cfhinitiative

MONDAY HEALTH BURST ON THE HEALTH IMPLICATIONS OF GENDER BASED VIOLENCE

Gender-Based Violence (GBV) is a grave human rights violation with profound and far-reaching effects on the health and well-being of individuals and communities. It manifests in various forms, including physical, sexual, psychological, and economic harm, stemming from entrenched gender norms and power imbalances. The impact of GBV extends beyond the immediate survivors, affecting public health systems, economic productivity, and societal stability.

The physical consequences of GBV are often severe and enduring. Survivors frequently suffer injuries such as fractures, bruises, burns, and, in cases of sexual violence, sexually transmitted infections, unintended pregnancies, and complications like pelvic inflammatory disease and chronic pain. For pregnant women, GBV can lead to miscarriage, preterm labor, and low birth weight, posing risks to both maternal and child health. These physical effects often require extensive medical attention, straining healthcare resources.

An illustrative example is an intervention by the Centre for Family Health Initiative (CFHI), where a maid who was molested by her caregiver suffered severe damage to her genital organs. CFHI provided critical medical assistance, ensuring she received treatment until her full recovery. This case highlights the physical devastation of GBV and the vital role of timely medical intervention in mitigating long-term harm.

The psychological toll of GBV is equally devastating. Survivors commonly experience anxiety, depression, post-traumatic stress disorder (PTSD), and, in many cases, suicidal thoughts or behaviors. The trauma inflicted by abuse often disrupts cognitive and emotional functioning, leading to difficulties in personal relationships, social interactions, and daily activities. For children exposed to GBV, the consequences are particularly alarming, as they may develop behavioral problems, emotional distress, and long-term mental health challenges that can persist into adulthood.

In addition to mental health impacts, GBV has dire effects on reproductive and sexual health. Survivors of sexual violence face heightened risks of infections, including HIV/AIDS, as well as unintended pregnancies and complications from unsafe abortions. The stigma associated with such violence often deters survivors from seeking necessary medical attention, exacerbating health problems, and deepening feelings of isolation and shame.

Beyond individual health outcomes, the public health implications of GBV are vast. Healthcare systems are often overwhelmed by the demand for services, including medical treatment and psychological support for survivors. Maternal mortality rates, the spread of sexually transmitted infections, and the intergenerational transmission of trauma further strain public health infrastructures.

The societal and economic costs of GBV are equally alarming. Survivors may lose their livelihoods due to physical or psychological impairments, contributing to decreased productivity and financial instability. This not only affects individuals and their families but also undermines national development, perpetuating cycles of poverty and inequality. The economic burden of GBV, which includes healthcare costs, legal expenses, and lost workforce participation, highlights the urgency of addressing this pervasive issue.

To mitigate the impact of GBV, a multifaceted approach is essential. Governments must enforce robust legal frameworks to protect survivors and prosecute perpetrators, while healthcare providers must integrate GBV screening and survivor-centered care into their services. Community-level interventions are critical for challenging harmful gender norms and fostering awareness, creating an environment where GBV is recognized and condemned. Providing accessible support systems, such as counseling, safe shelters, and legal aid, is equally vital to helping survivors rebuild their lives.

The health impacts of GBV underscore its significance as a public health crisis that requires immediate and sustained action. Addressing the root causes of GBV and providing comprehensive care for survivors is not just a moral imperative but a societal necessity. By prioritizing the fight against GBV, societies can promote health, equality, and well-being for all, paving the way for a more just and equitable future.

Reference:

Gender based violence is a public health issue: using a health systems approach

 

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SPEAK WEDNESDAY ON EMPATHY IN ACTION: MENS’S ROLE IN ENDING VIOLENCE AGAINST WOMEN

On the occasion of International Men’s Day yesterday, we are reminded of the transformative power men hold in eliminating violence against women. This issue impacts one in three women globally, according to UN Women, and addressing it requires an inclusive, empathetic approach.

Violence is Not Inherent—It’s Learned

Research by World Health Organization (WHO) shows that violence is often learned during childhood, and men who grow up in violent environments are statistically more likely to perpetuate such behavior later in life.WHO emphasises that children exposed to abuse are at a greater risk of becoming perpetrators of violence in adulthood.

