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Reza S, Dewan SMR, Islam MS, Shahriar M. Response of Bangladesh to the World Health Organization call to eliminate cervical cancer as a public health issue: An observational report. Health Sci Rep 2024; 7:e2178. [PMID: 38915360 PMCID: PMC11194611 DOI: 10.1002/hsr2.2178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 04/01/2024] [Accepted: 05/17/2024] [Indexed: 06/26/2024] Open
Abstract
Background Despite being preventable, cervical cancer remains a leading cause of mortality among Bangladeshi women. This article addresses the trends in Bangladesh's response to the World Health Organization's (WHO) request for the eradication of cervical cancer within the nation. Discussion When it comes to cervical cancer, healthcare institutions need to be concerned in terms of protocols for diagnosis and treatment, staff education, and available resources. More than a quarter of all female cancers in Bangladesh are caused by cervical cancer, which can be prevented through better healthcare infrastructure, earlier diagnosis, more qualified healthcare professionals, improved urban and rural hospital infrastructure, community-based clinics, expanded affordable vaccinations, school-based delivery systems, adoption of single-dose vaccine schedules, raising awareness, and compiling a registry of previously affected results. WHO applauds Bangladesh's Ministry of Health and Family Welfare for its efforts to develop the National Strategy for cervical cancer prevention and control, which will guide and strengthen the country's activities to prevent and treat cervical cancer. Conclusion The endeavor to eradicate this global disease burden should not be limited to Bangladesh; all nations should participate collectively to prevent the malignancy from returning and threatening human civilization.
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Affiliation(s)
- Sejuti Reza
- Department of Pharmacy, School of MedicineUniversity of Asia PacificDhakaBangladesh
| | | | | | - Mohammad Shahriar
- Department of Pharmacy, School of MedicineUniversity of Asia PacificDhakaBangladesh
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Wee HL, Canfell K, Chiu HM, Choi KS, Cox B, Bhoo-Pathy N, Simms KT, Hamashima C, Shen Q, Chua B, Siwaporn N, Toes-Zoutendijk E. Cancer screening programs in South-east Asia and Western Pacific. BMC Health Serv Res 2024; 24:102. [PMID: 38238704 PMCID: PMC10797973 DOI: 10.1186/s12913-023-10327-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 11/14/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND The burden of cancer can be altered by screening. The field of cancer screening is constantly evolving; from the initiation of program for new cancer types as well as exploring innovative screening strategies (e.g. new screening tests). The aim of this study was to perform a landscape analysis of existing cancer screening programs in South-East Asia and the Western Pacific. METHODS We conducted an overview of cancer screening in the region with the goal of summarizing current designs of cancer screening programs. First, a selective narrative literature review was used as an exploration to identify countries with organized screening programs. Second, representatives of each country with an organized program were approached and asked to provide relevant information on the organizations of their national or regional cancer screening program. RESULTS There was wide variation in the screening strategies offered in the considered region with only eight programs identified as having an organized design. The majority of these programs did not meet all the essential criteria for being organized screening. The greatest variation was observed in the starting and stopping ages. CONCLUSIONS Essential criteria of organized screening are missed. Improving organization is crucial to ensure that the beneficial effects of screening are achieved in the long-term. It is strongly recommended to consider a regional cancer screening network.
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Affiliation(s)
- Hwee-Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Karen Canfell
- The Daffodil Centre, A Joint Venture with Cancer Council NSW and the University of Sydney, Sydney, NSW, Australia
| | - Han-Mo Chiu
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kui Son Choi
- Graduate School of Cancer Science and Policy, National Cancer Center, Ilsandonggu, Goyang, Republic of Korea
| | - Brian Cox
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Nirmala Bhoo-Pathy
- Centre for Epidemiology and Evidence-Based Practice, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Kate T Simms
- The Daffodil Centre, A Joint Venture with Cancer Council NSW and the University of Sydney, Sydney, NSW, Australia
| | - Chisato Hamashima
- Division of Cancer Screening Assessment and Management, Institute of Cancer Control, National Cancer Center, Tokyo, Japan
- Teikyo University, Tokyo, Japan
| | - Qianyu Shen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Brandon Chua
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Niyomsri Siwaporn
- Department of Medical Services, Ministry of Public Health, National Cancer Institute of Thailand, Bangkok, Thailand
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Esther Toes-Zoutendijk
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
- Department of Public Health, Erasmus MC University Medical Center, P.O. Box 2014, Rotterdam, CA, 3000, the Netherlands.
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Chowdhury MZI, Mubin N, Mohib T, Chowdhury N, Chowdhury TF, Laskar AMH, Sultana S, Raihan M, Turin TC. Cancer screening research in Bangladesh: Insights from a scoping review. Glob Public Health 2024; 19:2351186. [PMID: 38752425 DOI: 10.1080/17441692.2024.2351186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 04/29/2024] [Indexed: 06/14/2024]
Abstract
This scoping review summarises the findings of research conducted on cancer screening in Bangladesh, including the prevalence, awareness, barriers, and evaluation of screening programmes, by performing a comprehensive search of electronic databases and gray literature. 25 studies that met inclusion criteria were included in the final analysis. Most of the studies were about screening for cervical cancer, were quantitative, were cross-sectional, and were conducted in hospital settings. The main challenges to screening uptake were shyness, fear, a lack of knowledge, and an inadequate understanding of the concept of screening. Visual inspection with acetic acid (VIA) was found to be a simple and cost-efficient way to detect early-stage cervical cancer. However, breast self-examination (BSE) was reported to be insufficient. Education was found to have a positive impact on cancer screening knowledge and practice, but more needs to be done to improve screening rates, such as the utilisation of media, particularly in rural areas. The results of this scoping review highlight Bangladesh's low cancer screening prevalence and uptake and suggest that targeted awareness campaigns and enhanced access to screening services are required to increase cancer screening uptake and reduce the cancer burden in Bangladesh.
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Affiliation(s)
- Mohammad Ziaul Islam Chowdhury
- Department of Psychiatry, University of Calgary, Calgary, Canada
- Department of General Educational Development, Daffodil International University, Dhaka, Bangladesh
| | - Nazirum Mubin
- Department of Radiotherapy, Dhaka Medical College Hospital, Dhaka, Bangladesh
| | - Tasmira Mohib
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Nashit Chowdhury
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | | | - Sanchita Sultana
- School of Health Sciences, Central Michigan University, Mount Pleasant, MI, USA
| | - Mohammad Raihan
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Tanvir C Turin
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Sharma J, Yennapu M, Priyanka Y. Screening Guidelines and Programs for Cervical Cancer Control in Countries of Different Economic Groups: A Narrative Review. Cureus 2023; 15:e41098. [PMID: 37519623 PMCID: PMC10381098 DOI: 10.7759/cureus.41098] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
Screening guidelines and practices differ according to resource availability and continually update as scientific developments take place. In this article, we have reviewed screening guidelines and programs for cervical cancer prevention in selected countries belonging to different economic groups viz high income, middle income, and low income. We have selected six countries - the United States of America (USA), the United Kingdom (UK), India, South Africa, Bangladesh, and Malawi. Considerable differences are observed across the health systems. Countries with established screening guidelines complemented by organised nationwide programs or insurance practices have much better screening rates. Human Papilloma Virus (HPV) DNA testing is currently the test of choice in the majority of settings for cervical cancer screening due to its higher sensitivity (up to 90-100%) and longer screening intervals (three to five years). It is also cost-effective, less dependent on operator expertise, and suitable for all settings as compared to a Pap smear test or visual inspection with acetic acid (VIA). Self-sampling of HPV can further help to improve screening coverage by increasing opportunities of reaching to women who would otherwise not participate in screening programs. Resource-constrained countries recommend VIA-based screening in their national programs due to its low cost. The share of cervical cancer is higher in middle and low-income countries as they have lower screening coverage, compared to high-income countries. The main barriers faced in the implementation of the program in low-income countries (LICs) are pertaining to the health system, patient-specific challenges, and healthcare provider-specific challenges.
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Affiliation(s)
- Jyoti Sharma
- Council of Scientific and Industrial Research-National Institute of Science Communication and Policy Research (CSIR-NIScPR), Academy of Scientific and Innovative Research (AcSIR), New Delhi, IND
- Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, IND
| | - Madhavi Yennapu
- Council of Scientific and Industrial Research-National Institute of Science Communication and Policy Research (CSIR-NIScPR), Academy of Scientific and Innovative Research (AcSIR), New Delhi, IND
| | - Yamini Priyanka
- Division of Reproductive Child Health and Nutrition, Indian Council of Medical Research, New Delhi, IND
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Chueiri PS, Gonçalves MR, Hauser L, Mengue S, Agostinho M, Roman R, Wollmann L, Dilda A, da Silva RAM, Harzheim E. Brazilian Survey on Preventive Actions for the Population With Access to Primary Healthcare: Inefficient Spending in a Country in Economic Crisis. Int J Health Policy Manag 2022; 11:1905-1912. [PMID: 34523857 PMCID: PMC9808240 DOI: 10.34172/ijhpm.2021.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 07/24/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Cancer ranks second as a cause of death in Brazil. Although preventive practices are part of the daily routine of primary healthcare (PHC) teams, organized screening programs are lacking. This study aimed to evaluate the adequacy of preventive interventions in the main cancer types, as defined by the Brazilian government. METHODS We analyzed cross-sectional data from a larger project conducted in 2016 with PHC service users and physicians from all over Brazil, interviewed by trained research staff. The sample was stratified by the number of PHC physicians per geographic region, who were eligible for inclusion if they had been working in the same PHC unit for at least one year. Twelve adult patients with at least two encounters were included per participating physician. Only the data from service users were analyzed in this study. We evaluated the questions about preventive practices and calculated the following indicators: coverage, focus, screening errors, and screening ratio. National guidelines and international evidence were used as a comparison parameter. RESULTS The study population consisted of 6160 service users. The data indicate that the recommendations for cervical, breast, and prostate cancer screening and for treatment of tobacco dependence are not adequately followed. Coverage for breast and cervical cancer screening presented an overutilization bias, with rates 50% and 9% above the expected, respectively. The screening focus was also inadequate: 24%, 47%, and 54% of the screening tests for the three cancer types were performed in individuals outside the recommended age range. 31% of smokers were not approached for treatment. CONCLUSION These findings indicate that the Brazilian population has been subjected to inadequate and potentially iatrogenic interventions in PHC. New policies based on stricter criteria of adequacy and increased use of the concept of quaternary prevention may improve the effectiveness and equity of the health system.
