Cervical cancer screening coverage and the availability of healthcare resources for public health midwives in the Jaffna district

Abstract

Effective cervical cancer screening requires high rates of service coverage. Very little is known about the determinants of cervical cancer screening coverage in Sri Lanka. This study aims to describe the association between the availability of resources for public health midwives (PHM), sociodemographic and work-related factors, and cervical cancer screening coverage in the Jaffna district in northern Sri Lanka. A descriptive cross-sectional study was carried out among field PHMs working in Jaffna District in 2019. Data were collected with a pre-tested, self-administered questionnaire at the monthly Medical Officer of Health conferences. Data were analysed with SPSS (v21). Frequencies, percentages and the Chi Squared test were used in the analysis. The critical level was set at 0.05. A total of 131 (of 144) field PHMs working in Jaffna district participated in the study (response rate 91%). Over half (n=67, 51%) had >10 years’ work experience, 44% (n=58) covered an additional PHM area and 48% (n=63) reported having received training in organising cervical cancer screening. In the sample, 49% (n=64) of PHMs reported having all essential facilities for cervical cancer screening and 48 (75%) achieved ≥50% coverage. Although 11 PHMs (8%) achieved 100% coverage, less than half the sample (n=54, 41%) achieved the Ministry of Health target of ≥70% coverage. Achieving 50% coverage was significantly associated with the availability of all essential facilities (p=0.01) and work experience (p=0.03), but not with having received training in organising cervical cancer screening (p=0.73). None of the selected sociodemographic and work-related factors were associated with having achieved the target of ≥ 70% coverage. Public health facilities and human resources are essential for improving cervical cancer screening coverage in Jaffna and elsewhere in Sri Lanka.