Cervical cancer screening prevalence and its correlates in Cameroon: secondary data analysis of the 2018 demographic and health surveys

Impact of telephone reminders on posttreatment follow-up among women treated for cervical precancers in Cameroon: A randomized controlled trial

Background

Effective management of cervical precancerous lesions requires appropriate posttreatment follow-up. In Cameroon like in many Low-and-Middle-Income Countries (LMICs), most women treated for cervical precancers do not present for posttreatment follow-up. The aim of this study was to investigate if a telephone reminder sent to women about missed follow-up appointment could reduce the proportion of those who fail to attend the recommended follow-up, and to examine the association of telephone reminders with posttreatment follow-up adherence.

Methods

We carried out a randomized controlled trial nested within a cohort of women screened and treated for cervical precancer (based on positive VIA/VILI results) in a screen-and-treat cervical cancer prevention program in Cameroon. Women who had met clinical criteria for posttreatment follow-up of cervical precancer and did not attend the follow-up appointment within 3 years of precancer treatment were randomly selected and allocated in a 1:1 ratio to the intervention group (receiving a telephone call and text message reminder in addition to the counselling done at the clinic after precancer treatment) and the control group (no telephone reminder after the in-clinic counselling following precancer treatment, per standard of care). Women in the intervention group were contacted by phone, reminded on the importance of posttreatment follow-up they had missed, and invited to return to the clinic for follow-up. The telephone calls were followed by a text message to enhance the understanding of the telephone conversation. The rate of posttreatment follow-up in the intervention group was compared to that of the control group six months after the telephone reminders. A logistic regression analysis was carried out to examine the association between telephone reminders and posttreatment follow-up adherence. Statistical significance was set at p < 0.05.

Results

Between 2022 and 2023, up to 203 women treated for cervical precancers who failed to return to the hospital for posttreatment follow-up within 3 years of receiving precancer treatment were enrolled in this study. Posttreatment follow-up following the telephone reminders was 25.6 % (22/86) and 6.1 % (6/99) in the intervention and control groups, respectively (p<0.001). In the logistic regression analysis, women who received the telephone reminders were four times [aOR = 3.97, 95 %CI (1.29--12.17), p=0.016)] more likely to return for precancer posttreatment follow-up compared to those who did not receive the telephone reminders. Women treated for low-grade cervical precancerous lesions were over five times [aOR=5.44, 95%CI (1.00   29.63), p = 0.059] more likely to attend posttreatment follow-up compared to those treated for high-grade lesions. HIV status was not associated with adherence to posttreatment follow-up. The overall posttreatment follow-up rate increased significantly (p = 0.0024) from 26.45 % (73/276) at baseline, to 36.59 % (101/276) following the intervention.

Conclusion

Telephone reminders of women treated for cervical precancer who missed their posttreatment appointment in screen-and-treat program in Cameroon significantly increased adherence to posttreatment follow-up. Despite these promising findings, the overall rate of missed posttreatment appointment remained high, suggesting that beyond the lack of education, other factors such as cultural, financial and geographic barriers may play a role in the observed poor adherence to posttreatment follow-up in LMICs. Incorporating telephone reminders into the health package of services for cervical precancer prevention in these settings can improve adherence to posttreatment follow-up.

Knowledge and Prevalence of Cervical Cancer Screening Among Women Receiving Prenatal Care in Accra, Ghana: A Cross-Sectional Study

Objectives

The primary purpose of this study was to assess the knowledge and prevalence of cervical cancer screening (CCS) among women attending prenatal care clinics in the Okaikwei North Municipal Assembly (ONMA) in the Greater Accra region, Ghana. The study also aimed to examine whether there were differences in CCS knowledge between the women attending the prenatal care clinics.

Design

This study utilized a cross-sectional, quantitative approach and a two-stage cluster sampling method.

Setting

The study involved 393 women receiving prenatal care at three health facilities in the district, namely NK Salem Medical Centre Hospital (NMCH), Achimota Hospital (AH), and Lapaz Community Hospital (LCH).

Primary outcome

Level of Knowledge and Prevalence of CCS.

Results

The sampled participants from the three hospitals were Achimota (36.6%), Lapaz Community (32.1%), and NK Salem (31.3%). The mean age (SD) was 29.7 (±3.8) years. The age group 21 to 30 years formed the majority (57.8%). The prevalence of CCS among women receiving prenatal care was 7.4%; although most of them had heard about CCS, a proportion (46.5%) of them did not know CCS was, and only 33.9% knew Pap Smear as the test for detecting cervical cancer. A very small proportion (19.8%) of the women receiving prenatal care had CCS knowledge. There was a statistically significant difference in mean knowledge by 1.47 between women receiving prenatal care at AH and LCH, as well as by 1.82 between NMCH and LCH.

Conclusion

There was a very low knowledge and prevalence of CCS in the district. Knowledge of CCS differed significantly between the health facilities in the district.

Correlates of cervical cancer awareness among women aged 30-49 in five sub-Saharan African nations: Evidence from the Demographic and Health Survey (DHS)-2017-2023

Cervical cancer is the leading cause of cancer-related mortality in low- and middle-income countries (LMICs). Prior studies associate high cervical cancer awareness with reductions in cervical cancer incidence. In this study, we utilize nationally representative Demographic and Health Surveys Program (DHS) to analyze correlates of cervical cancer awareness to inform global strategies. All DHS surveys between 2017-2023 were queried for questions on cervical cancer awareness. Socio-demographic variables (e.g., age, marital status), socioeconomic variables (e.g., education, wealth, literacy) and variables pertaining to healthcare decision making, distance traveled, intimate partner violence (IPV), and female genital mutilation/circumcision (FGC/M)) were extracted. Sample weights were applied, and logistic regressions were performed. Variables with p < 0.20 were included in multivariate analysis. Data was obtained from 30,214 women aged 30-49 years old living in Benin, Cameroon, Madagascar, Mauritania, and Mozambique, 19,403 of whom were asked questions on cervical cancer awareness. Cervical cancer awareness varied from 53% in Cameroon to 12% in Benin. Literacy, frequency of watching television, mobile telephone ownership, visiting a local healthcare facility and hormonal contraceptive use were associated with increased cervical cancer awareness, while lack of healthcare decision making independence was associated with decreased awareness after multivariate adjustment. Women who experienced emotional IPV were associated with increased awareness in Cameroon. Less than 4% of all women were screened for cervical cancer. Given the known association between awareness and screening, targeted efforts to increase awareness among women without communication modalities has the potential to reduce global cervical cancer disparities. Potential strategies include co-locating cervical cancer awareness programs with public health programs and implementing large-scale telecommunication outreach programs to improve awareness.

