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Aubrey-Basler K, Bursey K, Pike A, Penney C, Furlong B, Howells M, Al-Obaid H, Rourke J, Asghari S, Hall A. Interventions to improve primary healthcare in rural settings: A scoping review. PLoS One 2024; 19:e0305516. [PMID: 38990801 PMCID: PMC11239038 DOI: 10.1371/journal.pone.0305516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 06/01/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Residents of rural areas have poorer health status, less healthy behaviours and higher mortality than urban dwellers, issues which are commonly addressed in primary care. Strengthening primary care may be an important tool to improve the health status of rural populations. OBJECTIVE Synthesize and categorize studies that examine interventions to improve rural primary care. ELIGIBILITY CRITERIA Experimental or observational studies published between January 1, 1996 and December 2022 that include an historical or concurrent control comparison. SOURCES OF EVIDENCE Pubmed, CINAHL, Cochrane Library, Embase. CHARTING METHODS We extracted and charted data by broad category (quality, access and efficiency), study design, country of origin, publication year, aim, health condition and type of intervention studied. We assigned multiple categories to a study where relevant. RESULTS 372 papers met our inclusion criteria, divided among quality (82%), access (20%) and efficiency (13%) categories. A majority of papers were completed in the USA (40%), Australia (15%), China (7%) or Canada (6%). 35 (9%) papers came from countries in Africa. The most common study design was an uncontrolled before-and-after comparison (32%) and only 24% of studies used randomized designs. The number of publications each year has increased markedly over the study period from 1-2/year in 1997-99 to a peak of 49 papers in 2017. CONCLUSIONS Despite substantial inequity in health outcomes associated with rural living, very little attention is paid to rural primary care in the scientific literature. Very few studies of rural primary care use randomized designs.
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Affiliation(s)
- Kris Aubrey-Basler
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Division of Public Health and Applied Health Sciences, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Krystal Bursey
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Andrea Pike
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Carla Penney
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Bradley Furlong
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Mark Howells
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Harith Al-Obaid
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - James Rourke
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Shabnam Asghari
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Division of Public Health and Applied Health Sciences, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Amanda Hall
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Division of Public Health and Applied Health Sciences, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
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Lamichhane B, Adhikari B, Poudel L, Pandey AR, Kakchhapati S, K. C. SP, Giri S, Dulal BP, Joshi D, Gautam G, Baral SC. Factors associated with uptake of breast and cervical cancer screening among Nepalese women: Evidence from Nepal Demographic and Health Survey 2022. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002971. [PMID: 38466682 PMCID: PMC10927089 DOI: 10.1371/journal.pgph.0002971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 02/06/2024] [Indexed: 03/13/2024]
Abstract
Breast cancer screening (BCS) and cervical cancer screening (CCS) are integral parts of initiatives to reduce the burden associated with these diseases. In this context, we aimed to determine factors associated with BCS and CCS uptake among Nepalese women aged 30 to 49 years using data from the Nepal Demographic Health Survey (NDHS) 2022. We performed a weighted analysis to account complex survey design of the NDHS 2022. We employed univariable and multivariable logistic regression to determine factors associated with the uptake of BCS and CCS and results were presented as crude odds ratio and adjusted odds ratio (AOR) along with 95% confidence interval (CI). The uptake of BCS and CCS among Nepalese women aged 30 to 49 years were 6.5% and 11.4% respectively. Women from Terai compared to mountain region (AOR = 0.54, 95%CI: 0.31, 0.93) and those engaged in agriculture compared to non-working (AOR = 0.59, 95%CI: 0.42, 0.82) women had lower odds of BCS uptake. Conversely, Dalit women compared to Brahmin/Chhetri (AOR = 2.08, 95%CI: 1.37, 3.16), and women with basic (AOR = 1.49, 95%CI: 1.04, 2.13), secondary (AOR = 1.96, 95%CI: 1.33, 2.88), and higher education (AOR = 2.80, 95% CI: 1.51, 5.19) compared to those with no education had higher odds of BCS uptake. Women from rural areas (AOR = 0.76, 95%CI: 0.61, 0.96), and those living in Bagmati (AOR = 2.16, 95% CI: 1.44, 3.23) and Gandaki (AOR = 2.09, 95%CI: 1.40, 3.14) provinces had higher odds of CCS uptake compared to their urban counterparts and those living in Koshi province, respectively. The odds of CCS increased with age (AOR = 1.06, 95%CI: 1.04, 1.08). Women with secondary education (AOR = 1.47, 95%CI: 1.06, 2.04) had higher odds of CCS uptake compared to those without education. Similarly, married women (AOR = 8.24, 95%CI: 1.03, 66.21), and those with health insurance (AOR = 1.41, 95%CI: 1.08, 1.83) had higher odds of CCS. In conclusion, the uptake of both BCS and CCS was relatively poor among Nepalese women indicating a need for targeted and tailored intervention to increase BCS and CCS uptake.
