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Chughtai N, Perveen K, Gillani SR, Abbas A, Chunara R, Manji AA, Karani S, Noorali AA, Zakaria M, Shamsi U, Chishti U, Khan AA, Soofi S, Pervez S, Samad Z. National cervical cancer burden estimation through systematic review and analysis of publicly available data in Pakistan. BMC Public Health 2023; 23:834. [PMID: 37147640 PMCID: PMC10163779 DOI: 10.1186/s12889-023-15531-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 03/27/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Cervical cancer is a major cause of cancer-related deaths among women worldwide. Paucity of data on cervical cancer burden in countries like Pakistan hamper requisite resource allocation. OBJECTIVE To estimate the burden of cervical cancer in Pakistan using available data sources. METHODS We performed a systematic review to identify relevant data on Pakistan between 1995 to 2022. Study data identified through the systematic review that provided enough information to allow age specific incidence rates and age standardized incidence rates (ASIR) calculations for cervical cancer were merged. Population at risk estimates were derived and adjusted for important variables in the care-seeking pathway. The calculated ASIRs were applied to 2020 population estimates to estimate the number of cervical cancer cases in Pakistan. RESULTS A total of 13 studies reported ASIRs for cervical cancer for Pakistan. Among the studies selected, the Karachi Cancer Registry reported the highest disease burden estimates for all reported time periods: 1995-1997 ASIR = 6.81, 1998-2002 ASIR = 7.47, and 2017-2019 ASIR = 6.02 per 100,000 women. Using data from Karachi, Punjab and Pakistan Atomic Energy Cancer Registries from 2015-2019, we derived an unadjusted ASIR for cervical cancer of 4.16 per 100,000 women (95% UI 3.28, 5.28). Varying model assumptions produced adjusted ASIRs ranging from 5.2 to 8.4 per 100,000 women. We derived an adjusted ASIR of 7.60, (95% UI 5.98, 10.01) and estimated 6166 (95% UI 4833, 8305) new cases of cervical cancer per year. CONCLUSION The estimated cervical cancer burden in Pakistan is higher than the WHO target. Estimates are sensitive to health seeking behavior, and appropriate physician diagnostic intervention, factors that are relevant to the case of cervical cancer, a stigmatized disease in a low-lower middle income country setting. These estimates make the case for approaching cervical cancer elimination through a multi-pronged strategy.
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Affiliation(s)
- Novera Chughtai
- Department of Obstetrics and Gynecology, Aga Khan University, Karachi, Pakistan
| | - Kausar Perveen
- Department of Medicine, CITRIC Health Data Science Center, Aga Khan University, 1st Floor Faculty Office Building, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | | | - Aamir Abbas
- Department of Medicine, CITRIC Health Data Science Center, Aga Khan University, 1st Floor Faculty Office Building, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Rumi Chunara
- Department of Biostatistics, School of Global Public Health, New York University, New York, USA
- Department of Computer Science and Engineering, Tandon School of Engineering, New York University, New York, USA
| | - Afshan Ali Manji
- Department of Medicine, CITRIC Health Data Science Center, Aga Khan University, 1st Floor Faculty Office Building, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Salima Karani
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Maheen Zakaria
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Uzma Shamsi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Uzma Chishti
- Department of Obstetrics and Gynecology, Aga Khan University, Karachi, Pakistan
| | - Adnan A Khan
- Research and Development Solutions, Islamabad, Pakistan
| | - Sajid Soofi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Shahid Pervez
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Zainab Samad
- Department of Medicine, CITRIC Health Data Science Center, Aga Khan University, 1st Floor Faculty Office Building, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan.
- Department of Medicine, Aga Khan University, Karachi, Pakistan.
