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Mantula F, Toefy Y, Sewram V. Barriers to cervical cancer screening in Africa: a systematic review. BMC Public Health 2024; 24:525. [PMID: 38378542 PMCID: PMC10877795 DOI: 10.1186/s12889-024-17842-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/22/2024] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION Africa has one of the highest burdens of cervical cancer in the world. The unacceptably high incidence and mortality rates could be reduced through implementing a comprehensive approach to its prevention and control that includes screening, which however, is low in most low-and-middle-income countries. Hence, this systematic review aims at exploring factors that prevent women from utilising cervical cancer screening services in the region. METHODS A mixed method systematic review was conducted. A search was performed on PubMed (Medline), EMBASE, CINAHL (EBSCOHOST) and Scopus databases for articles published until May 2019 without time, language or study design limits. Two reviewers critically appraised the included studies independently using the standard quality assessment criteria for evaluating primary research papers. Results of the quantitative and mixed methods studies were transformed into qualitative data and synthesised using thematic analysis. RESULTS From a potential 2 365 studies, 24 from 11 countries met the eligibility criteria and were selected; eight qualitative, 13 quantitative, and three that used the mixed-method approach. The primary barriers were identified as poor access to screening services, lack of awareness and knowledge on cervical cancer and screening, and socio-cultural influences. Service providers perceived lack of skills, screening equipment and supplies, and staff shortages as the major barriers to the provision of screening services. CONCLUSION Barriers to cervical cancer screening in Africa are multifaceted and require a holistic approach that will address them concurrently at the health system, individual, interpersonal, community and structural levels. Political will complimented by stakeholder involvement is required in the development and implementation of strategies that will ensure acceptability, availability, accessibility, and affordability of screening to minimise barriers in accessing the service.
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Affiliation(s)
- Fennie Mantula
- African Cancer Institute, Stellenbosch University, P.O Box 241, Cape Town, 8000, South Africa.
- Department of Nursing and Midwifery, Faculty of Medicine, National University of Science and Technology, P.O. Box A.C. 939, Ascot, Bulawayo, Zimbabwe.
| | - Yoesrie Toefy
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O Box 241, Cape Town, 8000, South Africa
| | - Vikash Sewram
- African Cancer Institute, Stellenbosch University, P.O Box 241, Cape Town, 8000, South Africa.
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O Box 241, Cape Town, 8000, South Africa.
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Zewdie A, Shitu S, Kebede N, Gashaw A, Eshetu HB, Eseyneh T, Kasahun AW. Determinants of late-stage cervical cancer presentation in Ethiopia: a systematic review and meta-analysis. BMC Cancer 2023; 23:1228. [PMID: 38097989 PMCID: PMC10720221 DOI: 10.1186/s12885-023-11728-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/08/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Behind breast, colorectal, and lung cancers, cervical cancer is the fourth most common cancer affecting females. Despite, it is a preventable form of cancer both the incidence and mortality figures reflect it as a major reproductive health problem. Late-stage cervical cancer diagnosis is associated with complicated clinical presentation which can result in short survival time and increased mortality. Several factors contribute to the late-stage presentation of cervical cancer patients. In Ethiopia nationally summarized evidence on the level and the factors contributing to late-stage cervical cancer diagnosis is scarce. Therefore, this systematic review and meta-analysis aimed to assess the pooled prevalence of late-stage cervical cancer diagnosis and its determinants in Ethiopia. METHOD A systematic review and meta-analysis were conducted using PRISMA guidelines. Comprehensive literature was searched in PubMed, Embase, Google Scholar, and African Online Journal to retrieve eligible articles. A weighted inverse variance random effect model was used to estimate pooled prevalence. Cochrane Q-test and I2 statistics were computed to assess heterogeneity among studies. Funnel plot and Egger's regression test were done to assess publication bias. RESULT Overall, 726 articles were retrieved and finally 10 articles were included in this review. The pooled prevalence of late-stage cervical cancer diagnosis in Ethiopia was 60.45% (95%CI; 53.04%-67.85%). Poor awareness about cervical cancer and its treatment (AOR = 1.55, 95% CI: (1.03 - 2.33, longer delay to seek care (AOR = 1.02, 95% CI: (1.01 - 1.03)) and rural residence (AOR = 2.07, 95% CI:( 1.56 - 2.75)) were significantly associated to late-stage diagnosis. CONCLUSION In Ethiopia, six in every ten cervical cancer cases are diagnosed at the late stage of the disease. Poor awareness about cervical cancer and its treatment, long patient delay to seek care, and rural residence were positively associated with late-stage diagnosis. Therefore intervention efforts should be made to improve public awareness about cervical cancer, minimize patient delay to seek care, and expand screening services specifically in the rural residing segment of the population to detect the disease early and improve survival.
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Affiliation(s)
- Amare Zewdie
- Department of Public Health, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia.
| | - Solomon Shitu
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Natnael Kebede
- Department of Health Promotion, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Anteneh Gashaw
- Department of Midwifery, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Habitu Birhan Eshetu
- Department of Health Promotion and Health Behaviour, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, PO.Box.196, Gondar, Ethiopia
| | - Tenagnework Eseyneh
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Abebaw Wasie Kasahun
- Department of Public Health, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
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Ayanto SY, Belachew Lema T, Wordofa MA. Women's and health professionals' perceptions, beliefs and barriers to cervical cancer screening uptake in Southern Ethiopia: a qualitative study. Sex Reprod Health Matters 2023; 31:2258477. [PMID: 37812407 PMCID: PMC10563609 DOI: 10.1080/26410397.2023.2258477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
Cervical cancer remains a public health problem worldwide. Screening for cervical cancer is poorly implemented in resource-limited settings. In Ethiopia, evidence from the community and health professionals regarding implementation of the screening programme is lacking. The objective of this study was to explore women's and health professionals' perceptions, beliefs, and barriers in relation to cervical screening in Southern Ethiopia. Five focus group discussions among women and six key informant interviews with health professionals were conducted from June to July 2022 to gather the required data from a total of 42 participants. The participants were purposively selected from a diverse group to ensure varied viewpoints. Data were collected through group discussions and face-to-face interviews using a semi-structured interview guide. The interview sessions were tape-recorded. The data were analysed using a thematic approach. Women demonstrated a low level of awareness and perceived risk. Also, the perceived benefit of screening for cervical cancer during healthy periods was low. Individual and system-level barriers to screening include low awareness, stigma, poor perceptions towards health screening and causes of cervical cancer, low risk perception and competing domestic priorities, shortage of trained human and other resources, human resource turnover, low implementation and lack of close follow-up of screening programmes. In summary, lack of awareness, misconceptions, and poor perceptions were common. Screening implementation and uptake were low due to individual, psychosocial, and system-related barriers. Therefore, behavioural change communication and system-strengthening efforts need to be in place to effectively tackle the observed gaps.
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Affiliation(s)
- Samuel Yohannes Ayanto
- Assistant Professor, Department of Population and Family Health, Jimma University, P.O. Box 378, Jimma, Ethiopia
| | - Tefera Belachew Lema
- Professor, Department of Nutrition and Dietetics, Jimma University, Jimma, Ethiopia
| | - Muluemebet Abera Wordofa
- Associate Professor, Department of Population and Family Health, Jimma University, Jimma, Ethiopia
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Nair V, Dau H, Vidler M, AboMoslim M, Mutamba B, Scott M, Nesbitt Z, Deodatha J, Byiringiro SD, Niyotwiringiye C, Mithani N, Smith L, Ogilvie G, Rulisa S. Understanding the cervical cancer self-collection preferences of women living in urban and rural Rwanda. PLOS Glob Public Health 2023; 3:e0002135. [PMID: 37768884 PMCID: PMC10538759 DOI: 10.1371/journal.pgph.0002135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/07/2023] [Indexed: 09/30/2023]
Abstract
Cervical cancer is a leading cause of cancer among women in low- and middle-income countries. Women in Rwanda have high rates of cervical cancer due to limited access to effective screening methods. Research in other low-resource settings similar to Rwanda has shown that HPV-based self-collection is an effective cervical cancer screening method. This study aims to compare the preferences of Rwandan women in urban and rural settings toward self-collection and to report on factors related to self-collection amenability. A cross-sectional survey was conducted from June 1-9, 2022. Women were recruited from one urban and one rural clinic in Rwanda. Women were eligible for the study if they were ≥ 18 years and spoke Kinyarwanda or English. The survey consisted of 51 questions investigating demographics and attitudes towards self-collection for cervical cancer screening. We reported descriptive statistics stratified by urban and rural sites. In total, 169 urban and 205 rural women completed the survey. The majority of respondents at both sites had a primary school or lower education and were in a relationship. Both urban and rural respondents were open to self-collection; however, rates were higher in the rural site (79.9% urban and 95.6% rural; p-value<0.001). Similarly, women in rural areas were more likely to report feeling unembarrassed about self-collection (65.3% of urban, 76.8% of rural; p-value<0.001). Notably, almost all urban and rural respondents (97.6% urban and 98.5% rural) stated they would go for a cervical cancer pelvic examination to a nearby health center if their self-collected results indicated any concern (p-value = 0.731). Rwandan women in both urban and rural areas largely support self-collection for cervical cancer screening. Further research is needed to better understand how to implement self-collection screening services in Rwanda.