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Affiliation(s)
- Bipul Lamichhane
- Research and Development Department, HERD International, Lalitpur, Nepal
| | - Bikram Adhikari
- Research and Development Department, HERD International, Lalitpur, Nepal
| | - Lisasha Poudel
- Central Department of Public Health Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Achyut Raj Pandey
- Research and Development Department, HERD International, Lalitpur, Nepal
| | | | | | - Santosh Giri
- Research and Development Department, HERD International, Lalitpur, Nepal
| | | | - Deepak Joshi
- Research and Development Department, HERD International, Lalitpur, Nepal
| | - Ghanshyam Gautam
- Research and Development Department, HERD International, Lalitpur, Nepal
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Dangal G, Dhital R, Dwa YP, Poudel S, Pariyar J, Subedi K. Implementation of cervical cancer prevention and screening across five tertiary hospitals in Nepal and its policy implications: A mixed-methods study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002832. [PMID: 38236836 PMCID: PMC10796028 DOI: 10.1371/journal.pgph.0002832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/23/2023] [Indexed: 01/22/2024]
Abstract
In Nepal, cervical cancer is the most common cancer among women despite the existing policies. This study intends to assess the implementation of cervical cancer prevention and screening through service utilization by women, knowledge and attitude among health professionals, and the perceptions of stakeholders in Nepal. This mixed-methods study was conducted in 2022 across five tertiary hospitals in Kathmandu, Nepal. The quantitative study comprised the health professionals and women attending gynecology outpatient clinics from the selected hospitals. The qualitative study comprised stakeholders including service providers and experts on cervical cancer from selected hospitals, civil societies, and the Ministry of Health and Population. The utilization of screening through pap smear among 657 women across five hospitals was 22.2% and HPV vaccination was 1.5%. The utilization of cervical cancer screening was associated with older age [adjusted odds ratio (AOR) = 1.09, CI: 1.07, 8.19], married (AOR = 3.024, CI: 1.12, 8.19), higher education (AOR = 3.024, CI:1.12, 8.42), oral contraceptives use (AOR = 2.49, CI: 1.36, 4.39), and ever heard of cervical cancer screening (AOR = 13.28, CI: 6.85, 25.73). Among 254 health professionals, the knowledge score was positively associated with them ever having a training [Standardized Beta (β) = 0.20, CI: 0.44, 2.43)] and having outreach activities in their hospital (β = 0.19 CI: 0.89, 9.53) regarding cervical cancer screening. The female as compared to male health professionals (β = 0.16, CI: 0.41, 8.16, P = 0.03) and having a cervical cancer screening guideline as compared to none (β = 0.19 CI: 0.89, 9.53, P = 0.026) were more likely to have a better attitude for screening. The qualitative findings among 23 stakeholders reflected implementation challenges in policy, supply, service delivery, providers, and community. This study showed low utilization of prevention and services by women and implementation gaps on cervical cancer prevention and screening services across five tertiary hospitals in Kathmandu, Nepal. The findings could help designing more focused interventions.
