Community-based Cervical Screening Research Articles

The Women Who Fear the Unknown: Potential Drivers of the Cervical Cancer Epidemic in Rural Nigeria

Background: Visual inspection of the cervix under acetic acid is the most cost-effective method for the control of cervical cancer in sub-Saharan Africa. The region bears about 90% of the global burden of the disease accounting for about 85% of new disease and more than 90% of the mortality. The WHO piloted a largely successful community-based cervical screening in six African countries including Nigeria between 2009 and 2012. Community-based cervical screening was subsequently adopted in Nigeria as a major strategy for preventing cervical cancer. An evaluation of the community-based cervical screening in two rural local government areas in Ogun state, Nigeria, however, revealed that more than 95% of sexually active women had never had cervical screening done despite availability of the services. A substantial number of these women would not want to have cervical screening done because of the fear of a positive cervical screening result. Aim: The current study explored the characteristics of women who are unwilling to have cervical screening because of the fear of a negative result in two rural local government areas in Nigeria. Methods: A post hoc analysis of data collected for the evaluation of community-based cervical screening in two rural LGAs in Nigeria. The analysis described the characteristics of 700 sexually active women aged 25 to 64 years who declined to have cervical screening. The socio-demographic characteristics, perception (0 to 6) and knowledge scores (0 to 36) of the participants were fitted into a multivariate logistic regression model to predict the fear of an unfavorable cervical screening result. Results: About 81% (567) of the women were unwilling to get a cervical screening due to the fear of a negative result. Age, gravidity, knowledge, and perception about cervical cancer and screening were associated with the women declining cervical screening due to the fear of a negative result. On multivariate logistic regression analysis age (OR: 0.968, P = 0.007) and knowledge score (OR: 0.914, P < 0.001) were found to predict the fear of a negative result. The adjusted outcome variable model showed fair discrimination (AUC = 0.67) and good calibration ( P = 0.416). Conclusion: Many women in rural Nigeria decline to have cervical screening mainly because of the fear of a negative result which is in turn predicted by younger age and poorer knowledge scores about cervical cancer and screening. There is a need for further qualitative research to explore the dimensions of fear as it relates to refusal to have cervical screening among rural women in Nigeria.

Setting up a community-based cervical screening service in a low-income country: a pilot study from north-western Tanzania

ObjectivesTo report the results of a pilot study for a service for cervical cancer screening and diagnosis in north-western Tanzania.MethodsThe pilot study was launched in 2012 after a community-level information campaign. Women aged 15–64 years were encouraged to attend the district health centres. Attendees were offered a conventional Pap smear and a visual inspection of the cervix with acetic acid (VIA).ResultsThe first 2500 women were evaluated. A total of 164 women (detection rate 70.0/1000) were diagnosed with high-grade cervical intraepithelial neoplasia and invasive cervical cancer. The performance of VIA was comparable to that of Pap smear. The district of residence, a history of untreated sexually transmitted disease, an HIV-negative status (inverse association), and parity were independently associated with the detected prevalence of disease. The probability of invasive versus preinvasive disease was lower in HIV-positive women and in women practicing breast self-examination.ConclusionsThe diagnostic procedure had an acceptable level of quality. Factors associated with the detected prevalence of disease will allow for a more targeted promotion of the service. Cervical screening should be coordinated with sexually transmitted disease and HIV infection control activities.

The understanding and perception of service providers about the community-based cervical screening in Nigeria

Background: Community-based cervical screening based on the single visit approach using the visual inspection approach (VIA) and treatment with cryotherapy is the most appropriate method in limited resource settings in the short- to medium-term for the control of cervical cancer. Aim: The study is aimed at assessing the service providers understanding and perception of community-based cervical screening. Materials and Methods: A cross-sectional study of 31 health workers providing cervical screening services in Ogun State, Nigeria, using closed and open ended questions. Results: There was a huge turnover of health workers who had been involved in cervical screening. Over 90% of the health workers opined that screening should commenced before the age of 25 years. Their opinion of the recommended screening interval for cervical cancer varied; with 54.8%, 16.1%, and 29.0% giving 3, 2 years, and 1 year, respectively. The VIA is the most recommended screening test by the health workers (74.2%). The majority of health workers (87.1%) felt that the logistic and technical support provided for the cervical screening program was not adequate. Cervical cancer screening is thought to be of low priority within the health system by 45.2% of the respondents while 32.3% think that it is of moderate priority. The majority of the health workers (90.3%) said that the health authority in their local government do not budget funds for cervical cancer prevention. Conclusion: The service providers perceive the need for an urgent improvement in the community-based cervical screening through awareness creation, reduction in health worker turnover, and support and integration of cervical screening services.

Risk Factors for Cervical Abnormalities Among Hong Kong Chinese Women: A Large-Scale Community-Based Cervical Screening Program

We sought to identify the prevalence of and risk factors associated with cervical abnormalities among Chinese women in Hong Kong. A community-based cervical screening program was offered free of charge in Hong Kong. Information on the demographics, sexual experience, and obstetrical history of women who attended the Cervical Screening Clinic were collected and tabulated with their Pap smear results to establish the risk factors associated with cervical abnormalities among Hong Kong Chinese women. A total of 44,219 women attended the Cervical Screening Clinic for their first Pap smear tests over an 8-year period, with the prevalence of cervical abnormality at 4.51%. Adjusted for all associating factors, the significant risk factors of cervical abnormalities identified among Hong Kong Chinese women are being aged 40-49 (odds ratio [OR] 1.53), being single (OR 1.52) or cohabiting (OR 1.52), having received primary school education only (OR 1.53), having had three or more sexual partners (OR 1.52), onset of sexual activity at age ≤18 (OR 1.53), having reported bleeding after intercourse (OR 1.44), and having had more than three pregnancies (OR 1.47). Condom use was identified as the single most significant protective factor reducing the risk of cervical abnormalities among these women (OR 0.76). This first population study in Hong Kong provides a better understanding of the risk factors associated with cervical abnormalities among Hong Kong Chinese women. A primary preventive strategy to reduce cervical cancer incidence should focus on modifying these preventable risk factors, complemented by population-based cervical screening programs to increase the coverage rate to 80% in the long term, together with human papillomavirus (HPV) vaccination.

Women's perceptions and social barriers determine compliance to cervical screening: Results from a population based study in India

Background: Success of cervical screening initiatives depends on high participation of the target population, which in turn is determined by the women's perceptions, health orientation and other socio-cultural issues. The present study identifies the immediate social and cultural barriers that prevent women to attend cervical screening facilities. Methods: Women non-compliant to a community-based cervical screening program were identified. From them 500 were randomly selected for interview using a structured questionnaire that was designed on the basis of feedbacks received from several focused group discussions. Questionnaire listed 24 possible reasons for non-compliance. The women were asked to select the most pertinent reason(s) for her non-attendance or to reveal if they had any reason other than the listed ones. Results: A total of 469 non-compliant women were interviewed. They had significantly lower literacy rate compared to the compliant women (OR = 2.25; 95% CI: 1.23–4.13). Nearly half of the interviewed women responded that they themselves opted to stay away from the program. Most common reasons cited for non-attendance in this group were reluctance to go for medical test in the absence of any symptoms and apprehension to have a test that detects cancer. Second major group of responders comprised of women who were willing, yet could not attend due to various hurdles. Most common hurdles were inability to leave household chores, pre-occupation with family problems and lack of approval from husbands. Conclusions: Modification of health behavior through education and social empowerment of women are essential for a population based cervical screening program to succeed in India.