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Affiliation(s)
| | - Marcelo Rodrigues Gonçalves
- Graduate Program in Epidemiology, TelehealthRS Project, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Lisiane Hauser
- Graduate Program in Epidemiology, TelehealthRS Project, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Sotero Mengue
- Graduate Program in Epidemiology, TelehealthRS Project, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | - Rudi Roman
- Graduate Program in Epidemiology, TelehealthRS Project, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Lucas Wollmann
- Community Health Services, Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | - Anna Dilda
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | - Erno Harzheim
- School of Medicine, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil
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Banik R, Naher S, Rahman M, Gozal D. Investigating Bangladeshi Rural Women's Awareness and Knowledge of Cervical Cancer and Attitude Towards HPV Vaccination: a Community-Based Cross-Sectional Analysis. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:449-460. [PMID: 32734448 DOI: 10.1007/s13187-020-01835-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Cervical cancer remains a significant disease burden and contributes to prominent cancer-related mortality among women. This study aimed to assess awareness and knowledge of cervical cancer and attitude towards HPV vaccination among rural women in Bangladesh. A cross-sectional study was carried out from September 2019 to January 2020 involving 600 women selected using multi-stage sampling from six rural areas of Bangladesh. Face-to-face interviews were conducted using a semi-structured questionnaire consisting of socio-demographic information, knowledge (20-items) and, attitudes (5-items). Most of the participants (71.8%) were aware of cervical cancer. Women's awareness was significantly associated with marital status, education level, employment status, and internet/social media use (p < 0.05). Mass media was the main source of information and 2.3% of the women had previously undergone cervical cancer screening. Knowledge regarding symptoms, risk factors, and preventive measures was limited with a mean knowledge score of 8.73 (SD: 2.68). Only 5.3% of women had vaccinated against HPV, but the willingness to receive the HPV vaccine was high (76.6%) among those who were not vaccinated. The cost of the HPV vaccine (40.1%) and lack of adequate knowledge (34.3%) were the main reasons behind women's unwillingness to receive the vaccine. Higher odds of willingness to receive the HPV vaccine were found among women aged 15-29 years (aOR: 1.92, CI = 1.21-3.04, p = 0.006), had high education (aOR: 1.93, CI = 1.25-4.42, p = 0.005), and internet/social media users (aOR: 2.32, CI: 1.51-3.56, p < 0.001). These results highlight the urgent need for educational intervention on cervical cancer and the institution of national policies providing HPV vaccination coverage.
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Affiliation(s)
- Rajon Banik
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh.
| | - Shabnam Naher
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Mahmudur Rahman
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - David Gozal
- Department of Child Health, University of Missouri, Columbia, MO, USA
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7
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Sharmin S, Sabikunnahar B, Aditya A, Khan MAAK, Nessa A, Ahsan CR, Yasmin M. Genotypic distribution and prevalence of human papillomavirus infection in an apparently healthy female population in Bangladesh. IJID REGIONS (ONLINE) 2021; 1:130-134. [PMID: 35757826 PMCID: PMC9216681 DOI: 10.1016/j.ijregi.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/08/2021] [Accepted: 10/14/2021] [Indexed: 11/19/2022]
Abstract
Objective Human papillomavirus (HPV) comprises around 120 genotypically related viruses, classified into low- and high-risk HPVs, which are capable of replicating inside the keratinocytes of skin or mucous membranes. Studies suggest that infections with HPV-16 or HPV-18 have a higher rate of developing cancer. The aim of our study was to detect HPV early, and to estimate the genotype-specific prevalence of HPV in apparently healthy and asymptomatic females in Bangladesh. Method After cervical swab specimen collection, a VIA test was performed to identify any type of abnormality in the cervix. A multiplex PCR amplification of HPV DNA, using L1 consensus primer systems, was performed with type-specific primers, followed by sequencing to detect HPV genotypes. Result Of the 417 females, 121 were found to be HPV positive. The most prevalent high-risk HPV genotypes were found to be HPV-16 and HPV-18. Different patient demographic parameters, such as age, socioeconomic status, education, and history of first intercourse, were also studied to establish correlations with HPV infection. Conclusion Our results might provide some insights into factors that influence the development of cervical cancer. They might also help in guiding better patient management, increased public health awareness, further testing, and the implementation of existing vaccines.
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Affiliation(s)
- Shahana Sharmin
- Department of Microbiology, University of Dhaka, Dhaka, 1000, Bangladesh
| | | | - Arpita Aditya
- Department of Microbiology, University of Dhaka, Dhaka, 1000, Bangladesh
| | | | - Ashrafun Nessa
- Department of Gynecological Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, 1000, Bangladesh
| | | | - Mahmuda Yasmin
- Department of Microbiology, University of Dhaka, Dhaka, 1000, Bangladesh
- Corresponding author: Professor Dr Mahmuda Yasmin, Department of Microbiology, University of Dhaka, Dhaka 1000, Bangladesh.
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8
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Rangolo N, Tshitangano TG, Olaniyi FC. Compliance of Professional Nurses at Primary Health Care Facilities to the South African Cervical Cancer Screening Guidelines. NURSING REPORTS 2021; 11:741-749. [PMID: 34968263 PMCID: PMC8715466 DOI: 10.3390/nursrep11040069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/25/2021] [Accepted: 08/02/2021] [Indexed: 11/17/2022] Open
Abstract
Despite the availability of the South African cervical cancer screening guidelines at clinics, women still present in district hospitals of Thulamela Municipality with no cervical cancer screening results. Thus, many cervical cancer screenings done at the hospitals often come back positive for cervical cancer at advanced stages. This study was conducted to investigate the compliance of professional nurses at primary health care facilities (PHCs) in Thulamela Municipality to the South African cervical cancer screening guidelines. The study adopted a qualitative approach. Purposive, non-probability sampling method was used to select PHCs and recruit eligible participants. Sample size was determined by data saturation. A digital recorder was used to log individual responses during interview sessions. Data from the digital recordings were transcribed verbatim. Results were analysed and interpreted in accordance with the consolidated criteria for reporting qualitative research (COREQ) checklist. This study established that clinic professional nurses are non-compliant to the South African cervical cancer screening guidelines owing to several challenges they face, such as inadequate knowledge of the cervical cancer screening guidelines, shortage of resources, shortage of staff and patients' factors. We recommend a strengthening of the South African cervical cancer screening guideline, in-service trainings and workshops on cervical cancer and cervical cancer screening guideline as well as improvement on patients' education.
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Affiliation(s)
| | | | - Foluke Comfort Olaniyi
- Department of Public Health, University of Venda, Thohoyandou 0950, South Africa; (N.R.); (T.G.T.)
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9
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Nessa A, Uddin SM, Azad AK. Initiation of Population-Based Cervical and Breast Cancer Screening in Bangladesh. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-021-00550-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Viswanathan V, Ganeshkumar P, Selvam JM, Selvavinayagam TS. Referral mechanism and beneficiary adherence in cervical cancer screening program in Tiruchirappalli district, Tamil Nadu state, India, 2012-2015. Indian J Cancer 2021; 59:39-45. [PMID: 34380836 DOI: 10.4103/ijc.ijc_548_19] [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: 12/24/2022]
Abstract
Background A screening program for cervical cancer was established in 2011 in Tamil Nadu. Since the inception of the program, coverage, and dropout of screening has not been analyzed. We conducted a study to describe the referral mechanism in the cervical cancer screening program implemented in Tamil Nadu, to estimate the level of adherence to the referral process by the beneficiaries, and to identify strengths and weaknesses related to the referral mechanism in the program. Methods This descriptive study was conducted during 2015-2016 in the Tiruchirappalli administrative district of Tamil Nadu. All women aged 30 years and above, who were screened in public health facilities, were the participants. Using a structured form, we collected the data maintained in the registers at the district health administration. We estimated the screening coverage, follow-up evaluation, and dropout rates at different stages of the referral mechanism. We used SPSS and Epi Info software for analysis. Results Coverage of cervical cancer screening was 4,838(41.6%). We estimated 4,838(41.6%) of screened positives were lost to follow-up for a colposcopy examination. Biopsy samples were obtained from 3425(84%) of those who required a biopsy. Cervical cancer was diagnosed in 159(4.6%) and precancerous lesions in 528(15.4%) women. Conclusion More than half of the target population was screened in public health facilities. The dropout rate was less than half of those screened at the colposcopy evaluation level. Major pitfalls of the program were human resource issues at referral centers and poor maintenance of meaningful data.
