Quality of Actions to Control Cervical Cancer in Bahia, Brazil.

Eduarda Anjos,Patty Almeida,Vanessa Bezerra,Poliana Martins,Nília Maria Brito De Lima Prado,Adriano Santos

doi:10.31557/apjcp.2021.22.8.2343

Abstract

Objective:To assess the quality of the actions to control cervical cancer (CC) and its correlates. Methods:This is a cross-sectional study conducted from January to March 2019 in 19 municipalities in Bahia, Brazil, with a sample of 241 doctors and nurses from primary health care (PHC). Three dependent variables were chosen- “Performance of educational, promotion, prevention, and monitoring actions” (D1); “Access to diagnostic tests” (D2); “Non-occurrence of high grade cervical squamous intraepithelial lesions (HSIL)” (D3). Poisson regression with robust variance was used, adopting hierarchical input variables to estimate the prevalence ratios and confidence intervals of 95%. Results:The following prevalence rates were found: D1 39.8% (95% CI: 33.8-46.2); D2 73.9% (95% CI: 67.9-79.1); and D3 46.4% (95% CI: 39.9-53.0). These dimensions remained associated with the dependent variables: D1- having professional training courses on the topic; consideration to ensure that collection takes place appropriately by a professional; and women having access to medical transport; D2- nurses treating low-grade lesions; D3- recording the Papanicolaou in electronic medical records; D1 and D2- professionals joining the service through public tender; D1 and D3- working in the PHC (≥ 2 years); D2 and D3- recording Papanicolaou in physical records; and performance of Papanicolaou by residents. Conclusion:Better trained professionals and professionals working in stable work arrangements are associated with comprehensive actions to control CC. Such strategies indicate that investments in work management result in a more organized PHC and more solution-centered work processes. Therefore, working in the PHC for a longer time and nurses performing more clinical actions (collection and treatment) are favored by such organizational actions. Investments in diagnostic support contribute to perceptions of more comprehensive actions to control CC.

Highlights

Cervical cancer (CC) is a global public health problem (GLOBOCAN, 2019), being the fourth with the highest incidence in the world
These dimensions remained associated with the dependent variables: D1- having professional training courses on the topic; consideration to ensure that collection takes place appropriately by a professional; and women having access to medical transport; D2- nurses treating low-grade lesions; D3- recording the Papanicolaou in electronic medical records; D1 and D2- professionals joining the service through public tender; D1 and D3- working in the primary health care (PHC) (≥ 2 years); D2 and D3- recording Papanicolaou in physical records; and performance of Papanicolaou by residents
The World Health Organization (WHO) has established a goal to eliminate the disease (Canfell et al, 2020), through the expansion of vaccinations against human papilloma virus (HPV), cervical screening, and treatment of cases of high grade cervical squamous intraepithelial lesions (HSIL) and CC (Arrossi et al, 2017), associated with programs to ensure the quality of these actions

Summary

Introduction

Cervical cancer (CC) is a global public health problem (GLOBOCAN, 2019), being the fourth with the highest incidence in the world. Low- and middle-income countries are the most affected, while in high-income countries, with early detection and treatment of high-grade intraepithelial lesions (HSIL), the incidence of CC is controlled (WHO, 2014; Arrossi et al, 2017). The World Health Organization (WHO) has established a goal to eliminate the disease (Canfell et al, 2020), through the expansion of vaccinations against human papilloma virus (HPV), cervical screening, and treatment of cases of HSIL and CC (Arrossi et al, 2017), associated with programs to ensure the quality of these actions. The line of care of CC makes it possible for the user to walk through the services that must be provided at the different levels of the network, by means of continuous streams that provide full care (Galvão et al, 2019)

Methods

Results

Conclusion