Anthony Keedi, from the ABAAD Resource Centre for Gender Equality, emphasizes that violence is not a natural trait in men but a learned behavior shaped by societal expectations. Transforming this requires teaching men that masculinity includes caregiving and emotional expression, fostering respect instead of dominance.

Pathway to Change

According to the MenEngage Alliance, embracing positive masculinity is a crucial step. Men must reject harmful stereotypes that equate strength with control and instead model behaviors rooted in empathy and equality. When men publicly advocate for these changes, they inspire others in their communities to shift perspectives.

Also, silence is complicity. Men have the privilege to challenge misogynistic behaviors and advocate for change in their communities. From workplaces to social circles, speaking up fosters new norms where violence is intolerable.

Ending violence against women isn’t just about protecting women; it’s about building a society where everyone thrives. When men actively participate in this cause, they not only support gender equality but also unlock greater emotional freedom for themselves. A world free of violence benefits all genders, fostering healthier families and communities.

Men have the power to redefine their roles in relationships and society at large. By leading with empathy, they can bridge the gap between acknowledging the issue and being part of the solution.

Speak Wednesday is an initiative of CFHI to address issues around gender-based violence and gender bias.

#SpeakWednesday #EmpathyInAction #EndViolence #InternationalMensDay #GenderEquality

References:

  1. MenEngage Alliance
  2. OHCHR
  3. UN Women
  4. World Health Organization (WHO)

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MONDAY HEALTH BURST ON PREVENTING UTIs: WHY TOILET HYGIENE MATTERS

Preventing urinary tract infections (UTIs) begins with understanding the importance of toilet hygiene. UTIs, a common health issue affecting millions globally, occur when harmful bacteria enter the urinary system, causing discomfort, pain, and potentially severe complications like kidney infections. Poor toilet hygiene is a leading cause of UTIs, as it can introduce bacteria, such as Escherichia coli (E. coli), from the digestive tract into the urinary system. Practices like improper wiping or neglecting to wash hands after using the restroom significantly increase the risk of infection.

To reduce the likelihood of UTIs, it’s essential to adopt proper hygiene practices. Wiping from front to back prevents bacteria from the anal area from reaching the urethra, while thorough handwashing eliminates germs that could spread to other surfaces or the body. Keeping the genital area clean and dry is equally important since damp environments encourage bacterial growth. Regularly cleaning toilets, whether at home or in public spaces, also minimizes exposure to harmful bacteria. Avoiding the habit of holding urine is crucial, as regular urination flushes out bacteria, preventing them from multiplying.

Staying hydrated is another vital aspect of UTI prevention. Drinking plenty of water helps dilute urine and flush out bacteria, promoting frequent urination that naturally cleanses the urinary tract. This practice, combined with good hygiene, creates a strong defense against infections.

Women, due to their shorter urethras, are more prone to UTIs, making toilet hygiene even more critical. Specific measures, such as avoiding harsh soaps and wearing breathable cotton underwear, help reduce irritation and bacterial growth.

In 2020, CFHI commemorated World Toilet Day in Saburi Community, Abuja, where over 55 community members were sensitized on the dangers of open defecation, the importance of proper hygiene practices, the need to promote climate action, and the benefits of embracing effective waste disposal methods. This impactful initiative highlighted CFHI’s dedication to improving sanitation, fostering healthier living conditions, and driving environmental sustainability within the community.

Toilet hygiene, when paired with good hydration and regular urination habits, serves as a powerful tool in preventing UTIs and promoting overall urinary tract health. By maintaining these simple yet effective practices, individuals can protect their health and avoid the discomfort of infections. Prevention is always better than cure, and prioritizing hygiene is a step toward long-term well-being.

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SPEAK WEDNESDAY ON IMPACT OF DOMESTIC VIOLENCE ON CHILDREN’S MENTAL HEALTH AND DEVELOPMENT

Domestic violence is a shadow that reaches far beyond the immediate victims. When violence seeps into a home, it affects everyone, especially children, who often become silent witnesses to trauma and suffering. The impact of domestic violence on children’s mental health and development is a pressing concern that many may overlook. The psychological toll of exposure to violence in childhood can have lasting effects on a child’s mental well-being, social skills, and overall development.