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Affiliation(s)
- Varun Nair
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
- Integrated Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hallie Dau
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maryam AboMoslim
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Zoey Nesbitt
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Nadia Mithani
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laurie Smith
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
- BC Cancer, Vancouver, Canada
| | - Gina Ogilvie
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- BC Centre for Disease Control, Vancouver, Canada
| | - Stephen Rulisa
- School of Medicine and Pharmacy, University Teaching Hospital of Kigali, University of Rwanda, Kigali, Rwanda
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Mwenda V, Bor JP, Nyangasi M, Njeru J, Olwande S, Njiri P, Arbyn M, Weyers S, Tummers P, Temmerman M. Integrating human papillomavirus testing as a point-of care service using GeneXpert platforms: Findings and lessons from a Kenyan pilot study (2019-2020). PLoS One 2023; 18:e0286202. [PMID: 37228154 DOI: 10.1371/journal.pone.0286202] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Globally, cervical cancer is a major public health problem, with about 604,000 new cases and over 340,000 deaths in 2020. In Kenya, it is the leading cause of cancer deaths, with over 3,000 women dying in 2020 alone. Both the Kenyan cancer screening guidelines and the World Health Organization's Global Cervical Cancer Elimination Strategy recommend human papillomavirus (HPV) testing as the primary screening test. However, HPV testing is not widely available in the public healthcare system in Kenya. We conducted a pilot study using a point of care (POC) HPV test to inform national roll-out. METHODS The pilot was implemented from October 2019 to December 2020, in nine health facilities across six counties. We utilized the GeneXpert platform (Cepheid, Sunnyvale, CA, USA), currently used for TB, Viral load testing and early infant diagnosis for HIV, for HPV screening. Visual inspection with acetic acid (VIA) was used for triage of HPV-positive women, as recommended in national guidelines. Quality assurance (QA) was performed by the National Oncology Reference Laboratory (NORL), using the COBAS 4800 platform (Roche Molecular System, Pleasanton, CF, USA). HPV testing was done using either self or clinician-collected samples. We assessed the following screening performance indicators: screening coverage, screen test positivity, triage compliance, triage positivity and treatment compliance. Test agreement between local GeneXpert and central comparator high-risk HPV (hrHPV) testing for a random set of specimens was calculated as overall concordance and kappa value. We conducted a final evaluation and applied the Nominal Group Technique (NGT) to identify implementation challenges and opportunities. KEY FINDINGS The screening coverage of target population was 27.0% (4500/16,666); 52.8% (2376/4500) were between 30-49 years of age. HPV positivity rate was 22.8% (1027/4500). Only 10% (105/1027) of HPV positive cases were triaged with VIA/VILI; 21% (22/105) tested VIA/VILI positive, and 73% (16/22) received treatment (15 received cryotherapy, 1 was referred for biopsy). The median HPV testing turnaround time (TAT) was 24 hours (IQR 2-48 hours). Invalid sample rate was 2.0% (91/4500). Concordance between the Cepheid and COBAS was 86.2% (kappa value = 0.71). Of 1042 healthcare workers, only 5.6% (58/1042) were trained in cervical cancer screening and treatment, and only 69% (40/58) of those trained were stationed at service provision areas. Testing capacity was identifed as the main challenge, while the community strategy was the main opportunity. CONCLUSION HPV testing can be performed on GeneXpert as a near point of care platform. However, triage compliance and testing TAT were major concerns. We recommend strengthening of the screening-triage-treatment cascade and expansion of testing capacity, before adoption of a GeneXpert-based HPV screening among other near point of care platforms in Kenya.
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Affiliation(s)
- Valerian Mwenda
- National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - Joan-Paula Bor
- National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - Mary Nyangasi
- National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - James Njeru
- Clinton Health Access Initiative, Nairobi, Kenya
| | | | | | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
- Department of Human Structure and Repair, Gent University Hospital, Ghent, Belgium
| | - Steven Weyers
- Department of Human Structure and Repair, Gent University Hospital, Ghent, Belgium
- Department of Obstetrics and Gynaecology, University Hospital, Gent, Belgium
| | - Philippe Tummers
- Department of Human Structure and Repair, Gent University Hospital, Ghent, Belgium
- Department of Obstetrics and Gynaecology, University Hospital, Gent, Belgium
- Department of Obstetrics and Gynaecology, University Hospital, Gent, Belgium
| | - Marleen Temmerman
- Department of Obstetrics and Gynaecology, University Hospital, Gent, Belgium
- Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Nairobi, Kenya
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Rawat A, Mithani N, Sanders C, Namugosa R, Payne B, Mitchell-Foster S, Orem J, Ogilvie G, Nakisige C. "We Shall Tell them with Love, Inform them what we have Learnt and then Allow them to go" - Men's Perspectives of Self-Collected Cervical Cancer Screening in Rural Uganda: A Qualitative Inquiry. J Cancer Educ 2023; 38:618-624. [PMID: 35384556 DOI: 10.1007/s13187-022-02163-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 05/20/2023]
Abstract
Uganda has high incidence rates of cervical cancer (47.5/100,000/year) due to limited screening access. In settings where men hold most of the decision-making power, they play an important role in women's uptake of cervical cancer screening. We aimed to capture men's knowledge, beliefs and perspectives about cervical cancer, community-based screening and health system barriers. Focus group discussions were conducted with men in rural Uganda. Data were verbatim translated and transcribed into English. Transcripts were analysed in ATLAS.ti using a deductive approach of thematic content analysis and applied to an implementation research framework. Twenty-three men participated in focus groups. Men held poor knowledge of cervical cancer, its causes and treatment. Men felt screening would be acceptable by women if men and women were educated. Men highlighted health system barriers to accessing screening including: 1) poor-quality health services, 2) large distances to facilities/lack of affordable transportation and 3) lack of health workers/mistreatment by health workers. Men described supporting women through assisting with transportation, psychosocial support and sharing information. They requested services for men to be decentralized alongside community outreaches for cervical cancer screening. Engaging men in the implementation, education and planning of community-based cervical cancer screening programs is critical. Not engaging men is a missed opportunity to provide them with services and education. Concerted efforts must be made in educating men and reducing health system barriers to ensure rural women receive cervical cancer screening and follow-up care in low-income settings. Clinicaltrials.gov, NCT04000503; Registered 27 June 2019.
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Affiliation(s)
- Angeli Rawat
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, 2206 East Mall Drive, Vancouver, BC, V6T 1Z3, Canada.
- Women's Health Research Institute, H203-4500 Oak St, Vancouver, BC, V6H 3N1, Canada.
