Knowledge and practices of general practitioners at district hospitals towards cervical cancer prevention in Burundi, 2015: a cross-sectional study

Healthcare providers' knowledge, attitude, and practice towards cervical cancer screening in Sub-Saharan Africa: systematic review and meta-analysis

Introduction

Cervical cancer is a prevalent cancer among women in low and middle-income countries, but it can be largely prevented through screening programs and HPV vaccination. This study aimed to determine the level of knowledge, attitudes, and practices regarding cervical cancer screening among healthcare providers in Sub-Saharan African countries.

Methods

Systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Relevant databases including PubMed, Cochrane Library, AJOL, Google Scholar, and ScienceDirect databases were used to retrieve and search articles. The study included published and unpublished research written in English between January 2013 and May 16, 2024 for studies reporting knowledge, attitude, and practice towards cervical cancer screening among healthcare providers in Sub-Saharan Africa. This review has been registered on PROSPERO. The heterogeneity of the data was evaluated using the I2 statistic. A meta-analysis was conducted using STATA 17 software, with a 95% confidence interval. The researchers also conducted publication bias and sensitivity analysis.

Results

The review included 30 studies involving 7542 healthcare providers. The pooled magnitude of good knowledge status towards cervical cancer was 67.93% (95% CI: 53.36-82.50) whereas the pooled magnitude of positive attitude towards cervical cancer was 55.26% (95% CI: 34.28- 76.23). The results also showed that about 49.68% (95% CI: 33.18-66.17) of healthcare providers had good knowledge status about cervical cancer screening, 66.63%(95% CI: 50.36- 82.89) had a positive attitude towards it, and only 17.23% (95% CI; 6.08-28.37) had ever screened for cervical cancer.

Conclusion

The overall magnitude of knowledge and attitude of healthcare providers in Sub-Saharan Africa towards cervical cancer and its screening was suboptimal. Furthermore, a low percentage of female healthcare providers in the region had undergone screening for cervical cancer. As a result, policymakers and program administrators should focus on improving the knowledge, attitude, and practices of healthcare providers to meet the global health goal of cervical cancer screening and effectively eliminating cervical cancer. Healthcare providers must serve as role models for other women who should also undergo screening.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023495241.

Knowledge on Cervical Cancer Services and Associated Risk Factors by Health Workers in the Eastern Cape Province

Globally, cancer is a leading cause of death, with cervical cancer ranking second among all cancers. Its adversity impacts not only individuals but also families, societies, and governments. The quality of services, as informed by the knowledge and adequacy of the health workers, plays an important role in both prevention, diagnosis, and management of the disease. A cross-sectional study among 108 purposively selected health workers in rural health facilities in the Eastern Cape province was conducted to assess knowledge on cervical cancer and associated risk factors through the use of validated structured questionnaires. The Statistical Package for Social Sciences was used for analysis, with a 95% confidence interval and a p-value of 0.05 considered significant. A total of 91.7% of the 108 participants were female, and 25% were over the age of 50. A total of 88% and 85.2% indicated sexually transmitted disease and human immunodeficiency virus as major risk factors, respectively. The HPV, pap smear, and vaccination age were known by 64.8%, and vaccine availability was known by 71.3%. Only 40.7% of workers were trained on cervical screening, and 35.2% were trained on the interpretation of pap smear results. An overall knowledge score of 53% was obtained, with more experienced clinicians scoring lower grades. This study identified inadequacies in essential knowledge for successful implementation of cervical cancer services and found that extensive training was needed.

Evaluation of effectiveness, acceptability and safety of thermal ablation in the treatment of cervical neoplasia in Burundi

This longitudinal study aimed at evaluating the effectiveness, acceptability and safety of the thermal ablation procedure (TA) in the treatment of cervical neoplasia. Women referred to the Gynaecology ward for symptoms or for opportunistic screening were assessed by visual inspection with acetic acid (VIA) and colposcopy. Those with lesions eligible to ablation were counselled and treated by TA. They were inquired about the level of pain during the procedure, and their level of satisfaction. Patients were followed up at 6 weeks for any complication and reassessed by VIA and colposcopy at 12 months for any persistent or recurrent lesion and for any adverse event. A total of 86 women with a positive VIA test were included in the study. The mean age was 46 years (28-61 years). Most of the women did not complain about any adverse event during treatment; one-third presented mild pain or cramp. At the 6-week visit, watery discharge was the main adverse event reported. All women were highly satisfied with TA and most of them would recommend it. At the 12-month visit, 82 women were examined (95% follow-up rate), and the overall cure rate was 96% (low-grade lesions: 98%; high-grade lesions: 94%). Three women presented low- and high-grade lesions that were treated by TA. No major adverse event or hospitalisation after the treatment was reported. In conclusion, TA was an effective procedure with a high cure rate at the 1-year follow-up visit. It was acceptable and safe, with only minor short-term side-effects reported and with a high satisfaction rate among the patients.