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Affiliation(s)
- Vidhya Viswanathan
- Department of Epidemiology, Indian Council of Medical Research - National Institute of Epidemiology, Ayapakkam, Chennai, Tamil Nadu, India
| | - Parasuraman Ganeshkumar
- Department of Epidemiology, Indian Council of Medical Research - National Institute of Epidemiology, Ayapakkam, Chennai, Tamil Nadu, India
| | - Jerard M Selvam
- National Health Mission, Government of Tamil Nadu, Tamil Nadu, India
| | - T S Selvavinayagam
- Department of Public Health and Preventive Medicine, Government of Tamil Nadu, Tamil Nadu, India
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Salwa M, Al-Munim TA. HPV Vaccination in Bangladesh: Ethical Views. RECENT RESULTS IN CANCER RESEARCH. FORTSCHRITTE DER KREBSFORSCHUNG. PROGRES DANS LES RECHERCHES SUR LE CANCER 2021; 218:31-37. [PMID: 34019160 DOI: 10.1007/978-3-030-63749-1_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Human papillomavirus (HPV) vaccination of young adolescent girls as a part of primary prevention of cervical cancer is now a routine practice in many countries. Bangladesh, a lower-middle income country, observed a successful HPV vaccination demonstration program recently. As much as the benefits of the vaccination programs are well-recorded, the ethics of administration of it is not focused highly; rather the focus tends to be on the most efficient method to get it done. In countries like Bangladesh, vaccination-related ethical issues are often overlooked. Thus, addition of HPV vaccination to the existing immunization programs calls for logical discussion and consideration to preserve the highest ethical standard in administering this vaccine to a sensitive age group of adolescence. This chapter summarizes some ethical concerns related to the HPV vaccination implementation in Bangladesh.
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Affiliation(s)
- Marium Salwa
- Bangabandhu Sheikh Mujib Medical University, Shahbag,, Dhaka-1000,, Bangladesh.
| | - Tarek Abdullah Al-Munim
- Independent Consultant, House #238, Road #5, Mohammadi Housing Society, Mohammadpur,, Dhaka-1207,, Bangladesh
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Bhatla N, Nessa A, Oswal K, Vashist S, Sebastian P, Basu P. Program organization rather than choice of test determines success of cervical cancer screening: Case studies from Bangladesh and India. Int J Gynaecol Obstet 2021; 152:40-47. [PMID: 33205399 DOI: 10.1002/ijgo.13486] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 11/16/2020] [Indexed: 11/08/2022]
Abstract
The call for elimination of cervical cancer as a public health problem by the World Health Organization has led to intense focus on the burden of disease, available resources, and the possibility of introducing efficient systems for screening and treatment that allow effective cancer control in limited-resource settings. Presently, the focus is on the introduction of rapid, technologically less-demanding, affordable HPV testing. However, until such tests become widely available, the momentum that has been gained using visual inspection with acetic acid (VIA) should not be lost. Countries with limited resources and a heavy burden of cervical cancer, such as Bangladesh and India, introduced and scaled up VIA-based programs with varying degrees of programmatic organization and performance. Despite its limitations, VIA's simplicity and affordability has allowed these countries to build infrastructure, increase numbers of trained healthcare personnel, and develop a system of multilevel coordination within the health system. Such efforts will have long-term advantages provided that countries have access to an appropriate HPV test and build on their efforts to improve program organization through a strengthened health system, translating lessons learned in program implementation, logistics, and compliance with the new paradigm.
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Affiliation(s)
- Neerja Bhatla
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashrafun Nessa
- Department of Gynecological Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Kunal Oswal
- Prevention Early Detection Palliative Care Program and Cancer Care, Tata Trusts, Mumbai, India
| | - Shachi Vashist
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Paul Sebastian
- Prevention Early Detection Palliative Care Program and Cancer Care, Tata Trusts, Mumbai, India
| | - Partha Basu
- International Agency for Research on Cancer, World Health Organization, Lyon, France
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13
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Hoque MR, Haque E, Karim MR. Cervical cancer in low-income countries: A Bangladeshi perspective. Int J Gynaecol Obstet 2020; 152:19-25. [PMID: 32989750 DOI: 10.1002/ijgo.13400] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/18/2020] [Accepted: 09/24/2020] [Indexed: 11/06/2022]
Abstract
Cervical cancer is the fourth most common cancer among women worldwide, with approximately 70% of cases involving infection with human papillomavirus (HPV) genotypes 16 and 18. According to International Agency for Research on Cancer, more than 50 million Bangladeshi women are at risk of developing cervical cancer, and 17 686 new cases and 10 362 deaths occur annually. If diagnosed at the precursor stage, however, cervical cancer is a condition that can be successfully treated. As a result, screening programs are necessary to identify the disease before it progresses to invasive cancer. In the present review, we discuss the overall situation of cervical cancer in Bangladesh, summarizing the sociodemographic status of affected women, associated risk factors, screening approaches, and treatment options. We emphasize the potential of visual inspection with acetic acid (VIA) as a cost-effective screening approach for detecting cervical lesions among poor women in the community. In a resource-limited country such as Bangladesh, VIA may represent an ideal model to build an effective awareness campaign through urban and rural hospitals, community-based clinics, and other health facilities available in industry.
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Affiliation(s)
- Mohammad Razuanul Hoque
- Department of Biochemistry and Molecular Biology, University of Chittagong, Chittagong, Bangladesh
| | - Effi Haque
- Institute of Genetics and Animal Breeding of the Polish Academy of Sciences, Magdalenka, Poland
| | - M Rezaul Karim
- Laboratory for Cancer Biology, Department of Biotechnology and Genetic Engineering, Jahangirnagar University, Savar, Dhaka, Bangladesh
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Mandal R, Basu P. Cancer screening and early diagnosis in low and middle income countries : Current situation and future perspectives. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:1505-1512. [PMID: 30353287 DOI: 10.1007/s00103-018-2833-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Limited health system capacities and competing health priorities in low and middle income countries (LMICs) necessitate a pragmatic approach to population-based cancer screening. Thus, the challenges faced by LMICs to implement a 'western' model of screening for common cancers and the possible means to overcome these challenges are presented. Breast cancer is the number one cancer with a rising trend in the majority of LMICs. Implementation of mass-scale mammography-based screening is not feasible and sustainable in most of them. While some LMICs have introduced breast cancer screening based on clinical breast examination (CBE), the programs need to be of appropriate quality. All LMICs should improve the capacity for early diagnosis of breast cancer along with other common cancers through community education, training of frontline health workers, facilitating prompt referrals and improving the infrastructure for cancer diagnosis and treatment. Resources permitting, the LMICs with high burden of cervical cancer may consider human papillomavirus (HPV) detection-based screening; a simple low-cost alternative is visual inspection with acetic acid (VIA). Regardless of the choice, a strong linkage should be established between screening and treatment with implementation of robust quality assurance. The few LMICs with a rising trend of colorectal cancers and adequate resources may implement demonstration projects to screen with fecal immunochemical tests (FIT). Oral cancer screening of habitual tobacco and/or alcohol users using oral visual examination (OVE) may be implemented in countries with high burden of the cancer, but primary prevention (i.e., tobacco/alcohol cessation) should be prioritized. Screenings for other cancers are not recommended for LMICs.
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Affiliation(s)
| | - Partha Basu
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer (WHO), 150 cours Albert Thomas, 69372, Lyon Cedex 08, France.
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15
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Types of urinary incontinence in Bangladeshi women at midlife: Prevalence and risk factors. Maturitas 2018; 116:18-23. [DOI: 10.1016/j.maturitas.2018.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/16/2018] [Accepted: 07/19/2018] [Indexed: 11/23/2022]
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Salwa M, Abdullah Al-Munim T. Ethical issues related to human papillomavirus vaccination programs: an example from Bangladesh. BMC Med Ethics 2018; 19:39. [PMID: 29945621 PMCID: PMC6019993 DOI: 10.1186/s12910-018-0287-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Human Papilloma Virus (HPV) vaccine was introduced in Bangladesh through the arrangement of a demonstration project in Gazipur district in 2016, targeting grade five female students and non-school going girls (age range 10–12 years). HPV vaccination is expected to be eventually included in the nationwide immunization program if the demonstration project is successful. However, introduction and implementation of such a vaccination program raises various ethical concerns. This review paper illustrates a step by step assessment of the ethical concerns surrounding the HPV vaccination implementation in Bangladesh considering specific elements in administering and conducting the program as well as the intended results. Policy-makers, vaccine implementers, vaccine recipients, and an ethics specialist in Bangladesh were interviewed. Electronic database and websites have also been reviewed for relevant published literature and government statements. Main body of the abstract This program imparted inadequate knowledge about HPV and cervical cancer to the recipients and participants. There was lack of autonomous and informed choice of the girls and their parents about taking the vaccine. The program did not have any follow-up plan for the adverse effects in the long run. The impact of a female-only strategy in the larger societal context was overlooked. There was lack of awareness among the implementers about safeguarding the ethical issues pertaining to HPV vaccination. Conclusion Adolescent health education imparted in the scope of the vaccination program should contain adequate information about HPV, its mode of transmission, risk factors along with the importance of secondary prevention despite primary prevention. Adolescent boys should be given HPV related health education as well. The right of making informed choice should be appreciated and respected. More ethical discussion and debate should be done among the public health professionals of Bangladesh in order to increase awareness about ethical issues related to human health.