| | - Nadia Mithani
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, 2206 East Mall Drive, Vancouver, BC, V6T 1Z3, Canada
- Women's Health Research Institute, H203-4500 Oak St, Vancouver, BC, V6H 3N1, Canada
| | - Catherine Sanders
- Women's Health Research Institute, H203-4500 Oak St, Vancouver, BC, V6H 3N1, Canada
| | - Ruth Namugosa
- Uganda Cancer Institute, Upper Mulago Hill Road, P.O. Box 3935, Kampala, Uganda
| | - Beth Payne
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, 2206 East Mall Drive, Vancouver, BC, V6T 1Z3, Canada
- Women's Health Research Institute, H203-4500 Oak St, Vancouver, BC, V6H 3N1, Canada
| | - Sheona Mitchell-Foster
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Jackson Orem
- Uganda Cancer Institute, Upper Mulago Hill Road, P.O. Box 3935, Kampala, Uganda
| | - Gina Ogilvie
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, 2206 East Mall Drive, Vancouver, BC, V6T 1Z3, Canada
- Women's Health Research Institute, H203-4500 Oak St, Vancouver, BC, V6H 3N1, Canada
| | - Carolyn Nakisige
- Uganda Cancer Institute, Upper Mulago Hill Road, P.O. Box 3935, Kampala, Uganda
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Guliashvili G, Taboridze I, Mebonia N, Alibegashvili T, Kazakhashvili N, Imnadze P. Evaluation of barriers to cervical cancer screening in Georgia. Cent Eur J Public Health 2023; 31:9-18. [PMID: 37086415 DOI: 10.21101/cejph.a7621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/24/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVES The Cervical Cancer (CC) Screening Programme in Georgia provides insufficient coverage of the target population. The aim of the study is to identify the barriers to cervical cancer screening for women in Georgia in order to plan and implement adequate measures to increase the screening effectiveness. METHODS The study is based on the results of a survey of 582 women aged 25-60 years (mean age 42.11 + 12.17). Respondents were selected in out-patient clinics. The questionnaire included questions related to the place of residence, ethnicity, religion, marital status, education, employment, cervical cancer awareness and screening, screening participation practices, and barriers to participation. RESULTS The following factors reliably increase the chance of participating in the screening: residing in Tbilisi, OR = 1.84 (95% CI: 1.10-3.07); higher education, OR = 1.87 (95% CI: 1.09-3.19); being employed as a nurse, OR = 3.42 (95% CI: 1.49-7.85); receiving screening-related information from medical staff, OR = 2.43 (95% CI: 1.42-4.15); and from television, OR = 2.57 (95% CI: 1.47-4.50). The chance of participating in the screening is reduced due to incomplete secondary education, OR = 0.10 (95% CI: 0.01-0.77); single marital status, OR = 0.49 (95% CI: 0.28-0.87); employment in public service, OR = 0.39 (95% CI: 0.17-0.89); and receiving screening-related information from friends, OR = 0.26 (95% CI: 0.09-0.77). Women with higher education are undoubtedly more informed about screening, screening procedures and free programmes than those without higher education. The common barrier to participation in the screening was "fear of the manipulation-related pain" but the most frequent answer was "I'm afraid that the test will detect cancer (36.3%)." Women with a lower level of education are more likely to believe that "Pap testing is appropriate for the women who have active sexual life", and/or "have multiple sexual partners", and/or "have children," and "it is not necessary if a woman has no complaints". CONCLUSION Screening participation among women in Georgia depends on screening availability, formal education and awareness of CC, sources of information, and employment type.
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Affiliation(s)
- Gvantsa Guliashvili
- Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
- Georgian National Screening Centre, Tbilisi, Georgia
| | - Iamze Taboridze
- David Aghmashenebeli University of Georgia, Tbilisi, Georgia
| | - Nana Mebonia
- National Centre for Disease Control and Public Health, Tbilisi, Georgia
| | | | - Nata Kazakhashvili
- Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - Paata Imnadze
- Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
- National Centre for Disease Control and Public Health, Tbilisi, Georgia
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Petersen Z, Jaca A, Ginindza TG, Maseko G, Takatshana S, Ndlovu P, Zondi N, Zungu N, Varghese C, Hunting G, Parham G, Simelela P, Moyo S. Barriers to uptake of cervical cancer screening services in low-and-middle-income countries: a systematic review. BMC Womens Health 2022; 22:486. [PMID: 36461001 PMCID: PMC9716693 DOI: 10.1186/s12905-022-02043-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 10/10/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Low-and-middle-income countries (LMICs) bear a disproportionate burden of cervical cancer mortality. We aimed to identify what is currently known about barriers to cervical cancer screening among women in LMICs and propose remedial actions. DESIGN This was a systematic review using Medical Subject Headings (MeSH) terms in Google Scholar, PubMed, Scopus, and Web of Science databases. We also contacted medical associations and universities for grey literature and checked reference lists of eligible articles for relevant literature published in English between 2010 and 2020. We summarized the findings using a descriptive narrative based on themes identified as levels of the social ecological model. SETTING We included studies conducted in LMICs published in English between 2010 and 2020. PARTICIPANTS We included studies that reported on barriers to cervical cancer screening among women 15 years and older, eligible for cervical cancer screening. RESULTS Seventy-nine articles met the inclusion criteria. We identified individual, cultural/traditional and religious, societal, health system, and structural barriers to screening. Lack of knowledge and awareness of cervical cancer in general and of screening were the most frequent individual level barriers. Cultural/traditional and religious barriers included prohibition of screening and unsupportive partners and families, while social barriers were largely driven by community misconceptions. Health system barriers included policy and programmatic factors, and structural barriers were related to geography, education and cost. Underlying reasons for these barriers included limited information about cervical cancer and screening as a preventive strategy, poorly resourced health systems that lacked policies or implemented them poorly, generalised limited access to health services, and gender norms that deprioritize the health needs of women. CONCLUSION A wide range of barriers to screening were identified across most LMICs. Urgent implementation of clear policies supported by health system capacity for implementation, community wide advocacy and information dissemination, strengthening of policies that support women's health and gender equality, and targeted further research are needed to effectively address the inequitable burden of cervical cancer in LMICs.
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Affiliation(s)
- Z. Petersen
- grid.417715.10000 0001 0071 1142Human & Social Capabilities (HSC), Human Sciences Research Council, Pretoria, South Africa
| | - A. Jaca
- grid.415021.30000 0000 9155 0024Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - T. G. Ginindza
- grid.16463.360000 0001 0723 4123Public Health Medicine, University of KwaZulu-Natal (UKZN), Durban, South Africa ,Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), Durban, South Africa
| | - G. Maseko
- grid.417715.10000 0001 0071 1142Human & Social Capabilities (HSC), Human Sciences Research Council, Pretoria, South Africa
| | - S. Takatshana
- grid.417715.10000 0001 0071 1142Human & Social Capabilities (HSC), Human Sciences Research Council, Pretoria, South Africa
| | - P. Ndlovu
- grid.417715.10000 0001 0071 1142Human & Social Capabilities (HSC), Human Sciences Research Council, Pretoria, South Africa
| | - N. Zondi
- grid.417715.10000 0001 0071 1142Human & Social Capabilities (HSC), Human Sciences Research Council, Pretoria, South Africa
| | - N. Zungu
- grid.417715.10000 0001 0071 1142Human & Social Capabilities (HSC), Human Sciences Research Council, Pretoria, South Africa ,grid.16463.360000 0001 0723 4123Public Health Medicine, University of KwaZulu-Natal (UKZN), Durban, South Africa
| | - C. Varghese
- grid.3575.40000000121633745Cervical Cancer Elimination Initiative, World Health Organization, Geneva, Switzerland
| | - G. Hunting
- grid.3575.40000000121633745Cervical Cancer Elimination Initiative, World Health Organization, Geneva, Switzerland
| | - G. Parham
- grid.3575.40000000121633745Cervical Cancer Elimination Initiative, World Health Organization, Geneva, Switzerland
| | - P. Simelela
- grid.3575.40000000121633745Cervical Cancer Elimination Initiative, World Health Organization, Geneva, Switzerland
| | - S. Moyo
- grid.417715.10000 0001 0071 1142Human & Social Capabilities (HSC), Human Sciences Research Council, Pretoria, South Africa ,grid.7836.a0000 0004 1937 1151School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Isaacson S, Adewumi K, Smith JS, Novak C, Oketch S, Huchko MJ. A Qualitative Exploration of Barriers to Treatment Among HPV-Positive Women in a Cervical Cancer Screening Study in Western Kenya. Oncologist 2022; 28:e9-e18. [PMID: 36239434 PMCID: PMC9847557 DOI: 10.1093/oncolo/oyac208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 09/09/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cervical cancer screening through self-collected high-risk human papillomavirus (HPV) testing has increased screening uptake, particularly in low-resource settings. Improvement ultimately depends, however, on women with positive results accessing follow-up treatment. Identifying the barriers to timely treatment is needed to tailor service delivery for maximum impact. MATERIALS AND METHODS This qualitative study was conducted within a self-collected HPV screening trial in Migori County, Kenya. HPV-positive women were referred for no-cost cryotherapy treatment at the county hospital. Women not attending within 60 days of receiving HPV-positive results were randomly selected for in-depth interviews (IDIs). IDIs were coded and analyzed to develop an analytical framework and identify treatment barriers. RESULTS Eighty-one women were interviewed. IDIs showed a poor understanding of HPV and cervical cancer, impacting comprehension of screening results and treatment instructions. All 81 had not undergone treatment but reported intending to in the future. Eight reported seeking treatment unsuccessfully or not qualifying, primarily due to pregnancy. Transportation costs and long distances to the hospital were the most reported barriers to treatment. Other obstacles included work, household obligations, and fear of treatment. Impacts of social influences were mixed; some women reported their husbands prevented seeking treatment, others reported their husbands provided financial or emotional support. Few women experienced peer support. CONCLUSIONS Women faced many barriers to treatment following HPV screening in rural Kenya. Transportation barriers highlight a need for local treatment capacity or screen-and-treat approaches. Ensuring women understand their results and how to seek treatment is essential to improving cervical cancer screening in low-resource settings.
