Akazi (meaning ‘women’ in Chichewa), is a project designed to promote a systematic approach to breast cancer control in Malawi and to facilitate efficient utilisation of available resources in the country. This way, Akazi seeks to improve survival, reduce suffering and lessen the cost of prolonged care for patients, and their families.
In sub-Saharan Africa, three women for every hundred die annually due to breast cancer. In Malawi, breast cancer is the third most-common cancer in women, with very low survival rates from the time of diagnosis (average of 5.6 months). Only 9.5% of patients survive beyond 18 months.
However, breast cancer has one of the highest rates of avoidable mortality and Akazi has established a programme of work aiming at lowering the casualties of breast cancer, following three steps:
Akazi has three aims:
Akazi will investigate and assess the current health sector’s capacity for early diagnosis of breast cancer and will provide recommendations to inform the development of the first National Breast Cancer Programme (NBCP) for Malawi.
Early detection services, effective referral systems and access to treatment are rarely available for rural women. This is a particular challenge in Malawi, which has the highest rural density population in sub-Saharan Africa. Akazi will strengthen preparedness for early detection of breast cancer in Malawi through the establishment of a national clinical breast examination (CBE) training curriculum. CBE is the preferred method for breast cancer early detection at primary care facilities in low and middle-income countries.
Akazi is exploring the possibility of institutionalising the CBE training, working closely with the College of Medicine at the University of Malawi, which has expressed an interest in obtaining accreditation for the AKAZI CBE curriculum, and the Ministry of Health.
Women, especially in rural areas, experience many barriers to seeking care such as needing to obtain their husbands’ approval, fear of diagnosis, fear of being abandoned by partners or losing their jobs due to the stigma and discrimination associated with detecting a lump in the breast, let alone having cancer. The combination of cultural, educational, socioeconomic and geographical barriers plays a large role in a woman’s decision to seek medical help and results in women presenting to health facilities with advanced-stage breast cancer, if at all. Akazi will address these issues by developing tailored breast health awareness interventions in Malawi, combining community education on breast health awareness and breast cancer symptoms, with information on where and how to seek help.
The project is a collaboration between RCSI, the Agency for Scientific Research and Training (ASRT) and Kamuzu University of Health Sciences, funded by the Irish Research Council COALESCE programme.