Effect of girls' education on cancer awareness and screening in a natural experiment in Lesotho

Breast and cervical cancers are important causes of disability and premature death among women in Sub-Saharan Africa. Previous research has linked girls' education to cancer service access. Here, we examine the causal effect of girls' educational attainment on cancer screening practices by means of a natural experiment in Lesotho. In particular, we exploit variation in educational attainment among women that was introduced by an educational policy (a school-entry age cut-off). Data on awareness towards breast cancer, knowledge of Pap smear, breast self-exam, breast clinical exam, and having received a Pap smear is extracted from the Lesotho Demographic and Health Surveys 2009-10 and 2014 (N = 7971). Each additional year of schooling caused by the education policy increases awareness of breast cancer by 4.7 percentage points (p = 0.014, 95% Confidence Interval [CI]: 1.0, 8.5), awareness of Pap smear by 5.9 percentage points (p = 0.001, 95% CI: 2.3, 9.5), and engagement in Pap smear by 3.5 percentage points (p = 0.004, 95% CI: 1.1, 5.8). We found no statistically significant effects on breast self-exam and breast clinical exam.

Mass Media Exposure and Cervical Cancer Screening in Rural Sub-Saharan Africa: A Multi-Country Cross-Sectional Analysis

Background and Aims

Cervical cancer is a pressing global public health challenge, with sub-Saharan Africa (SSA) experiencing disproportionately high incidence and mortality rates compared to other regions. Early detection through screening and timely treatment is essential for mitigating the burden of this disease. Evidence suggests that mass media exposure can play a pivotal role in increasing cervical cancer screening uptake. This study aimed to examine the prevalence of cervical cancer screening in SSA and to identify factors associated with screening uptake, with a specific focus on the influence of mass media among rural women.

Methods

The analysis utilized data from the Demographic and Health Surveys (DHS) conducted in 11 SSA countries, encompassing responses from 72,565 rural women of reproductive age (15-49 years). The primary outcome variable was cervical cancer screening status. Descriptive statistics, including frequencies and cross-tabulations, were employed to characterize the sample. Given the skewed distribution of the outcome variable, complementary log-log regression models were applied to estimate adjusted odds ratios (AORs) in both bivariate and multivariable analyses. Robustness of the statistical models and their fitness were rigorously assessed to ensure the validity of the findings.

Results

The overall prevalence of cervical cancer screening among women in the 11 countries was 8.47%. Women with exposure to mass media were significantly more likely to undergo screening. Specifically, women who watched television less than once a week (AOR = 1.22, 95% CI: 1.07-1.38) or at least once a week (AOR = 1.39, 95% CI: 1.26-1.53) had higher odds of being screened compared to those with no exposure to television. Similar positive associations were observed for radio and newspaper/magazine exposure. Women who listened to the radio at least once a week (AOR = 1.59, 95% CI: 1.45-1.74) and those who read newspapers/magazines at least once a week (AOR = 1.68, 95% CI: 1.48-1.90) demonstrated increased odds of undergoing screening. Additional predictors of screening included older age, higher education levels, greater wealth, higher parity, and fewer barriers to accessing healthcare, such as not needing permission or assistance to seek care.

Conclusion

This study highlights the critical role of mass media-television, radio, and newspapers/magazines-in promoting cervical cancer screening among rural women in SSA. Public health stakeholders and governments should prioritize leveraging these platforms to design and disseminate culturally tailored campaigns aimed at overcoming barriers to screening in rural communities. By optimizing the reach and effectiveness of mass media, particularly traditional channels prevalent in rural SSA, cervical cancer screening rates can be significantly improved, thereby reducing the disease burden in the region.

HPV E6/E7-Induced Acetylation of a Peptide Encoded by a Long Non-Coding RNA Inhibits Ferroptosis to Promote the Malignancy of Cervical Cancer

Although a fraction of functional peptides concealed within long non-coding RNAs (lncRNAs) is identified, it remains unclear whether lncRNA-encoded peptides are involved in the malignancy of cervical cancer (CC). Here, a 92-amino acid peptide is discovered, which is named TUBORF, encoded by lncRNA TUBA3FP and highly expressed in CC tissues. TUBORF inhibits ferroptosis to promote the malignant proliferation of CC cells. Mechanistically, human papillomavirus (HPV) oncogenes E6 and E7 upregulate TUBORF through CREB-binding protein (CBP)/E1A-binding protein p300 (p300)-mediated histone H3 lysine 27 acetylation (H3K27ac) of lncTUBA3FP enhancer. Furthermore, E6 and E7 elevate and recruit acetyltransferase establishment of sister chromatid cohesion N-acetyltransferase 1 (ESCO1) to bind to and acetylate TUBORF, which facilitates the degradation of immunity-related GTPase Q (IRGQ) via a ubiquitin-proteasome pathway, resulting in the inhibition of ferroptosis and promotion of the malignant proliferation of CC cells. Importantly, silencing ESCO1 or TURORF amplifies anticancer effects by paclitaxel both in CC cells and in vivo. These novel findings reveal oncopeptide TUBORF and its acetyltransferase ESCO1 as important regulators of ferroptosis and tumorigenesis during cervical cancer pathogenesis and establish the scientific basis for targeting these molecules for treating CC.

Cervical cancer screening uptake and its predictors among women aged 30-49 in Ghana: Providing evidence to support the World Health Organization's cervical cancer elimination initiative

INTRODUCTION

Cervical cancer remains a global health challenge, disproportionately affecting women in low- and middle-income countries, including Ghana. Hence, this study examined the regional variations and predictors of cervical cancer screening uptake among women aged 30-49 in Ghana.

METHODS

Data for this study was obtained from the 2022 Ghana Demographic and Health Survey, comprising 7,124 women aged 30-49. The regional variations in women's uptake of cervical cancer screening was presented using spatial map. A mixed-effect multilevel binary logistic regression was used to examine the factors associated with cervical cancer screening uptake. The results were presented using adjusted odds ratios (aORs) with 95% confidence intervals (CIs).

