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Rahman MS, Rahman MM, Acharya K, Haruyama R, Shah R, Matsuda T, Inoue M, Abe SK. Disparities and Determinants of Testing for Early Detection of Cervical Cancer among Nepalese Women: Evidence from a Population-Based Survey. Cancer Epidemiol Biomarkers Prev 2024; 33:1046-1056. [PMID: 38820125 DOI: 10.1158/1055-9965.epi-24-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/12/2024] [Accepted: 05/24/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Cervical cancer presents a considerable challenge in South Asia, notably in Nepal, where screening remains limited. Past research in Nepal lacked national representation and a thorough exploration of factors influencing cervical cancer screening, such as educational and socioeconomic disparities. This study aims to measure these gaps and identify associated factors in testing for early detection of cervical cancer among Nepalese women. METHODS Data from the 2019 Nepal Noncommunicable Disease Risk Factors survey (World Health Organization STEPwise approach to noncommunicable risk factor surveillance), involving 2,332 women aged 30 to 69 years, were used. Respondents were asked if they had undergone cervical cancer testing through visual inspection with acetic acid, Pap smear, or human papillomavirus test ever or in the past 5 years. The slope index of inequality (SII) and relative concentration index were used to measure socioeconomic and education-based disparities in cervical cancer test uptake. RESULTS Only 7.1% [95% confidence interval (CI): 5.1-9.9] Nepalese women had ever undergone cervical cancer testing, whereas 5.1% (95% CI: 3.4-7.5) tested within the last 5 years. The ever uptake of cervical cancer testing was 5.1 percentage points higher (SII: 5.1, 95% CI: -0.1 to 10.2) among women from the richest compared with the poorest households. Education-based disparities were particularly pronounced, with a 13.9 percentage point difference between highly educated urban residents and their uneducated counterparts (SII: 13.9, 95% CI: 5.8-21.9). CONCLUSIONS Less than one in ten women in Nepal had a cervical cancer testing, primarily favoring higher educated and wealthier individuals. IMPACT Targeted early detection and cervical cancer screening interventions are necessary to address these disparities and improve access and uptake.
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Affiliation(s)
- Md Shafiur Rahman
- Division of Prevention, National Cancer Center Institute for Cancer Control, Tokyo, Japan
- Research Centre for Child Mental Development, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Md Mahfuzur Rahman
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | | | - Rei Haruyama
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Richa Shah
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Tomohiro Matsuda
- Division of International Health Policy Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Manami Inoue
- Division of Prevention, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Sarah K Abe
- Division of Prevention, National Cancer Center Institute for Cancer Control, Tokyo, Japan
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Sabeena S, Ravishankar N, Kalpana MM. Implementation strategies of cervical cancer screening in South Asia: A systematic review. Int J Gynaecol Obstet 2024; 166:483-493. [PMID: 38268412 DOI: 10.1002/ijgo.15366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/23/2023] [Accepted: 12/28/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Cervical cancer is a preventable cancer by screening, vaccination and timely management of preinvasive cervical lesions. However, about 90% of the global burden of cervical cancer is reported from developing countries. OBJECTIVE This systematic review aimed to analyze the strategies implemented for cervical cancer screening in South Asia. SEARCH STRATEGY An electronic search of PubMed/MEDLINE, Scopus and Google Scholar was carried out for articles published in English, evaluating the implementation of cervical cancer screening between December 2000 and June 2023 in South Asia using appropriate search terms. SELECTION CRITERIA Cross-sectional studies, randomized control trials (RCTs) or non-randomized controlled trials evaluating different cervical screening strategies were included. DATA COLLECTION AND ANALYSIS A three-stage selection process was performed using a validated proforma including the title, author, year of publication, objective, country, study design, screening methods, strategies and outcomes, and results. The systematic review was designed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias was evaluated with the National Heart, Lung, and Blood Institute's (NHLBI) Quality Assessment Tools. MAIN RESULTS Out of the initial 1135 articles reviewed systematically, 23 studies met the inclusion criteria and were included in the qualitative synthesis of results. The implementation outcomes measured were acceptability (n = 23 100%), feasibility (n = 22, 95.7%), fidelity (n = 14, 60.9%), sustainability (n = 7, 30.4%), coverage (n = 4, 17.4%) and cost (n = 1, 4.3%). CONCLUSION Cervical cancer screening can be effectively implemented by restructuring the ongoing programs.