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Affiliation(s)
- Ganesh Dangal
- Nepal Society of Obstetricians and Gynaecologists, Kathmandu, Nepal
- Kathmandu Model Hospital, Kathmandu, Nepal
| | | | - Yam Prasad Dwa
- Nepal Society of Obstetricians and Gynaecologists, Kathmandu, Nepal
- KIST Medical College and Teaching Hospital, Lalitpur, Nepal
| | - Sandesh Poudel
- Nepal Society of Obstetricians and Gynaecologists, Kathmandu, Nepal
- Paropakar Maternity and Women’s Hospital, Kathmandu, Nepal
| | - Jitendra Pariyar
- Nepal Society of Obstetricians and Gynaecologists, Kathmandu, Nepal
- Civil Service Hospital of Nepal, Kathmandu, Nepal
| | - Kirtipal Subedi
- Nepal Society of Obstetricians and Gynaecologists, Kathmandu, Nepal
- Paropakar Maternity and Women’s Hospital, Kathmandu, Nepal
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Dhoj Shrestha A, Gyawali B, Shrestha A, Shrestha S, Neupane D, Ghimire S, Campbell C, Kallestrup P. Effect of a female community health volunteer-delivered intervention to increase cervical cancer screening uptake in Nepal: a cluster randomized controlled trial. Prev Med Rep 2022; 29:101948. [PMID: 36161136 PMCID: PMC9501993 DOI: 10.1016/j.pmedr.2022.101948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 11/18/2022] Open
Abstract
A community-based cluster randomized controlled trial. An FCHV-delivered intervention increased cervical cancer screening uptake. Screening uptake among women aged 30–60 years in a semi-urban area of Nepal.
This study aimed to assess the effect of Female Community Health Volunteer (FCHV)-delivered intervention to increase cervical cancer screening uptake among Nepalese women. A community-based, open-label, 2-group, cluster randomized controlled trial (CRCT) was conducted in a semi-urban setting in Western Nepal. Fourteen clusters (1:1) were randomly assigned to the intervention group, which received a 12-month intervention delivered by FCHVs or the control group (usual care). Between April and June 2019, 690 women aged 30–60 years were recruited for CRCT during the baseline survey. A follow-up assessment was conducted after the completion of the 12 months intervention. The primary outcome was the change in cervical cancer screening from baseline to 12-month follow-up. Of 690 women, 646 women completed the trial. 254 women in the intervention group and 385 women in the control group were included in the primary outcome analysis. There was a significant increase in cervical cancer screening uptake in the intervention group [relative risk (RR), 1.48; 95 % confidence interval (CI) 1.32, 1.66; P < 0.01)], compared to the control group. The secondary outcome was the change in median knowledge score among women that increased from 2 [interquartile range (IQR) 1–4] (baseline) to 6 [IQR 3–9] (follow-up) in the intervention group. However, the median knowledge score remained almost the same among women in the control group 2 [IQR 1–5] to 3 [IQR 2–5]. Our study findings reported that an FCHV-delivered intervention significantly increased cervical cancer screening uptake among women living in a semi-urban setting in Nepal. Trial registration: ClinicalTrials.gov NCT03808064.
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Ochomo EO, Ndege S, Itsura P. Focused Training of Community Health Volunteers on Cervical Cancer in Rural Kisumu. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:466-473. [PMID: 32720131 PMCID: PMC7855100 DOI: 10.1007/s13187-020-01839-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The cancer disease burden is higher in the low- and middle-income countries like Kenya where uptake of screening services is low. Community health volunteers (CHVs) have been shown to be effective in improving uptake of health services and could also be used in cervical cancer screening. However, they still have inadequate knowledge hindering effective public education. The aim of this study is to determine the effect of focused training of the CHVs on their knowledge on cervical cancer and screening uptake among women of reproductive age. This was a quasi-experimental study in rural sub-counties of Nyando and Nyakach. Nyando was the intervention arm with 186 CHVs and Nyakach the control with 239 CHVs. Participants' knowledge on cervical cancer was assessed using a self-administered questionnaire. CHVs in the intervention arm were trained about cervical cancer and screening. Knowledge was re-assessed following a 6-month public education period. The focused training improved the CHVs' knowledge on cervical cancer to 60.9% compared to 13.4% in the control arm (p = 0.004) at the end-line. The knowledge was dependent on the level of education (χ2 = 34.41, p = 0.045), religion (χ2 = 25.85, p = 0.007), and occupation (χ2 = 95.04, p < 0.0001). Screening uptake was significantly associated with knowledge of risk factors (p = 0.019) and sign and symptoms (p = 0.017). Screening uptake improved in the intervention arm while declined in the control arm. The training significantly improved the CHVs' knowledge on cervical cancer and uptake of screening services in the intervention area, Kisumu County, Kenya, and should be continuous.