Knowledge and attitudes of healthcare professionals working in a training and research hospital on early diagnosis of cervical cancer (a Somalia example): cross-sectional study

Background

Despite the early diagnosis and treatment of cervical cancer, it is still a significant public health problem in Somalia. This study was conducted to evaluate the knowledge and attitudes of healthcare professionals towards the early diagnosis of cervical cancer.

Methods

This study was conducted in Mogadishu, the capital of Somalia, between December 2020 and February 2021. The cross-sectional study consisted of a total of 280 healthcare professionals. The study data was collected using a questionnaire consisting of 38 questions evaluating the knowledge and attitudes of all healthcare professionals towards the early diagnosis of cervical cancer, an additional 15 questions for women only, and a total of 43 questions.

Results

22.1% of the participants received cervical cancer training during vocational education and training. Cervical cancer education after graduation is 16.8%, and the rate of providing education to patients is only 29.6%. The rate of female healthcare professionals having a Pap smear test is 2%. The participants' cervical cancer total knowledge score was 16.5 ± 6.69, and the success rate was 63.46. The highest success rate in knowledge subgroup questions was HPV questions with 69.6. A statistically significant difference was found between the participants' profession, training on the subject during their vocational education, and total knowledge scores (p < 0.001). When the knowledge question subscales were compared, a significant difference was found between participants' gender and HPV questions subscale score (p = 0.028). A statistically significant difference was found between the participants' professions, receiving training on the subject during vocational training, and all subscales (p < 0.05). A statistically significant difference was found between the participants' income status and risk factors questions scores (p = 0.026).

Conclusion

This study shows that the knowledge and training of healthcare professionals working in a training and research hospital in Somalia for early cervical cancer diagnosis are not sufficient. In addition, it reveals that female healthcare professionals have almost no Pap smears. Therefore, studies and training should be planned to train all healthcare professionals, especially female healthcare professionals, and overcome all possible obstacles to the acceptance of the screening tests by women.

Vaccinators' Perception of HPV Vaccination in the Saa Health District of Cameroon

Introduction: Cervical cancer is the second most prevalent cancer among women in Cameroon. In November 2020, the HPV vaccine was introduced into the expanded programme on immunisation. However, uptake of the vaccine has been slow in the Centre region as opposed to other regions in the country. We therefore sought to describe vaccinators' perception of HPV vaccination in Saa health district.

Methods: A self-administered questionnaire with both open-ended and closed questions was used to assess the perception of HPV vaccination among 24 vaccinators from the Saa health district. Quantitative data were summarised as proportions while qualitative data were deductively and inductively coded and thematically analysed.

Results: Most vaccinators (75%, n = 18) had a good knowledge about cervical cancer and HPV vaccination. Fourteen (58.3%, n = 14) vaccinators correctly reported the target group, number and spacing of doses for the HPV vaccine. Fourteen (58.3%) vaccinators favoured HPV vaccination while the others (n = 10) were sceptical. Sceptics felt manufacturers hadn't given enough proof of the safety of the vaccine and lacked confidence in government's assessment of the epidemiological situation. The COVID 19 pandemic, fear of infertility and the negative influence of social media were perceived as the main reasons for community hesitancy. Vaccinators criticised health authorities for failing to sensitise the population about the HPV vaccine before its introduction.

Conclusion: Vaccinators' perceptions of HPV vaccination may influence the offer of HPV vaccination services. Measures to increase acceptance of HPV vaccination and ownership of the activity among vaccinators have to be put in place.

Awareness and Knowledge about Human Papilloma Virus Infection among Students at Secondary Occupational Health School in China

Cervical cancer (CC) is one of the most common causes of cancer-related deaths worldwide. CC is mainly caused by human papilloma virus (HPV), which can be prevented by vaccination. We conducted a cross-sectional study in secondary occupational health school (SOHS) through a questionnaire aimed to assess the awareness and knowledge regarding HPV infection of students. A total of 2248 students participated in the survey, 45.3% of them had heard about CC, while only 21.9% of them had heard about HPV; and 74.2% had no idea of the causal link between HPV infection and CC. Most participants displayed poor awareness and knowledge about HPV infection. The results suggested that age, grade, major, academic performance, etc. were correlated with higher awareness of CC, HPV and HPV infection (p < 0.05). In multivariable logistic analysis, third-grade students had the most increased awareness of CC (OR = 17.13, 95%CI: [8.11, 36.15]), HPV (OR = 6.59, 95%CI: [4.16, 10.43]) and HPV vaccine (OR = 2.78, 95%CI: [1.78, 4.32]) when compared to first-grade. Awareness and knowledge regarding HPV infection were insufficient among students in SOHS. As the future healthcare providers, these results highlight the need to supplement targeted education to improve their awareness and knowledge of HPV and vaccination.

