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

Nkurunziza, Charles; Ghebre, Rahel; Magriples, Urania; Ntasumbumuyange, Diomede; Bazzett‐Matabele, Lisa

doi:10.1016/j.gore.2021.100810

Cited by 5 publications

(6 citation statements)

References 19 publications

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“…At the healthcare provider level, healthcare providers' adherence to screening guidelines, and their advice played a significant role in motivating and encouraging eligible women to undergo screening which is consistent with a study that identified encouraging women to have CCS increases the uptake [81]. However, there were also barriers reported by providers, such as fragmented services, a lack of staff, insufficient training, increased workloads, and prioritizing curative healthcare which is supported by other studies [65,82,83]. These barriers shed light on the need to ensure adequate staffing, resources, training, and institutional support for healthcare providers to integrate cervical cancer screening effectively.…”

Section: Discussionsupporting

confidence: 76%

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

Kassa,

Shifti,

Alemu

et al. 2024

PLOS Glob Public Health

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

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Section: Discussionsupporting

confidence: 76%

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

Kassa,

Shifti,

Alemu

et al. 2024

PLOS Glob Public Health

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“…In focus group interview, we used a semi-structured interview guide 22 with 9 open ended questions with possibility of probing as needed ( Supplementary Material S1 ) and conducted face-to-face interview with recording of voices. The choice for focus group interview was based on the fact that most of existing qualitative research related to cervical cancer screening in Rwanda have used structured questionnaires or questions with yes/no answers 18 , 23 , 24 therefore, to be able to collect in depth subjective opinions 22 , 25 from primordial potential beneficiary of cervical screening we opted for focus group interview. One team of facilitators conducted interview for all five focus groups.…”

Section: Methodsmentioning

confidence: 99%

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

Gafaranga¹,

Manirakiza²,

Ndagijimana³

et al. 2022

IJWH

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Background Cervical cancer is a global public health problem with marked geographical disparity. High morbidity and mortality rates in developing countries are associated with low screening rates. In 2020, in Rwanda, 3.7 million women aged 15–59 years were at risk of developing cervical cancer, the most commonly diagnosed female cancer in Rwanda. Despite Rwanda being the first African country to vaccinate against human papilloma virus with a three-dose regimen vaccination coverage of nearly 93% in the target population of girls aged <15 years, and having established cervical cancer screening program, recent studies have found low screening rates. Our study sought to determine knowledge, motivators and barriers of cervical cancer screening. Methods We conducted a qualitative descriptive study; using focus group interview in an urban health facility (Muhima district hospital) and a rural health center (Nyagasambu health center) offering cervical screening services in Rwanda. Participants were women seeking these services and other women attending the health facility for any reason, and female staff working in these facilities. Interviews were recorded and transcribed, and data were analyzed using content analysis. Results Thirty women participated in focus group interview, with an average age of 39 years. Many of women showed knowledge about cervical cancer existence and prevention methods. However, fear for pain, lack of knowledge about screening, how and where the screening was done, and concern for privacy were recurring subthemes. Some participants also mentioned lack of health insurance as a barrier for cervical cancer screening. Conclusion Barriers to uptake cervical cancer screening services in Rwanda are related to poor information about cervical cancer and the importance of screening as well as non-adherence to medical insurance. Population sensitization through campaign and community outreach activities could have a positive impact on increasing the usage of cervical cancer screening in Rwanda.

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“…The Rwandan study reported an absence of association between knowledge and specialty, education level, or work experience. 50 Specialty of practice and years of experience were significantly associated with knowledge about HPV as per Almazrou, 51 among physicians in Saudi Arabia. However, according to Chawla et al, 38 age, specialty of practice, and years of experience were associated with knowledge, but no difference was noted between genders.…”

Section: Discussionmentioning

confidence: 93%

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

Albayat,

Mundodan,

Elmardi

et al. 2024

Womens Health (Lond Engl)

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Background: The human papilloma virus is a global problem that affects sexually active women and men, with cervical cancer being the most serious associated disease. Most cervical cancer cases can be prevented by vaccination against the human papilloma virus early in life. The objective of this study was to assess the knowledge, attitudes, and practices among physicians working in Qatar, regarding the human papilloma virus, infection, and prevention using vaccines. Study-design: This was a cross-sectional study using quantitative data collection. Methodology: An online survey targeting physicians working in Qatar was conducted, using a web-based pretested questionnaire. The questionnaire comprised four sections capturing a few demographic details, 33 questions in the Knowledge Section, 12 questions eliciting the attitude, and 14 practice-related questions. Mean knowledge score was calculated and those with a score more than the mean score were considered to have sufficient knowledge. Association between knowledge and attitude/practices/independent variables were looked for using bivariate and multivariate analysis. Logistic regression was used to identify the predictors for recommending human papilloma virus vaccines. Results: Of the 557 physicians who participated, 83.7% had sufficient knowledge, but only 69.1% knew that human papilloma virus vaccines were available in Qatar. The majority (89.4%) knew that human papilloma virus infection could be asymptomatic and 96.1% knew at least one symptom; 77% believed the human papilloma virus vaccine would substantially decrease the chances of human papilloma virus infection and related cancers and 46.5% felt physicians were less motivated to promote the human papilloma virus vaccine. The perceived barriers to community acceptance of the human papilloma virus vaccine were lack of awareness regarding the relationship between human papilloma virus and cervical cancer (61.6%), doubts regarding efficacy (32.5%), fear regarding safety (26.9%), concern that the human papilloma virus vaccination may encourage risky sexual behavior (26.8%), and perceived low-risk (23.3%) and cost (24.6%). Only 21.5% commonly discussed sexual health with their clients. More than one-third were not interested in recommending the human papilloma virus vaccine. Bivariate analysis showed nationality, specialization, discussing with patients, and recommending vaccine to be significantly associated with knowledge. Bivariate and regression analysis identified that female gender and physician’s religion were significant predictors to recommend the human papilloma virus vaccine. Conclusion: Most physicians have good knowledge. Less than one-fourth commonly discussed sexual health with their clients. More than one-third were not interested in recommending the human papilloma virus vaccine. This issue might affect the human papilloma virus vaccination program implementation if not well addressed.

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

Cited by 5 publications

References 19 publications

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

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

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

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

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