RESULTS

The uptake of cervical cancer screening was 7.27% [6.33, 8.35] in Ghana. Significant variations in cervical cancer screening existed across regions, with the lowest uptake in Western, Oti, Savannah, and North East regions. Women in rural areas had lower odds of being screened for cervical cancer [aOR = 0.46; 95% CI = 0.28, 0.76] compared to those in urban areas. Women living in the Central, Greater Accra, Volta, Eastern, Ashanti, Ahafo, Bono East, Oti, Northern, North East, Upper East, and Upper West regions all had higher odds of undergoing cervical cancer screening compared to those in the Western region. Women with higher education [aOR = 2.71; 95% CI = 1.23, 5.94] were more likely to be screened for cervical cancer compared to those with no formal education. Women who visited a health facility in the past year had higher odds of being screened for cervical cancer [aOR = 1.48; 95% CI = 1.02, 2.15] relative to those who did not. Reading newspapers or magazines increased the odds of cervical cancer screening uptake [aOR = 1.80; 95% CI = 1.10, 2.92] . Women who belonged to the middle [aOR = 2.19; 95% CI = 1.07, 4.49], richer [aOR = 2.85; 95% CI = 1.28, 6.38], and richest [aOR = 3.08; 95% CI: 1.25, 7.59] wealth indices were more likely to be screened for cervical cancer compared to those in the poorest wealth index.

CONCLUSIONS

Our findings highlight critical disparities in cervical cancer screening uptake in Ghana, particularly emphasizing the need for targeted interventions to address the lower screening rates among women in the Western, Oti, Savannah, and North East regions. The significant association between cervical cancer screening uptake and healthcare access, media exposure, and wealth underscores the importance of enhancing healthcare infrastructure and outreach in underserved regions. To improve screening rates, it is recommended that public health initiatives focus on increasing awareness through community education programs, promoting health facility visits, and leveraging media platforms to disseminate information about cervical cancer screening. Additionally, policies should aim to reduce geographical and socioeconomic barriers, ensuring equitable access to screening services across all regions, especially for women in lower wealth quintiles.

Multiple sexual partnership as an independent predictor of cervical cancer screening among women of reproductive age: an analysis of the 2022 Kenya demographic and health survey

BACKGROUND

Literature shows that women's sexual behavior, specifically, engagement in multiple sexual partnerships (MSP) has some association with the risk of developing cervical cancer. In the context of the Kenyan demographic and health survey, MSP is defined as having more one sexual partner excluding spouse, in last 12 months. Yet, it is unclear how engagement in MSP independently predicts women's uptake of cervical cancer screening (CCS). The study examined the association between recent MSP and CCS uptake among women of reproductive age in Kenya.

METHODS

Data of 16,824 women aged 15-49 who participated in the 2022 Kenya demographic and health survey was used. Recent MSP was defined as having more than one sexual partner, excluding spouse, in last 12 months. The analysis was carried out in STATA version 18. Chi-square tests, bivariable and multivariable logistic regression were performed. The adjusted odds ratio from the multivariable logistic regression were reported along with the 95% confidence interval (CI).

RESULTS

The analysis shows that only 16.68% of the sampled women (i.e., 2,837 out of a total sample of 16,824) had ever been screened for cervical cancer by a healthcare professional. In the bivariable analysis, women who were involved in MSP were more likely [OR = 1.20; 95%CI: 1.07-1.34] to undergo screening for cervical cancer compared to those not involved in MSP. This association remains significant after adjusting for confounders [AOR = 1.34; 95%CI: 1.19-1.52].

CONCLUSION

The low screening rate in Kenya is concerning given the importance of early detection in improving cervical cancer outcomes. The study concludes that recent engagement in MSP is significantly associated with women's uptake of CCS. The study further concludes that there is a need for public health campaigns to raise awareness about the importance of cervical cancer screening among all women, regardless of their sexual behavior. Educational initiatives must emphasize that cervical cancer screening is crucial for all women, not just those with MSP.

Population-based cross-sectional survey of cervical cancer screening prevalence and socio-demographic correlates in Bangladeshi women

BACKGROUND

Cervical cancer, albeit preventable, is the second-most deadly gynecological cancer in developing nations. Little is known about cervical cancer among Bangladeshi women. This study aims to estimate the prevalence of cervical cancer screening and demographic correlates to identify potential variabilities in screening rates among different demographic groups and regions.

METHODS

This study used secondary data from the WHO STEPS 2018 Survey. We used Bayesian regression to perform the bivariate analyses between the outcome and each explanatory factor, as it generates more acceptable results and improves parameter estimates. The top-ranked socio-demographic factors were identified using a two-step cluster analysis. This method determines the relevance of predictor variables and automatically establishes the number of clusters.

RESULTS

The prevalence of Bangladeshi women who had ever been screened for cervical cancer was 6.2%. In the adjusted model, women with the following socio-demographic factors had a higher likelihood of developing cervical cancer: being 18-29 years old (AOR = 3.3, 95% CI: 0.24, 15.27) or 45-59 years old (AOR = 2.8, 95% CI: 1.22, 6.0), currently married (AOR = 2.3, 95% CI: 1.36, 3.70), and employed (AOR = 2.4, 95% CI: 1.40, 4.06). Women in the Barisal division were found to have higher odds of being screened for cervical cancer (AOR = 21, 95% CI: 0.66, 121.97). Cluster analysis found residence status predisposes women to cervical cancer screening.

CONCLUSION

There is a significant potential for substantial reductions in the burden of cervical cancer in Bangladesh by strengthening the application of cervical cancer screening. Future studies should examine how socioeconomic status, culture, and healthcare access affect cervical cancer screening trends for different divisions in Bangladesh. An independent national cancer registry is urgently needed to evaluate screening trends and outcomes.

Determinants of cervical cancer screening among women of childbearing age in four sub-Saharan African countries: insights from large population surveys

BACKGROUND

Cervical cancer is the most common cause of cancer-related mortality among women in Africa. Cervical cancer screening in women is associated with decreased incidence and mortality of cervical cancer. There is a dearth of recent data regarding the prevalence and associated factors of cervical cancer screening in sub-Saharan Africa. Therefore, this study is intended to determine the prevalence and associated factors impacting cervical cancer screening among women in four sub-Saharan African countries.

METHODS

Data from the recent demographic and health surveys of four countries in sub-Saharan Africa conducted between 2022 and 2023. Multilevel mixed-effects logistic regression was used to determine the factors associated with the outcome variable. Variables with a p-value < 0.05 were declared statistically significant.

RESULTS

The prevalence of cervical cancer screening among women of childbearing age in four sub-Saharan African countries was 8.90% (95% CI: 8.67%, 9.13%). At the individual level, being older, educated, non-breastfeeding, employed, wealthier, sexually active, using contraceptives, having media exposure, visiting healthcare facilities in the last 12 months, and residing in urban areas were associated with higher odds of cervical cancer screening. At the community level, being from communities with a high level of literacy and media exposure increases the odds of cervical cancer screening among women in sub-Saharan Africa.