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Affiliation(s)
- Sinéad Isaacson
- Epidemiology Department, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Konyin Adewumi
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Jennifer S Smith
- Epidemiology Department, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carissa Novak
- Harvard Global Health Institute, Harvard University, Cambridge, MA, USA
| | | | - Megan J Huchko
- Corresponding author: Megan J. Huchko, MD, MPH, Duke Global Health Institute, Duke University, Durham, NC, USA.
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10
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Mabachi NM, Wexler C, Acharya H, Maloba M, Oyowe K, Goggin K, Finocchario-Kessler S. Piloting a systems level intervention to improve cervical cancer screening, treatment and follow up in Kenya. Front Med (Lausanne) 2022; 9:930462. [PMID: 36186820 PMCID: PMC9520305 DOI: 10.3389/fmed.2022.930462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Although preventable, Cervical Cancer (CC) is the leading cause of cancer deaths among women in Sub-Saharan Africa with the highest incidence in East Africa. Kenyan guidelines recommend an immediate screen and treat approach using either Pap smear or visual screening methods. However, system (e.g., inadequate infrastructure, weak treatment, referral and tracking systems) and patient (e.g., stigma, limited accessibility, finance) barriers to comprehensive country wide screening continue to exist creating gaps in the pathways of care. These gaps result in low rates of eligible women being screened for CC and a high loss to follow up rate for treatment. The long-term goal of 70% CC screening and treatment coverage can partly be achieved by leveraging electronic health (eHealth, defined here as systems using Internet, computer, or mobile applications to support the provision of health services) to support service efficiency and client retention. To help address system level barriers to CC screening treatment and follow up, our team developed an eHealth tool—the Cancer Tracking System (CATSystem), to support CC screening, treatment, and on-site and external referrals for reproductive age women in Kenya. Preliminary data showed a higher proportion of women enrolled in the CATSystem receiving clinically adequate (patients tested positive were treated or rescreened to confirm negative within 3 months) follow up after a positive/suspicious screening, compared to women in the retrospective arm.
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Affiliation(s)
- Natabhona M. Mabachi
- Practice-Based Research, Innovation, and Evaluation Division, American Academy of Family Physicians, Leawood, KS, United States
- Department of Family and Community Medicine, University of Kansas Medical Center, Kansas City, KS, United States
- *Correspondence: Natabhona M. Mabachi,
| | - Catherine Wexler
- Department of Family and Community Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Harshdeep Acharya
- Department of Family and Community Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - May Maloba
- Global Health Innovations, Nairobi, Kenya
| | | | - Kathy Goggin
- Children’s Mercy Research Institute, Kansas City, MO, United States
| | - Sarah Finocchario-Kessler
- Department of Family and Community Medicine, University of Kansas Medical Center, Kansas City, KS, United States
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11
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Zhang M, Sit JWH, Chan DNS, Akingbade O, Chan CWH. Educational Interventions to Promote Cervical Cancer Screening among Rural Populations: A Systematic Review. Int J Environ Res Public Health 2022; 19:ijerph19116874. [PMID: 35682457 PMCID: PMC9180749 DOI: 10.3390/ijerph19116874] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/27/2022] [Accepted: 06/01/2022] [Indexed: 02/04/2023]
Abstract
The urban-rural gap in cervical cancer screening uptake is a significant public health consideration. Educational interventions are commonly adopted to promote cervical cancer screening among females in rural areas; however, the characteristics and effectiveness of these educational interventions remain unclear. In this review, we aimed to identify the characteristics of educational interventions used in rural populations and to evaluate the effects of these interventions on cervical cancer screening-related outcomes. Seven English databases were searched in January 2022. Randomized controlled trials (RCTs) and quasi-experimental studies were included. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Randomized Controlled Trials and the JBI Critical Appraisal Checklist for Quasi-Experimental Studies were used for quality appraisal. RevMan 5.4 software was used for the meta-analysis. A narrative synthesis was conducted in instances where a meta-analysis was inappropriate. Three RCTs and seven quasi-experimental studies conducted in six countries were included. A social cognitive theory-based framework, the community setting, group sessions, healthcare professional-led approaches, and culture-tailored materials were implemented in the educational interventions for cervical cancer screening. The educational content mainly included basic information on cervical cancer screening, psychological issues, barriers and strategies to overcome them, and locally available resources. Educational interventions increased the knowledge and uptake of cervical cancer screening in the rural population. However, the studies only evaluated the short-term effects of these educational interventions, with the cervical screening behavior only being assessed in one instance for each participant. Educational interventions promote cervical cancer screening among females in rural areas. Theory-driven, community-involved, group-based, and healthcare professional-led approaches should be prioritized in the application of educational interventions in rural populations. Both the short- and long-term, influences of educational interventions on the cervical cancer screening behavior of females in rural areas need to be recognized.
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Affiliation(s)
- Mengyue Zhang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Janet W H Sit
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Dorothy Ngo Sheung Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Oluwadamilare Akingbade
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Carmen W H Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
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12
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Lau J, Shrestha P, Shaina Ng J, Jianlin Wong G, Legido-Quigley H, Tan KK. Qualitative factors influencing breast and cervical cancer screening in women: A scoping review. Prev Med Rep 2022; 27:101816. [PMID: 35656228 PMCID: PMC9152777 DOI: 10.1016/j.pmedr.2022.101816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/04/2022] [Accepted: 04/30/2022] [Indexed: 11/28/2022] Open
Abstract
Breast and cervical are top cancers for women globally, but few studies have summarised how gender norms influence screening uptake, given sexual connotations and physical exposure. These beliefs may play a central role in decision-making, and understanding them is crucial to improving screening rates and services. This review scopes international literature for gender-based qualitative factors influencing women’s screening uptake. A systematic search of peer-reviewed English articles in PubMed, Scopus, and CINAHL was conducted from inception until December 2019. Articles were included if they were about breast or cervical cancer screening, had mixed or qualitative methodology, and sampled women from the general population. 72 studies spanning 34 countries were analysed. Eight studies also included healthcare providers’ views. Our narrative thematic analysis summarised primary themes extracted from each study into first-level subthemes, then synthesising second-level and third-level themes: (I) gender socialisation of women, (II) gender inequality in society, and (III) lack of empowerment to women in making screening decisions. Women tended to face sociocultural/role-based constraints, were expected to prioritise family, and keep bodily exposure to their husbands. Women showed low awareness and had fewer opportunities for health education compared to men. Male relations were often gatekeepers to financial resources needed to pay for screening tests. Screening risked community norms about women’s or husbands’ perceived embarrassing sexual behaviours. These findings suggest that interventions targeting unhelpful stigmatising beliefs about women’s cancer screening must concurrently address community general norms, familial role-based beliefs, as well as at male relations who hold the purse-strings.
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Affiliation(s)
- Jerrald Lau
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Pami Shrestha
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Janelle Shaina Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gretel Jianlin Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Ker-Kan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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13
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Osei EA, Ani-Amponsah M. Ghanaian women's perception on cervical cancer threat, severity, and the screening benefits: A qualitative study at Shai Osudoku District, Ghana. Public Health in Practice 2022; 3:100274. [PMID: 36101759 PMCID: PMC9461327 DOI: 10.1016/j.puhip.2022.100274] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/28/2022] [Accepted: 05/10/2022] [Indexed: 11/30/2022] Open
Abstract
Objective Cervical is one of the topmost causes of fatalities worldwide with mortality and incidence rates highest in sub-Saharan Africa including Ghana. The knowledge about cervical cancer threat and severity has not been extensively studied in most developing and developed countries of which Ghana is not exempted. The study, therefore, aimed to explore the views of women about cervical cancer threat, severity, and the benefits of cervical cancer screening in rural communities in the Greater Accra Region of Ghana. Study design Qualitative exploratory descriptive design was used to purposively sample 17 participants. Methods The data collection tool was pretested among 4 women from women to ensure its trustworthiness. Participants were interviewed face to face using a semi-structured interview guide. The interviews were recorded with audio recorders, transcribed verbatim and content analyzed. Ethics approval was obtained from Noguchi Memorial Institute for Medical Research Institutional Review Board (NMIMR-IRB). Results Findings of this study discovered that participants perceived Cervical cancer (CC) as serious on the basis that it is causing death of most women and lead to depression, isolation and thoughts of suicide, and poor sexual performance. Almost all the women in this study were aware that cervical cancer screening (CCS) is beneficial in the early detection of cervical cancer and protecting women against cervical cancer in order to reduce the mortalities associated with cervical cancer. In conclusion, there is high perceived severity to CC and benefits of CCS and hence other studies could be done to assess the uptake of the screening and willingness to participate in the screening among these participants. It is expected that this high perceived severity and benefits will translate into their practices of CCS and hence other researchers could explore this phenomenon.
