A Comprehensive Assessment of Interventions in Women Cervical Cancer Screening in South Sudan

Abstract

Introduction: The substantial impact of cervical cancer, particularly in low-resource environments like South Sudan, underscores the urgent need for preventive solutions, as access remains sparse. Contemporary treatment options while accessible, bring about severe side effects without greatly extending disease-free survival, emphasizing the importance of preventive screening, especially for adult women. The glaring absence of screening leads to women potentially suffering from progressed cervical cancer, a grim reality in South Sudan that contributes to around 12% of the female disease burden. Consequently, it is vital to examine the reach, associated elements, and health system initiatives aimed at cervical cancer screening in this region. This study intended to conduct an in-depth analysis of South Sudan's health system with a focus on understanding and evaluating the current interventions in place for cervical cancer screening among women.
 Methods: The research was based on a community-oriented cross-sectional survey aimed at evaluating cervical cancer screening habits among women of childbearing age in five South Sudanese counties. The participants were women aged 26-65 years, with 575 samples in total. A four-stage random sampling procedure was followed in each stratum, focusing on half the Payams per county. Structured interviews were utilized for primary data collection, supplemented by key informant discussions for qualitative data. Descriptive statistics and log-binomial regression models were used for data analysis. The study was conducted in Torit, Magwi, Terekeka, Raja, and Aweil North, targeting women of reproductive age due to their HPV infection risk.
 Results: The study found that only 11.5% of women in South Sudan had been screened for cervical cancer. Factors associated with cervical cancer screening rates included women who reported shorter waiting times for medical services (aPR=3.47 [CI=1.69-7.14]), received HPV vaccination (aPR=4.71 [CI=3.04-7.31]), kind and caring health workers (aPR=3.35 [CI=1.47-7.63]), and integrated cervical screening facilities (aPR=2.28 [CI=1.45-3.60]) had higher screening rates. However, the study found little evidence of community or institutional interventions aimed at increasing cervical cancer screening rates.
 Conclusion: Based on the findings, cervical cancer screening coverage for women in South Sudan is very low, at only 11.5%. However, certain factors were found to be associated with higher screening prevalence, including shorter wait times, caring and kind health workers, and integrated screening facilities were also associated with higher screening prevalence. It is concerning that there were virtually no interventions at the institutional level to increase screening rates. These findings suggest the need for targeted interventions to improve access to screening services and strengthen health systems to increase cervical cancer screening coverage in South Sudan.