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Affiliation(s)
| | - Nagaraja Ravishankar
- Department of Biostatistics, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India
| | - M M Kalpana
- Department of Obstetrics and Gynecology, Government Medical College, Kozhikode, Kerala, India
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Zhang M, Chen J, Cui M, Jia J, Zhao M, Zhou D, Zhu L, Luo L. Analysis of the global burden of cervical cancer in young women aged 15-44 years old. Eur J Public Health 2024; 34:839-846. [PMID: 38756096 PMCID: PMC11293822 DOI: 10.1093/eurpub/ckae084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Understanding the burden of cervical cancer (CC) in young women aged 15-44 years old are essential for formulating effective preventive strategies. METHODS Utilizing the Global Burden of Disease 2019 Study, we estimated incidence, disability-adjusted life-years (DALYs), years of life lost (YLLs) and years lived with disability (YLDs) due to CC among young women from 1990 to 2019. Additionally, we evaluated the temporal trends using estimated annual percentage changes (EAPCs) during this period. We conducted a decomposition analysis to assess the absolute contributions of three components: population growth, population age structure and epidemiologic changes. RESULTS Globally, there were 187 609.22 incident cases of CC worldwide, resulting in 2621 917.39 DALYs in 2019. From1990 to 2019, the age-standardized rates were decline, only the age-standardized YLDs rate (EAPC = 0.02; 95% CI: -0.02 to 0.05) showed a stable trend. The largest increase in age-standardized incidence rate (ASIR) and age-standardized YLDs rate observed in the high-middle social demographic index (SDI) quintiles. Population growth and age structure changes were associated with substantial changes in cases of CC, especially in South Asia and East Asia. CONCLUSIONS Globally, the burden of CC in young women continues to increase, as measured by the absolute number. As populations are growing and age structure changes were associated with substantial changes in cases of CC, governments will face increasing demand for treatment, and support services for CC, especially in South Asia and East Asia.
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Affiliation(s)
- Min Zhang
- Maternal and Child Health Development Research Center, Shandong Provincial Maternal and Child Health Care Hospital, Qingdao University, Jinan, China
- School of Public Health, Jiamusi University, Jiamusi, China
| | - Jiayi Chen
- School of Clinical and Basic Medicine, Shandong First Medical University (Shandong Academy of Medical Sciences), Jinan, China
| | - Meimei Cui
- Maternal and Child Health Development Research Center, Shandong Provincial Maternal and Child Health Care Hospital, Qingdao University, Jinan, China
- School of Basic Medical, Shandong Second Medical University, Weifang, China
| | - Jingjing Jia
- Maternal and Child Health Development Research Center, Shandong Provincial Maternal and Child Health Care Hospital, Qingdao University, Jinan, China
- School of Basic Medical, Jiamusi University, Jiamusi, China
| | - Ming Zhao
- Maternal and Child Health Development Research Center, Shandong Provincial Maternal and Child Health Care Hospital, Qingdao University, Jinan, China
- School of Public Health, Jiamusi University, Jiamusi, China
| | - Dan Zhou
- Maternal and Child Health Development Research Center, Shandong Provincial Maternal and Child Health Care Hospital, Qingdao University, Jinan, China
- School of Public Health, Jiamusi University, Jiamusi, China
| | - Liling Zhu
- School of Public Health, Jiamusi University, Jiamusi, China
| | - Limei Luo
- Maternal and Child Health Development Research Center, Shandong Provincial Maternal and Child Health Care Hospital, Qingdao University, Jinan, China
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Acharya K, Bhattarai N, Dahal R, Bhattarai A, Paudel YR, Dharel D, Aryal K, Adhikari K. Examining the availability and readiness of health facilities to provide cervical cancer screening services in Nepal: a cross-sectional study using data from the Nepal Health Facility Survey. BMJ Open 2024; 14:e077537. [PMID: 39038865 PMCID: PMC11288140 DOI: 10.1136/bmjopen-2023-077537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/08/2024] [Indexed: 07/24/2024] Open