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Affiliation(s)
- Evans Appiah Osei
- School of Nursing and Midwifery, Department of Midwifery, Valley View University, Ghana. P.O. Box DT 595, Oyibi, Ghana
- Corresponding author.
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14
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Bevilacqua KG, Gottschlich A, Murchland AR, Alvarez CS, Rivera-Andrade A, Meza R. Cervical cancer knowledge and barriers and facilitators to screening among women in two rural communities in Guatemala: a qualitative study. BMC Womens Health 2022; 22:197. [PMID: 35643497 PMCID: PMC9148459 DOI: 10.1186/s12905-022-01778-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/05/2022] [Indexed: 11/28/2022] Open
Abstract
Background Approximately 80% of deaths due to cervical cancer occur in low- and middle-income countries. In Guatemala, limited access to effective screening and treatment has resulted in alarmingly high cervical cancer incidence and mortality rates. Despite access to free-of-cost screening, women continue to face significant barriers in obtaining screening for cervical cancer.
Methods In-depth interviews (N = 21) were conducted among women in two rural communities in Guatemala. Interviews followed a semi-structured guide to explore knowledge related to cervical cancer and barriers and facilitators to cervical cancer screening. Results Cervical cancer knowledge was variable across sites and across women. Women reported barriers to screening including ancillary costs, control by male partners, poor provider communication and systems-level resource constraints. Facilitators to screening included a desire to know one’s own health status, conversations with other women, including community health workers, and extra-governmental health campaigns. Conclusions Findings speak to the many challenges women face in obtaining screening for cervical cancer in their communities as well as existing facilitators. Future interventions must focus on improving cervical cancer-related knowledge as well as mitigating barriers and leveraging facilitators to promote screening.
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Affiliation(s)
- Kristin G Bevilacqua
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
| | - Anna Gottschlich
- BC Women's Hospital and Health Service, Women's Health Research Institute, 4500 Oak St, Vancouver, BC, V6H N9, Canada.,Faculty of Medicine, University of British Columbia, 31702194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Audrey R Murchland
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Christian S Alvarez
- Instituto de Nutrición de Centro América y Panamá,, Calzada Roosevelt 6-25 Zona 11, Guatemala City, Guatemala
| | - Alvaro Rivera-Andrade
- Instituto de Nutrición de Centro América y Panamá,, Calzada Roosevelt 6-25 Zona 11, Guatemala City, Guatemala
| | - Rafael Meza
- School of Public Health, Department of Epidemiology, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
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15
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Gerstl S, Lee L, Nesbitt RC, Mambula C, Sugianto H, Phiri T, Kachingwe J, Llosa AE. Cervical cancer screening coverage and its related knowledge in southern Malawi. BMC Public Health 2022; 22:295. [PMID: 35164716 PMCID: PMC8842862 DOI: 10.1186/s12889-022-12547-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/03/2022] [Indexed: 12/24/2022] Open
Abstract
Background Cervical cancer (CC) is the fourth most common cancer among women worldwide and Malawi has the world’s highest rate of cervical cancer related mortality. Since 2016 the National CC Control Strategy has set a screening coverage target at 80% of 25-49-year-old women. The Ministry of Health and Médecins Sans Frontières (MSF) set up a CC program in Blantyre City, as a model for urban areas, and Chiradzulu District, as a model for rural areas. This population-based survey aimed to estimate CC screening coverage and to understand why women were or were not screened. Methods A population-based survey was conducted in 2019. All resident consenting eligible women aged 25-49 years were interviewed (n = 1850) at households selected by two-stage cluster sampling. Screening and treatment coverage and facilitators and barriers to screening were calculated stratified by age, weighted for survey design. Chi square and design-based F tests were used to assess relationship between participant characteristics and screening status. Results The percentage of women ever screened for CC was highest in Blantyre at 40.2% (95% CI 35.1-45.5), 38.9% (95% CI 32.8-45.4) in Chiradzulu with supported CC screening services, and lowest in Chiradzulu without supported CC screening services at 25.4% (95% CI 19.9-31.8). Among 623 women screened, 49.9% (95% CI 44.0-55.7) reported that recommendation in the health facility was the main reason they were screened and 98.5% (95% CI 96.3-99.4) recommended CC screening to others. Among 1227 women not screened, main barriers were lack of time (26.0%, 95% CI 21.9-30.6), and lack of motivation (18.3%, 95% CI 14.1-23.3). Overall, 95.6% (95% CI 93.6-97.0) of women reported that they had some knowledge about CC. Knowledge of CC symptoms was low at 34.4% (95% CI 31.0-37.9) and 55.1% (95% CI 51.0-59.1) of participants believed themselves to be at risk of CC. Conclusion Most of the survey population had heard about CC. Despite this knowledge, fewer than half of eligible women had been screened for CC. Reasons given for not attending screening can be addressed by programs. To significantly reduce mortality due to CC in Malawi requires a comprehensive health strategy that focuses on prevention, screening and treatment.
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Affiliation(s)
- Sibylle Gerstl
- Epicentre / Médecins Sans Frontières (MSF), Paris, France.
| | - Lawrence Lee
- Epicentre / Médecins Sans Frontières (MSF), Paris, France
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Lee F, Bula A, Chapola J, Mapanje C, Phiri B, Kamtuwange N, Tsidya M, Tang J, Chinula L. Women's experiences in a community-based screen-and-treat cervical cancer prevention program in rural Malawi: a qualitative study. BMC Cancer 2021; 21:428. [PMID: 33882885 PMCID: PMC8061221 DOI: 10.1186/s12885-021-08109-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 03/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malawi has the world's highest cervical cancer incidence and mortality due to high rate of HIV coupled with inadequate screening and treatment services. The country's cervical cancer control program uses visual inspection with acetic acid (VIA) and cryotherapy, but screening is largely limited by poor access to facilities, high cost of cryotherapy gas, and high loss-to-follow-up. To overcome these limitations, we implemented a community-based screen-and-treat pilot program with VIA and thermocoagulation. Through a qualitative study, we explore the experiences of women who underwent this community-based pilot screening program. METHODS We implemented our pilot program in rural Malawi and conducted an exploratory qualitative sub-study. We conducted in-depth interviews with women who were treated with thermocoagulation during the program. We used semi-structured interviews to explore screen-and-treat experience, acceptability of the program and attitudes towards self-sampling for HPV testing as an alternative screening method. Content analysis was conducted using NVIVO v12. RESULTS Between July - August 2017, 408 participants eligible for screening underwent VIA screening. Thirty participants had VIA positive results, of whom 28 underwent same day thermocoagulation. We interviewed 17 of the 28 women who received thermocoagulation. Thematic saturation was reached at 17 interviews. All participants reported an overall positive experience with the community-based screen-and-treat program. Common themes were appreciation for bringing screening directly to their villages, surprise at the lack of discomfort, and the benefits of access to same day treatment immediately following abnormal screening. Negative experiences were rare and included discomfort during speculum exam, long duration of screening and challenges with complying with postprocedural abstinence. Most participants felt that utilizing self-collected HPV testing could be acceptable for screening in their community. CONCLUSIONS Our exploratory qualitative sub-study demonstrated that the community-based screen-and-treat with VIA and thermocoagulation was widely accepted. Participants valued the accessible, timely, and painless thermocoagulation treatment and reported minimal side effects. Future considerations for reaching rural women can include community-based follow-up, cervical cancer education for male partners and self-sampling for HPV testing.
