Outcomes from Integrating Anti-cervical Cancer Teachings into the Curriculum of High Schools in a South-Eastern Nigerian State

Background: Quests for the global elimination of cervical cancer and its related SDG goals by 2030 are achievable if realistic approaches for improving outcomes in LMICs are entrenched. Targeting teenage high schoolers in these countries, which largely lack universally-affordable anti-cervical cancer measures, can be a game-changer. This paper evaluates a 2019 Harvard-endorsed measure that integrated relevant teachings into the curricula of some Nigerian high schools, in what was a global-first.

Method: A 12-month, quasi-experimental (pre-and-post-tests) research that evaluated the impact of the above initiative on three public schools randomly selected from a pool of 261 in South-east Nigeria. The intervention was "exposure" to anti-cervical teachings, which included "repetitions" and "examination/assessments" designed to enhance "engagement". Both genders were among the 2,498 recruited participants. Data collections with questionnaires were at three different intervals over 12 months.

Results: At Phase-1 (baseline), there were 1,699 (68.0%) responses, while Phases 2 (one-month post-intervention) and 4 (12-month post-intervention) had 1,797 (71.9%) and 500 (20.0%) responses, respectively. COVID-19 lockdowns washed out Phase-3 (six-month post-intervention). The majority in all groups were aged 15-19 years. Males dominated in phases 1 (55.9%) and 2 (67.3%), and females (65.6%) in Phase 4. Overall, there were increased knowledge on "General Awareness", "HPV Vaccinations", "Risk Factors" and "Symptoms", particularly between Phases 2 and 1. Levels at Phase-4 were higher than at Phase-2, with the exception of "Pap Smears", as knowledge gained in half of its assessing items became negative (reversed) at Phase-4. These observed changes were non-different between gender, age groups, and classes of high schools. Relative to Phase 2, knowledge changes at Phase-4 for questions associated with established myths ("spiritual attacks"; OR 0.39; CI 0.29-0.52 and "enemy poisons"; OR 0.49; CI 0.37-0.65) were reversed, even though they were originally increased significantly between Phases 2 and 1.

Conclusion: Anti-cervical cancer enlightenment interventions to teenage high school students were largely effective, but appears guaranteed if engagement-enhancing measures are maintained over time. Extra efforts should be put into debunking prevailing myths.