CONCLUSION

The prevalence of cervical cancer screening among childbearing-age women was found to be low. To improve cervical cancer screening practices among women of childbearing age, it is therefore advised to support women's empowerment, mass media campaigns, and regular visits to healthcare facilities.

Challenges faced in managing cervical cancer patients who present post-operatively with more advanced disease in LMICs: Case studies from Cameroon

Cameroon is a low-and-middle income country (LMIC) with one of the highest incidence and mortality from cervical cancer in Africa. In this Central African country where the prevalence of human immunodeficiency virus (HIV) is high and the screening coverage is low, cervical cancer is the most deadly and the second most common cancer among women. Notwithstanding the growing burden of cervical cancer in Cameroon, most patients - often of lower socioeconomic status - continue to encounter multi-level barriers to timely and adequate care. These include the lack of physical and financial access to healthcare facilities, limited quality pathology, imaging and treatment services, ignorance of disease by the population, shortage of a well-trained oncology workfroce, which result in significant delays in gaining access to screening, diagnosis, treatment and care. This paper presents 3 cases of patients with advanced cervical cancer who had surgery (hysterectomy) as primary treatment, without appropriate post-surgical investigation to further specify disease stage, persistence of residual disease, and need for adjuvant chemoradiation. Pathology services and diagnostic imaging procedures remain scarce and underused in LMIC countries like Cameroon. Healthcare professionals involved in patient care lack adequate knowledge, skills and collaborative strategy to properly navigate these patients. To address these challenges, the health system should be reinforced with adequate infrastructures, sustainable funding should be secured to enhance universal health coverage and promote cancer prevention and control programs, multidisciplinary teams and coordination of care among providers should be improved, and relevant health indicators should be put in place to better monitor the quality of care delivered to patients who are mostly vulnerable and uninformed.

Factors associated with age at first screening for cervical cancer among adult Cape Verdean women: a cross-sectional study

BACKGROUND

Cervical cancer ranks third in terms of cancer incidence and mortality in Cape Verde. Understanding the factors associated with the age of cervical cancer screening (CCS) is essential because it helps identify populations at risk of delayed screening, enabling targeted interventions to ensure timely detection and treatment, ultimately reducing the burden of cervical cancer. We examined the factors associated with age at first screening for cervical cancer among adult Cape Verdean women.

METHODS

Data from the 2020 WHO STEPs survey were used. We analyzed data from 1,082 women aged 30-69 years who had ever screened for cervical cancer. Bivariable and multivariable logistic regression models were computed in STATA version 18.

RESULTS

Overall, 30.6% of women in the study had their first CCS before or at age 30. Except for visits to the health facility within the last 12 months, all variables significantly predicted women's first age for CCS in the crude model. In the adjusted model, women with tertiary education showed greater odds [AORs = 9.85; 95% CI: 4.12-23.54] compared to those with no formal education. Compared to those who were never married, previously married women had significantly lower odds of screening at an early age [AOR = 0.63; 95% CI: 0.39-0.99]. Women without hypertension had higher odds [AOR = 1.66; 95% CI: 1.18-2.34] of early screening compared to those with hypertension. Also, women who were currently working had significantly higher odds of early screening than those unemployed [AOR = 1.49; 95% CI: 1.09-2.04].

CONCLUSION

In conclusion, implementing targeted educational campaigns, addressing socio-economic barriers, and integrating cervical cancer screening into routine healthcare services can increase the early screening uptake among Cape Verdean women. There is a need to integrate CCS in the routine healthcare services of women living with hypertension. Also, the positive association between formal education and age at first screening, it is imperative for the Cape Verdean public health departments to implement comprehensive education programs within schools to promote awareness about CCS.

Early age at menarche and history of sexually transmitted infections significantly predict cervical cancer screening uptake among women aged 25-49 years: evidence from the 2021 Côte d'Ivoire demographic and health survey

INTRODUCTION

Cervical cancer is the second dominant type of cancer among Ivorian women with an estimated age-standardised incidence and mortality rate of 31.2 cases and 22.8 deaths per 100,000 women in 2020, respectively. The Ivorian government through its Ministry of Health implemented the National Cancer Control Programme (NCCP) in 2003 with the aim of improving the prevention, early detection and treatment of cancers in Côte d'Ivoire. Yet, there is a low uptake of CCS (1.2%). Thus, making CCS uptake an important public health concern in the country. Understanding of the extent to which reproductive factors predict CCS uptake is limited in literature. This study aimed to investigate reproductive factors as a predictor of women's uptake of CCS in Côte d'Ivoire.

METHODS

Data from the 2021 Côte d'Ivoire Demographic and Health Survey. A sample of 9,078 women aged 25-49 years were analyzed. The outcome variable was CCS uptake while other variables considered included age at menarche, history of STI, sexual debut, parity, age, educational level, wealth index, health insurance, place of residence, and media exposure. A multivariable logistic regression model was fitted to examine the association between the outcome of interest and predictors at 95% confidence interval.

RESULTS

Approximately, 7.52% of women aged 25-49 years had ever undergone testing for cervical cancer by a healthcare provider. Early menarche was associated with lower odds of CCS uptake [AOR = 0.78; CI = 0.65-0.95]. Compared to those who had no STI, women with a history of STI were more likely to screen for cervical cancer [AOR = 2.63; CI = 2.02-3.42]. Increasing age, higher educational attainment, having health insurance, and being exposed to media were significantly associated with CCS uptake.

CONCLUSION

In Cote d'Ivoire, age at menarche and STI history constitute reproductive factors that were significantly associated with women's uptake of CCS. It is imperative for public policy to focus on increasing CCS in these higher-risk women (i.e., women who experienced early menarche, women with early sexual debut and higher parity) through increased sensitization on cervical cancer risk factors.

Drivers of cervical cancer prevention and management in sub-Saharan Africa: a qualitative synthesis of mixed studies

BACKGROUND

Cervical cancer is a public health concern in the sub-Saharan Africa region. Cervical cancer screening is one of the strategies for detecting early precancerous lesions. However, many women have poor access to and utilization of screening services in the region. This review aimed to synthesize evidence on the challenges and opportunities of screening, early detection and  management of cervical cancer in sub-Saharan Africa.