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Affiliation(s)
- Fan Lee
- University of North Carolina (UNC) Department of Obstetrics and Gynecology, Chapel Hill, USA.
| | | | | | | | | | | | | | - Jennifer Tang
- University of North Carolina (UNC) Department of Obstetrics and Gynecology, Chapel Hill, USA
- UNC-Project Malawi, Lilongwe, Malawi
| | - Lameck Chinula
- University of North Carolina (UNC) Department of Obstetrics and Gynecology, Chapel Hill, USA
- UNC-Project Malawi, Lilongwe, Malawi
- Kamuzu Central Hospital, Lilongwe, Malawi
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17
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Lewis S, Moucheraud C, Schechinger D, Mphande M, Banda BA, Sigauke H, Kawale P, Dovel K, Hoffman RM. "A loving man has a very huge responsibility": A mixed methods study of Malawian men's knowledge and beliefs about cervical cancer. BMC Public Health 2020; 20:1494. [PMID: 33008344 PMCID: PMC7532091 DOI: 10.1186/s12889-020-09552-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/16/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In Malawi, numerous barriers may prevent women from accessing cervical cancer screening services - including social factors such as male partner involvement. We conducted surveys that included open- and closed-ended questions with married Malawian men to evaluate their knowledge and beliefs about cervical cancer. METHODS HIV-positive adult (≥18 years) men (married or in a stable relationship) were recruited from an antiretroviral therapy clinic in Lilongwe, Malawi. Men were asked a series of survey questions to assess their knowledge about cervical cancer, experience with cervical cancer, their female partner's screening history, and their beliefs about gender norms and household decision-making. Following the survey, participants responded to a set of open-ended interview questions about cervical cancer screening, and men's role in prevention. RESULTS One hundred-twenty men were enrolled with average age 44 years and 55% having completed secondary school or higher education. Despite only moderate knowledge about cervical cancer and screening (average assessment score of 62% correct), all men expressed support of cervical cancer screening, and most (86%) believed they should be involved in their female partner's decision to be screened. Over half (61%) of men said their female partner had previously been screened for cervical cancer, and this was positively correlated with the male respondent having more progressive gender norms around sexual practices. Some men expressed concerns about the screening process, namely the propriety of vaginal exams when performed by male clinicians, and whether the procedure was painful. CONCLUSIONS Male partners in Malawi want to be involved in decisions about cervical cancer screening, but have limited knowledge about screening, and hold rigid beliefs about gender norms that may affect their support for screening. Messaging campaigns addressing men's concerns may be instrumental in improving women's adoption of cervical cancer screening services in Malawi and similar settings.
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Affiliation(s)
- Samuel Lewis
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Corrina Moucheraud
- University of California Los Angeles Fielding School of Public Health, Los Angeles, CA, USA
| | - Devon Schechinger
- University of California Los Angeles Meyer and Renee Luskin School of Public Affairs, Los Angeles, CA, USA
| | | | | | | | - Paul Kawale
- African Institute for Development Policy, Lilongwe, Malawi
| | - Kathryn Dovel
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
- Partners in Hope Medical Center, Lilongwe, Malawi
| | - Risa M Hoffman
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
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Abstract
Background Fear of infertility (FOI) is often reported in studies about reproductive health but this literature not yet mapped. The aim of this rapid scoping review of qualitative studies was to describe the nature of FOI in Africa. Methods Eligibility criteria were qualitative data from Africa reporting views of women and men of any age. MEDLINE and CINAHL databases were searched for English language citations to February 2019 using keywords related to fear, infertility and Africa. Two independent reviewers screened texts for inclusion. Results Of 248 citations identified, 38 qualitative and six review papers were included. FOI was reported in diverse groups (e.g., men, women, fertile, infertile, married, unmarried, teachers, religious leaders). Two types of fears were identified: (1) fear of triggering infertility due to specific reproductive choices and (2) fear of the dire future consequences of infertility. Choices were perceived to affect fertility via internal accumulation and blockage (e.g., of menstrual blood), structural damage (e.g., burnt eggs), internal movement of contraceptive material, deliberate toxicity preventing population growth and behavioral effects impeding sexual activity. Diverse feared consequences of infertility were reported (e.g., polygamy, economic hardships). Fears were reported to affect reproductive behaviour (e.g., stopping contraception), help-seeking and social behaviour. Conclusion FOI is a phenomenon that should be studied in its own right. Fears could originate from genuine threats, incorrect knowledge, distortions of truths, or dissemination of false information. Rigorous studies are needed to better understand FOI and integrate it in health education, client counselling and family planning service provision.
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Affiliation(s)
- Jacky Boivin
- School of Psychology. College of Biomedical and Life Sciences, Cardiff University, 70 Park Place, CF10 3AT, Cardiff, Wales, UK.
| | - Judith Carrier
- Wales Centre for Evidence Based Care, School of Health Care Sciences, Cardiff University, Cardiff, Wales, UK
| | | | - Deborah Edwards
- Wales Centre for Evidence Based Care, School of Health Care Sciences, Cardiff University, Cardiff, Wales, UK
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Pierz AJ, Randall TC, Castle PE, Adedimeji A, Ingabire C, Kubwimana G, Uwinkindi F, Hagenimana M, Businge L, Musabyimana F, Munyaneza A, Murenzi G. A scoping review: Facilitators and barriers of cervical cancer screening and early diagnosis of breast cancer in Sub-Saharan African health settings. Gynecol Oncol Rep 2020; 33:100605. [PMID: 32637528 PMCID: PMC7327246 DOI: 10.1016/j.gore.2020.100605] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 01/11/2023] Open
Abstract
To address gaps in access to cervical cancer screening and early diagnosis of breast cancer services in Sub-Saharan African (SSA), this scoping review was conducted to explore facilitators and barriers that exist on the patient-, provider-, and system-level. An extensive literature search was conducted in accordance with scoping review methodology and the Cochrane guidelines. Our search criteria were limited to original research studies conducted in community or clinical settings in SSA within the last 10 years (2010-2020). Themes found from this review included patient knowledge and provider education, access to screening services, trust, health-related behaviors, attitudes, values, and practices, community and social values, health infrastructure, resource allocation, and political will. Identified barriers included lack of knowledge about cervical and breast cancer among patients, gaps in education and training among providers, and lack of resources and health infrastructure at the facility level and within the overall health system. Facilitators included perceived risk of cancer, support and encouragement of the provider, and utilization of novel approaches in low-resource settings by health systems. To better address individual-, provider-, and health system and facility-based facilitators and barriers to care, there is a need for political and financial investment and further research on the health service delivery in specific national health systems, especially in the context of the global campaign to eliminate cervical cancer as a public health problem.
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Affiliation(s)
- Amanda J. Pierz
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Thomas C. Randall
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Philip E. Castle
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Charles Ingabire
- Division of Clinical Education and Research, Rwanda Military Hospital, Kigali, Rwanda
| | | | | | - Marc Hagenimana
- Cancer Diseases Unit, Rwanda Biomedical Center, Kigali, Rwanda
| | - Lydia Businge
- Division of Clinical Education and Research, Rwanda Military Hospital, Kigali, Rwanda
| | - Francoise Musabyimana
- Division of Clinical Education and Research, Rwanda Military Hospital, Kigali, Rwanda
| | - Athanase Munyaneza
- Division of Clinical Education and Research, Rwanda Military Hospital, Kigali, Rwanda
| | - Gad Murenzi
- Division of Clinical Education and Research, Rwanda Military Hospital, Kigali, Rwanda
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20
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Ruddies F, Gizaw M, Teka B, Thies S, Wienke A, Kaufmann AM, Abebe T, Addissie A, Kantelhardt EJ. Cervical cancer screening in rural Ethiopia: a cross- sectional knowledge, attitude and practice study. BMC Cancer 2020; 20:563. [PMID: 32552740 PMCID: PMC7298871 DOI: 10.1186/s12885-020-07060-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 06/11/2020] [Indexed: 01/03/2023] Open
Abstract
Background Cervical cancer is the fourth most common cancer among women worldwide. Sub- Saharan Africa has a high incidence, prevalence and mortality due to shortage and underutilization of screening facilities. This study aims to assess knowledge and attitude towards cervical cancer and its prevention, as well as practice of cervical cancer screening. Methods This cross-sectional community- based study was conducted in Butajira, Ethiopia in February 2018. Systematic cluster randomized sampling was used to select households from which women in the targeted age group of 30–49 years were invited to participate. Data was collected using a quantitative door to door approach. The questionnaire included socio-demographic data, obstetric history, general knowledge, risk factors, attitude and practice. Logistic regression was used to assess factors associated with knowledge, attitude and practice after dichotomizing the scores using the median as cut off point. Results Three hundred forty-two out of 354 women completed the interviewer administered questionnaire making the response rate 96.3%. 125 women (36%) were aware of cervical cancer and 14 (4.7%) knew symptoms. None of the women named HPV as a risk factor. 61% thought it was a deadly disease, 13.5% felt at risk of developing cervical cancer and 60.7% said cervical cancer is treatable. Eight women (2.3%) had previously been screened. 48.1% had a source of information concerning cervical cancer, of which 66.5% named nurses. Better knowledge was associated with 1–8 years of education (OR = 2.4; CI: 2.4–1.3), having a source of information (OR = 9.1, CI:4.0–20.6), use of contraceptives (OR = 2.3, CI: 1.3–4.0) and a higher income (OR = 1.009, CI: 1.00–1.01). Naming nurses (OR:5.0, CI:2.4–10.3), another source of information (OR = 3.3, CI:1.2–9.0), use of contraceptives (OR = 2.2, CI:1.2–3.8) and living in an urban area (OR = 3.3, CI:1.2–9.0) were associated with a positive attitude. Naming nurses (OR = 21,0, CI:10.4–42.3) and another source of information (OR = 5.8, CI:2.4–13.5) were associated with participating in cervical cancer screening. Conclusion Most women were unaware of cervical cancer, HPV-infection as a risk factor and did not feel susceptible to cervical cancer. As Health workers were the most commonly mentioned source of information, focus should be put on their further education.