Registered nurses' perspectives on barriers of cervical cancer screening in Swaziland: a qualitative study

Introduction

cervical cancer is highly preventable and curable if diagnosed and treated early, however, it is still the leading cause of death among women. Despite efforts to increase cervical cancer screening, its uptake is still low. The purpose of the study was to investigate the perspectives of registered nurses on barriers of cervical cancer screening in Swaziland.

Methods

an exploratory qualitative design was used for the study. Face to face in depth interviews were conducted with 15 registered nurses using an interview guide. The study was conducted in four clinics from both the private and public sectors, which were purposively sampled. Interviews were captured using an audio recording device, they were transcribed verbatim and then analysed using thematic analysis.

Results

four themes emerged which were deterrents to cervical cancer screening. These were perceived client barriers, health care system related barriers, nurse related barriers and the nature of the procedure.

Conclusion

these barriers to service provision need to be addressed by extensive health education to women as well as the cervical cancer screening programme to provide all resources required to increase the uptake of screening.

Knowledge, attitudes, and practice of cervical cancer prevention among health workers in rural health centres of Northern Uganda

Background

Cervical cancer is a leading cancer and cause of premature death among women in Uganda aged 15 to 44 years. To address the increasing burden of cervical cancer in Uganda, the Ministry of Health has adopted several strategies which include public education and advocacy. This study aims to assess knowledge, attitudes, and practice of cervical cancer prevention among health workers employed in rural health centres (HCs) III and IV in the Acholi sub-region of Northern Uganda.

Methods

We conducted a cross-sectional survey of nurses, midwives, and clinical officers between February and April 2019 using self-administered questionnaire. We sampled fifty-four HCs III and eight HCs IV. In Uganda, HCs are structured from HC I to HC IV and the health care package provided increases with increasing level of the HC. We used Epidata version 3.1 to create database and analysis was performed using Stata 16. Descriptive and logistic regression analyses were performed. Factors with p-values ≤ 0.05 were considered as predictors of outcome.

Results

There were 286 participants who completed the questionnaire: Majority (188, 66%) were females. Nurses were 153 (54%). 141 (75%) female participants self-reported to have been screened for cervical cancer. 171 (60%) participants had adequate knowledge of cervical cancer. 187 (66%) participants had positive attitudes. Participants who indicated not to have ever received training on cervical cancer screening were less likely to have adequate knowledge (AOR = 0.39, 95% CI 0.21–0.71). Participants who indicated not to have ever been trained on cervical cancer screening were less likely to have positive attitudes (AOR = 0.52, 95% CI 0.28–0.97).

Conclusion

Health workers from rural HCs in Uganda play crucial role in cervical cancer prevention as they can reach a wider community. Their significance in the prevention of cervical cancer points to the need for Uganda and other sub-Sahara Africa (SSA) countries to establish training to improve their knowledge, attitudes, and practical skills on cervical cancer screening. Furthermore, Uganda government should develop and disseminate guidelines for cervical cancer prevention to rural health workers to promote standardised cervical cancer prevention activities.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-021-07847-z.

Burundi Cancer Care Needs: A Call to Action

Burundi is a landlocked country in the East Central Africa region. Beyond a long civil war strife, cancer care remains overlooked, in terms of both infrastructure and human resources needs, and it shows from estimated global incidence and mortality figures. Through a focused literature search, this study highlights the main cancer care needs in this country, with the aim to gather global oncology support to Burundi. IMPLICATIONS FOR PRACTICE: There is little knowledge about the state of oncology in Burundi. This article, based on a literature search, depicts an image of the current state of cancer care in Burundi and aims to compel global health enthusiasts to join in curbing the death toll of cancers in Burundi.

Health systems constraints and facilitators of human papillomavirus immunization programmes in sub-Saharan Africa: a systematic review