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Affiliation(s)
- Marium Salwa
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
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Toliman PJ, Kaldor JM, Tabrizi SN, Vallely AJ. Innovative approaches to cervical cancer screening in low- and middle-income countries. Climacteric 2018; 21:235-238. [PMID: 29488817 DOI: 10.1080/13697137.2018.1439917] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The estimated cervical cancer burden is over ten-fold greater in low- and middle-income countries (LMICs) than in high-income countries. This health gap is thought to be primarily due to limited access to effective screening and treatment programs for cervical pre-cancer and cancer in such settings. The World Health Organization advocates a policy of 'screen and treat' approach to cervical screening in LMICs and subsequently visual inspection of the cervix with acetic acid (VIA) or Lugo's iodine (VILI), followed by ablative cervical cryotherapy if indicated, and this policy has been implemented in many high-burden settings. The performance of VIA/VILI as a primary screening tool for the detection of cervical pre-cancer and cancer has, however, been inconsistent. Recently, many high-income countries have integrated HPV-DNA testing into their cervical cancer screening programs. The comparatively high cost and resource requirements of HPV-based screening have to date prevented many LMICs from doing the same. A significant development has been the entrance of innovative, easy-to-use and highly accurate HPV tests that can be provided at point of care; these could enable LMICs to implement 'test and treat' approaches for cervical cancer screening.
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Affiliation(s)
- P J Toliman
- a Sexual and Reproductive Health Unit , Papua New Guinea Institute of Medical Research , Goroka , Papua New Guinea.,b Public Health Interventions Research Group , The Kirby Institute, UNSW , Sydney , Australia
| | - J M Kaldor
- b Public Health Interventions Research Group , The Kirby Institute, UNSW , Sydney , Australia
| | - S N Tabrizi
- c Department of Microbiology and Infectious Disease , The Royal Women's Hospital , Parkville , VIC , Australia.,d Department of Obstetrics and Gynaecology , University of Melbourne , Parkville , VIC , Australia
| | - A J Vallely
- a Sexual and Reproductive Health Unit , Papua New Guinea Institute of Medical Research , Goroka , Papua New Guinea.,b Public Health Interventions Research Group , The Kirby Institute, UNSW , Sydney , Australia
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18
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Sivaram S, Majumdar G, Perin D, Nessa A, Broeders M, Lynge E, Saraiya M, Segnan N, Sankaranarayanan R, Rajaraman P, Trimble E, Taplin S, Rath GK, Mehrotra R. Population-based cancer screening programmes in low-income and middle-income countries: regional consultation of the International Cancer Screening Network in India. Lancet Oncol 2018; 19:e113-e122. [PMID: 29413465 PMCID: PMC5835355 DOI: 10.1016/s1470-2045(18)30003-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/17/2017] [Accepted: 11/16/2017] [Indexed: 12/16/2022]
Abstract
The reductions in cancer morbidity and mortality afforded by population-based cancer screening programmes have led many low-income and middle-income countries to consider the implementation of national screening programmes in the public sector. Screening at the population level, when planned and organised, can greatly benefit the population, whilst disorganised screening can increase costs and reduce benefits. The International Cancer Screening Network (ICSN) was created to share lessons, experience, and evidence regarding cancer screening in countries with organised screening programmes. Organised screening programmes provide screening to an identifiable target population and use multidisciplinary delivery teams, coordinated clinical oversight committees, and regular review by a multidisciplinary evaluation board to maximise benefit to the target population. In this Series paper, we report outcomes of the first regional consultation of the ICSN held in Agartala, India (Sept 5-7, 2016), which included discussions from cancer screening programmes from Denmark, the Netherlands, USA, and Bangladesh. We outline six essential elements of population-based cancer screening programmes, and share recommendations from the meeting that policy makers might want to consider before implementation.
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Affiliation(s)
- Sudha Sivaram
- Public Health Research Branch, Center for Global Health, US National Cancer Institute, Rockville, MD, USA.
| | | | - Douglas Perin
- Public Health Research Branch, Center for Global Health, US National Cancer Institute, Rockville, MD, USA
| | - Ashrafun Nessa
- Department of Obstetrics and Gynecology, Bangabandhu Sheikh, Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | - Mireille Broeders
- Department for Health Evidence, Radboudumc, and Dutch Expert Centre for Screening, Nijmegen, Netherlands
| | - Elsebeth Lynge
- Center of Epidemiology and Screening, University of Copenhagen, Copenhagen, Denmark
| | - Mona Saraiya
- Division of Cancer Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nereo Segnan
- Center for Epidemiology and Prevention in Oncology, CPO Piemonte, WHO Collaborative Center for Cancer Early Diagnosis and Screening, University Hospital Città della Salute e della Scienza, Turin, Italy
| | - Rengaswamy Sankaranarayanan
- Screening Group, International Agency for Research on Cancer, Lyon, France; RTI International-India, New Delhi, India
| | - Preetha Rajaraman
- Office of Global Affairs, US Department of Health and Human Services, US Embassy, New Delhi, India
| | - Edward Trimble
- Public Health Research Branch, Center for Global Health, US National Cancer Institute, Rockville, MD, USA
| | - Stephen Taplin
- Public Health Research Branch, Center for Global Health, US National Cancer Institute, Rockville, MD, USA
| | - G K Rath
- Rotary Cancer Center, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Ravi Mehrotra
- National Institute of Cancer Prevention and Research, and WHO-Framework Convention on Tobacco Control Smokeless Tobacco Global Knowledge Hub, National Capital Region, India
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19
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Vallely AJ, Toliman PJ, Ryan C, Rai G, Wapling J, Gabuzzi J, Kumbia A, Kombuk B, Kombati Z, Vallely LM, Kelly-Hanku A, Wand H, Tabrizi SN, Mola GDL, Kaldor JM. Association between visual inspection of the cervix with acetic acid examination and high-risk human papillomavirus infection, Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis in Papua New Guinea. Aust N Z J Obstet Gynaecol 2018; 58:576-581. [PMID: 29380356 DOI: 10.1111/ajo.12783] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 01/05/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Papua New Guinea (PNG) has among the highest estimated burdens of cervical cancer globally but currently has no national cervical screening program. Visual inspection of the cervix with acetic acid (VIA) is a low-cost screening strategy endorsed by the World Health Organization that has been adopted in many low-resource settings but not previously evaluated in PNG. AIM To evaluate the association between VIA examination findings and high-risk HPV (hrHPV) infection; and the impact of concomitant genital Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis on the interpretation of VIA findings. METHODS A prospective clinical cohort study among women aged 30-59 years attending Well Woman Clinics in PNG. Main outcome measures were VIA examination findings and laboratory-confirmed hrHPV, C. trachomatis, N. gonorrhoeae and T. vaginalis. RESULTS A total of 614 women were enrolled, of whom 87.5% (537/614) underwent VIA, and 12.5% (77/614) did not due to pre-existing cervicitis or inability to visualise the transformation zone. Among the 537 women who underwent VIA, 21.6% were VIA positive, 63.7% VIA negative, and 14.7% had indeterminate findings. The prevalence of hrHPV infection (n = 614) was 14.7%; C. trachomatis, 7.5%; N. gonorrhoeae, 8.0%; and T. vaginalis, 15.0%. VIA positive women were more likely to have HPV16 (odds ratio: 5.0; 95%CI: 1.6-15.6; P = 0.006) but there was no association between HPV18/45, all hrHPV types (combined), C. trachomatis, N. gonorrhoeae or T. vaginalis. CONCLUSIONS VIA positivity was associated with HPV16, but not with other hrHPV infections, nor with genital C. trachomatis, N. gonorrhoeae or T. vaginalis in this setting.
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Affiliation(s)
- Andrew J Vallely
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Pamela J Toliman
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Claire Ryan
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.,The Burnet Institute, Melbourne, Victoria, Australia
| | - Glennis Rai
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Johanna Wapling
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.,The Burnet Institute, Melbourne, Victoria, Australia
| | - Josephine Gabuzzi
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Antonia Kumbia
- Eastern Highlands Provincial Hospital, Goroka, Papua New Guinea
| | - Benny Kombuk
- Mt Hagen General Hospital, Mount Hagen, Papua New Guinea
| | - Zure Kombati
- Mt Hagen General Hospital, Mount Hagen, Papua New Guinea
| | - Lisa M Vallely
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Angela Kelly-Hanku
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Handan Wand
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sepehr N Tabrizi
- Department of Microbiology and Infectious Diseases, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Glen D L Mola
- Department of Obstetrics and Gynaecology, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - John M Kaldor
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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20
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Holme F, Kapambwe S, Nessa A, Basu P, Murillo R, Jeronimo J. Scaling up proven innovative cervical cancer screening strategies: Challenges and opportunities in implementation at the population level in low- and lower-middle-income countries. Int J Gynaecol Obstet 2017; 138 Suppl 1:63-68. [PMID: 28691331 DOI: 10.1002/ijgo.12185] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The problem of cervical cancer in low- and lower-middle-income countries (LLMICs) is both urgent and important, and calls for governments to move beyond pilot testing to population-based screening approaches as quickly as possible. Experiences from Zambia, Bangladesh, Guatemala, Honduras, and Nicaragua, where scale-up of evidence-based screening strategies is taking place, may help other countries plan for large-scale implementation. These countries selected screening modalities recommended by the WHO that are within budgetary constraints, improve access for women, and reduce health system bottlenecks. In addition, some common elements such as political will and government investment have facilitated action in these diverse settings. There are several challenges for continued scale-up in these countries, including maintaining trained personnel, overcoming limited follow-up and treatment capacity, and implementing quality assurance measures. Countries considering scale-up should assess their readiness and conduct careful planning, taking into consideration potential obstacles. International organizations can catalyze action by helping governments overcome initial barriers to scale-up.
