In the heart of Kenya’s Kibra, an informal settlement often described as Africa’s largest slum, a group of dedicated nurses is working tirelessly to protect young girls from cervical cancer. Among them is nurse Lencer Akinyi, who uses every opportunity to educate the community about the importance of the human papillomavirus (HPV) vaccine. In a setting where misinformation and competing survival needs often take precedence, she and her colleagues persist in their mission to ensure every eligible girl receives the life-saving jab.
During a routine health talk at Karanja Road community clinic, Akinyi speaks with urgency, emphasizing hygiene and vaccination. Her audience, a small group of parents and patients, listens intently. Some approach her afterward with questions, seeking clarity on her message. One of them, Josephat Muyayi, recalls his initial hesitation about the HPV vaccine. Despite hearing about it multiple times, the rumors circulating in his community made him reluctant. However, repeated sensitization efforts by Akinyi and her team finally convinced him to allow his daughter to receive the vaccine.
Cervical cancer is the leading cause of cancer-related deaths among Kenyan women, with approximately 3,591 fatalities reported annually. The HPV vaccine, capable of preventing more than 90% of cervical cancers, is a crucial tool in combating this crisis. However, in Kibra, several challenges hinder vaccination efforts. Many residents lack access to smartphones and televisions, making it difficult to receive accurate health information. Additionally, low literacy levels and cultural beliefs contribute to vaccine hesitancy. Parents juggling financial struggles often prioritize immediate survival needs over preventive healthcare, making it even harder to promote vaccination.
School-based vaccination programs are designed to reach girls between the ages of 10 and 14, but high rates of absenteeism and school dropouts in informal settlements mean that many girls miss out. Furthermore, early sexual activity and marriage expose them to the virus before they can be immunized. Recognizing these barriers, health workers like Akinyi and community health promoters (CHPs) go beyond schools, tracking unvaccinated girls and engaging with parents in their homes.
Their efforts are yielding results. Sub-county public health nurse Anne Boraya reports that HPV vaccination rates in Kibra have increased significantly. In 2022, 1,946 girls received their first dose of the vaccine, while 1,659 completed the second dose. By 2023, those numbers had risen to 2,806 and 1,790, respectively. The increase is attributed to persistent community engagement and education, as well as improved collaboration with schools and local organizations.
However, the journey has not been easy. Akinyi recalls how, in the early days of the vaccination program, students would bring consent forms marked with red ink instructing nurses not to vaccinate them. To address these concerns, health workers now conduct information sessions at school meetings, allowing parents to ask questions and dispel fears. This approach has fostered trust, with some school administrators who initially resisted now reaching out to request vaccination days.
Beyond schools, CHPs like Rukia Jamaldin map eligible girls within the community, often encountering resistance. Some residents perceive their visits as intrusive and refuse to engage. However, Jamaldin remains undeterred, making multiple visits until she gains the trust of hesitant families. She also reaches out to religious groups that oppose vaccination, patiently explaining the vaccine’s benefits until some parents relent and allow their daughters to receive it.
Despite financial constraints and a lack of resources, these health workers continue their outreach efforts. Without transportation, they walk long distances to reach different parts of Kibra. Many even use their own money to help sick patients get medical care, believing that such gestures build goodwill and make families more likely to accept vaccination.
Since the introduction of the HPV vaccine in Kenya in 2019, 3.3 million girls have received the first dose, while 2.3 million have completed both doses. In 2023 alone, 602,741 girls received the second dose, surpassing the 519,391 who received the first. The government aims to continue increasing coverage, ensuring that every girl receives protection against cervical cancer.
To achieve long-term success, experts stress the need for continuous awareness campaigns. Nairobi County Deputy EPI Logistician Peter Njoroge notes that just as COVID-19 vaccine messaging remains visible in Kibra through murals and T-shirts, similar efforts should be made for the HPV vaccine. Embedding the message into daily conversations and community spaces will help normalize vaccination and increase acceptance.
For Akinyi and her colleagues, the goal remains clear—to prevent unnecessary deaths from a preventable disease. As clinical officer Waida Kasaya puts it, “Our only goal is to work with everyone to stop women from dying from a preventable illness.” Through persistence, community collaboration, and unwavering dedication, these nurses are turning the tide against cervical cancer in one of Kenya’s most challenging environments.