Abstract
OBJECTIVE We assessed the availability and readiness of health facilities to provide cervical cancer screening services in Nepal. DESIGN Cross-sectional study. SETTING We used secondary data from a nationally representative 2021 Nepal Health Facility Survey, specifically focusing on the facilities offering cervical cancer screening services. OUTCOME MEASURES We defined the readiness of health facilities to provide cervical cancer screening services using the standard WHO service availability and readiness assessment manual. RESULTS The overall readiness score was 59.1% (95% CI 55.4% to 62.8%), with more equipment and diagnostic tests available than staff and guidelines. Public hospitals (67.4%, 95% CI 63.0% to 71.7%) had the highest readiness levels. Compared with urban areas, health facilities in rural areas had lower readiness. The Sudurpashchim, Bagmati and Gandaki provinces had higher readiness levels (69.1%, 95% CI 57.7% to 80.5%; 60.1%, 95% CI 53.4% to 66.8%; and 62.5%, 95% CI 56.5% to 68.5%, respectively). Around 17% of facilities had trained providers and specific guidelines to follow while providing cervical cancer screening services. The basic healthcare centres (BHCCs) had lower readiness than private hospitals. Facility types, province and staff management meetings had heterogeneous associations with three conditional quantile scores. CONCLUSION The availability of cervical cancer screening services is limited in Nepal, necessitating urgent action to expand coverage. Our findings suggest that efforts should focus on improving the readiness of existing facilities by providing training to healthcare workers and increasing access to guidelines. BHCCs and healthcare facilities in rural areas and Karnali province should be given priority to enhance their readiness.
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Affiliation(s)
| | | | - Rudra Dahal
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Asmita Bhattarai
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Provincial Primary Health Care, Alberta Health Services, Edmonton, Alberta, Canada
| | - Yuba Raj Paudel
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Dinesh Dharel
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Kabita Aryal
- Government of Nepal Ministry of Health and Population, Kathmandu, Nepal
| | - Kamala Adhikari
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Provincial Population and Public Health, Alberta Health Services, Edmonton, Alberta, Canada
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Lin X, Fang Y, Mi X, Fu J, Chen S, Wu M, Jin N. Asiatic acid inhibits cervical cancer cell proliferation and migration via PI3K/AKT/mTOR signaling pathway. Heliyon 2024; 10:e34047. [PMID: 39055791 PMCID: PMC11269897 DOI: 10.1016/j.heliyon.2024.e34047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 06/15/2024] [Accepted: 07/02/2024] [Indexed: 07/27/2024] Open
Abstract
Cervical cancer (CC) is a malignant tumor of the female reproductive system that typically occurs in cervical cells and has high incidence and mortality rates, strong metastatic ability, and poor prognosis. Asiatic acid (AA) exhibits anti-inflammatory, anti-depressant, and anti-tumor effects. However, the molecular targets and mechanisms underlying AA-mediated inhibition of CC metastasis remain unclear. AA affects the proliferation, metastasis, and epithelial-mesenchymal transition (EMT) process of CC cell lines. MTT experiments verified that AA inhibited the proliferation ability of CC cells, and the effect of AA on the lateral and longitudinal migration ability of CC was evaluated through wound healing and Transwell assays. Western blotting was used to explore whether AA inhibits EMT process in HeLa and C33a cells. Currently, targeting the PI3K/AKT/mTOR pathway as a strategy for cancer treatment remains an evolving field. However, the molecular mechanism by which AA inhibits CC via the PI3K/AKT/mTOR pathway remains unclear and requires further investigation.