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Affiliation(s)
| | - Sharon Kapambwe
- Ministry of Health of Zambia and Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Ashrafun Nessa
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Partha Basu
- International Agency for Research on Cancer, Lyon, France
| | - Raul Murillo
- Centro Javeriano de Oncologia, Hospital Universitario San Ignacio, Bogota, Colombia
- Faculty of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
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21
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Islam RM, Bell RJ, Billah B, Hossain MB, Davis SR. The prevalence of symptomatic pelvic floor disorders in women in Bangladesh. Climacteric 2016; 19:558-564. [PMID: 27763801 DOI: 10.1080/13697137.2016.1240771] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate the prevalence of, and risk factors for, pelvic floor disorders (PFDs) in women in Bangladesh. METHODS A nationally representative sample of 1590 Bangladeshi women, aged 30-59 years, was recruited using a multistage cluster sampling technique, between September 2013 and March 2014. Urinary incontinence (UI), fecal incontinence (FI) and pelvic organ prolapse (POP) were assessed using validated questionnaires. The weighted prevalence and the factors associated with each PFD were investigated using multivariable weighted logistic regression. RESULTS The weighted prevalence of UI was 23.7% (95% confidence interval (CI) 21.3-26.0%), FI 5.3% (95% CI 4.0-6.6%), POP 16.2% (95% CI 14.2-18.2%), and having at least one PFD 35.3% (95% CI 32.6-37.9%). Women were more likely to have at least one PFD if aged 40-49 years (adjusted odds ratio (AOR) 1.46, 95% CI 1.02-2.08; p = 0.040) or 50-59 years (AOR 2.39, 95% CI 1.59-3.58; p < 0.0001), compared with women aged 30-39 years. Having at least one PFD was positively associated with having three or more versus fewer children (AOR 1.61, 95% CI 1.14-2.27; p = 0.007), being in the middle (AOR 3.05, 95% CI 1.72-5.41; p < 0.0001), second lowest (AOR 2.49, 95% CI 1.39-4.47; p = 0.002) or lowest (AOR 3.13, 95% CI 1.68-5.86; p < 0.0001) wealth quintile compared with the highest, and self-reporting diabetes (AOR 2.55, 95% CI 1.54-4.23; p < 0.0001). CONCLUSIONS One-third of Bangladeshi women aged 30-59 years had at least one symptomatic PFD. Risk factors included greater age, higher parity, lower wealth status and self-reported diabetes. The diagnosis, treatment, and prevention of PFDs in Bangladesh need greater attention, as the prevalence of these disabling conditions is likely to increase with the aging of the population.
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Affiliation(s)
- R M Islam
- a Women's Health Research Program, School of Public Health and Preventive Medicine , Monash University , Melbourne , Victoria , Australia.,b Department of Population Sciences , University of Dhaka , Dhaka , Bangladesh
| | - R J Bell
- a Women's Health Research Program, School of Public Health and Preventive Medicine , Monash University , Melbourne , Victoria , Australia
| | - B Billah
- c Biostatistics Unit, School of Public Health and Preventive Medicine , Monash University , Melbourne , Victoria , Australia
| | - M B Hossain
- b Department of Population Sciences , University of Dhaka , Dhaka , Bangladesh
| | - S R Davis
- a Women's Health Research Program, School of Public Health and Preventive Medicine , Monash University , Melbourne , Victoria , Australia
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22
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Prevalence and severity of vasomotor symptoms and joint pain in women at midlife in Bangladesh: a population-based survey. Menopause 2016; 23:731-9. [DOI: 10.1097/gme.0000000000000615] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Islam RM, Bell RJ, Billah B, Hossain MB, Davis SR. Awareness of breast cancer and barriers to breast screening uptake in Bangladesh: A population based survey. Maturitas 2016; 84:68-74. [DOI: 10.1016/j.maturitas.2015.11.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 11/02/2015] [Accepted: 11/03/2015] [Indexed: 11/24/2022]
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Selmouni F, Zidouh A, Alvarez-Plaza C, El Rhazi K. Perception and satisfaction of cervical cancer screening by Visual Inspection with Acetic acid (VIA) at Meknes-Tafilalet Region, Morocco: a population-based cross-sectional study. BMC WOMENS HEALTH 2015; 15:106. [PMID: 26597844 PMCID: PMC4657367 DOI: 10.1186/s12905-015-0268-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 11/19/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND This study aims to explore the perception and satisfaction of cervical cancer screening by Visual Inspection with Acetic acid (VIA) in Meknes-Tafilalet Region among target women. METHODS A cross-sectional study was conducted using face-to-face interviews with women, routinely attending health centers, who met the inclusion criteria. Descriptive analysis was undertaken to report data. RESULTS A total of 324 women were included in the study. Results revealed low awareness about cervical cancer (19.6 %) and a very high acceptability of VIA screening (94.5 %). Of the 306 women screened, 99 % stated that they would recommend the VIA testing to their friends and female relatives. All those women who were screened negative expressed their intent to repeat the test every three years. Those found VIA positive affirmed they would perform confirmatory explorations. The majority (96.3 %) of the women believed that screening by VIA could save their lives; cervical cancer was a concern for 98.6 %; and only 11.6 % felt anxious about repeating the VIA test. The majority of women (98.6 %) were satisfied with the service received at the health center. CONCLUSIONS This study showed that the participants had a strong perception about cervical cancer screening and were willing to have further confirmation or future retests.
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Affiliation(s)
- Farida Selmouni
- Complutense University of Madrid, Madrid, Spain. .,Higher Institute of Nursing Professions and Techniques of Health of Rabat, Rabat, Morocco.
| | - Ahmed Zidouh
- Lalla Salma Foundation, Cancer Prevention and Treatment, Rabat, Morocco.
| | | | - Karima El Rhazi
- Laboratory of Epidemiology, Clinical Research and Community Health, Sidi Mohamed Ben AbdIllah University, Fez, Morocco.
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25
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Islam RM, Bell RJ, Billah B, Hossain MB, Davis SR. Lack of Understanding of Cervical Cancer and Screening Is the Leading Barrier to Screening Uptake in Women at Midlife in Bangladesh: Population-Based Cross-Sectional Survey. Oncologist 2015; 20:1386-92. [PMID: 26590177 DOI: 10.1634/theoncologist.2015-0235] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 09/23/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cervical cancer (CCa) is the second most common cancer among women in Bangladesh. The uptake of CCa screening was less than 10% in areas where screening has been offered, so we investigated the awareness of CCa and CCa screening, and factors associated with women's preparedness to be screened. METHODS A nationally representative, cross-sectional survey of women aged 30-59 years was conducted in 7 districts of the 7 divisions in Bangladesh, using a multistage cluster sampling technique. Factors associated with the awareness of CCa and screening uptake were investigated separately, using multivariable logistic regression. RESULTS On systematic questioning, 81.3% and 48.6% of the 1,590 participants, whose mean age was 42.3 (±8.0) years, had ever heard of CCa and CCa screening, respectively. Having heard of CCa was associated with living in a rural area (adjusted odds ratio [OR]: 0.42; 95% confidence interval [CI]: 0.26-0.67), being 40-49 years old (OR: 1.59; 95% CI: 1.15-2.0), having no education (OR: 0.25; 95% CI: 0.16-0.38), and being obese (OR: 2.04; 95% CI: 1.23-3.36). Of the 773 women who had ever heard of CCa screening, 86% reported that they had not been screened because they had no symptoms and 37% did not know screening was needed. Only 8.3% had ever been screened. Having been screened was associated with being 40-49 years old (OR: 2.17; 95% CI: 1.19-3.94) and employed outside the home (OR: 3.83; 95% CI: 1.65-8.9), and inversely associated with rural dwelling (OR: 0.54; 95% CI: 0.30-0.98) and having no education (OR: 0.29; 95% CI: 0.10-0.85). CONCLUSION Lack of awareness of CCa and of understanding of the concept of screening are the key barriers to screening uptake in women at midlife in Bangladesh. Targeted educational health programs are needed to increase screening in Bangladesh with the view to reducing mortality.