The World Health Organization (WHO) reports that children exposed to violence are at greater risk of developing mental health disorders like post-traumatic stress disorder (PTSD), depression, and anxiety, sometimes beginning as early as in childhood and potentially lasting a lifetime​. This exposure can lead to significant emotional turmoil, with many children experiencing constant fear, self-doubt, and an inability to trust, making it difficult for them to form stable, healthy relationships later in life

The stress and trauma associated with domestic violence can impair a child’s cognitive development, impacting their ability to concentrate, learn, and socialize. Studies from the National Institute of Mental Health show that children growing up in violent households are more likely to struggle academically and have difficulty processing emotions and handling conflict in constructive ways​. This may manifest in behavioural issues, aggressive responses, or social withdrawal.

Additionally, these children are at higher risk of substance abuse and other forms of self-destructive behaviour as they attempt to cope with unresolved trauma​. ~ American Psychological Association.

Breaking the cycle of domestic violence requires comprehensive approaches that involve not only supporting survivors but also recognizing and addressing the needs of children affected by this trauma. Educational programs that promote awareness, early intervention efforts, and accessible counselling services for children are essential to helping young people recover and build healthy lives. By investing in resources that support children’s mental health, communities can help mitigate the impacts of domestic violence on future generations. Through collective efforts, we can create safe environments that foster resilience and healing, ensuring a brighter, healthier future for all children.

Speak Wednesday is an initiative of CFHI to address issues around gender-based violence and gender bias.

#SpeakWednesday #EndDomesticViolence #ProtectOurChildren #BreakTheCycle #SupportMentalHealth #FutureWithoutViolence

References

  • World Health Organization. (2021). Violence against children. Retrieved from WHO.
  • National Institute of Mental Health. (2020). Children’s exposure to violence and mental health. Retrieved from NIMH.
  • American Psychological Association. (2020). Impact of childhood trauma on mental health. Retrieved from APA.
  • Centers for Disease Control and Prevention. (2021). Childhood trauma and public health. Retrieved from CDC.
  • (2022). Supporting children affected by domestic violence. Retrieved from UNICEF.

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MONDAY HEALTH BURST ON HEART HEALTH IN MEN: REDUCING CARDIOVASCULAR DISEASE RISK

The World Health Organization reports that in 2019, an estimated 17.9 million people died from cardiovascular diseases (CVDs), accounting for 32% of all global deaths.1 As a leading cause of death among men worldwide, cardiovascular disease presents significant but often preventable risks. By understanding these risk factors and adopting healthy lifestyle changes, men can take proactive steps to greatly reduce their chances of developing heart-related conditions.

CVD encompasses various conditions affecting the heart and blood vessels, including heart attacks, strokes, and high blood pressure. Men, especially in middle age, face higher risks due to genetic, environmental, and lifestyle factors. As men tend to develop CVD at younger ages than women, early prevention is critical.

Several modifiable risk factors contribute to CVD in men. High blood pressure is a common cause, as it damages arteries and strains the heart. Managing blood pressure through regular monitoring, reducing sodium intake, and managing stress is essential. High LDL (bad) cholesterol, another major risk, can lead to artery blockages. A balanced diet rich in fruits, vegetables, whole grains, and healthy fats can help maintain cholesterol levels.

Smoking greatly raises heart disease risk by damaging blood vessels and lowering oxygen levels in the blood, making quitting one of the most impactful steps toward a healthier heart. Physical inactivity also increases the risk of heart disease; regular exercise strengthens the heart, improves circulation, and controls weight, blood pressure, and cholesterol. The American Heart Association recommends at least 150 minutes of moderate exercise per week.

Diabetes is another risk factor, as high blood sugar can damage blood vessels. Managing diabetes through proper diet, regular exercise, and medication reduces the risk.

Men can improve heart health with a few practical lifestyle changes. Adopting a heart-healthy diet that includes low saturated fats, high fiber, fruits, vegetables, and lean proteins is crucial, along with incorporating omega-3-rich foods like salmon and walnuts, which promote cardiovascular health. Regular exercise is also essential, as it strengthens the heart and boosts circulation. Maintaining a healthy weight is particularly important, as obesity increases the risk of heart disease and related conditions like high blood pressure and diabetes. Even modest weight loss can lead to significant heart health benefits.

Stress management is another key component of heart health. Chronic stress can contribute to high blood pressure and unhealthy coping mechanisms such as overeating or smoking. Relaxation techniques such as deep breathing, meditation, or yoga can help manage stress.

