Healthcare provider challenges to early detection of cervical cancer at primary healthcare level in Rwanda

Healthcare Provider-Related Factors in the Diagnostic Delay of Cervical Cancer: A Cross-Sectional Study

Background and objective Cervical cancer is the second most common malignancy among Indian women. In 2018, the World Health Organization (WHO) called for global action toward the elimination of cervical cancer through the triple-intervention strategy. One of its pillars is ensuring 70% screening coverage of eligible women with a high-performance test at least twice in their lifetime. Various factors contribute to the delayed diagnosis of cervical cancer, increasing the burden of the disease. In this study, we aimed to determine the healthcare provider (HCP)-related factors in the diagnostic delay of advanced cervical cancer. Methods This prospective cross-sectional study was conducted over two months in the cancer clinic of the Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India. We interviewed 384 women diagnosed with advanced cervical cancer [the International Federation of Gynecology and Obstetrics (FIGO) stage IB3-IVB] by using a questionnaire to capture data inputs regarding the various healthcare services they had received in the past 10 years along with details of HCPs. The collected data were analyzed using the software STATA version 17.0. Results Among 384 participants, 185 (48.1%) had interacted with an HCP in the past 10 years; 157 (40.8%) of them had visited a healthcare facility. Among these 185 women, only 22.16% had been advised to undergo screening, and only 15.18% had been tested despite several having access to primary health centers within 10 km of their residence. The lack of screening guidance by HCPs accounted for 78% of delayed diagnoses of cervical cancer. Conclusions Based on our findings, a deficiency in screening guidance in the asymptomatic period by healthcare providers across various levels of our healthcare system contributed significantly to the delayed diagnosis of cervical cancer.

Integration of cervical cancer screening into healthcare facilities in low- and middle-income countries: A scoping review

Cervical cancer is a prevalent disease among women, especially in low- and middle-income countries (LMICs), where most deaths occur. Integrating cervical cancer screening services into healthcare facilities is essential in combating the disease. Thus, this review aims to map evidence related to integrating cervical cancer screening into existing primary care services and identify associated barriers and facilitators in LMICs. The scoping review employed a five-step framework as proposed by Arksey and O'Malley. Five databases (MEDLINE, Maternity Infant Care, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science) were systematically searched. Data were extracted, charted, synthesized, and summarised. A total of 28 original articles conducted in LMICs from 2000 to 2023 were included. Thirty-nine percent of the reviewed studies showed that cervical cancer screening (CCS) was integrated into HIV clinics. The rest of the papers revealed that CCS was integrated into existing reproductive and sexual health clinics, maternal and child health, family planning, well-baby clinics, maternal health clinics, gynecology outpatient departments, and sexually transmitted infections clinics. The cost-effectiveness of integrated services, promotion, and international initiatives were identified as facilitators while resource scarcity, lack of skilled staff, high client loads, lack of preventive oncology policy, territorial disputes, and lack of national guidelines were identified as barriers to the services. The evidence suggests that CCS can be integrated into healthcare facilities in LMICs, in various primary care services, including HIV clinics, reproductive and sexual health clinics, well-baby clinics, maternal health clinics, and gynecology OPDs. However, barriers include limited health system capacity, workload, waiting times, and lack of coordination. Addressing these gaps could strengthen the successful integration of CCS into primary care services and improve cervical cancer prevention and treatment outcomes.

Knowledge, attitude, and practices regarding human papilloma virus vaccination among physicians in Qatar

BACKGROUND

The human papilloma virus is a global problem that affects sexually active women and men, with cervical cancer being the most serious associated disease. Most cervical cancer cases can be prevented by vaccination against the human papilloma virus early in life. The objective of this study was to assess the knowledge, attitudes, and practices among physicians working in Qatar, regarding the human papilloma virus, infection, and prevention using vaccines.

STUDY-DESIGN

This was a cross-sectional study using quantitative data collection.

METHODOLOGY

An online survey targeting physicians working in Qatar was conducted, using a web-based pretested questionnaire. The questionnaire comprised four sections capturing a few demographic details, 33 questions in the Knowledge Section, 12 questions eliciting the attitude, and 14 practice-related questions. Mean knowledge score was calculated and those with a score more than the mean score were considered to have sufficient knowledge. Association between knowledge and attitude/practices/independent variables were looked for using bivariate and multivariate analysis. Logistic regression was used to identify the predictors for recommending human papilloma virus vaccines.