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Affiliation(s)
- Rakibul M Islam
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia Department of Population Sciences, University of Dhaka, Dhaka, Bangladesh
| | - Robin J Bell
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Baki Billah
- Biostatistics Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mohammad B Hossain
- Department of Population Sciences, University of Dhaka, Dhaka, Bangladesh
| | - Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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26
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Basu P, Mittal S, Banerjee D, Singh P, Panda C, Dutta S, Mandal R, Das P, Biswas J, Muwonge R, Sankaranarayanan R. Diagnostic accuracy of VIA and HPV detection as primary and sequential screening tests in a cervical cancer screening demonstration project in India. Int J Cancer 2015; 137:859-67. [PMID: 25631198 DOI: 10.1002/ijc.29458] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 01/14/2015] [Indexed: 12/22/2022]
Abstract
Visual inspection after acetic acid application (VIA) and human papillomavirus (HPV) detection tests have been recommended to screen women for cervical cancer in low and middle income countries. A demonstration project in rural India screened 39,740 women with both the tests to compare their accuracies in real population setting. The project also evaluated the model of screening women in the existing primary health care facilities, evaluating the screen positive women with colposcopy (and biopsy) in the same setup and recalling the women diagnosed to have disease for treatment at tertiary center. Accuracy of VIA and HPV test used sequentially was also studied. VIA was performed by trained health workers and Hybrid Capture II (HC II) assay was used for oncogenic HPV detection. Test positivity was 7.1% for VIA and 4.7% for HC II. Detection rate of CIN 3+ disease was significantly higher with HC II than VIA. Sensitivities of VIA and HC II to detect 162 histology proved CIN 3+ lesions were 67.9 and 91.2%, respectively after adjusting for verification bias. Specificity for the same disease outcome and verification bias correction was 93.2% for VIA and 96.9% for HC II. Triaging of VIA positive women with HPV test would have considerably improved the positive predictive value (4.0 to 37.5% to detect CIN 3+) without significant drop in sensitivity. All VIA positive women and 74.0% of HC II positive women had colposcopy. There was high compliance to treatment and significant stage-shift of the screen-detected cancers towards more early stage.
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Affiliation(s)
- Partha Basu
- Department of Gynecological Oncology, Chittaranjan National Cancer Institute, Kolkata, 700026, India
| | - Srabani Mittal
- Department of Gynecological Oncology, Chittaranjan National Cancer Institute, Kolkata, 700026, India
| | - Dipanwita Banerjee
- Department of Gynecological Oncology, Chittaranjan National Cancer Institute, Kolkata, 700026, India
| | - Priyanka Singh
- Department of Gynecological Oncology, Chittaranjan National Cancer Institute, Kolkata, 700026, India
| | - Chinmay Panda
- Department of Gynecological Oncology, Chittaranjan National Cancer Institute, Kolkata, 700026, India
| | - Sankhadeep Dutta
- Department of Gynecological Oncology, Chittaranjan National Cancer Institute, Kolkata, 700026, India
| | - Ranajit Mandal
- Department of Gynecological Oncology, Chittaranjan National Cancer Institute, Kolkata, 700026, India
| | - Pradip Das
- Department of Gynecological Oncology, Chittaranjan National Cancer Institute, Kolkata, 700026, India
| | - Jaydip Biswas
- Department of Gynecological Oncology, Chittaranjan National Cancer Institute, Kolkata, 700026, India
| | - Richard Muwonge
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France
| | - Rengaswamy Sankaranarayanan
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France
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Visual Inspection of Cervix With Acetic Acid as a Screening Modality for Cervical Cancer. J Low Genit Tract Dis 2015; 19:340-4. [PMID: 26247262 DOI: 10.1097/lgt.0000000000000145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess feasibility and suitability of visual inspection of cervix with acetic acid (VIA) in detecting cervical intraepithelial neoplasia (CIN), and compare it with Papanicolaou test. METHODS This was a diagnostic accuracy cross-sectional study conducted at an Egyptian teaching hospital, where 784 women were offered Papanicolaou test, VIA, colposcopy, and cervical biopsy. RESULTS Histopathologically confirmed CIN 2/3 was noted in 26 cases (3.3%) and cervical cancer in 3 cases (0.4%). Twenty-seven (93.1%) of these 29 cases of CIN 2+, including one invasive cancer, were suggested by VIA. The test sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) to detect CIN 2+ were 93.1%, 90.6%, 26.6%, and 99.7%, respectively. Positive likelihood ratio (LR +) and negative likelihood ratio (LR-) for VIA were 9.90 (95% confidence interval [CI], 7.77-12.62) and 0.08 (95% CI, 0.02-0.29), respectively. Twenty-six cases (89.7%) of CIN 2+ were suggested by Papanicolaou test, whereas all 3 cancers were missed by this test. Papanicolaou test sensitivity, specificity, PPV, and NPV to detect CIN 2+ were 89.7%, 99.1%, 78.8%, and 99.6%, respectively. Positive likelihood ratio and LR- for the Papanicolaou test were 96.7 (95% CI, 45.78-204.23) and 0.10 (95% CI, 0.04-0.3), respectively. Colposcopy suggested 28 cases (96.6%) of CIN 2+, including 2 cancers. Colposcopy sensitivity, specificity, PPV, and NPV to detect CIN 2+ were 96.6%, 99.2%, 82.4%, and 99.9%, respectively. CONCLUSION Visual inspection of the cervix with acetic acid is a feasible and suitable screening test for cervical cancer in under-resourced settings in developing countries. Its performance is comparable to the Papanicolaou test.
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Maseko FC, Chirwa ML, Muula AS. Health systems challenges in cervical cancer prevention program in Malawi. Glob Health Action 2015; 8:26282. [PMID: 25623612 PMCID: PMC4306748 DOI: 10.3402/gha.v8.26282] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 11/24/2014] [Accepted: 12/14/2014] [Indexed: 11/14/2022] Open
Abstract
Background Cervical cancer remains the leading cause of cancer death among women in sub-Saharan Africa. In Malawi, very few women have undergone screening and the incidence of cervical cancer is on the increase as is the case in most developing countries. We aimed at exploring and documenting health system gaps responsible for the poor performance of the cervical cancer prevention program in Malawi. Design The study was carried out in 14 randomly selected districts of the 29 districts of Malawi. All cervical cancer service providers in these districts were invited to participate. Two semi-structured questionnaires were used, one for the district cervical cancer coordinators and the other for the service providers. The themes of both questionnaires were based on World Health Organization (WHO) health system frameworks. A checklist was also developed to audit medical supplies and equipment in the cervical cancer screening facilities. The two questionnaires together with the medical supplies and equipment checklist were piloted in Chikwawa district before being used as data collection tools in the study. Quantitative data were analyzed using STATA and qualitative in NVIVO. Results Forty-one service providers from 21 health facilities and 9 district coordinators participated in the study. Our findings show numerous health system challenges mainly in areas of health workforce and essential medical products and technologies. Seven out of the 21 health facilities provided both screening and treatment. Results showed challenges in the management of the cervical cancer program at district level; inadequate service providers who are poorly supervised; lack of basic equipment and stock-outs of basic medical supplies in some health facilities; and inadequate funding of the program. In most of the health facilities, services providers were not aware of the policy which govern their work and that they did not have standards and guidelines for cervical cancer screening and treatment. Conclusion Numerous health system challenges are prevailing in the cervical cancer prevention program in Malawi. These challenges need to be addressed if the health system is to improve on the coverage of cervical cancer screening and treatment.
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Affiliation(s)
- Fresier C Maseko
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Zomba, Malawi;
| | | | - Adamson S Muula
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Zomba, Malawi
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Bangladesh Midlife Women's Health Study (BMWHS): Methods, challenges and experiences. Maturitas 2015; 80:89-94. [DOI: 10.1016/j.maturitas.2014.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 10/10/2014] [Accepted: 10/12/2014] [Indexed: 11/22/2022]
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Nessa A, Hussain MA, Rashid MHU, Akhter N, Roy JS, Afroz R. Role of print and audiovisual media in cervical cancer prevention in Bangladesh. Asian Pac J Cancer Prev 2014; 14:3131-7. [PMID: 23803091 DOI: 10.7314/apjcp.2013.14.5.3131] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Visual inspection of cervix with acetic acid (VIA) is offered at 252 centers in 64 districts of Bangladesh. VIA+ve women are managed at colposcopy clinics of Bangabandhu Sheikh Mujib Medical University (BSMMU) and 14 Medical College Hospitals (MCHs). This research work has been supported by 'UICC Cancer Prevention Campaign' programme. OBJECTIVES This study explored the role of print materials and electronic media to improve cervical cancer screening in the present socio-cultural context of Bangladesh. METHODS This study was performed from January to August 2011 at two upazilas of Bangladesh (Singair with screening facility and Sonargaon without screening facility). Data were collected by focus group discussion (FGD) with women, husbands and community people before and after intervention. Information on cervical cancer screening and VIA camps was disseminated using advertisement through local cable line of the television, microphone announcement, service providers and leaflet throughout the week prior to a VIA camp. Three-day VIA camps were organized at the upazila health complex (UHC) of both upazilas. Quantitative data was gathered from women at the camps on source of information on VIA and the best method of awareness creation. RESULTS The population was aware of "cancer" and a notable number knew about cervical cancer. Baseline awareness on prevention and VIA was low and it was negligible where screening services were unavailable. Awareness was increased fourfold in both upazilas after interventions and half of the women and the majority of the community people became aware of screening and available facilities. Cable line advertisement (25.5%), microphone announcement (21.4%), and discussion sessions (20.4%) were effective for awareness creation on VIA. Television was mentioned as the best method (37.4%) of awareness creation. CONCLUSION Television should be used for nation-wide awareness creation. For local awareness creation, cable line advertisement, microphone announcements and health education at Uthan Baithaks/ EPI sessions can easily be adopted by the government.
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Affiliation(s)
- Ashrafun Nessa
- Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University, Bangladesh.