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Affiliation(s)
- Xiuying Lin
- Medical College, Yanbian University, Yanji, China
- Reproductive Medicine Center, Jilin Province People's Hospital, Changchun, China
| | - Yanqiu Fang
- Reproductive Medicine Center, Jilin Province People's Hospital, Changchun, China
| | - Xuguang Mi
- Reproductive Medicine Center, Jilin Province People's Hospital, Changchun, China
| | - jianhua Fu
- Reproductive Medicine Center, Jilin Province People's Hospital, Changchun, China
| | - Shiling Chen
- Reproductive Medicine Center, Jilin Province People's Hospital, Changchun, China
| | - Mengxue Wu
- Reproductive Medicine Center, Jilin Province People's Hospital, Changchun, China
| | - Ningyi Jin
- Medical College, Yanbian University, Yanji, China
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Sanchez-Gendriz I, Carvalho DDA, Galvão-Lima LJ, Sales-Moioli AIL, Brito T, Fernandes F, Henriques J, Lima T, Guedes LA, Cruz AS, Morais AHF, Santos JPQ, Arrais E, Coutinho KD, Machado GM, Cunha-Oliveira A, Dos Reis Vale Gomes CA, Valentim RAM. Digital dual test syphilis/HIV detection based on Fourier Descriptors of Cyclic Voltammetry curves. Comput Biol Med 2024; 174:108454. [PMID: 38608326 DOI: 10.1016/j.compbiomed.2024.108454] [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: 11/24/2023] [Revised: 03/10/2024] [Accepted: 04/07/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Effective and timely detection is vital for mitigating the severe impacts of Sexually Transmitted Infections (STI), including syphilis and HIV. Cyclic Voltammetry (CV) sensors have shown promise as diagnostic tools for these STI, offering a pathway towards cost-effective solutions in primary health care settings. OBJECTIVE This study aims to pioneer the use of Fourier Descriptors (FDs) in analyzing CV curves as 2D closed contours, targeting the simultaneous detection of syphilis and HIV. METHODS Raw CV signals are filtered, resampled, and transformed into 2D closed contours for FD extraction. Essential shape characteristics are captured through selected coefficients. A complementary geometrical analysis further extracts features like curve areas and principal axes lengths from CV curves. A Mahalanobis Distance Classifier is employed for differentiation between patient and control groups. RESULTS The evaluation of the proposed method revealed promising results with classification performance metrics such as Accuracy and F1-Score consistently achieving values rounded to 0.95 for syphilis and 0.90 for HIV. These results underscore the potential efficacy of the proposed approach in differentiating between patient and control samples for STI detection. CONCLUSION By integrating principles from biosensors, signal processing, image processing, machine learning, and medical diagnostics, this study presents a comprehensive approach to enhance the detection of both syphilis and HIV. This setts the stage for advanced and accessible STI diagnostic solutions.
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Affiliation(s)
- Ignacio Sanchez-Gendriz
- Laboratory of Technological Innovation in Health (LAIS), Hospital Universitário Onofre Lopes, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil.
| | - Dionísio D A Carvalho
- Laboratory of Technological Innovation in Health (LAIS), Hospital Universitário Onofre Lopes, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil
| | - Leonardo J Galvão-Lima
- Laboratory of Technological Innovation in Health (LAIS), Hospital Universitário Onofre Lopes, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil
| | - Ana Isabela Lopes Sales-Moioli
- Laboratory of Technological Innovation in Health (LAIS), Hospital Universitário Onofre Lopes, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil
| | - Talita Brito
- Laboratory of Technological Innovation in Health (LAIS), Hospital Universitário Onofre Lopes, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil
| | - Felipe Fernandes
- Laboratory of Technological Innovation in Health (LAIS), Hospital Universitário Onofre Lopes, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil
| | - Jorge Henriques
- Department of Informatics Engineering, Center for Informatics and Systems of the University of Coimbra, Universidade de Coimbra, Coimbra, Portugal
| | - Thaisa Lima
- Laboratory of Technological Innovation in Health (LAIS), Hospital Universitário Onofre Lopes, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil; Ministry of Health, Esplanada dos Ministérios, Brasília, Brazil