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Affiliation(s)
| | - Samson Ndege
- AMPATH Cervical Cancer Program, P.O. Box 4606, Eldoret, Kenya
- School of Public Health, Moi University, P.O. Box 4606, Eldoret, Kenya
| | - Peter Itsura
- AMPATH Cervical Cancer Program, P.O. Box 4606, Eldoret, Kenya
- School of Medicine, Moi University, P.O. Box 4606, Eldoret, Kenya
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Shrestha AD, Gyawali B, Shrestha A, Shrestha S, Neupane D, Ghimire S, Campbell C, Kallestrup P. Knowledge, attitude, preventive practices and utilization of cervical cancer screening among women in Nepal: a community-based cross-sectional study. Eur J Cancer Prev 2022; 31:73-81. [PMID: 34871200 DOI: 10.1097/cej.0000000000000670] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Cervical cancer continues to be a global public health concern and a leading cause of cancer deaths among Nepalese women. In spite of the availability of screening and treatment services in Nepal, the utilization of screening has been low. This study investigated knowledge, attitude, preventive practices and utilization of cervical cancer screening among women in a semi-urban area of Pokhara Metropolitan City of Nepal. METHODS A community-based cross-sectional survey was carried out among 729 women 30-60 years of age, between April and June 2019. Participants were selected by systematic random sampling, and a door-to-door home visit was conducted for data collection. A pretested interviewer-administered Nepali questionnaire was used to collect information on sociodemographic variables, knowledge, attitude and preventive practices regarding cervical cancer screening. RESULTS The mean age of the participants was 45.9 years (SD ±7.7); the majority were married (86.7%). Among the participants, 44.9% were ever screened for cervical cancer. However, only 10.4% of participants received timely repeated screening for cervical cancer. The median knowledge score achieved by participants was 2.0 [interquartile range (IQR) 1-4] on a scale of maximum score 36, the median attitude score was 31.0 (IQR 29-32) on a scale of 40 and the median preventive practice score was 3.0 (IQR 3-4) on a scale of five. CONCLUSION This study showed low knowledge and low utilization of cervical cancer screening among women in Nepal. We recommend a community-based educational intervention to educate and empower women to increase knowledge and utilization of cervical cancer screening.
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Affiliation(s)
- Aamod Dhoj Shrestha
- Center for Global Health, Department of Public Health, Aarhus University, Denmark
- COBIN, Nepal Development Society, Bharatpur, Nepal
| | - Bishal Gyawali
- Global Health Section, Department of Public Health, University of Copenhagen, Denmark
| | - Archana Shrestha
- Department of Public Health, Kathmandu University School of Medical Sciences, Nepal
| | - Sadeep Shrestha
- School of Public Health, University of Alabama Birmingham, Alabama
| | - Dinesh Neupane
- COBIN, Nepal Development Society, Bharatpur, Nepal
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | - Per Kallestrup
- Center for Global Health, Department of Public Health, Aarhus University, Denmark
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Rademaker C, Bhandary S, Harder H. Knowledge, awareness, attitudes and screening practices towards breast and cervical cancer among women in Nepal: a scoping review. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01688-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Abstract
Aim
Breast and cervical cancers have emerged as major global health challenges and disproportionately affect women in low- and middle-income countries, including Nepal. This scoping review aimed to map the knowledge, attitudes and screening practices for these cancers among Nepali women to improve cancer outcomes and reduce inequality.
