Implementation strategies to improve cervical cancer prevention in sub-Saharan Africa: a systematic review

Johnson, Lauren G.; Armstrong, Allison; Joyce, Caroline M.; Teitelman, Anne M.; Buttenheim, Alison M.

doi:10.1186/s13012-018-0718-9

Cited by 58 publications

(70 citation statements)

References 85 publications

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“…Educational interventions were the most common type of intervention used to increase uptake of cervical screening in sub-Saharan Africa. The rationale for educational interventions is consistent with previous literature that names lack of knowledge or awareness as the most common barrier to cervical screening in low-and-middle-income countries and another review that found educational strategies were the most common among all cancer prevention efforts in sub-Saharan Africa [34,35]. Educational interventions were not very effective overall.…”

Section: Discussionsupporting

confidence: 80%

“…Pap smears may also be more widely available in certain countries like South Africa. Another review of cervical cancer prevention in sub-Saharan Africa found that VIA was the most commonly used secondary screening method [35]. Both VIA and HPV testing have been declared strategies for closing the cancer divide between LMIC and high-income countries because of their costeffectiveness and feasibility [43] so the overrepresentation of Pap smear testing in our study may limit the generalizability and significance of our findings.…”

Section: Limitationsmentioning

confidence: 79%

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Interventions to increase uptake of cervical screening in sub-Saharan Africa: a scoping review using the integrated behavioral model

et al. 2020

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Background: Sub-Saharan Africa (SSA) experiences disproportionate burden of cervical cancer incidence and mortality due in part to low uptake of cervical screening, a strategy for prevention and down-staging of cervical cancer. This scoping review identifies studies of interventions to increase uptake of cervical screening among women in the region and uses the Integrated Behavioral Model (IBM) to describe how interventions might work. Methods: A systematic search of literature was conducted in PubMed, Web of Science, Embase, and CINAHL databases through May 2019. Screening and data charting were performed by two independent reviewers. Intervention studies measuring changes to uptake in screening among women in SSA were included, with no restriction to intervention type, study setting or date, or participant characteristics. Intervention type and implementation strategies were described using behavioral constructs from the IBM.Results: Of the 3704 citations the search produced, 19 studies were selected for inclusion. Most studies were published between 2014 and 2019 (78.9%) and were set in Nigeria (47.4%) and South Africa (26.3%). Studies most often assessed screening with Pap smears (31.6%) and measured uptake as ever screened (42.1%) or screened during the study period (36.8%). Education-based interventions were most common (57.9%) and the IBM construct of knowledge/skills to perform screening was targeted most frequently (68.4%). Willingness to screen was high, before and after intervention. Screening coverage ranged from 1.7 to 99.2% post-intervention, with six studies (31.6%) reporting a significant improvement in screening that achieved ≥60% coverage. (Continued on next page)Conclusions: Educational interventions were largely ineffective, except those that utilized peer or community health educators and mHealth implementation strategies. Two economic incentivization interventions were moderately effective, by acting on participants' instrumental attitudes, but resulted in screening coverage less than 20%. Innovative service delivery, including community-based self-sampling, acted on environmental constraints, striving to make services more available, accessible, and appropriate to women, and were the most effective. This review demonstrates that intent to perform screening may not be the major determinant of screening behavior, suggesting other theoretical frameworks may be needed to more fully understand uptake of cervical screening in sub-Saharan Africa, particularly for health systems change interventions.

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Section: Discussionsupporting

confidence: 80%

Section: Limitationsmentioning

confidence: 79%

Interventions to increase uptake of cervical screening in sub-Saharan Africa: a scoping review using the integrated behavioral model

et al. 2020

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“…Cervical cancer educational strategies have been shown to improve screening in studies which targeted rural populations of sub-Saharan Africa [12-14]. Erku et al describe that the odds of undergoing cervical cancer screening among women who had a comprehensive knowledge on cervical cancer and screening were 2.02 times higher than those who did not in a northwest Ethiopian population [8].…”

Section: Discussionmentioning

confidence: 99%

Knowledge and awareness of cervical cancer in Southwestern Ethiopia is lacking: a descriptive analysis