Given the vast investments made in national immunization programmes (NIPs) and the significance of NIPs to public health, it is important to understand what influences the optimal performance of NIPs. It has been established that well-performing NIPs require enabling health systems. However, systematic evidence on how the performance of health systems impacts on NIPs is lacking, especially from sub-Saharan Africa. We conducted a qualitative systematic review to synthesize the available evidence on health systems constraints and facilitators of NIPs in sub-Saharan Africa, using human papillomavirus immunization programmes as a proxy. Fifty-four articles published between 2008 and 2018 were found to be eligible. Data extraction was guided by an analytical model on the interface between NIPs and health systems. A cross-cutting thematic analysis of the extracted data was performed. This systematic review provides evidence necessary for informing ongoing health systems strengthening initiatives in sub-Saharan Africa. There is evidence to suggest that NIPs in sub-Saharan Africa have surmounted significant health systems constraints and have achieved notable public health success. This success can be attributed to strong political endorsement for vaccines, clear governance structures and effective collaboration with global partners. Despite this, significant health systems constraints persist in service delivery, vaccine communication, community engagement, the capacity of the health workforce and sustainable financing. These constraints could derail further progress if not addressed through health systems strengthening efforts. There is a need to expand the research agenda to include the comprehensive evaluation of health systems constraints and facilitators of NIPs within sub-Saharan Africa.

Prevalence and genotype-specific distribution of human papillomavirus in Burundi according to HIV status and urban or rural residence and its implications for control

BACKGROUND

Human papillomaviruses are the most important causative agents for invasive cervical cancer development. HPV type-specific vaccination and HPV cervical cancer screening methods are being widely recommended to control the disease but the epidemiology of the circulating HPV types may vary locally. The circulating HPV-strains have never been assessed in Burundi. This study determined the prevalence and genotype-specific distribution of HPV in four different strata in Burundi: HIV-infected or non-infected and women living in rural or urban areas. Implications for HPV diagnosis and vaccine implementation was discussed.

METHODS

Four cross-sectional surveys were conducted in Burundi (2013 in a rural area and 2016 in urban area) among HIV-infected and uninfected women living in rural and urban areas. Liquid-Based Cytology (LBC) and HPV genotyping were performed and risk factors for HPV infection and cervical pre-cancer lesions were determined using logistic regression model.

RESULTS

HPV prevalence was very high in urban area with significant differences between HIV-positive and negative women (p<0.0001). In fact, 45.7% of HIV-positive participants were infected with any HPV type and all were infected with at least one HR/pHR-HPV type. Among the HIV-negative participants, 13.4% were HPV-infected, of whom, only four women (2.7%) were infected with HR/pHR-HPV types. In rural area, HPV infection did not significantly differ between HIV-positive and negative women (30.0% and 31.3% respectively; p = 0.80). In urban area, multiple infections with HR/pHR-HPV types were detected in 13.9% and 2.7% among HIV-positive and negative women respectively (p<0.0001), whereas in rural area, multiple infections with HR/pHR-HPV types were detected in 4.7% and 3.3% of HIV-positive and negative women respectively (p = 0.56). The most prevalent HR/pHR-HPV types in HIV-positive women living in urban area were HPV 52, 51, 56, 18 and 16 types. In HIV-negative women living in urban area, the most prevalent HR/pHR-HPV types were HPV 66, 67, 18, 45 and 39 types. In HIV-positive women living in rural area, the most prevalent HR/pHR-HPV types were HPV 66, 16, 18 and 33 types. In HIV-negative women living in rural area, the most prevalent HR/pHR-HPV types were HPV 16, 66, 18, 35 and 45 types. Independent risk factors associated with cervical lesions were HPV and HIV infections.

CONCLUSIONS

There is a high burden of HR and pHR-HPV infections, in particular among HIV-infected women living in urban area. The study points out the need to introduce a comprehensive cervical cancer control programme adapted to the context. This study shows that the nonavalent vaccine covers most of the HR/pHR-HPV infections in rural and urban areas among HIV-infected and uninfected women.

Knowledge of HPV and acceptability of HPV vaccine among women in western China: a cross-sectional survey

BACKGROUND

Since most cervical cancer cases are caused by persistent high-risk human papillomavirus (HR-HPV) infection, knowledge of HPV among women is essential for the prevent of cervical cancer. This study was aimed to assess knowledge among women in western China about HPV and its association with cervical cancer, and to assess their acceptance of HPV vaccination.

METHODS

A sample of healthy women undergoing routine physical examinations in the Health Management Center of West China Hospital, Sichuan University between January and December 2014 completed a questionnaire.

RESULTS

A total of 1300 questionnaires were distributed, and 1109 were completed and analyzed. Only 28.85% of respondents (n = 320) had heard of HPV; among this subgroup, only half (53.44%) knew that it causes cervical cancer, only 26 (8.13%) correctly answered all questions about HPV. Multivariate analysis showed that respondents who had heard of HPV were more likely than other respondents to have a family history of any cancer, to undergo regular Pap tests and to have completed at least secondary education. Half of all respondents (51.22%) reported that they would be willing to be vaccinated against HPV.

CONCLUSION

Although most women in western China lack basic knowledge about HPV, at least half are willing to take the HPV vaccine. Public health efforts to educate the public about HPV and its connection to cervical cancer should be strengthened and expanded.