Finally, routine check-ups allow for early detection and monitoring of blood pressure, cholesterol, and blood sugar levels. Discussing family history with a healthcare provider is also crucial for assessing overall risk and creating a personalized plan for heart health.

Reducing the risk of cardiovascular disease is within reach through consistent lifestyle changes and preventive care. A heart-healthy diet, active lifestyle, quitting smoking, stress management, and regular health screenings are all effective ways to lower the risk of heart disease. By prioritizing heart health today, men can prevent complications and enjoy a longer, healthier life.

Reference:

  1. https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)

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SPEAK WEDNESDASY ON PROTECTING OUR FUTURE: COMBATING GENDER-BASED VIOLENCE IN CHILDHOOD AND ADOLESCENCE

Gender-based violence (GBV) leaves lifelong scars, particularly when it affects young people. Children and adolescents worldwide experience violence in environments meant to be safe—homes, schools, and communities. Addressing this problem early in life is essential, as GBV in childhood not only affects immediate well-being but also shapes a young person’s future.

Adolescent girls are especially vulnerable to forms of GBV like early marriage and sexual violence. The World Health Organization (WHO) highlights that one in four girls will experience sexual violence before reaching adulthood, often in environments where cultural norms uphold gender inequalities and prioritize male dominance. UNICEF adds that boys also experience GBV in unique ways, facing pressures to adopt aggressive behaviour in alignment with rigid views of masculinity. These pressures often lead boys to both experience and perpetuate violence later in life, continuing a cycle that affects future generations.

Protecting children from GBV is an ongoing effort that requires commitment from everyone—parents, educators, community leaders, and policymakers. Addressing gender-based violence (GBV) in children and adolescents requires a combination of education, community support, and legal protections. Education in schools and communities about respect, equality, and personal rights is crucial. By raising awareness on GBV prevention and empowering young people to understand their rights, communities can help prevent violence before it begins. Together, we can build a future where young people are free to grow up in safety and pursue their potential. Ending GBV among youth is not just about safety; it’s about creating a foundation of respect and equality that will shape the generations to come.

Speak Wednesday is an initiative of CFHI to address issues around gender-based violence and gender bias.

#SpeakWednesday #EndChildViolence #ProtectOurFuture #StopGBV #YouthSafety #BreakTheCycle #GenderEquality ##GenderJustice

 

References

  1. World Health Organization (WHO). Preventing Violence Against Children and Adolescents, WHO, 2023
  2. UNICEF. Safe to Learn: Protecting Children in Schools, UNICEF, 2023
  3. UNICEF Nigeria. Child Protection Programs and Gender-Based Violence, UNICEF Nigeria, 2023

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MONDAY HEALTH BURST ON GESTATIONAL DIABETES: WHAT PREGNANT WOMEN SHOULD KNOW

Gestational diabetes is a form of diabetes that develops during pregnancy due to elevated blood sugar levels. Although it typically resolves after childbirth, managing it carefully is essential for the health of both mother and baby. Pregnancy induces various hormonal changes, some of which interfere with insulin, the hormone responsible for controlling blood sugar. When the body cannot produce enough insulin, gestational diabetes can result. This condition can occur even in women with no history of diabetes.

Certain factors such as age, family history, pre-pregnancy weight, previous gestational diabetes, and ethnicity can increase the likelihood of developing gestational diabetes. Gestational diabetes often has no clear symptoms, making regular screening essential. Some women may experience thirst, frequent urination, fatigue, and blurred vision, but these symptoms are common in pregnancy, so they may go unnoticed.

Screening and Diagnosis:
Routine screening for gestational diabetes is generally conducted between the 24th and 28th weeks of pregnancy, though high-risk individuals may be tested earlier. The glucose tolerance test (GTT) is frequently used, requiring the mother to consume a sugary drink followed by blood sugar level checks.

Proper management of gestational diabetes is crucial to avoid complications. A balanced diet, emphasizing vegetables, whole grains, lean proteins, and controlled carbohydrates, helps stabilize blood sugar. Consulting a dietitian can aid in creating a personalized meal plan, Physical activity improves insulin sensitivity. Low-impact exercises like walking or swimming can be helpful, Regular monitoring is necessary to understand the body’s response to food and exercise, and in some cases, insulin or other medications may be required to maintain safe blood sugar levels.