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Affiliation(s)
- Friederike Ruddies
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-Universität Halle-Wittenberg, 06097, Halle (Saale), Germany
| | - Muluken Gizaw
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-Universität Halle-Wittenberg, 06097, Halle (Saale), Germany.,School of Public Health, Department of Preventive Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Brhanu Teka
- Department of Microbiology, Immunology and Parasitology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sarah Thies
- Clinic for Gynecology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institutes of Health, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-Universität Halle-Wittenberg, 06097, Halle (Saale), Germany
| | - Andreas M Kaufmann
- Clinic for Gynecology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institutes of Health, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Tamrat Abebe
- Department of Microbiology, Immunology and Parasitology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adamu Addissie
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-Universität Halle-Wittenberg, 06097, Halle (Saale), Germany.,School of Public Health, Department of Preventive Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eva Johanna Kantelhardt
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-Universität Halle-Wittenberg, 06097, Halle (Saale), Germany.
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21
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Maza M, Meléndez M, Herrera A, Hernández X, Rodríguez B, Soler M, Alfaro K, Masch R, Conzuelo-Rodríguez G, Obedin-Maliver J, Cremer M. Cervical Cancer Screening with Human Papillomavirus Self-Sampling Among Transgender Men in El Salvador. LGBT Health 2020; 7:174-181. [PMID: 32407149 DOI: 10.1089/lgbt.2019.0202] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose: Sexual and gender minority persons in low-income countries have very limited access to routine health services. This study evaluated the feasibility of using a self-sampled human papillomavirus (HPV) test to increase access to screening for cervical cancer among transgender men in El Salvador. Methods: We partnered with a local advocacy organization for recruitment. A total of 24 transgender men (men assigned female at birth) ages 19-55 were enrolled and provided consent. Questionnaires assessed sociodemographics, health and sexual histories, and knowledge about HPV and cervical cancer. Screening was performed with a self-sampled HPV test. Participants with a positive test were offered colposcopy and cryotherapy treatment, if appropriate. Those with a negative test were advised to return in 5 years for rescreening. Results: Out of 24 consenting participants, 23 (95.83%) agreed to conduct HPV self-sampling, and 22/23 (95.65%) expressed willingness to self-sample in the future. Among self-sampled individuals, 3/23 (13%) tested positive and accepted colposcopy and biopsy. Analyses of biopsied tissue revealed one case of cervical intraepithelial neoplasia grade 1. Conclusion: HPV self-sampling and subsequent procedures were accepted by the majority of participants. This screening method may be a viable alternative to cytology among transgender men in El Salvador.
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Affiliation(s)
- Mauricio Maza
- Basic Health International, Pittsburgh, Pennsylvania, USA; New York, New York, USA; and San Salvador, El Salvador
| | - Mario Meléndez
- Basic Health International, Pittsburgh, Pennsylvania, USA; New York, New York, USA; and San Salvador, El Salvador
| | - Alejandra Herrera
- Basic Health International, Pittsburgh, Pennsylvania, USA; New York, New York, USA; and San Salvador, El Salvador
| | - Xavier Hernández
- Asociación Generación Hombres Trans El Salvador, San Salvador, El Salvador
| | - Bryan Rodríguez
- Asociación Generación Hombres Trans El Salvador, San Salvador, El Salvador
| | - Montserrat Soler
- Basic Health International, Pittsburgh, Pennsylvania, USA; New York, New York, USA; and San Salvador, El Salvador.,Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Karla Alfaro
- Basic Health International, Pittsburgh, Pennsylvania, USA; New York, New York, USA; and San Salvador, El Salvador
| | - Rachel Masch
- Basic Health International, Pittsburgh, Pennsylvania, USA; New York, New York, USA; and San Salvador, El Salvador
| | - Gabriel Conzuelo-Rodríguez
- Basic Health International, Pittsburgh, Pennsylvania, USA; New York, New York, USA; and San Salvador, El Salvador
| | - Juno Obedin-Maliver
- Department of Obstetrics and Gynecology, Standford School of Medicine, Palo Alto, California, USA
| | - Miriam Cremer
- Basic Health International, Pittsburgh, Pennsylvania, USA; New York, New York, USA; and San Salvador, El Salvador.,Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
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22
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Abstract
Patient engagement in research is marked by partnership between clinicians, scientists, and people with lived experience of a disease, who jointly develop and implement research and disseminate results. Patient engagement in research has been shown to lead to more impactful and relevant findings. There is a global need for quality research contextualized for low- and middle-income countries (LMICs). Patient involvement in research could address this need, yet it remains a practice more commonly employed in high income countries. In this paper, the authors explore LMIC-specific challenges and opportunities for patient engagement in research. Limitations to patient engagement in research include gaps in health infrastructure, socioeconomic status, cultural stigma, and uncertain roles. Potential solutions to address these challenges include strategic national and international research partnerships, initiatives to combat stigma, and sensitization and training of stakeholders in patient engagement in research. Reflecting on their patient engagement experience with eye cancer research in Canada and Kenya, and supported by evidence of patient engagement in other low-resource settings, the authors provide a roadmap for patient engagement in research in LMICs.
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Affiliation(s)
- Ana Janic
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.,Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, ON, Canada.,The Centre for Global Child Health, SickKids Research Institute, Toronto, ON, Canada
| | - Kahaki Kimani
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | - Isabel Olembo
- Syndications and Agency Operations Department, Eastern and Southern African Trade and Development Bank, Nairobi, Kenya
| | - Helen Dimaras
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada. .,Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada. .,Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, ON, Canada. .,The Centre for Global Child Health, SickKids Research Institute, Toronto, ON, Canada. .,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada. .,Division of Clinical Public Health, University of Toronto, Toronto, ON, Canada.
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23
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Oketch SY, Kwena Z, Choi Y, Adewumi K, Moghadassi M, Bukusi EA, Huchko MJ. Perspectives of women participating in a cervical cancer screening campaign with community-based HPV self-sampling in rural western Kenya: a qualitative study. BMC Womens Health 2019; 19:75. [PMID: 31196175 PMCID: PMC6567898 DOI: 10.1186/s12905-019-0778-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 06/05/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Despite cervical cancer being preventable with effective screening programs, it is the most common cancer and the leading cause of cancer-related death among women in many countries in Africa. Screening involving pelvic examination may not be feasible or acceptable in limited-resource settings. We sought to evaluate women's perspectives on human papillomavirus (HPV) self-sampling as part of a larger trial on cervical cancer prevention implementation strategies in rural western Kenya. METHODS We invited 120 women participating in a cluster randomized trial of cervical cancer screening implementation strategies in Migori County, Kenya for in-depth interviews. We explored reasons for testing, experience with and ability to complete HPV self-sampling, importance of clinician involvement during screening, factors and people contributing to screening decision-making, and ways to encourage other women to come for screening. We used validated theoretical frameworks to analyze the qualitative data. RESULTS Women reported having positive experiences with the HPV self-sampling strategy. The factors facilitating uptake included knowledge and beliefs such as prior awareness of HPV, personal perception of cervical cancer risk, desire for improved health outcomes, and peer and partner encouragement. Logistical and screening facilitators included confidence in the ability to complete HPV self-sampling strategy, proximity to screening sites and feelings of privacy and comfort conducting the HPV self- sampling. The barriers to screening included fear of need for a pelvic exam, fear of disease and death associated with cervical cancer. We classified these findings as capabilities, opportunities and motivations for health behavior using the COM-B framework. CONCLUSIONS Overall, HPV self-sampling was an acceptable cervical cancer screening strategy that seemed to meet the needs of the women in this community. These findings will further inform aspects of implementation, including outreach messaging, health education, screening sites and emphasis on availability and effectiveness of preventative treatment for women who screen positive.