Methods
Five electronic databases (CINAHL, Embase, Global Health, PsycINFO and PubMed), grey literature, and reference and citation lists were searched for articles published in English up to June 2021. Articles were screened against inclusion/exclusion criteria, and data from eligible studies were extracted. Results were summarised narratively.
Results
The search yielded 615 articles, 38 of which were included in this scoping review (27 cervical cancer, 10 breast cancer, 1 both cancers). Levels of knowledge regarding breast and cervical varied widely. The main knowledge gaps were misconceptions about symptoms and risk factors, and poor understanding of screening behaviours. Screening practices were mostly inadequate due to socio-cultural, geographical or financial barriers. Positive attitudes towards cervical screening were associated with higher education and increased knowledge of screening modalities. Higher levels of knowledge, (health) literacy and participation in awareness campaigns facilitated breast cancer screening.
Conclusion
Knowledge and screening practices for breast and cervical cancer among Nepali women were poor and highlight the need for awareness and education programmes. Future research should explore community health worker-led awareness and screening interventions for cervical cancer, and programmes to increase the practice of breast self-examination and clinical breast examinations to support early diagnosis of breast cancer.
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Female health education package enhances knowledge, attitudes, and self-efficacy of housewives in cervical cancer screening. ENFERMERIA CLINICA 2021. [PMID: 33849166 DOI: 10.1016/j.enfcli.2020.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This research was conducted to identify the effectiveness of FEMALE health education on the knowledge, attitudes, and self-efficacy of women in the Banjarbaru Selatan District, Banjarbaru. The quasi experimental pre-post test with control group design. Study was carried out on 428 housewives, 213 as control groups and 215 as intervention groups respectively. The sampling technique used convenience sampling. The results showed that there was a significant differences before and after intervention in knowledge, attitudes, and self-efficacy in women (p=0.000, p=0.003, and p=0.002 respectively) in the intervention group which is also significant different from respondent in the control group. This study recommends that nurses could use this FEMALE health education to educate women in the community in order to improve the coverage of cervical cancer screening.
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Srinivas V, Herbst De Cortina S, Nishimura H, Krupp K, Jayakrishna P, Ravi K, Khan A, Madhunapantula SV, Madhivanan P. Community-based Mobile Cervical Cancer Screening Program in Rural India: Successes and Challenges for Implementation. Asian Pac J Cancer Prev 2021; 22:1393-1400. [PMID: 34048166 PMCID: PMC8408397 DOI: 10.31557/apjcp.2021.22.5.1393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Indexed: 11/28/2022] Open
Abstract
Background: The aim of this study is to demonstrate the feasibility; mention the challenges encountered and highlight the success of implementing a community-based mobile cervical cancer-screening program in rural India. Methods: Communities were mobilized through extensive peer education and by screening in existing community spaces using a mobile clinic model. An initial “screen and treat” protocol was transitioned to “screen, test, and treat” using Pap smears for confirmatory testing, and cryotherapy or Loop Electrosurgical Excision Procedure (LEEP) for treatment. We trained 50 Peer Educators and conducted 190 screening camps in 58 locations. Results: Of 3,821 registered women, 3,544 (92.8%) accepted screening. Overall, 440/3544 (12.4%, 95% CI 11.3-13.5%) women had VIA-positive lesions. Under “screen and treat”, 56/156 (35.9%) women accepted same-day treatment. Under “screen, test, and treat”, 555/762 (72.8%) women received a Pap smear. Overall, 83 women underwent cryotherapy (n=56) and LEEP (n=27). Of those, 49 (59.0%) participants were followed up, with normal VIA results up to two years after treatment. In summary, the peer educators promoted awareness of cervical cancer and helped in gaining buy-in from communities. Acceptance of same-day treatment was low and accompanied by loss to follow-up, limiting the utility of VIA in these studies. Conclusions: Mobile infrastructure utilized in community spaces brought screening directly to rural women. Culturally appropriate methods to increase linkage to treatment and additional screening options such as HPV DNA testing should be explored.