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Williams JH, Carter SM, Rychetnik L. 'Organised' cervical screening 45 years on: How consistent are organised screening practices? Eur J Cancer 2014; 50:3029-38. [PMID: 25282406 DOI: 10.1016/j.ejca.2014.09.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 09/04/2014] [Accepted: 09/05/2014] [Indexed: 11/25/2022]
Abstract
Organised screening programmes have been remarkably successful in reducing incidence and mortality from cervical cancer, while opportunistic screening varies in its effectiveness. Experts recommend that cervical screening or HPV testing be carried out only in the context of an organised programme. We sought to answer the following study questions: What does it mean for a cervical screening programme to be organised? Is there a place for opportunistic screening (in an organised programme)? We reviewed 154 peer-reviewed papers on organised and opportunistic approaches to cervical screening published between 1970 and 2014 to understand how the term 'organised' is used, formally and in practice. We found that despite broad recognition of a prescriptive definition of organisation, in practice the meaning of organisation is much less clear. Our review revealed descriptions of organised programmes that differ significantly from prescribed norms and from each other, and a variety of ways that opportunistic and organised programmes intersect. We describe the breadth of the variation in cervical cancer screening programmes and examine the relationships and overlaps between organised and opportunistic screening. Implications emerging from the review include the need to better understand the breadth of organisation in practice, the drivers and impacts of opportunistic screening and the impact of opportunistic screening on population programme outcomes. Appreciation of the complexity of cervical screening programmes will benefit both screeners and women as programmes are changed to reflect a partially vaccinated population, new evidence and new technologies.
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Affiliation(s)
- Jane H Williams
- Centre for Values, Ethics and the Law in Medicine (VELiM), K25, School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia.
| | - Stacy M Carter
- Centre for Values, Ethics and the Law in Medicine (VELiM), K25, School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia.
| | - Lucie Rychetnik
- School of Medicine, University of Notre Dame, NSW 2010, Australia; Centre for Values, Ethics and the Law in Medicine (VELiM), K25, School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia.
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Maseko FC, Chirwa ML, Muula AS. Client satisfaction with cervical cancer screening in Malawi. BMC Health Serv Res 2014; 14:420. [PMID: 25245860 PMCID: PMC4180310 DOI: 10.1186/1472-6963-14-420] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 09/15/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Assessing client and patient satisfaction towards a service is of programmatic importance. A study was conducted in Malawi between July and October 2013 to assess client satisfaction among women who had been screened for cervical cancer using Visual Inspection with Acetic acid test. METHODS This was a cross sectional descriptive study which was conducted in 16 out of 43 cervical cancer screening centres. A semi structured questionnaire was used for data collection. Data were analyzed using STATA version 11 for windows. Descriptive statistics were computed to summarize participant characteristics. Logistic regression was also conducted to assess the relationship between client satisfaction with the service and the independent variables. RESULTS One hundred and twenty women with a mean age of 33.7 (SD = 10.1) participated in the survey. All women reported being satisfied with the received service at the facility, with 68.33% reported to be very satisfied. All demographic characteristics such as age, marital status, level of education, with exception of distance to the nearest health facility had no statistically significant association with satisfaction at both univariate and multivariate analysis. However, previous knowledge about the cause of the disease itself, its prevention, knowledge that the disease can be cured, knowledge of clinic times, previous knowledge of the VIA screening test and the source from where they heard about cervical cancer had a statistical significant relationship with the outcome variable. Logistic regression revealed that satisfaction in this study was predicted by having an appointment before the screening with adjusted odd ratio of 5.71(95%CI: 1.75 - 18.63), having previous knowledge of the VIA test, AOR = 0.021(95% CI: 0.002-0.226) distance from the home to the health facility AOR = 0.11(95%CI: 0.02-0.65) and waiting time AOR = 0.09 with 95% CI: 0.09 - 0.83. Having an appointment had the only independent variable with a positive relationship with satisfaction. CONCLUSION Women were satisfied with the screening service. The study also showed several challenges in cervical cancer screening services which can be considered as areas of potential improvement.
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Affiliation(s)
- Fresier C Maseko
- Department of Public Health, School of Public Health and Family Medicine, University of Malawi, College of Medicine, Mahatma Gandhi Road, Private Bag 360, Chichiri, Blantyre 3, Malawi.
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Nessa A, Nahar KN, Begum SA, Anwary SA, Hossain F, Nahar K. Comparison between visual inspection of cervix and cytology based screening procedures in Bangladesh. Asian Pac J Cancer Prev 2014; 14:7607-11. [PMID: 24460341 DOI: 10.7314/apjcp.2013.14.12.7607] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cervical cancer continues to be a major problem in Bangladesh with approximately 18,000 new cases annually of which over 10,000 women die from it. Visual inspection of the cervix after 3-5% acetic acid (VIA) application is a simple and easy to learn method for cervical cancer screening, although cytology-based screening is more often applied in developed countries where it has successfully reduced the prevalence of cervical cancer. OBJECTIVE To compare the efficacy of VIA and cytology-based primary methods for cervical cancer screening in Bangladesh. MATERIALS AND METHODS This hospital based comparative study was conducted at the VIA centre and Colposcopy Clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU) from October 2008 to October 2010. RESULTS Among 650 women, 74 (11.4%) were VIA+ve and 8 (1.2%) had abnormalities in their Pap smear reports. During colposcopy, 38 (7.7%) women had different grades of CIN and 4 (0.6%) had cervical cancer. The gold standard histology findings proved 20 women had CIN I, 14 had CIN II/II and 4 had cervical cancer. Among the 38 histology diagnosed abnormalities, VIA test could identify 30 abnormalities including two cervical cancers. However, Pap smear could detect only 8 cases of histological abnormalities (2 low grade and 6 had high grade lesion) and it missed all the cervical cancer cases. The sensitivity and specificity of VIA were 88.9% and 52.1%. The positive predictive value (PPV) and negative predictive value (NPV) were 41.0%, and 92.6% respectively. Moreover, the sensitivity, specificity, PPV and NPV of Pap smear were 33.3%, 95.8%, 75.0% and 79.3%, respectively. CONCLUSIONS VIA test should be used as the primary screening tool even with its low sensitivity and specificity in low resource countries like Bangladesh. False positive results may be greater, but overtreatment can be minimized by colposcopy evaluation of the VIA positive women.
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Affiliation(s)
- Ashrafun Nessa
- Gyne-oncology Unit, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh E-mail :
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Chary AN, Rohloff PJ. Major challenges to scale up of visual inspection-based cervical cancer prevention programs: the experience of Guatemalan NGOs. GLOBAL HEALTH: SCIENCE AND PRACTICE 2014; 2:307-17. [PMID: 25276590 PMCID: PMC4168631 DOI: 10.9745/ghsp-d-14-00073] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 07/01/2014] [Indexed: 01/08/2023]
Abstract
Scale up of visual inspection with acetic acid (VIA) in Guatemala encountered major challenges, including high attrition of people trained, didactic training without hands-on skills building, lack of continued supervision, and provision of VIA alone without immediate on-site provision of cryotherapy. Background: Like many other low- and middle-income countries, Guatemala has adopted visual inspection with acetic acid (VIA) as a low-resource alternative to the Pap smear for cervical cancer screening. Nongovernmental organizations (NGOs) introduced VIA to Guatemala in 2004, and a growing number of NGOs, working both independently and in collaboration with the Guatemalan Ministry of Health, employ VIA in cervical cancer prevention programs today. While much research describes VIA efficacy and feasibility in Latin America, little is known about NGO involvement with VIA programming or experiences with VIA outside the context of clinical trials and pilot projects in the region. Methods: To explore challenges faced by NGOs implementing VIA programs in Guatemala, we conducted semi-structured interviews with 36 NGO staff members involved with 20 VIA programs as direct service providers, program administrators, and training course instructors. Additionally, we collected data through observation at 30 NGO-sponsored cervical cancer screening campaigns, 8 cervical cancer prevention conferences, and 1 week-long NGO-sponsored VIA training course. Results: Frequently highlighted challenges included staff turnover, concerns over training quality, a need for opportunities for continued supervision, and problems with cryotherapy referrals when immediate treatment for VIA-positive women was unavailable. Conclusions: Reducing staff turnover, budgeting to train replacement providers, standardizing training curricula, and offering continued supervision are key strategies to improve VIA service quality and program sustainability. Alternative training methods, such as on-the-job mentoring and course prerequisites of online learning, could help increase training time available for clinical supervision. Efforts should be made to ensure that VIA testing is coupled with immediate cryotherapy, that providers trained in VIA are also trained in cryotherapy, and that cryotherapy supplies and equipment are maintained. Where this is not possible and only VIA screening is available, referral systems must be strengthened.
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Affiliation(s)
- Anita Nandkumar Chary
- Washington University in St. Louis, School of Medicine and Department of Anthropology , St. Louis, MO. , USA
| | - Peter J Rohloff
- Harvard Medical School, Brigham and Women's Hospital , Boston, MA. , USA
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Krishnan S, Madsen E, Porterfield D, Varghese B. Advancing cervical cancer prevention in India: implementation science priorities. Oncologist 2014; 18 Suppl:13-25. [PMID: 24334478 DOI: 10.1634/theoncologist.18-s2-13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Cervical cancer is the leading cause of cancer mortality in India, accounting for 17% of all cancer deaths among women aged 30 to 69 years. At current incidence rates, the annual burden of new cases in India is projected to increase to 225,000 by 2025, but there are few large-scale, organized cervical cancer prevention programs in the country. We conducted a review of the cervical cancer prevention research literature and programmatic experiences in India to summarize the current state of knowledge and practices and recommend research priorities to address the gap in services. We found that research and programs in India have demonstrated the feasibility and acceptability of cervical cancer prevention efforts and that screening strategies requiring minimal additional human resources and laboratory infrastructure can reduce morbidity and mortality. However, additional evidence generated through implementation science research is needed to ensure that cervical cancer prevention efforts have the desired impact and are cost-effective. Specifically, implementation science research is needed to understand individual- and community-level barriers to screening and diagnostic and treatment services; to improve health care worker performance; to strengthen links among screening, diagnosis, and treatment; and to determine optimal program design, outcomes, and costs. With a quarter of the global burden of cervical cancer in India, there is no better time than now to translate research findings to practice. Implementation science can help ensure that investments in cervical cancer prevention and control result in the greatest impact.