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Affiliation(s)
- Sandra Y. Oketch
- Center for Microbiology Research, Kenya Medical Research Institute, P. O. Box 54840 00200, Mbagathi Road, Nairobi, Kenya
| | - Zachary Kwena
- Center for Microbiology Research, Kenya Medical Research Institute, P. O. Box 54840 00200, Mbagathi Road, Nairobi, Kenya
| | - Yujung Choi
- Duke Global Health Institute, Box 90519, 310 Trent Drive, Durham, NC 27710 USA
| | - Konyin Adewumi
- Duke Global Health Institute, Box 90519, 310 Trent Drive, Durham, NC 27710 USA
| | - Michelle Moghadassi
- Department of Obstetrics and Gynecology, University of California San Francisco, 550 16th Street, 3749, San Francisco, CA 94158 USA
| | - Elizabeth A. Bukusi
- Center for Microbiology Research, Kenya Medical Research Institute, P. O. Box 54840 00200, Mbagathi Road, Nairobi, Kenya
- Department of Obstetrics and Gynecology, University of Nairobi, P. O. Box 54840 00200, Nairobi, Kenya
- Department of Obstetrics and Gynecology, Aga Khan University, P. O. Box 30270 00100, Third Avenue, Limuru Rd, Nairobi, Kenya
- Departments of Obstetrics and Gynecology, University of Washington, P. O. Box 356460, Seattle, WA 98195 USA
| | - Megan J. Huchko
- Duke Global Health Institute, Box 90519, 310 Trent Drive, Durham, NC 27710 USA
- Department of Obstetrics and Gynecology, Duke University, Box 90519, 310 Trent Drive, Durham, NC 27710 USA
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24
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Gatumo M, Gacheri S, Sayed AR, Scheibe A. Women's knowledge and attitudes related to cervical cancer and cervical cancer screening in Isiolo and Tharaka Nithi counties, Kenya: a cross-sectional study. BMC Cancer 2018; 18:745. [PMID: 30021564 PMCID: PMC6052645 DOI: 10.1186/s12885-018-4642-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 06/27/2018] [Indexed: 12/18/2022] Open
Abstract
Background Cervical cancer is the most common cancer among women in Kenya. However, only 3% of women are routinely screened. This study aimed to assess women’s knowledge and attitudes towards cervical cancer and cervical cancer screening in Kenya’s Isiolo and Tharaka Nithi counties. Methods A cross-sectional survey was conducted between January and March 2017. Using a multistage cluster sampling methodology, 451 women 18 years of age and older participated in the study. Interviewers administered a 35-item questionnaire collecting demographic information, knowledge of risk factors and attitudes towards cervical cancer and cervical cancer screening. Bivariate and multivariate analyses of cervical cancer knowledge and demographic characteristics were conducted. Results The response rate for the study was 98% (451/460). Two-thirds of the study participants originated from Tharaka Nithi county (n = 318). Respondents reported a median age of 32; 70.5% were married; and 35.0% had primary education. Eighty percent of the participants were aware of cervical cancer, 25.6% of whom had previously undergone a cervical screening examination, and 44.4% had above-average knowledge of risk factors of cervical cancer. Knowledge of cervical cancer risk factors was significantly associated with employment status (adjusted odds ratio = 1.6; 95% CI: 1.0–2.6) and county of origin (adjusted odds ratio = 2.8; 95% CI: 1.6–5.0). Almost all (89.2%) of those who had heard of cervical cancer categorised it as “scary”. There was a marginal significant difference in the overall attitude assessment score towards cervical cancer between participants from Isiolo and Tharaka Nithi counties; the mean (SD) score was 2.13 (0.34) and 2.20 (0.30) respectively. The score was comparatively higher among participants residing in Tharaka Nithi (95% CI: 0.002–0.146; p = 0.043). Conclusions Interventions to increase cervical cancer knowledge are needed in Isiolo and Tharaka Nithi counties, Kenya. Additional research is needed to further understand and assess the effectiveness of different strategies to improve attitudes regarding cervical cancer in order to increase the uptake of screening services, particularly among less-educated women and those in hard-to-reach areas. Electronic supplementary material The online version of this article (10.1186/s12885-018-4642-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Murithi Gatumo
- Community Health Access Program (CHAP), P O Box 2756, Nairobi, 00202, Kenya.
| | - Susan Gacheri
- Community Health Access Program (CHAP), P O Box 2756, Nairobi, 00202, Kenya
| | - Abdul-Rauf Sayed
- Bristol-Myers Squibb Foundation (BMSF), Woodmead office park, Johannesburg, South Africa
| | - Andrew Scheibe
- Bristol-Myers Squibb Foundation (BMSF), Woodmead office park, Johannesburg, South Africa
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25
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Senkomago V, Duran D, Loharikar A, Hyde TB, Markowitz LE, Unger ER, Saraiya M. CDC Activities for Improving Implementation of Human Papillomavirus Vaccination, Cervical Cancer Screening, and Surveillance Worldwide. Emerg Infect Dis 2018; 23. [PMID: 29155666 PMCID: PMC5711299 DOI: 10.3201/eid2313.170603] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Cervical cancer incidence and mortality rates are high, particularly in developing countries. Most cervical cancers can be prevented by human papillomavirus (HPV) vaccination, screening, and timely treatment. The US Centers for Disease Control and Prevention (CDC) provides global technical assistance for implementation and evaluation of HPV vaccination pilot projects and programs and laboratory-related HPV activities to assess HPV vaccines. CDC collaborates with global partners to develop global cervical cancer screening recommendations and manuals, implement screening, create standardized evaluation tools, and provide expertise to monitor outcomes. CDC also trains epidemiologists in cancer prevention through its Field Epidemiology Training Program and is working to improve cancer surveillance by supporting efforts of the World Health Organization in developing cancer registry hubs and assisting countries in estimating costs for developing population-based cancer registries. These activities contribute to the Global Health Security Agenda action packages to improve immunization, surveillance, and the public health workforce globally.
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26
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Ragan KR, Buchanan Lunsford N, Lee Smith J, Saraiya M, Aketch M. Perspectives of Screening-Eligible Women and Male Partners on Benefits of and Barriers to Treatment for Precancerous Lesions and Cervical Cancer in Kenya. Oncologist 2017; 23:35-43. [PMID: 28798272 PMCID: PMC5759810 DOI: 10.1634/theoncologist.2017-0053] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 07/14/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cervical cancer is the leading cause of female cancer mortality in Kenya. Kenya's National Cervical Cancer Prevention Program Strategic Plan outlines efforts to reduce the burden; however, treatment services remain limited. This study identified male and female perspectives regarding benefits, facilitators, and barriers to treatment for precancerous lesions and cervical cancer. MATERIALS AND METHODS Ten focus groups were conducted in Nairobi and Nyanza in 2014 with females aged 25-49 years (n = 60) and male partners (n = 40). Participants were divided into groups dependent on screening status, sex, language, and geographic location. Qualitative analytic software was used to analyze transcribed and translated data. RESULTS Treatment was endorsed as beneficial for the prevention of death and the improvement of wellness, quality of life, symptoms, and family life. Barriers reported by males and females included the following: (a) concerns about side effects; (b) treatment-related fear and stigma; (c) marital discord; (d) financial and access issues; (e) religious and cultural beliefs; and (f) limited knowledge. Male endorsement of wanting to improve knowledge and communication with their partners, in spite of stigmatizing beliefs and misperceptions regarding females with abnormal screening results or those who have been diagnosed with cancer, was novel. CONCLUSION Incorporating qualitative data on benefits of and barriers to treatment for precancerous lesions and cervical cancer into Kenya's national priorities and activities is important. These findings can be used to inform the development and successful implementation of targeted, region-specific community outreach and health messaging campaigns focused on alleviating the country's cervical cancer burden. IMPLICATIONS FOR PRACTICE This article provides important insight into female and male partner perspectives regarding benefits, facilitators, and barriers to treatment for precancerous lesions and cervical cancer. These novel research findings can inform the development of targeted community health interventions, educational messages, and resources and aid stakeholders in strengthening strategic plans regarding treatment coverage and cervical cancer prevention. Because several treatment barriers identified in this study are similar to barriers associated with cervical cancer screening in low- and middle-resourced countries, effective messaging interventions could address barriers to receipt of both screening and treatment.
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Affiliation(s)
- Kathleen R Ragan
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Atlanta, Georgia, USA
| | - Natasha Buchanan Lunsford
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Atlanta, Georgia, USA
| | - Judith Lee Smith
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Atlanta, Georgia, USA
| | - Mona Saraiya
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Atlanta, Georgia, USA
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