RESULTS

Of the 557 physicians who participated, 83.7% had sufficient knowledge, but only 69.1% knew that human papilloma virus vaccines were available in Qatar. The majority (89.4%) knew that human papilloma virus infection could be asymptomatic and 96.1% knew at least one symptom; 77% believed the human papilloma virus vaccine would substantially decrease the chances of human papilloma virus infection and related cancers and 46.5% felt physicians were less motivated to promote the human papilloma virus vaccine. The perceived barriers to community acceptance of the human papilloma virus vaccine were lack of awareness regarding the relationship between human papilloma virus and cervical cancer (61.6%), doubts regarding efficacy (32.5%), fear regarding safety (26.9%), concern that the human papilloma virus vaccination may encourage risky sexual behavior (26.8%), and perceived low-risk (23.3%) and cost (24.6%). Only 21.5% commonly discussed sexual health with their clients. More than one-third were not interested in recommending the human papilloma virus vaccine. Bivariate analysis showed nationality, specialization, discussing with patients, and recommending vaccine to be significantly associated with knowledge. Bivariate and regression analysis identified that female gender and physician's religion were significant predictors to recommend the human papilloma virus vaccine.

CONCLUSION

Most physicians have good knowledge. Less than one-fourth commonly discussed sexual health with their clients. More than one-third were not interested in recommending the human papilloma virus vaccine. This issue might affect the human papilloma virus vaccination program implementation if not well addressed.

Cervical cancer in Northern Tanzania-What do women living with HIV know

Background

Cervical cancer (CC) is more prevalent in women living with human immunodeficiency virus (HIV) infection compared to the general population. The magnitude is high among all countries burdened with HIV-Tanzania is no exception. Despite the unprecedented risk, women living with HIV (WLHIV) may not be aware of the risk and might have unfounded beliefs thereof. This study aimed to determine the knowledge, awareness, and beliefs on CC screening among WLHIV attending a clinic at the Kilimanjaro Christian Medical Centre (KCMC) in Northern Tanzania.

Methods

This hospital-based cross-sectional study was conducted among 327 WLHIV attending care and treatment clinic (CTC) at KCMC. A pre-tested questionnaire was used to collect quantitative data. Both descriptive and regression methods were used to determine CC knowledge, awareness, and beliefs as well as factors associated with knowledge of CC among WLHIV using SPSS version 23.

Results

Participants' mean age was 46 ± 10.4 years. Although just half (54.7%) of WLHIV had insufficient knowledge of CC, the majority of the participants (83.5%) were able to recognize at least three risk factors, but with limited understanding of symptoms and prevention. The majority held positive beliefs on CC and screening practices. Factors associated with good knowledge of CC included being married (AOR: 3.66, 95% CI: 1.84-7.28), having used ART for at least 2 years (AOR: 4.08, 95% CI: 1.36-12.21), and having previously screened for CC (AOR: 1.62, 95% CI: 1.01-2.59).

Conclusion

WLHIV attending care and treatment center had insufficient knowledge about CC screening. To further improve screening and treatment for CC, at both facility and community levels, targeted awareness and education campaigns are warranted.

Knowledge, Barriers and Motivators to Cervical Cancer Screening in Rwanda: A Qualitative Study

Background

Cervical cancer is a global public health problem with marked geographical disparity. High morbidity and mortality rates in developing countries are associated with low screening rates. In 2020, in Rwanda, 3.7 million women aged 15–59 years were at risk of developing cervical cancer, the most commonly diagnosed female cancer in Rwanda. Despite Rwanda being the first African country to vaccinate against human papilloma virus with a three-dose regimen vaccination coverage of nearly 93% in the target population of girls aged <15 years, and having established cervical cancer screening program, recent studies have found low screening rates. Our study sought to determine knowledge, motivators and barriers of cervical cancer screening.

Methods

We conducted a qualitative descriptive study; using focus group interview in an urban health facility (Muhima district hospital) and a rural health center (Nyagasambu health center) offering cervical screening services in Rwanda. Participants were women seeking these services and other women attending the health facility for any reason, and female staff working in these facilities. Interviews were recorded and transcribed, and data were analyzed using content analysis.

Results

Thirty women participated in focus group interview, with an average age of 39 years. Many of women showed knowledge about cervical cancer existence and prevention methods. However, fear for pain, lack of knowledge about screening, how and where the screening was done, and concern for privacy were recurring subthemes. Some participants also mentioned lack of health insurance as a barrier for cervical cancer screening.

Conclusion

Barriers to uptake cervical cancer screening services in Rwanda are related to poor information about cervical cancer and the importance of screening as well as non-adherence to medical insurance. Population sensitization through campaign and community outreach activities could have a positive impact on increasing the usage of cervical cancer screening in Rwanda.