| | - Luiz Affonso Guedes
- Department of Computer Engineering and Automation, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil
| | - Agnaldo S Cruz
- Laboratory of Technological Innovation in Health (LAIS), Hospital Universitário Onofre Lopes, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil
| | - Antonio H F Morais
- Laboratory of Technological Innovation in Health (LAIS), Hospital Universitário Onofre Lopes, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil; Advanced Nucleus of Technological Innovation (NAVI), Federal Institute of Rio Grande do Norte, Natal/RN, Brazil
| | - João Paulo Q Santos
- Laboratory of Technological Innovation in Health (LAIS), Hospital Universitário Onofre Lopes, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil; Advanced Nucleus of Technological Innovation (NAVI), Federal Institute of Rio Grande do Norte, Natal/RN, Brazil
| | - Ernano Arrais
- Laboratory of Technological Innovation in Health (LAIS), Hospital Universitário Onofre Lopes, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil; Department of Biomedical Engineering, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil
| | - Karilany Dantas Coutinho
- Laboratory of Technological Innovation in Health (LAIS), Hospital Universitário Onofre Lopes, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil; Department of Biomedical Engineering, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil
| | | | - Aliete Cunha-Oliveira
- Health Sciences Research Unit, Nursing (UICISA: E) and Nursing School of Coimbra (ESEnfC), Coimbra, Portugal; Center for Interdisciplinary Studies - CEIS20, University of Coimbra, Coimbra, Portugal
| | | | - Ricardo A M Valentim
- Laboratory of Technological Innovation in Health (LAIS), Hospital Universitário Onofre Lopes, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil; Department of Biomedical Engineering, Federal University of Rio Grande do Norte (UFRN), Natal/RN, Brazil
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Lamichhane B, Adhikari B, Poudel L, Pandey AR, Kakchhapati S, K. C. SP, Giri S, Dulal BP, Joshi D, Gautam G, Baral SC. Factors associated with uptake of breast and cervical cancer screening among Nepalese women: Evidence from Nepal Demographic and Health Survey 2022. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002971. [PMID: 38466682 PMCID: PMC10927089 DOI: 10.1371/journal.pgph.0002971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 02/06/2024] [Indexed: 03/13/2024]
Abstract
Breast cancer screening (BCS) and cervical cancer screening (CCS) are integral parts of initiatives to reduce the burden associated with these diseases. In this context, we aimed to determine factors associated with BCS and CCS uptake among Nepalese women aged 30 to 49 years using data from the Nepal Demographic Health Survey (NDHS) 2022. We performed a weighted analysis to account complex survey design of the NDHS 2022. We employed univariable and multivariable logistic regression to determine factors associated with the uptake of BCS and CCS and results were presented as crude odds ratio and adjusted odds ratio (AOR) along with 95% confidence interval (CI). The uptake of BCS and CCS among Nepalese women aged 30 to 49 years were 6.5% and 11.4% respectively. Women from Terai compared to mountain region (AOR = 0.54, 95%CI: 0.31, 0.93) and those engaged in agriculture compared to non-working (AOR = 0.59, 95%CI: 0.42, 0.82) women had lower odds of BCS uptake. Conversely, Dalit women compared to Brahmin/Chhetri (AOR = 2.08, 95%CI: 1.37, 3.16), and women with basic (AOR = 1.49, 95%CI: 1.04, 2.13), secondary (AOR = 1.96, 95%CI: 1.33, 2.88), and higher education (AOR = 2.80, 95% CI: 1.51, 5.19) compared to those with no education had higher odds of BCS uptake. Women from rural areas (AOR = 0.76, 95%CI: 0.61, 0.96), and those living in Bagmati (AOR = 2.16, 95% CI: 1.44, 3.23) and Gandaki (AOR = 2.09, 95%CI: 1.40, 3.14) provinces had higher odds of CCS uptake compared to their urban counterparts and those living in Koshi province, respectively. The odds of CCS increased with age (AOR = 1.06, 95%CI: 1.04, 1.08). Women with secondary education (AOR = 1.47, 95%CI: 1.06, 2.04) had higher odds of CCS uptake compared to those without education. Similarly, married women (AOR = 8.24, 95%CI: 1.03, 66.21), and those with health insurance (AOR = 1.41, 95%CI: 1.08, 1.83) had higher odds of CCS. In conclusion, the uptake of both BCS and CCS was relatively poor among Nepalese women indicating a need for targeted and tailored intervention to increase BCS and CCS uptake.
