Ethical issues evolving from patients’ perspectives on compulsory screening for syphilis and voluntary screening for cervical cancer in Kenya

Abstract

BackgroundPublic health aims to provide universal safety and progressive opportunities to populations to realise their highest level of health through prevention of disease, its progression or transmission. Screening asymptomatic individuals to detect early unapparent conditions is an important public health intervention strategy. It may be designed to be compulsory or voluntary depending on the epidemiological characteristics of the disease. Integrated screening, including for both syphilis and cancer of the cervix, is a core component of the national reproductive health program in Kenya. Screening for syphilis is compulsory while it is voluntary for cervical cancer. Participants’ perspectives of either form of screening approach provide the necessary contextual information that clarifies mundane community concerns.MethodsFocus group discussions with female clients screened for syphilis and cancer of the cervix were conducted to elicit their perspectives of compulsory and voluntary screening. The discussions were audiotaped, transcribed and thematic content analysis performed manually to explore emerging ethics issues.ResultsThe results indicate that real ethical challenges exist in either of the approaches. Also, participants were more concerned about the benefits of the procedure and whether their dignity is respected than the compulsoriness of screening per se. The implication is for the policy makers to clarify in the guidelines how to manage ethical challenges, while at the operational level, providers need to be judicious to minimize potential harms participants and families when screening for disease in women.ConclusionsThe context for mounting screening as a public health intervention and attendant ethical issues may be more complex than hitherto perceived. Interpreting emerging ethics issues in screening requires more nuanced considerations of individuals’ contextual experiences since these may be contradictory to the policy position. In considering mounting screening for Syphilis and cervical cancer as a public heal intervention, the community interests and perspectives should be inculcated into the program. Population lack of information on procedures may influence adversely the demand for screening services by the individuals at risk or the community as a collective agent.

Systematic Review on Epidemiology, Interventions and Management of Noncommunicable Diseases in Acute and Emergency Care Settings in Kenya

“…Wools-Kaloustian conducted a cross-sectional study at an HIV clinic in Western Kenya to assess prevalence of renal disease in these patients (18). Finally, a qualitative study was conducted by Aduda et al in an outpatient clinic to assess ethical considerations of screening for cervical cancer among patients (19). Of the ten studies, those with a specific disease focus were: cardiovascular disease (n=2), cancer (n=3), diabetes (n=2) and renal disease (n=1).…”

“…Of the five additional studies that were not conducted on ED patients, two were conducted in the outpatient setting at a well-established mission hospital, Tenwek hospital (16,17). The final three were conducted at specialty clinics: an outpatient diabetes clinic(15), an outpatient HIV clinic (18) and among cervical cancer patients at an antenatal clinic (19). Of note, none of the studies were nationally representative in sampling.…”

“…The final study addressing cancer was also the only qualitative study included, and the only study that addressed attitudes towards care or care received. The study addressed ethical issues related to compulsory and voluntary screening in outpatient clinics in Kisumu (19). They found that patients appreciated education associated with pre-testing, desired immediate results rather than waiting, demonstrated anxiety over results and coping with positive screening results, and desired verbal over written results given anxiety associated with the impersonal nature of written results, and illiteracy.…”

“…The final study addressing cancer was also the only qualitative study included, and the only study that addressed attitudes towards care or care received. The study addressed ethical issues related to compulsory and voluntary screening in outpatient clinics in Kisumu (19).…”

Need, Demand and Supply of Health Care in Regards to Growing Emerging and Reemerging Diseases in Sub-Saharan Africa

“…18 16 Olmsted et al, 2010 17 Selman et al, 2009 18 Gopalan, Mutasa, Friedman, & Das, 2014 " According to the authors, Demand-side financial incentive (DSF) is an emerging strategy to improve health seeking behavior and health status in many low-and middleincome countries. This narrative synthesis assessed the demand-and supply-side effects of DSF.…”