltimore, Maryland, USA
| | - Michael Humphrys
- Department of Microbiology and Immunology, University of Maryland Institute for Genome Sciences, Baltimore, Maryland, USA
| | - Lisa Bilski
- Department of Microbiology and Immunology, University of Maryland Institute for Genome Sciences, Baltimore, Maryland, USA
| | - Nicola Mulder
- Department of Integrative Biomedical Sciences, UCT Institute of Infectious Disease and Molecular Medicine, Cape Town, Western Cape, South Africa
| | - Linda-Gail Bekker
- University of Cape Town Desmond Tutu HIV Centre, Cape Town, Western Cape, South Africa
- Department of Medicine, UCT Institute of Infectious Disease and Molecular Medicine, Cape Town, Western Cape, South Africa
| | - Katherine Gill
- University of Cape Town Desmond Tutu HIV Centre, Cape Town, Western Cape, South Africa
- UCT Institute of Infectious Disease and Molecular Medicine, Cape Town, Western Cape, South Africa
| | - Heather Jaspan
- Department of Pathology, UCT Institute of Infectious Disease and Molecular Medicine, Cape Town, Western Cape, South Africa
- Seattle Children's Research Institute, Seattle, Washington, USA
- Departments of Global Health and Pediatrics, University of Washington, Seattle, Washington, USA
| | - Elizabeth Anne Bukusi
- Kenya Medical Research Institute, Nairobi, Nairobi County, Kenya
- Departments of Global Health and Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
| | - Jo-Ann Shelley Passmore
- Department of Pathology, UCT Institute of Infectious Disease and Molecular Medicine, Cape Town, Western Cape, South Africa
- Centre for the Aids Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
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