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Affiliation(s)
- Bipul Lamichhane
- Research and Development Department, HERD International, Lalitpur, Nepal
| | - Bikram Adhikari
- Research and Development Department, HERD International, Lalitpur, Nepal
| | - Lisasha Poudel
- Central Department of Public Health Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Achyut Raj Pandey
- Research and Development Department, HERD International, Lalitpur, Nepal
| | | | | | - Santosh Giri
- Research and Development Department, HERD International, Lalitpur, Nepal
| | | | - Deepak Joshi
- Research and Development Department, HERD International, Lalitpur, Nepal
| | - Ghanshyam Gautam
- Research and Development Department, HERD International, Lalitpur, Nepal
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Dangal G, Dhital R, Dwa YP, Poudel S, Pariyar J, Subedi K. Implementation of cervical cancer prevention and screening across five tertiary hospitals in Nepal and its policy implications: A mixed-methods study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002832. [PMID: 38236836 PMCID: PMC10796028 DOI: 10.1371/journal.pgph.0002832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/23/2023] [Indexed: 01/22/2024]
Abstract
In Nepal, cervical cancer is the most common cancer among women despite the existing policies. This study intends to assess the implementation of cervical cancer prevention and screening through service utilization by women, knowledge and attitude among health professionals, and the perceptions of stakeholders in Nepal. This mixed-methods study was conducted in 2022 across five tertiary hospitals in Kathmandu, Nepal. The quantitative study comprised the health professionals and women attending gynecology outpatient clinics from the selected hospitals. The qualitative study comprised stakeholders including service providers and experts on cervical cancer from selected hospitals, civil societies, and the Ministry of Health and Population. The utilization of screening through pap smear among 657 women across five hospitals was 22.2% and HPV vaccination was 1.5%. The utilization of cervical cancer screening was associated with older age [adjusted odds ratio (AOR) = 1.09, CI: 1.07, 8.19], married (AOR = 3.024, CI: 1.12, 8.19), higher education (AOR = 3.024, CI:1.12, 8.42), oral contraceptives use (AOR = 2.49, CI: 1.36, 4.39), and ever heard of cervical cancer screening (AOR = 13.28, CI: 6.85, 25.73). Among 254 health professionals, the knowledge score was positively associated with them ever having a training [Standardized Beta (β) = 0.20, CI: 0.44, 2.43)] and having outreach activities in their hospital (β = 0.19 CI: 0.89, 9.53) regarding cervical cancer screening. The female as compared to male health professionals (β = 0.16, CI: 0.41, 8.16, P = 0.03) and having a cervical cancer screening guideline as compared to none (β = 0.19 CI: 0.89, 9.53, P = 0.026) were more likely to have a better attitude for screening. The qualitative findings among 23 stakeholders reflected implementation challenges in policy, supply, service delivery, providers, and community. This study showed low utilization of prevention and services by women and implementation gaps on cervical cancer prevention and screening services across five tertiary hospitals in Kathmandu, Nepal. The findings could help designing more focused interventions.
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Affiliation(s)
- Ganesh Dangal
- Nepal Society of Obstetricians and Gynaecologists, Kathmandu, Nepal
- Kathmandu Model Hospital, Kathmandu, Nepal
| | | | - Yam Prasad Dwa
- Nepal Society of Obstetricians and Gynaecologists, Kathmandu, Nepal
- KIST Medical College and Teaching Hospital, Lalitpur, Nepal
| | - Sandesh Poudel
- Nepal Society of Obstetricians and Gynaecologists, Kathmandu, Nepal
- Paropakar Maternity and Women’s Hospital, Kathmandu, Nepal
| | - Jitendra Pariyar
- Nepal Society of Obstetricians and Gynaecologists, Kathmandu, Nepal
- Civil Service Hospital of Nepal, Kathmandu, Nepal
| | - Kirtipal Subedi
- Nepal Society of Obstetricians and Gynaecologists, Kathmandu, Nepal
- Paropakar Maternity and Women’s Hospital, Kathmandu, Nepal
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Shrestha IB, Bhusal S, Rajbanshi M, Mali P, Shrestha RB, Singh DR. Awareness of Cervical Cancer, Risk Perception, and Practice of Pap Smear Test among Young Adult Women of Dhulikhel Municipality, Nepal. J Cancer Epidemiol 2023; 2023:6859054. [PMID: 37663110 PMCID: PMC10474961 DOI: 10.1155/2023/6859054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/22/2023] [Accepted: 08/17/2023] [Indexed: 09/05/2023] Open
Abstract
Background Despite being one of the most preventable forms of cancer, cervical cancer remains an important public health problem, especially in developing countries. However, there is limited evidence regarding awareness and practice of screening for cervical cancer among women in resource-poor settings like Nepal. This study is aimed at assessing the awareness of cervical cancer, risk perception, and practice of Pap smear tests among adult women of Dhulikhel municipality of Kavreplanchowk district in Nepal. Methodology. A community-based cross-sectional study was conducted among 422 women (aged 18-45 years) residing across the Dhulikhel municipality of Nepal. Systematic random sampling method with face-to-face interviews was conducted to collect data. A descriptive analysis was performed to assess the sociodemographic characteristics of the participants. The chi-square test was used to determine the factors associated with risk perception and participants' demographic characteristics. Results The mean age (±SD) of the participants was 30.7 ± 7.9 years. This study found that around 55% and 38% of women had heard about cervical cancer and Pap smear test, respectively. Of those who had heard of the Pap test, only 37.6% had ever practiced the test. Similarly, 33.2% and 12.1% knew about the correct age group and time interval to perform the Pap test, respectively. Among those who had heard about cervical cancer, nearly 57% had positive perceptions toward cervical cancer. In addition, risk perception of cervical cancer was found to be associated with participant age, family type, and marital status. Conclusion The women had inadequate knowledge and practice of cervical cancer and Pap smear test. This study concluded the need for a context-specific and effective health awareness program to promote preventive measures for cervical cancer and enhance the practice of Pap smear test in the community.