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Affiliation(s)
| | - Sasha Herbst De Cortina
- Public Health Research Institute of India, Mysore, India.,School of Medicine, University of California Irvine, Irvine, USA.,Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, USA
| | - Holly Nishimura
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA
| | - Karl Krupp
- Public Health Research Institute of India, Mysore, India.,Department of Biochemistry, JSS Medical College, Leader, Special Interest Group (SIG) in Cancer Biology and Cancer Stem Cells JSS Academy of Higher Education & Research, Mysore, Karnataka, India
| | | | - Kavitha Ravi
- Public Health Research Institute of India, Mysore, India
| | - Anisa Khan
- Public Health Research Institute of India, Mysore, India
| | | | - Purnima Madhivanan
- Public Health Research Institute of India, Mysore, India.,Department of Biochemistry, JSS Medical College, Leader, Special Interest Group (SIG) in Cancer Biology and Cancer Stem Cells JSS Academy of Higher Education & Research, Mysore, Karnataka, India.,Department of Family & Community Medicine, College of Medicine, University of Arizona, Tucson, USA
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Experiences of cervical cancer survivors in Chitwan, Nepal: A qualitative study. PLoS One 2020; 15:e0234834. [PMID: 33151965 PMCID: PMC7644025 DOI: 10.1371/journal.pone.0234834] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/21/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Cervical cancer is a global leading cause of morbidity and mortality. The majority of cervical cancer deaths occur in developing countries including Nepal. Though knowledge of cervical cancer is an important determinant of women’s participation in prevention and screening for cervical cancer, little is known about this topic in Nepal. This study explores the experiences of cervical cancer survivors and assesses the attitude of family and community towards it and stigma related to this disease in Bharatpur, Nepal. Methods The study design was qualitative methods involving two focus-group discussions. A total of 17 cervical cancer survivors, who have completed two years of cancer treatment were selected purposively from Chitwan. All qualitative data were transcribed and translated into English and were thematically analyzed. Results The majority of the participants had scant knowledge about cervical cancer, its causative agent, showed less cervical cancer screening, delayed healthcare-seeking behavior despite having persistent symptoms before the diagnosis. The main reasons identified for not uptaking the cervical screening methods were an embarrassment and having no symptoms at all. Most of them endured social stigma related to cervical cancer in the form of physical isolation and verbal abuse. Conclusions There is an urgent need for interventions to make women and the public aware of cervical cancer and launch effective health education campaigns, policies for cervical cancer prevention programs. This implementation can save the lives of hundreds of women and help them avoid going through all the negative experiences related to cervical cancer. More studies are required to gain the perspectives, knowledge, experiences, and attitudes of cervical cancer survivors to add to the research.
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Ifediora CO, Azuike EC. Targeting cervical cancer campaigns on teenage high schoolers in resource-limited economies: lessons from an intervention study of Nigerian senior secondary school girls. Fam Pract 2019; 36:600-606. [PMID: 30541073 DOI: 10.1093/fampra/cmy125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Given the dearth of government-sponsored programmes, preventive lifestyles and practices are the realistic hopes for millions of women in developing countries against cervical cancer. Early interventions for teenage high school girls have been advocated recently, but evidence-base for sustainable activities at this demographic is lacking. This article reduces this gap by determining the impact of two cervical cancer education techniques. METHOD This is a 6-month interventional cohort study of 432 female high school students in South-eastern Nigeria. RESULTS A total of 317 (73.4%) and 301 (69.7%) valid responses were received from the pre-intervention (16.8 ± 1.5 years) and post-intervention (17.2 ± 1.6 years) surveys, respectively. About 213 (70.8%) were fully engaged with the interventions. Logistic regression revealed that participants who were 'engaged' with the interventions, either through symposium attendance or by reading of the printed handouts, showed significant improvements across multiple cervical cancer parameters regarding knowledge on 'pap smears' (analysed with four items), 'HPV vaccine' (two items) and 'risk factors' (two items). Improvements in Knowledge of 'early symptoms' were not improved, with 'post-coital bleeding' [odds ratio (OR) = 0.95; P = 0.87] and 'being asymptomatic' (OR = 0.69; P = 0.32) remaining statistically similar between the engaged and the unengaged. If 'engagement' with either intervention was disregarded, a chi-square analysis identified no significant improvement in knowledge on any parameter. CONCLUSION Ensuring 'engagement' with intervention campaigns is vital to achieving effective and sustainable cervical cancer knowledge. Engagement may be achieved by repeating the education activities across all the years/classes that make up high school in each developing country, along with formal examinations at each level.