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Chitha W, Sibulawa S, Funani I, Swartbooi B, Maake K, Hellebo A, Hongoro D, Mnyaka OR, Ngcobo Z, Zungu CM, Sithole N, Godlimpi L, Nomatshila SC, Mabunda SA, Essel V. A cross-sectional study of knowledge, attitudes, barriers and practices of cervical cancer screening among nurses in selected hospitals in the Eastern Cape Province, South Africa. BMC Womens Health 2023; 23:94. [PMID: 36894910 PMCID: PMC9996860 DOI: 10.1186/s12905-023-02251-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 02/28/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Cervical cancer is a preventable but highly prevalent cancer in many low -and middle-income countries including South Africa. Cervical cancer outcomes can be improved with improved vaccination, a well-coordinated and efficient screening programme, increased community awareness and uptake, and increased knowledge and advocacy of health professionals. This study therefore aimed to ascertain the knowledge, attitudes, practices and barriers of cervical cancer screening among nurses of selected rural hospitals in South Africa. METHODS A quantitative cross-sectional study was conducted in five hospitals in the Eastern Cape Province of South Africa between October and December 2021. A self-administered questionnaire was used to assess demographic characteristics of nurses and cervical cancer knowledge, attitudes, barriers and practices. A knowledge score of 65% was deemed adequate. Data were captured in Microsoft Excel Office 2016 and exported to STATA version 17.0 for analysis. Descriptive data analyses were used to report the results. RESULTS A total of 119 nurses participated in the study with just under two thirds (77/119, 64.7%) being professional nurses. Only 15.1% (18/119) of participants were assessed as having obtained a good knowledge score of ≥ 65%. The majority of these (16/18, 88.9%) were professional nurses. Of the participants with a good knowledge score, 61.1% (11/18) were from Nelson Mandela Academic Hospital, the only teaching hospital studied. Cervical cancer was deemed to be a disease of public health importance by 74.0% (88/119). However, only 27.7% (33/119) performed cervical cancer screening. Most of the participants (116/119, 97.5%) had an interest of attending more cervical cancer training. CONCLUSION The majority of nurse participants did not have adequate knowledge about cervical cancer and screening, and few performed screening tests. Despite this, there is a high level of interest in being trained. Meeting these training needs is of utmost importance to implementing a comprehensive cervical cancer screening programme in South Africa.
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Affiliation(s)
- Wezile Chitha
- Health Systems Enablement & Innovation Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Siyabonga Sibulawa
- Health Systems Enablement & Innovation Unit, University of the Witwatersrand, Johannesburg, South Africa.
| | - Itumeleng Funani
- Health Systems Enablement & Innovation Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Buyiswa Swartbooi
- Health Systems Enablement & Innovation Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Kedibone Maake
- Health Systems Enablement & Innovation Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Assegid Hellebo
- Health Systems Enablement & Innovation Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Danleen Hongoro
- Health Systems Enablement & Innovation Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Onke R Mnyaka
- Health Systems Enablement & Innovation Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Ziyanda Ngcobo
- Health Systems Enablement & Innovation Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Christopher M Zungu
- Health Systems Enablement & Innovation Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Nomfuneko Sithole
- Health Systems Enablement & Innovation Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Lizo Godlimpi
- Department of Public Health, Walter Sisulu University, Mthatha, South Africa
| | | | - Sikhumbuzo A Mabunda
- Health Systems Enablement & Innovation Unit, University of the Witwatersrand, Johannesburg, South Africa.,School of Population Health, University of New South Wales, Sydney, Australia.,George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Vivien Essel
- Health Systems Enablement & Innovation Unit, University of the Witwatersrand, Johannesburg, South Africa
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Sreeramulu P, Varsha A, Kattepur AK, Aswathappa D. A questionnaire based survey to assess knowledge and practice of health care workers regarding genital hygiene: from a rural tertiary hospital in India. Hosp Pract (1995) 2022; 50:298-305. [PMID: 35980119 DOI: 10.1080/21548331.2022.2113657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
PURPOSE Maintaining good genital hygiene is an important component in reducing human papilloma virus (HPV) infections and its sequelae such as cervical pre-cancer and cancer. Awareness on the exact practice of maintaining genital hygiene is important as they are different in men and women, and both are equally important in reducing genital HPV infections. STUDY DESIGN A questionnaire based survey was undertaken to assess knowledge and practice of cervical cancer and its relationship with genital hygiene. Interns, post graduate students, consultants and nurses were invited. Domain based assessment was done. Correlation between the domains was performed using Pearson's coefficient. RESULTS 87 respondents completed the questionnaire. 6 domains on awareness of physical and genital hygiene, cervical cancer causation and prevention, health education and personal experience of cervical cancer were explored. In the awareness domains, the response was uniformly poor in 45-50% of respondents. Nurses had poor knowledge in every domain of the questionnaire. CONCLUSIONS There is an urgent need to improve and bridge the gap of knowledge and practice in hygiene and cervical cancer. This is necessary since nurses and interns are the first line for disseminating proper information to the general public. Webinars, seminars and continued medical education (CME) programs must be included in the training curricula to impart knowledge on genital hygiene and cervical cancer.
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Affiliation(s)
- Pnms Sreeramulu
- Department of General Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka, India.,Department of Surgical Oncology, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka, India
| | - A Varsha
- Department of General Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka, India.,Department of Surgical Oncology, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka, India
| | - Abhay K Kattepur
- Department of General Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka, India.,Department of Surgical Oncology, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka, India
| | - D Aswathappa
- Department of General Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka, India.,Department of Surgical Oncology, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka, India
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