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Affiliation(s)
- Ishwori Byanju Shrestha
- Department of Public Health, Asian College for Advance Studies, Purbanchal University, Lalitpur, Nepal
- Research and Development Division, Dhulikhel Hospital, Kathmandu University, Kavre, Nepal
| | | | - Manish Rajbanshi
- Research and Development Division, Dhulikhel Hospital, Kathmandu University, Kavre, Nepal
- Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Prajita Mali
- Research and Development Division, Dhulikhel Hospital, Kathmandu University, Kavre, Nepal
| | | | - Devendra Raj Singh
- Department of Public Health, Asian College for Advance Studies, Purbanchal University, Lalitpur, Nepal
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
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10
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Tse KY, Ushijima K, Tan AL, Intasorn P, Pariyar J, Chang CL, Domingo EJ, Konar H, Kumarasamy S, Tjokroprawiro BA, Wilailak S. A questionnaire study on disparity of cervical cancer prevention programs in Asia-Oceania. J Obstet Gynaecol Res 2023; 49:1230-1243. [PMID: 36726190 DOI: 10.1111/jog.15566] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/13/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND Despite the introduction of cervical cancer screening and human papillomavirus (HPV) vaccines, the utilization pattern was not standardized. The aim of this study was to elicit the current prevention care in Asia-Oceania. METHODS An online questionnaire was circulated to different countries/cities in Asia-Oceania. The primary objective was to evaluate the coverage of HPV vaccination and cervical screening programs. The secondary objectives were to study the structures of these programs. Five case scenarios were set to understand how the respondents manage the abnormal screening results. RESULTS Fourteen respondents from 10 countries/cities had participated. Cervical cancer ranked the first in Myanmar and Nepal. About 10%-15% did not have national vaccination or screening program. The estimated coverage rate for vaccination and screening varied from less than 1% to 70%, which the coverage ran in parallel with the incidence and mortality rates of cervical cancer. All regions approved HPV vaccines, although only four provided free or subsidized programs for nonavalent vaccine. Cervical cytology remained the most common screening tool, and 20%-30% relied heavily on visual inspection using acetic acid. The screening age groups varied in different regions. From the case scenarios, it was noted that some respondents tended to offer more frequent screening tests or colposcopy than recommended by international guidelines. CONCLUSION This study revealed discrepancy in the practice of cervical cancer prevention in Asia-Oceania especially access to HPV vaccines. There is an urgent need for a global collaboration to eliminate cervical cancer by public education, reforming services, and medical training.
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Affiliation(s)
| | - Ka Yu Tse
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong, Hong Kong
| | - Kimio Ushijima
- Department of Obstetrics and Gynaecology, Kurume University, Kurume, Japan
| | | | - Perapong Intasorn
- Department of Obstetrics-Gynecology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jitendra Pariyar
- Gynecologic Oncology Unit, Civil Service Hospital, Kathmandu, Nepal
| | - Chih-Long Chang
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Efren J Domingo
- Department of Obstetrics and Gynaecology, University of the Philippines, Philippine General Hospital, Manila, Philippines
| | - Hiralal Konar
- Department of Obstetrics and Gynaecology, KPC Medical College and Hospital, Kolkata, India
| | | | | | - Sarikapan Wilailak
- Department of Obstetrics and Gynecology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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11
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Baral G. Cervical Cancer Screening and HPV Vaccination in Nepal. South Asian J Cancer 2023; 12:53-54. [PMID: 36851932 PMCID: PMC9966170 DOI: 10.1055/s-0043-1764155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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