METHODS

We conducted a structured narrative review of studies published in English. We included studies published from 1 January 2013 to mid-2022. Studies were selected following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Key search terms (detractors and enablers, cervical cancer screening, sub-Saharan Africa) were employed to identify studies from three electronic databases (HINARI, Science Direct, and PubMed). We also conducted searches on Google Scholar to identify relevant grey literatures. A thematic analysis was conducted and themes were identified, then explained using a socio-ecological framework (intrapersonal, interpersonal, organizational, community, policy levels).

RESULTS

We identified 60 studies in the final review. Cervical cancer screening and early detection and management programmes are influenced by drivers at multiple levels. Individual-level drivers included a lack of knowledge about cervical cancer and screening literacy, and a low risk in perception, attitude, susceptibility and perceived fear of test results, as well as sociodemographic characteristics of women. Interpersonal drivers were community embarrassment, women's relationships with health workers, support and encouragement, the presence of peers or relatives to model preventive behaviour, and the mothers' networks with others. At the organizational level, influencing factors were related to providers (cervical cancer screening practice, training, providers' profession type, skill of counselling and sex, expert recommendation and work commitments). At the community level, drivers of cervical cancer screening included stigma, social-cultural norms, social networks and beliefs. System- and policy-level drivers were lack of nearby facilities and geographic remoteness, resource allocation and logistics management, cost of screening, promotion policy, ownership and management, lack of decentralized cancer policy and lack of friendly infrastructure.

CONCLUSIONS

There were several drivers in the implementation of cervical cancer screening programmes at multiple levels. Prevention and management of cervical cancer programmes requires multilevel strategies to be implemented  across the individual level (users), community and organizational levels (providers and community users), and system and policy levels. The design and implementation of policies and programmes need to address the multilevel challenges.

Electronic aggregated data collection on cervical cancer screening in Bangladesh since 2014: what the data tells us?

INTRODUCTION

To reduce the high prevalence of cervical cancers among the Bangladeshi women, the Government of Bangladesh established a national cervical cancer screening programme in 2005 for women aged 30 to 60 years. The District Health Information System Version 2 (DHIS2) based electronic aggregated data collection system is used since the year 2013. This study summarises data from the year 2014 to 2022 to assess the effectiveness of the electronic data collection system in understanding the outcome of the screening programme.

METHODS

This is a descriptive study based on secondary data extracted in MS Excel from the DHIS2-based electronic repository of the national cervical cancer screening programme of Bangladesh. The respondents were women aged 30-60 years, screened for cervical cancer using VIA (Visual Inspection of cervix with Acetic acid) method in 465 government health facilities. The data were collected on the participants' residential location, month and year of screening, name and type of health facilities performing VIA, and VIA screening results.

RESULTS

The national screening programme reported a total 3.36 million VIA tests from 465 government hospitals in 8 years (2014 to 2022). The national average VIA-positivity rate was 3.6%, which varied from 1.4 to 9.5% among the districts. This national screening programme witnessed an exponential growth, year after year, with 83.3% increase in VIA test from 2014 to 2022. The primary and the secondary care hospitals were the highest collective contributors of VIA tests (86.2%) and positive cases (77.8%). The VIA-positivity rates in different hospital types varied widely, 7.0% in the medical university hospital, 5.7% in the medical college hospitals, 3.9% in the district/general hospitals, and 3.0% in the upazila health complexes.

CONCLUSIONS

A national cervical cancer screening programme using VIA method and a DHIS2-based electronic data collection backbone, is effective, sustainable, and useful to understand the screening coverage, VIA positivity rate and geographic distribution of the participants and case load to initiate policy recommendations and actions. Decentralization of the screening programme and more efforts at the primary and secondary care level is required to increase screening performances.

Prevalence and Predictive Factors of Cervical Cancer Screening in Saudi Arabia: A Nationwide Study

BACKGROUND

Cervical cancer, despite being preventable, is one of the most prevalent cancers among females globally and in Saudi Arabia. The literature demonstrated that, unlike global trends, cervical cancer incidence in Saudi Arabia is increasing. In addition to that, a high proportion of it is discovered in advanced stages. This state of late discovery was attributed to the absence of efficient preventive and screening programs. Observing the scale of the preventable morbidities and mortalities that can be caused by cervical cancer and the efforts and costs that are positioned to fight cervical cancer across the globe and the current ambiguity in the cervical cancer screening prevalence in Saudi Arabia brings the realization of the importance of conducting a study that properly explores the status of cervical cancer screening in Saudi Arabia.

AIM

This study aims to measure the prevalence and the predictive factors for cervical cancer screening among adult women who were previously sexually active in Saudi Arabia, as well as explore the participants' knowledge and attitude toward cervical cancer and human papillomavirus (HPV) vaccines.

METHODS

This study was a nationwide cross-sectional study conducted in Saudi Arabia between September 2023 and November 2023 on adult Saudi females between the ages of 21 and 65 years who were previously sexually active and did not undergo a hysterectomy. Data were collected through a convenience sampling technique where a self-administered survey was established and disseminated to the targeted population all over the country with the assistance of data collectors. Cervical cancer screening prevalence and screening predictive factors were measured. Factors associated with cervical cancer screening and knowledge of cervical cancer were tested using a chi-square test, an independent t-test, and an ANOVA test. Multivariate logistic regression was also used to determine predictors of cervical cancer screening.

RESULTS

The study included 2,337 participants. The prevalence of cervical cancer screening among Saudi females was observed to be 22.1%. The most commonly reported reason for not undergoing cervical cancer screening was that it was never recommended by a physician, as reported by 42.4%. Only 7.6% reported taking the HPV vaccine. The majority of the participants (84.1%) had a low knowledge level about cervical cancer. The multivariate logistic regression model revealed that the following factors were observed to be significantly predictive of undergoing cervical cancer screening: being 46-59 years of age (74% increase rate), having an income greater than 20,000 Saudi Riyals (SRs) (158% increase rate), having a history of gynecological problems (152% increase rate), knowing someone who underwent cervical cancer screening (393% increase rate), and receiving a recommendation from a healthcare practitioner to undergo cervical cancer screening (1300% increase rate).

CONCLUSION

There are clearly low rates of cervical cancer screening and even lower rates of uptake for the HPV vaccine, which are the prevention measures for cervical cancer. National initiatives and programs that promote HPV vaccine uptake and regular cervical cancer screening are highly recommended to minimize the morbidity and mortality of cervical cancer.

Prostate cancer screening uptake in Kenya: An analysis of the demographic and health survey

BACKGROUND

Prostate cancer (PCa) screening is a cost-effective strategy to promote early detection and treatment. Understanding the determinants of PCa screening uptake would help policy makers to identify high-risk populations and ensure the cost-effectiveness of health promotion interventions. This study aims to estimate the prevalence of PCa screening uptake and assess its associated factors among Kenyan men.