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Affiliation(s)
- Chris O Ifediora
- Department of Medicine, School of Medicine, Dentistry and Health, Griffith University, Southport, QLD, Australia.,Onyebuchi Chris Ifediora (OCI) Foundation, Awka, Nigeria
| | - Emmanuel C Azuike
- Department of Community Medicine and Primary Healthcare, Chukwuemeka Odumegwu Ojukwu University/University Teaching Hospital, Awka, Nigeria.,Foundation for Health and Development in Nigeria (FHDN), Awka, Nigeria
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Huchko M, Adewumi K, Oketch S, Saduma I, Bukusi E. 'I'm here to save my life': a qualitative study of experiences navigating a cryotherapy referral system for human papillomavirus-positive women in western Kenya. BMJ Open 2019; 9:e028669. [PMID: 31345973 PMCID: PMC6661588 DOI: 10.1136/bmjopen-2018-028669] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 06/28/2019] [Accepted: 07/05/2019] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND We sought to understand the beliefs, social norms and logistical factors that affect human papillomavirus (HPV)-positive women's uptake of cryotherapy treatment as part of a two-part cervical cancer screening strategy in rural Kenya. METHODS In-depth interviews within a parent cluster-randomised trial. SETTING Government-run county hospital in western Kenya. PARTICIPANTS 273 of 372 (73.4%) HPV-positive women who underwent cryotherapy RESULTS: Many women feared that an HPV infection meant they would develop cancer. Almost all women reported initial fear of the treatment procedure, followed by a more positive experience than anticipated. Lacking funds for transportation to the treatment site was the most common barrier. Women felt that decentralised treatment would be the most important facilitator of greater access. Spousal encouragement and financial support were key facilitators of treatment access, however many women felt that other husbands in the community would not be supportive. Women described successfully acquiring treatment as empowering, and almost all would recommend seeking cryotherapy to other women who test HPV-positive. Most felt eager to share their own experiences with others to encourage treatment. CONCLUSIONS The main facilitators of treatment access were understanding of the health risks and sense of empowerment. A decentralised treatment model or transportation support may facilitate access, along with improved health messaging about HPV infection, cancer and the treatment process. Focusing on women's personal feelings of empowerment may further improve uptake and satisfaction. These data will be used to design a strategy to improve linkage to treatment. TRIAL REGISTRATION NCT02124252.
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Affiliation(s)
- Megan Huchko
- Center for Global Reproductive Health, Duke Global Health Institute, Durham, North Carolina, USA
- Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Konyin Adewumi
- Center for Global Reproductive Health, Duke Global Health Institute, Durham, North Carolina, USA
- Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sandra Oketch
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Ibrahim Saduma
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Elizabeth Bukusi
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Obstetrics and Gynecology, Aga Khan University - Kenya, Nairobi, Kenya
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Barriers and facilitators to cervical cancer screening in Nepal: A qualitative study. SEXUAL & REPRODUCTIVE HEALTHCARE 2019; 20:20-26. [PMID: 31084813 DOI: 10.1016/j.srhc.2019.02.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/29/2019] [Accepted: 02/06/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Despite being preventable, cervical cancer remains the most common cancer among women in Nepal, a country where there is no nationwide screening programme. Hence, the objective was to investigate and better understand Nepali women's perceptions on barriers to participation in cervical cancer screening and what might facilitate their participation. METHODS A qualitative study design with focus group discussions was employed and women were purposively invited. The interviews were tape-recorded, transcribed verbatim, and analysed using manifest content analysis. FINDINGS Women had misconceptions about the screening and low levels of knowledge. Sociocultural barriers, service providers' behaviour, geographical challenges, and limited finances were all perceived as obstacles to attending screening centres. Facilitating factors, such as participation in awareness programmes and support from family and women's groups, may convince women to attend screening clinics. CONCLUSIONS The findings contribute information on Nepalese women's perceptions of cervical cancer screening. They may serve to support the Government of Nepal's promotion of cervical cancer screening and treatment as a right for all Nepali women, whenever necessary.
