Abstract
This review aims at identifying barriers to utilization of cervical cancer prevention services in low- and middle-income countries. An electronic search was conducted using the following key words, HPV vaccination, screening, barriers, utilization and low and middle income/developed countries. Using the Garrard (1999) Matrix method approach, a modified matrix was designed and used as a data collection tool and data related to each category listed on the tool were entered into a matrix containing columns reflecting the categories. Constant comparative analysis was used to identify thematic categories. 31 articles published between 2001 and 2014 were yielded from the search. Analysis of the contents of the articles showed that the underutilization of cervical cancer screening services in low and middle-income countries is the result of barriers in accessing and utilizing of the prevention services. Though not mutually exclusive, the barriers were categorized in three categories; individual, community and health system related. Individual barriers include lack of awareness and knowledge about risk factors and prevention of cervical cancer. Age, marital status, diffidence, social economic status, cultural and religious belief of the women also determine the women's' willingness to utilize the services. In some communities there is stigma attached to discussing reproductive health issues and this limits the young women's awareness of cervical cancer and its prevention. Understanding individual, community and health system barriers that hinder women's utilization of cervical cancer prevention services is very crucial in designing effective cervical cancer control programs in low- and middle-income countries.
Highlights
Cervical cancer is one of the most common cancers among women of reproductive age in low- and middle-income countries(LMIC) [1]
The questions are why should women keep on dying of cervical cancer when the disease is preventable? Why is there underutilization of cervical cancer prevention services in most low- and middle-income countries? This review aims at reviewing studies on factors that contribute to the low uptake of cervical cancer prevention services in low- and middle-income countries
The results shows that women in low- and middle-income countries fail to utilize cervical cancer prevention services due to factors related to individual, community and health systems Figure 1
Summary
Cervical cancer is one of the most common cancers among women of reproductive age in low- and middle-income countries(LMIC) [1]. Despite a drastic decrease in cervical cancer morbidity and mortality in high-income countries, there are 528000 new cases estimated globally every year [2] It is the fourth most common cause of cancer death in women worldwide. Secondary cancer prevention includes identifying women who are at risk for developing malignancy and implementing appropriate screening recommendations based on the risk assessment [3, 5] This may involve the use of cytology smears or, non-cytology based screening methods followed by treatment of the precancerous lesions [6]. The non-cytology based screening include the human papilloma virus DNA test and the visual inspection with acetic acid (VIA), which may be followed by cryotherapy to those women with positive test results Both of these approaches perform as well as or better than cytology based screening for identifying high-grade cervical cancer precursor lesions [7]. Even though the impact of screening has never been demonstrated through randomized trials, empirical evidence suggests that cervical cancer screening represents a viable strategy for significant reduction in morbidity and mortality in LMIC countries [9]
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