METHODS

The study relied on data from the 2014 Kenya Demographic and Health Survey. Both descriptive and inferential analyses were performed. Firth logistic regression was employed using the "firthlogit" command in STATA. The adjusted odds ratio and 95% confidence interval were presented.

RESULTS

Overall, the prevalence of PCa screening uptake was 4.4%. The odds of PCa screening uptake were high among men aged 50-54 [aOR= 2.08; CI= 1.23, 3.52], those who had health insurance coverage [aOR= 1.69; CI= 1.28, 2.23], those who read at least once in a week [aOR= 1.52; CI= 1.10, 2.10], and among those who watched TV at least once in a week [aOR= 1.73; CI= 1.18, 2.52]. Men who resided in the Eastern [aOR= 2.23; CI= 1.39, 3.60], Nyanza [aOR= 2.13; CI= 1.29, 3.53], and Nairobi [aOR= 1.97; CI= 1.01, 3.86] had a higher likelihood of getting screened for PCa.

CONCLUSION

In conclusion, the uptake of PCa screening in Kenya is low. To ensure the cost-effectiveness of health-promoting interventions that aim to improve PCa screening uptake in Kenya, men without health insurance coverage should be targeted and prioritized. Increasing literacy rate, sensitization via television, and increasing the insurance coverage in the country would significantly contribute to a higher uptake of PCa screening.

POLICY SUMMARY

To improve the uptake of PCa screening, there would be a need to implement a national advocacy campaign that will sensitize Kenyan men about the need to undergo PCa screening. This national advocacy campaign to increase the uptake of PCa screening in Kenya must leverage mass media platforms.

Body mass index and cervical cancer screening among women aged 15-69 years in Eswatini: evidence from a population-based survey

BACKGROUND

Cervical cancer stands as one of the most prevalent cancer types among women, despite its preventable nature through early screening and vaccination strategies. The link between being overweight or obese and various adverse health outcomes, including an elevated cancer risk, is well established. Within this study, our central objective was to explore the correlation between body mass index (BMI) and cervical cancer screening (CCS) rates. Moreover, we sought to investigate whether socioeconomic status potentially modulates this relationship.

METHODS

Our analysis encompassed 1791 respondents who participated in the World Health Organization's STEPwise approach to noncommunicable disease risk factor surveillance carried out in Eswatini in 2014. We assessed the connection between BMI, along with other determinants, and CCS through both unadjusted and adjusted logistic regression models.

RESULTS

The uptake of CCS was 14.4% and the prevalence of overweight and obesity was estimated at 28.1 and 34.9% respectively. After accounting for other pertinent variables, the likelihood of obtaining CCS was amplified for individuals classified as obese (adjusted odds ratio [aOR] = 1.99, 95% confidence interval [CI] = 1.26-3.12) or overweight (aOR = 1.98, 95% CI = 1.05-3.74). Furthermore, factors such as being separated or divorced (aOR = 2.03, 95% CI = 1.11-3.72) and engaging in regular physical exercise (aOR = 3.02, 95% CI = 1.21-6.02) were associated with increased odds of undergoing CCS.

CONCLUSIONS

This study underscores the noteworthy role played by both overweight and obesity, in conjunction with various socioeconomic factors, in shaping CCS patterns among the surveyed women. For Eswatini, targeted interventions aimed at enhancing CCS participation should take into account the multifaceted factors highlighted within this investigation.

Disparities in cervical cancer screening programs in Cameroon: a scoping review of facilitators and barriers to implementation and uptake of screening

BACKGROUND

Cervical cancer is the fourth most common cancer worldwide. Organized screening has achieved significant reductions in cervical cancer incidence and mortality in many high-income countries (HICs). But the gap between HICs and low-and-middle-income countries (LMICs) is still substantial as the highest burden of the disease is in LMICs. Cameroon is a LMIC, where cervical cancer is the leading cause of cancer-related deaths among women, only 3-5% of eligible women have been screened and there is no effective national cervical cancer prevention program.

OBJECTIVE(S)

Identify facilitators and barriers to the implementation and uptake of existing cervical cancer screening programs in Cameroon to inform the implementation of a comprehensive national program.

METHODS

We conducted a scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-analysis, extension for Scoping Reviews (PRISMA-ScR). Google Scholar and five electronic databases (PubMed, CINAHL, Embase, Cochrane library and Web of Science) were searched systematically from 2012 to 2022. Articles on cervical cancer screening programs in Cameroon were eligible for inclusion. Two reviewers independently screened search results and extracted relevant data.

RESULTS

A total of 182 articles were identified using our search strategy, and 20 were included. There was scarcity of publications from the North, Adamawa, East and South regions of Cameroon. Barriers and facilitators found were presented using the World Health Organisation framework for health systems. Cross-cutting barriers were: (1) the lack of a national training curriculum for screening providers with no elaborate, harmonized screening and treatment algorithm for cervical precancers; and (2) women's lack of information about cervical cancer screening activities. Conversely, provision of screening services at a low or no cost to women in some programs and the feasibility of using novel point of care screening methods like the Human Papillomavirus DNA test were identified as facilitators.

CONCLUSION

This scoping review indicates that there are knowledge and research gaps concerning the state of cervical cancer screening services in some regions of Cameroon. Moreover, it underlines the need for comprehensive cancer control policies and practices integrating all six-health system building blocks to reduce disparities between regions, and rural versus urban areas in Cameroon.

Prevalence and determinants of breast self-examination practices among women in their reproductive age in Namibia: an analysis of the 2013 Namibia demographic and Health Survey

BACKGROUND

In resource-constrained settings like Namibia, breast self-examination (BSE) is considered an important cost-effective intervention that is critical to the early detection of breast cancer, and better prognosis. Even though BSE is a simple, quick, and cost-free procedure, its practice varies across different contexts. Knowing the determinants of BSE is necessary to inform the implementation of policies and targeted interventions to improve the practice across the population. In Namibia, estimating the magnitude of BSE practice and its determinants using nationally representative data has received limited scholarly attention. Hence, the present study sought to examine the prevalence and determinants of BSE practices among women of reproductive age in Namibia.

METHODS

This study relied on the 2013 Namibia Demographic and Health Survey (NDHS), analysing data from women aged 15-49 years. Statistical analyses including bivariate and multivariate logistic regression analyses were done using Stata version 14. Adjusted odds ratio (AOR) and confidence interval (CI) are presented. We followed the 'Strengthening the Reporting of Observational Studies in Epidemiology' (STROBE) statement.