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Ochomo EO, Atieli H, Gumo S, Ouma C. Assessment of community health volunteers' knowledge on cervical cancer in Kadibo Division, Kisumu County: a cross sectional survey. BMC Health Serv Res 2017; 17:675. [PMID: 28946888 PMCID: PMC5613489 DOI: 10.1186/s12913-017-2593-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 09/04/2017] [Indexed: 11/14/2022] Open
Abstract
Background Globally, cervical cancer is the fourth most frequent cancer in women, with an estimated 530,000 new cases in 2012, representing 7.5% of all female cancer deaths. Of the estimated more than 270,000 deaths from cervical cancer every year, more than 85% occur in less developed regions. In sub-Saharan Africa, 34.8 new cases of cervical cancer are diagnosed per 100,000 women annually, and 22.5/100,000 women die from the disease. Despite the magnitude of this problem, Kenya still has a screening rate of 3.2%; therefore, cervical cancer prevalence has not been established. Community Health Volunteers (CHV) are required to create demand for screening in the community and capture this in the Ministry of Health (MOH) reporting tool MOH 514. The objective of this study was to determine the knowledge of risk factors, signs and symptoms of cervical cancer and screening services’ availability amongst CHVs to enable them sensitize the community about cervical cancer in Kadibo Division, Kisumu County. Method In a cross-sectional study, a saturated sample of 188 CHVs was interviewed. The knowledge of cervical cancer was presented by use of frequencies and proportions; the relationship between demographic characteristics and knowledge was determined using chi-square. Results A majority, 161 (85.6%), were women, 47 (25.0%) were aged 40–44, 91 (48.4%) had primary education and 132 (70.2%) were small-scale farmers. A total of 128 (68.1%) had low, 60 (31.9%) had average and none had high amount of knowledge of risk factors. On average, 95 (50.5%) had low, 15 (8.0%) had average and 78 (41.5%) had high amount of knowledge of signs and symptoms. Finally, 77 (41.0%) had high, 40 (21.2%) had average and 71 (37.8%) had low knowledge of the availability of screening services. Education (p = 0.012, χ2 = 3.839), occupation (p < 0.0001, χ2 = 12.722), and health centre of attachment (p < 0.0001, χ2 = 71.013) were significant factors in determining the knowledge of risk factors. The knowledge of the signs and symptoms of cervical cancer was determined by the occupation of the CHVs (p = 0.030, χ2 = 15.110) and the years of work as a CHV (p = 0.014, χ2 = 8.451). Finally, the education level (p = 0.011, χ2 = 8.605), occupation (p = 0.002, χ2 = 18.335) and health centre of attachment (p < 0.0001, χ2 = 101.705) were significant in determining the knowledge of availability of screening services at the various health facilities. Conclusion The following were found to significantly influence the knowledge of CHVs about cervical cancer: level of education, occupation, health facility of attachment and years of service as a CHV. There is need, therefore, for training on cervical cancer.
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Affiliation(s)
- Edwin Onyango Ochomo
- School of Public Health and Community Development, Maseno University, Private Bag, Maseno, Kenya.
| | - Harrysone Atieli
- School of Public Health and Community Development, Maseno University, Private Bag, Maseno, Kenya
| | - Sussy Gumo
- School of Arts and Social Sciences, Maseno University, Private Bag, Maseno, Kenya
| | - Collins Ouma
- School of Public Health and Community Development, Maseno University, Private Bag, Maseno, Kenya.,Ideal Research Center, P.O. Box 7244-40123, Kisumu, Kenya
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