Unmanaged gestational diabetes can lead to large birth weight, preterm birth, low blood sugar in the baby, and increased Type 2 diabetes (T2DM) risk for both mother and child. Blood sugar levels usually return to normal after childbirth. However, women who had gestational diabetes face a higher risk of developing type 2 diabetes in the future. Maintaining a healthy lifestyle and regular diabetes screenings can help monitor and reduce this risk.
Though gestational diabetes may seem daunting, early diagnosis and proactive management allow most women to have healthy pregnancies and babies. Attending prenatal appointments, following healthcare advice, and adopting a healthy lifestyle are essential steps in managing gestational diabetes effectively and ensuring a positive pregnancy experience.

CFHI in collaboration with Health Strategy and Delivery Foundation (HSDF) conducts T2DM and hypertension awareness, and free screening aimed at improving Diabetes health outcomes among the populations in selected communities of Imo state.

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SPEAK WEDNESDAY ON BREAKING THE CYCLE: HOW POVERTY FUELS GENDER-BASED VIOLENCE

In communities all over the world, the cycle of poverty and violence against women and girls has persisted for generations. Imagine a young girl growing up in a neighbourhood where money is tight, education is scarce, and opportunities are limited. She learns early that life is about survival, not dreams, and violence is part of her reality. Gender-based violence is an ugly reality that millions face daily, but poverty often goes unseen as the engine driving much of it.

Poverty fuels gender-based violence in numerous ways. For instance, economic dependence on a partner often leads women to stay in abusive relationships they might otherwise leave if they had the financial means to support themselves and their children. According to the United Nations Development Programme (UNDP), financial instability is a key driver that keeps women in cycles of dependency, as their limited options make it difficult to leave even dangerous situations. When only one partner controls finances, it’s easier for abusive patterns to take hold, creating an environment where the abused partner feels trapped.

The lack of support systems means that leaving a dangerous relationship could mean facing hunger and homelessness. Without an education or job skills, the idea of living independently seems impossible. This economic dependence creates a prison for many women, making them feel that they have no choice but to stay, even when they are in physical or emotional danger.

Beyond dependence, financial stress and scarcity can lead to heightened domestic tensions. According to the World Health Organization (WHO), poverty creates chronic stress, which often escalates into conflict and even violence within homes. Recent findings from the WHO highlights that in recent years, economic instability exacerbated by inflation, post-pandemic recovery issues, and widespread financial crises, has intensified this issue, particularly in impoverished regions. As economic conditions worsen, the vulnerabilities of women in abusive situations grow, as many find it even harder to escape due to financial dependencies.

Ultimately, addressing gender-based violence in the context of poverty is not only a matter of justice for women and girls but a necessity for society. When communities tolerate violence, they also waste the potential of women, who could otherwise contribute to economic and social development.

By addressing root causes through education, economic empowerment, legal protections, and community programs, we take steps to end the cycle of violence that keeps women trapped in poverty.

Speak Wednesday is an initiative of CFHI to address issues around gender-based violence and gender bias.

#SpeakWednesday # #EndGBV #GenderEquality #BreakTheCycle #PovertyAndViolence #WomenEmpowerment #EconomicEmpowerment

 

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SPEAK WEDNESDAY ON BREAKING BARRIERS: GILRS’ DREAMS OF EQUALITY IN EVERY FIELD

Imagine a world where every girl, regardless of her background, has the freedom to dream of being anything she wants to be—whether a doctor, an engineer, or a leader. Sadly, for many girls around the globe, these dreams remain out of reach due to entrenched gender-based violence and bias. Yet, despite the challenges, girls are rising to claim their rightful place in every field, fighting for equality in spaces where they were once invisible.

Gender bias often begins at an early age, limiting girls’ access to education and career opportunities. According to data from UNICEF, girls are still more likely to be excluded from primary and secondary education than boys. Even when they do receive an education, societal expectations often funnel them into traditional roles, discouraging their participation in STEM fields, leadership positions, and other high-impact careers. These biases follow them into adulthood, where they face wage gaps, workplace discrimination, and even physical violence.

Through policy reforms, educational programs, and advocacy, global efforts are beginning to turn the tide. Empowerment means more than survival; it means creating environments where girls are encouraged and supported to dream big.