RESULTS

Only 30.67% of the respondents practiced BSE. The odds of performing BSE were higher among those with health insurance coverage [AOR = 1.59, 95% CI: 1.34, 1.89], those who were separated from their spouses [AOR = 1.36, 95% CI: 1.03, 1.80], those within the richest wealth index [AOR = 1.69, 95% CI: 1.23, 2.33, p ≤ 0.001], and among Catholics [AOR = 0.84, 95% CI: 0.71, 0.98]. Women with secondary [AOR = 2.44, 95% CI:1.78, 3.35, p ≤ 0.001] or higher education [AOR = 3.39, 95%CI:2.24, 5.14] had higher odds of performing BSE. Women aged between 20-49 years had a significantly higher likelihood to practice BSE. Compared to women who live in Khomas, those living in Erongo, Karas, and Omaheke, were more likely to practice BSE than those in Kavango, Ohangwena, Omusati, Oshana, and Oshikoto.

CONCLUSION

We conclude that the determinants of BSE practice are age, educational level, marital status, health insurance coverage, religion, mobility in the last 12 months, early sexual debut, parity, household wealth index, and region of residence. Any policy or intervention to improve BSE practice among Namibian women of reproductive age must target adolescent girls, those with no formal education, those without health insurance coverage, multiparous women, and those in the poorest wealth index.

Determinants of Cervical Cancer Screening Among Women Aged 30-49 Years Old in Four African Countries: A Cross-Sectional Secondary Data Analysis

BACKGROUND

Early-stage cervical cancer screening is essential for providing women with a better chance of receiving effective treatment for precancerous and cancer stages. Delay in cervical cancer screening results in late presentation and cancer metastasis. National-level cervical cancer screening in resource-limited countries was scarce and not well studied in Africa based on national data specifically in Kenya, Cameroon, Nambia, and Zimbabwe.

OBJECTIVE

To determine the prevalence and determinants of cervical cancer screening among eligible women in Kenya, Cameroon, Nambia, and Zimbabwe.

METHODS

This study analyzed demographic and health survey data from Kenya, Cameroon, Nambia, and Zimbabwe. The data were extracted and analyzed by STATA version 15 and further analysis was done. Intraclass correlation coefficient, median odds ratio, and proportional change in variance were calculated to check the appropriateness of multilevel analysis. Variables with P-value < .25 were selected for multivariable multilevel logistic regression analysis. Finally, statistical significance between dependent and independent variables was assessed by odds ratios and 95% confidence intervals.

RESULTS

The prevalence of cervical cancer screening in 4 African countries (Nambia, Kenya, Cameroon, and Zimbabwe) was 23.4 [95%CI: 22.8-24.1]. The determinants identified in this study were women of age 41-50 years [AOR = 1.47; 95% CI 1.24, 1.73], rural residence [AOR = .67; 95% CI .55, .81], women who have their own work [AOR = 1.1; 95% CI 1.0, 1.37], smoking status [AOR = 1.89; 95% CI 1.17, 3.0], age at first birth >=35 [AOR = 5.27; 95% CI 1.29-21.52], condom use [AOR = 1.79; 95% CI 1.46,2.19], husbands having worked [AOR = 1.5; 95% CI 1.08,2.11], rich household wealth [AOR = 1.43; 95% CI 1.13,1.8], and having health insurance [AOR = 2.2; 95% CI 1.8,2.7].

CONCLUSION

The prevalence of cervical cancer screening in Kenya, Cameroon, Nambia, and Zimbabwe was low as compared to World Health Organization (WHO) recommendations. Age, residence, work status, smoking status, women's age at first birth, condom use, husbands having work, wealth status, and health insurance were the identified determinants of cervical cancer screening. Programme and policy interventions could address younger, rural residence women, poor wealth status women, women without work, and those who never use health insurance for the uptake of cervical cancer screening.

Development, Implementation, and Evaluation of a Distance Learning and Telementoring Program for Cervical Cancer Prevention in Cameroon

Importance

Although Africa has the highest burden of cervical cancer in the world, educational resources to achieve the 90-70-90 targets set by the World Health Organization in its strategy to eliminate cervical cancer are lacking in the region.

Objectives

To adapt, implement, and evaluate the Project Extension for Community Health Care Outcomes (ECHO), an innovative learning tool, to build capacity of clinicians to better incorporate new evidence-based guidelines into cervical cancer control policies and clinical practices.

Design, Setting, and Participants

This cross-sectional study assessed knowledge and practices of clinicians and support staff regarding cervical cancer prevention and control and compared them among respondents who had attended Project ECHO sessions (prior ECHO attendees) with those who had not but were planning on attending in the near future (newcomers) as part of the Cameroon Cervical Cancer Prevention Project ECHO. Satisfaction of prior ECHO attendees was also evaluated. Data were analyzed from January to March 2022.

Main Outcomes and Measures

Main outcomes were practices and knowledge regarding cervical cancer education and prevention and preinvasive management procedures compared among prior ECHO attendees and newcomers.

Results

Of the 75 participants (mean [SD] age, 36.4 [10.0] years; 65.7% [95% CI, 54.3%-77.1%] women) enrolled in this study, 41 (54.7%; 95% CI, 43.1%-66.2%) were prior ECHO attendees, and most were clinicians (55 respondents [78.6%; 95% CI, 68.7%-88.4%]). Overall, 50% (95% CI, 37.8%-62.2%) of respondents reported performing cervical cancer screening with visual inspection of the cervix after application of acetic acid (VIA) and/or visual inspection of the cervix after application of Lugol's iodine (VILI), 46.3% (95% CI, 34.0%-58.5%) of respondents reported performing human papillomavirus (HPV) testing, and 30.3% (95% CI, 18.9%-41.7%) of respondents reported performing cervical cytological examination in their practices, Approximately one-fourth of respondents reported performing cryotherapy (25.4% [95% CI, 14.7%-36.1%]), thermal ablation (27.3% [95% CI, 16.2%-38.3%]) or loop electrosurgical excisional procedure (LEEP, 25.0% [95% CI, 14.4%-35.6%]) for treatment of preinvasive disease. The clinical use of many of these screening and treatment tools was significantly higher among prior ECHO attendees compared with newcomers (VIA/VILI: 63.2% [95% CI, 47.4%-78.9%] vs 33.3% [95% CI, 16.0%-50.6%]; P = .03; cryotherapy: 40.5% [95% CI, 24.3%-56.8%] vs 6.7% [95% CI, 0.0%-15.8%]; P = .002; thermal ablation: 43.2% [95% CI, 26.9%-59.6%] vs 6.9% [95% CI, 0.0%-16.4%]; P = .002). Knowledge about cervical cancer education, prevention, and management procedures was satisfactory in 36.1% (95% CI, 23.7%-48.5%) of respondents; this proportion was significantly higher among prior ECHO attendees (53.8% [95% CI, 37.7%-69.9%]) compared with newcomers (4.5% [95% CI, 0.0%-13.5%]; P < .001). Approximately two-thirds of participants (68.8% [95% CI, 51.8%-85.8%]) reported that they had applied knowledge learned in our ECHO sessions to patient care in their practice or adopted best-practice care through their participation in this ECHO program.

