MULTILEVEL DETERMINANTS AND MECHANISTIC PATHWAYS OF GYNAECOLOGICAL CANCERS IN SUB- SAHARAN AFRICA: A TRANSLATIONAL FRAMEWORK FOR PREVENTION, EQUITY, AND HEALTH SYSTEM STRENGTHENING

Abstract

Background: Gynaecological cancers remain a leading cause of morbidity and mortality among women in Sub-Saharan Africa (SSA), with cervical cancer being disproportionately represented. The interplay between biological, environmental, and socioeconomic determinants of the component entities or pathologies underpins this burden, yet mechanistic integration across these domains towards a direction of mitigating this obvious burden remains limited. Methods: We conducted a narrative integrative synthesis of epidemiological, molecular, and health systems evidences with the aim of constructing a multilevel framework that links the upstream determinants to downstream carcinogenic pathways. Findings: Persistent human papillomavirus infection, when localized to the lower genital tract, particularly in sexually active women or those taken within the reproductive age funnel is the necessary cause of most cervical cancers through viral oncoprotein-mediated inactivation of tumour suppressor genes. Metabolic dysregulation and hyperoestrogenism are key among the upstream determinants that drive endometrial carcinogenesis, while defects in DNA repair pathways, particularly involving BRCA1 and BRCA2 genes, underlie ovarian cancer susceptibility. Environmental exposures shape infection dynamics and metabolic risk, whereas socioeconomic determinants critically govern access to prevention, early detection, and treatment of these neoplastic pathologies. Interpretation and Conclusion: The gynaecological cancer burden in Sub-Saharan Africa reflects a convergence and real-time interaction of proximal biological mechanisms and distal structural inequities in basic resource access and distribution especially for women. Effective control requires integrated strategies targeting molecular, behavioural, and health system levels of interventions.