Abstract
BackgroundCervical cancer is the leading cancer among Ugandan women, contributing to 40 % of all cancer cases recorded in the cancer registry. Having identified the substantial impact of cervical cancer among Ugandan women, the Ministry of Health in 2010 launched a Strategic Plan for Cervical Cancer prevention and control. This study was conducted to determine if health workers working in rural health centres (HCs) III and IV in Northern Uganda provide cervical cancer screening services as recommended in the Strategic Plan.MethodsA cross-sectional survey using a structured questionnaire was conducted among nurses, midwives and clinical officers working in rural HC III and IV in Northern Uganda. Data were entered in Epidata 3.1 and analysed using Stata 16 statistical software. Univariate, bivariate, and multivariate analyses were performed. Any factor with p-value ≤ 0.05 was considered a significant predictor of outcome.ResultsWe surveyed 286 health workers. Fifty-one (18 %) health workers were screening women for cervical cancer. Fifty-eight (21 %) health workers have guideline for cervical cancer screening in their HCs, 93 (33 %) participants were trained to screen women for cervical cancer. Two hundred sixty-two (92 %) participants provided HPV vaccination. Two hundred forty-six (87 %) participants were conducting health education about cervical cancer in their HCs. Factors associated with screening women for cervical cancer include: being a staff member from HCs III (AOR = 0.30, 95 % CI 0.13–0.68, p = 0.00), being staff of HCs that have organization to support cervical cancer screening services (AOR = 4.38, 95 % CI 1.99–9.63, p-=0.00), being a health worker who had been trained to screen for cervical cancer (AOR = 2.21, 95 % CI 1.00–4.90, p = 0.05) and staff from HCs that has guideline for cervical cancer screening (AOR = 2.89, 95 % CI 1.22–6.86, p = 0.02).ConclusionsThis study shows an overall structural problem related to the delivery of cervical cancer screening services in HC III and IV in Northern Uganda which the Strategic Plan has not addressed. These structural problems need urgent attention if the Uganda government and other sub-Saharan African (SSA) countries are to achieve the World Health Organization (WHO) 90–70–90 targets by 2030 to be on track for cervical cancer elimination.
Highlights
Cervical cancer is the leading cancer among Ugandan women, contributing to 40 % of all cancer cases recorded in the cancer registry
Study population A total of 286 health workers working in Health centre (HC) III and IV in Northern Uganda participated in the survey
Even among participants who indicated that screening women for cervical cancer occurs in their HCs, a greater proportion relied on other organizations to come and screen women for cervical cancer during health camp outreaches in their HCs
Summary
Cervical cancer is the leading cancer among Ugandan women, contributing to 40 % of all cancer cases recorded in the cancer registry. Having identified the substantial impact of cervical cancer among Ugandan women, the Ministry of Health in 2010 launched a Strategic Plan for Cervical Cancer prevention and control. About 85 % of cervical cancer incidence and mortality globally occurs in LMICs [5] and this represent a failure in healthcare systems to implement an efficient strategy for cervical cancer prevention and control [6]. Screening for cervical precancerous lesions with low cost methods such as visual inspection with acetic acid (VIA) can detect cervical intraepithelial neoplasia (CIN) grade 2 or 3 which are cervical precancerous lesions [7,8,9,10,11]. For cervical cancer screening to be beneficial, all women who screened positive for CIN need to receive prompt and effective treatment for the CIN detected [7, 11, 12]
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