Conclusions and Relevance

These findings suggest that the Project ECHO e-learning and telementoring program was associated with improved skills for clinicians and support staff and enhanced quality of care for patients. In the COVID-19 era and beyond, reinforced efforts to strengthen cervical cancer knowledge and best practices through distance learning and collaboration are needed.

Study protocol for assessing knowledge, attitudes and belief towards HPV vaccination of parents with children aged 9-14 years in rural communities of North West Cameroon: a qualitative study

INTRODUCTION

Despite human papilloma virus (HPV) vaccine being incorporated in the National Immunisation Programme in Cameroon in 2019, HPV vaccine uptake among eligible girls has been poor (5%). The barriers to HPV vaccination in this high-burden setting have not been previously studied, especially in rural areas. We propose to evaluate the knowledge, attitudes and beliefs of parents of girls aged 9-14 years regarding HPV vaccine.

METHODS AND ANALYSIS

Study design: a qualitative descriptive study will be conducted using one-on-one semi-structured interviews with parents of girls aged 9-14 years from 3 health districts in Cameroon (Mbingo, Njinikom and Fundong) who can converse in English or Pidgin English. Enrolment will occur until thematic saturation-approximately 40 participants. Analysis: quantitative methods will be used to describe the interviewees. All interviews will be audio recorded, transcribed and loaded into a tool to facilitate analysis (ATLAS.ti). Transcripts will be coded and thematic analysis will be conducted. Analysis will occur concurrent with interviews.

ETHICS AND DISSEMINATION

Ethics: institutional review board approval will be obtained from the Cameroon Baptist Convention Health Board (CBCHB), Cameroon and McMaster University, Hamilton, Canada. Dissemination: study findings will be presented via a report and webinar to the Ministry of Health, the funders, the CBCHB and in person to healthcare providers and interested members of the general population in the study region. Plans are to share findings internationally through peer-reviewed publication(s) and presentation(s).

TRIAL REGISTRATION NUMBER

NCT05325138.

Comprehensive Expression Profiling and Molecular Basis of CDC28 Protein Kinase Regulatory Subunit 2 in Cervical Cancer

More and more evidence suggests the oncogenic function of overexpressed CDC28 protein kinase regulatory subunit 2 (CKS2) in various human cancers. However, CKS2 has rarely been studied in cervical cancer. Herein, taking advantage of massive genetics data from multicenter RNA-seq and microarrays, we were the first group to perform tissue microarrays for CKS2 in cervical cancer. We were also the first to evaluate the clinical significance of CKS2 with large samples (980 cervical cancer cases and 422 noncancer cases). We further excavated the mechanism of the tumor-promoting activities of CKS2 in cervical cancer through analysis of genetic mutation profiles, Gene Ontology (GO), and Kyoto Encyclopedia of Genes and Genomes (KEGG) significant enrichment of genes coexpressed with CKS2. According to the results, expression data from multilevels unanimously supported the overexpression of CKS2 in cervical cancer. Patients with cervical cancer in stage II from inhouse microarrays had significantly higher expression of CKS2, and CKS2 overexpression had an adverse impact on the disease-free survival status of cervical cancer patients in GSE44001. Both mutation types of mRNA high and mRNA low appeared in cervical cancer cases from the TCGA Firehose project. Gene coexpressed with CKS2 participated in pathways including the cell cycle, estrogen signaling pathway, and DNA replication. In summary, upregulated CKS2 is closely associated with the malignant clinical development of cervical cancer and might serve as a valuable therapeutic target in cervical cancer.

Training, Supervision, and Competence Assessment of Cameroonian Health Care Providers Using HPV Self-Sampling, Triage by Visual Inspection, and Treatment by Thermal Ablation in a Single Visit

Background

Developing human resource capacity and efficient deployment of skilled personnel are essential for cervical cancer screening program implementation in resource-limited countries. Our aim was to provide a context-specific training framework, supervision, and effectiveness evaluation of health care providers in a cervical cancer screening program.

Methods

A 5-year cervical cancer screening program was implemented in Dschang, West Cameroon. Women were invited to perform human papillomavirus self-sampling (Self-HPV), followed by triage using visual inspection with acetic acid (VIA) and thermal ablation if needed. Health care providers were trained in four key learning phases to perform counseling, screening, and treatment process in a single visit. Training included (i) a 3-day basic course, (ii) 3-day advanced practical training, (iii) 2 weeks of supervision, and (iv) bi-monthly supervision by a mentor. The diagnostic performance of health care providers was compared between two time periods, period I (September 2018 to April 2019) and period II (May 2019 to January 2020), for an overall 17-month study period.

Results

Fourteen health care providers were recruited for the training course and 12 of them completed the training objectives. Follow-up and evaluations were conducted for three health care providers working in the screening unit at Dschang District Hospital. During the study period, 1,609 women performed Self-HPV, among which 759 were screened during period I and 850 during period II. HPV positivity was 18.2 and 17.1%, and VIA positivity was 45.7 and 71.0% in period I and II, respectively. VIA sensitivity was 60.0% (95% confidence interval [CI] 26.2–87.8) and 80.8% (95% CI 60.6–93.4) in period I and II, respectively (p = 0.390). VIA specificity decreased between period I (57.4, 95% CI 48.1–66.3) and II (30.8, 95% CI 22.6–40.0) (p < 0.001). Health care providers demonstrated substantial agreement with their mentor in their diagnoses during both periods (period I: Cohen's kappa coefficient [k] = 0.73, 95% CI 0.62–0.85, and period II: k = 0.62 0.47–0.76; p = 0.0549).

Discussion

Training, supervision, and a focus on effectiveness in cervical cancer screening are interventions that contribute to improving frontline provider competencies and maintaining a high quality of health care service delivery.