As we provide safe spaces for girls, enforce protective laws, and promote gender-sensitive policies, we are actively enabling them to take charge of their future. The dream of equality is not just a dream for girls—it is a collective dream that holds the promise of a better world for everyone. For every girl who is allowed to thrive, the world gains an advocate for change, a leader, and a force for good.

Speak Wednesday is an initiative of CFHI to address issues around gender-based violence and gender bias.

#SpeakWednesday #GirlsInSTEM #GenderEquality #WomenEmpowerment #LiteracyForAll #BreakTheSilence #EducationMatters #GenderJustice #EmpowerWomen

References:

  • UNICEF. “Education for Every Child.” UNICEF
  • United Nations. “HeForShe Campaign.” UN

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MONDAY HEALTH BURST ON THE IMPORTANCE OF HPV VACCINE IN CERVICAL CANCER PREVENGTION FOR GIRLS

Cervical cancer is one of the leading causes of cancer-related deaths among women globally, with the Human Papillomavirus (HPV) being the primary cause. Fortunately, advances in medical science have made cervical cancer largely preventable through the HPV vaccine. This vaccine plays a critical role in safeguarding girls’ health by preventing HPV infections, which can lead to cervical cancer and other related diseases.

HPV is a common virus, with more than 100 strains, out of which certain high-risk types like HPV-16 and HPV-18 are responsible for approximately 70% of cervical cancer cases. The virus is transmitted through skin-to-skin contact, primarily during sexual activity. Most HPV infections resolve on their own, but persistent infections with high-risk strains can cause abnormal changes in the cells of the cervix, eventually leading to cervical cancer.

Benefits of the HPV Vaccine for Girls

Preventing Cervical Cancer: The primary benefit of the HPV vaccine is its ability to prevent cervical cancer. By protecting against the high-risk HPV strains, the vaccine dramatically reduces the incidence of precancerous cervical lesions and, over time, cervical cancer itself. Countries that have achieved high vaccination coverage have observed declines of 73–85% in vaccine-type HPV prevalence, and declines of 41–57% in high grade lesions (cervical intraepithelial neoplasia, grade 2 or worse) among young women, less than 10 years after implementation of HPV vaccination.1

Protection Against Other Cancers: In addition to cervical cancer, the HPV vaccine also provides protection against other cancers caused by HPV, including cancers of the vagina, vulva, and oropharynx (throat). This broad protection further underscores the importance of the vaccine in promoting long-term health for girls.

Reducing Healthcare Burden: By preventing cervical cancer, the HPV vaccine helps to reduce the overall healthcare burden. Fewer cases of cervical cancer mean fewer medical treatments, surgeries, and long-term care needs, benefiting both individual families and healthcare systems.

For the HPV vaccine to have its full impact, it is essential to ensure that all girls have access to it, regardless of their socioeconomic status or location.

Many low- and middle-income countries face challenges in providing widespread access to the vaccine, but initiatives by governments, global health organizations, and non-governmental organizations (NGOs) are working to close this gap.

In 2023, CFHI took part in a training for Civil Society Organizations focused on integrating the Human Papillomavirus (HPV) vaccine into Nigeria’s Expanded Program on Immunization (EPI) schedule. After the training, CFHI with support from the National Primary Health Care Development Agency (NPHCDA) led several weeks of intensive community dialogue, training of community workers, sensitization, and referral efforts to promote HPV vaccine uptake in the Kuduru Community, Abuja. These efforts reached around 4,000 individuals, resulting in the successful mobilization of 2,300 girls for HPV vaccination in the Kurudu ward.

The HPV vaccine is a powerful tool in the fight against cervical cancer, offering girls protection against the virus that causes most cervical cancer cases. By getting vaccinated early, girls can significantly reduce their risk of developing cervical cancer, as well as other HPV-related cancers. With widespread adoption of the vaccine, we can move closer to a future where cervical cancer is a preventable disease, ensuring that girls grow up healthy, empowered, and free from the threat of this life-threatening condition.

It is vital for families, communities, and healthcare providers to work together in promoting HPV vaccination and addressing any misconceptions. Visit the nearest healthcare facility or reach out to the National Primary Health Care Development Agency for more details on HPV vaccination.

Reference:

  1. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30068-4/fulltext

 

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