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Chigbu CO, Onyebuchi AK. Use of a portable diathermy machine for LEEP without colposcopy during see-and-treat management of VIA-positive cervical lesions in resource-poor settings. Int J Gynaecol Obstet 2014; 125:99-102. [PMID: 24556087 DOI: 10.1016/j.ijgo.2013.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 10/13/2013] [Accepted: 01/27/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the effectiveness of cryotherapy and loop electrosurgical excision procedure without colposcopy (visual LEEP) in treating cervical lesions detected through visual inspection with acetic acid (VIA). METHODS In rural southeast Nigeria, women with VIA-positive lesions who were eligible for ablative treatment were selected to undergo immediate cryotherapy with nitrous oxide. Women with VIA-positive lesions who were not eligible for ablative treatment were selected to undergo visual LEEP at the same visit. A portable diathermy machine was used for LEEP. Participants were re-evaluated 6 months later using VIA. The main outcome measures included persistent VIA positivity at 6 months, duration of procedure, second clinic visits for complications, and patient acceptability. RESULTS In total, 304 women completed the study. Persistent VIA-positivity rates, duration of procedure, second clinic visits for complications, and patient acceptability were similar in the 2 groups. CONCLUSION Visual LEEP and cryotherapy have similar efficacy and patient acceptability in see-and-treat management of VIA-positive cervical lesions. In see-and-treat VIA-based cervical cancer prevention programs in low-resource countries, visual LEEP can be used to treat women who do not meet the criteria for ablative treatment. This would increase the treatment coverage of women with VIA-positive lesions and improve program efficiency.
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Affiliation(s)
- Chibuike O Chigbu
- Department of Obstetrics and Gynecology, University of Nigeria Enugu Campus, Enugu, Nigeria.
| | - Azubuike K Onyebuchi
- Department of Obstetrics and Gynecology, Federal Teaching Hospital, Abakaliki, Nigeria
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Krishnan S, Madsen E, Porterfield D, Varghese B. Advancing cervical cancer prevention in India: implementation science priorities. Oncologist 2013; 18:1285-97. [PMID: 24217555 PMCID: PMC3868423 DOI: 10.1634/theoncologist.2013-0292] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 10/04/2013] [Indexed: 12/31/2022] Open
Abstract
Cervical cancer is the leading cause of cancer mortality in India, accounting for 17% of all cancer deaths among women aged 30 to 69 years. At current incidence rates, the annual burden of new cases in India is projected to increase to 225,000 by 2025, but there are few large-scale, organized cervical cancer prevention programs in the country. We conducted a review of the cervical cancer prevention research literature and programmatic experiences in India to summarize the current state of knowledge and practices and recommend research priorities to address the gap in services. We found that research and programs in India have demonstrated the feasibility and acceptability of cervical cancer prevention efforts and that screening strategies requiring minimal additional human resources and laboratory infrastructure can reduce morbidity and mortality. However, additional evidence generated through implementation science research is needed to ensure that cervical cancer prevention efforts have the desired impact and are cost-effective. Specifically, implementation science research is needed to understand individual- and community-level barriers to screening and diagnostic and treatment services; to improve health care worker performance; to strengthen links among screening, diagnosis, and treatment; and to determine optimal program design, outcomes, and costs. With a quarter of the global burden of cervical cancer in India, there is no better time than now to translate research findings to practice. Implementation science can help ensure that investments in cervical cancer prevention and control result in the greatest impact.
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Affiliation(s)
- Suneeta Krishnan
- RTI International, Research Triangle Park, North Carolina, USA
- St. John's Research Institute, Bangalore, India
| | - Emily Madsen
- RTI International, Research Triangle Park, North Carolina, USA
| | - Deborah Porterfield
- RTI International, Research Triangle Park, North Carolina, USA
- Department of Social Medicine, School of Medicine, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA
| | - Beena Varghese
- St. John's Research Institute, Bangalore, India
- Public Health Foundation of India, New Delhi, India
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Mannava P, Abdullah A, James C, Dodd R, Annear PL. Health systems and noncommunicable diseases in the Asia-Pacific region: a review of the published literature. Asia Pac J Public Health 2013; 27:NP1-19. [PMID: 24097936 DOI: 10.1177/1010539513500336] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Addressing the growing burden of noncommunicable diseases (NCDs) in countries of the Asia-Pacific region requires well-functioning health systems. In low- and middle-income countries (LMICs), however, health systems are generally characterized by inadequate financial and human resources, unsuitable service delivery models, and weak information systems. The aims of this review were to identify (a) health systems interventions being implemented to deliver NCD programs and services and their outcomes and (b) the health systems bottlenecks impeding access to or delivery of these programs and services in LMICs of the Asia-Pacific region. A search of 4 databases for literature published between 1990 and 2010 retrieved 36 relevant studies. For each study, information on basic characteristics, type of health systems bottleneck/intervention, and outcome was extracted, and methodological quality appraised. Health systems interventions and bottlenecks were classified as per the World Health Organization health systems building blocks framework. The review identified interventions and bottlenecks in the building blocks of service delivery, health workforce, financing, health information systems, and medical products, vaccines, and technologies. Studies, however, were heterogeneous in methodologies used, and the overall quality was generally low. There are several gaps in the evidence base around NCDs in the Asia-Pacific region that require further investigation.
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Affiliation(s)
| | - Asnawi Abdullah
- University of Melbourne, Melbourne, Australia University Muhammadiyah Aceh, Indonesia
| | - Chris James
- World Health Organization Western Pacific Regional Office, Manila, Philippines
| | - Rebecca Dodd
- World Health Organization Western Pacific Regional Office, Manila, Philippines
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Abstract
Cervical cancer is both preventable and curable, yet it remains one of the leading causes of mortality in women worldwide. Approximately 88% of cervical cancer cases are diagnosed in low-resource countries, yet very few resources are allocated to prevention and treatment programs. In fact, it is estimated that only 5% of women in low-resources countries are screened appropriately for cervical cancer. Cytology-based programs are not feasible because of lack of healthcare infrastructure and cost, thus alternative methods of cancer screening, such as visual inspection with acetic acid and HPV-DNA testing, have been intensively studied and are reviewed in this article.
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Motivations and preferences of rural Nigerian women undergoing cervical cancer screening via visual inspection with acetic acid. Int J Gynaecol Obstet 2012; 120:262-5. [PMID: 23228820 DOI: 10.1016/j.ijgo.2012.10.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 09/30/2012] [Accepted: 11/20/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the motivations and preferences of women participating in visual inspection with acetic acid (VIA) mass cervical cancer screening programs in southeastern Nigeria. METHODS By means of interviewer-based questionnaires, data were collected from women participating in mass cervical cancer screenings with VIA in 3 randomly selected communities in each of 2 southeastern Nigerian states between March 1, 2011, and March 31, 2012. RESULTS A total of 2312 women were interviewed. Support from husband and community opinion leaders were the most frequently reported factors that motivated the women to participate in the screening. Most participants expected an immediate result for the screening test and immediate treatment for any abnormalities detected. CONCLUSION Community-based advocacy for cervical cancer screening is a very effective method of creating awareness for cervical cancer screening. Support from spouses and community leaders are important factors in a woman's decision to utilize cervical cancer screening services in southeastern Nigeria. Immediate results and treatments would make the most impact. Family and community participation should be integrated into cervical cancer prevention programs. This, together with a "see and treat" approach, may be central to overcoming the poor utilization of cervical cancer screening services in Nigeria and similar rural settings.
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Steben M, Jeronimo J, Wittet S, LaMontagne DS, Ogilvie G, Jensen C, Smith J, Franceschi S. Upgrading Public Health Programs for Human Papillomavirus Prevention and Control is Possible in Low- and Middle-income Countries. Vaccine 2012. [DOI: 10.1016/j.vaccine.2012.06.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Nessa A, Rashid MHU, E-Ferdous N, Chowdhury A. Screening for and management of high-grade cervical intraepithelial neoplasia in Bangladesh: A cross-sectional study comparing two protocols. J Obstet Gynaecol Res 2012; 39:564-71. [DOI: 10.1111/j.1447-0756.2012.01998.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sankaranarayanan R, Sauvaget C, Ramadas K, Ngoma T, Teguete I, Muwonge R, Naud P, Nessa A, Kuhaprema T, Qiao Y. Clinical trials of cancer screening in the developing world and their impact on cancer healthcare. Ann Oncol 2011; 22 Suppl 7:vii20-vii28. [DOI: 10.1093/annonc/mdr422] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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MAREE JE, LU X, WRIGHT S. Combining breast and cervical screening in an attempt to increase cervical screening uptake. An intervention study in a South African context. Eur J Cancer Care (Engl) 2011; 21:78-86. [DOI: 10.1111/j.1365-2354.2011.01292.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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