Saleem

Bekele

Fitzpatrick

et al. 2019

Preprint

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25Purpose 26 Cervical cancer remains the second most common cancer and cancer-related death among 27 women in Ethiopia. This is the first study, to our knowledge, describing the demographic, and 28 clinicopathologic characteristics of cervical cancer cases in a mainly rural, Southwestern 29 Ethiopian population with a low literacy rate to provide data on the cervical cancer burden and 30 help guide future prevention and intervention efforts. 31 32 Methods 33 A descriptive analysis of 154 cervical cancer cases at the Jimma University Teaching Hospital in 34 Southwestern Ethiopia from January 2008 -December 2010 was performed. Demographic and 35 clinical characteristics were obtained from patient questionnaires and cervical punch biopsies 36 were histologically examined. 37 38 Results 39Of the 154 participants with a histopathologic diagnosis of cervical cancer, 95.36% had not heard 40 of cervical cancer and 89.6% were locally advanced at the time of diagnosis. Moreover, 86.4% 41 of participants were illiterate, and 62% lived in a rural area. 42 43 Conclusion 44 A majority of the 154 women with cervical cancer studied at the Jimma University Teaching 45 Hospital in Southwestern Ethiopia were illiterate, had not heard of cervical cancer and had 46 advanced disease at the time of diagnosis. Given the low rates of literacy and knowledge 3 47 regarding cervical cancer in this population which has been shown to correlate with a decreased 48 odds of undergoing screening, future interventions to address the cervical cancer burden here 49 must include an effective educational component. 50 51 Introduction: 52 Cervical cancer pathology and demographic data is lacking from Southwestern Ethiopia. 53 The Jimma University Teaching Hospital (JUTH) is located in the city of Jimma which is 352 54 km southwest of Ethiopia's capital city Addis Ababa and is unique in that it acts as the only 55 teaching and referral hospital in the region, serving a population of 15 million people [1]. 56 Moreover, Jimma is part of the Oromia state which has one of the highest poverty rates (74.9% 57 of the population) and lowest literacy rates in the country (36% of all residents, with 17% of the 58 female residents living in rural settings) [2-3]. Contributory data from this hospital is vital since 59 every year, an estimated 7,095 women are diagnosed with cervical cancer and 4,732 deaths are 60 due to the disease in Ethiopia -it is currently the second most common cause of female cancer 61 deaths in Ethiopia, after breast cancer. 62 Infection with high-risk human papillomavirus (HPV) is the necessary cause of >99% of 63 cervical cancer [4]. Other contributing factors include smoking, total fertility rate, and human 64 immunodeficiency virus (HIV) infection [5]. The knowledge about cervical cancer in Ethiopia 65has been reported to range from 21.2% to 53.7%, with screening rates that ranged from 9.9% to 66 23.5%. Three of these four studies, however, took place in Northern Ethiopia [6][7][8][9]. Though there 67is not yet an organized cervical cance...

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“…Cervical cancer remains a global health problem [4] especially in remote areas of developing countries [5,6]. Current cervical cancer screening is based on the pap smear cytology and has led to significant reduction in the incidence and death related to cervical cancer [6,7]. In depth understanding of the natural history of human papillomavirus (HPV) infection and related cervical neoplasia has led to the search of biomarkers which can improve the cervical cancer screening process.…”

Section: Introductionmentioning

confidence: 99%

Evaluating the performance of a low-cost mobile phone attachable microscope in cervical cytology

et al. 2020

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Background: Cervical cancer remains a global health problem especially in remote areas of developing countries which have limited resources for cervical cancer screening. In this study, we evaluated the performance of a lowcost, smartphone attachable paper-based microscope when used for classifying images of cervical cytology. Methods: Cervical cytology samples included: 10 Normal, 10 Low-grade squamous intraepithelial lesion (LSIL), 10 High-grade squamous intraepithelial lesion (HSIL), and 10 Malignant Pap Smears. The agreement between conventional microscopy vs. Foldscope imaging was calculated using a weighted kappa coefficient. A confusion matrix was created with three classes: Normal, LSIL, and HSIL/malignant, to evaluate the performance of the Foldscope by calculating the accuracy, sensitivity, and specificity. Results: We observed a kappa statistic of 0.68 for the agreement. This translates into a substantial agreement between the cytological classifications by the Foldscope vs. conventional microscopy. The accuracy of the Foldscope was 80%, with a sensitivity and specificity of 85 and 90% for the HSIL/Mal category, 80 and 83.3%, for LSIL, and 70 and 96.7% for Normal. Conclusions: This study highlights the usefulness of the Foldscope in cervical cytology, demonstrating it has substantial agreement with conventional microscopy. Its use could improve cytologic interpretations in underserved areas and, thus, improve the quality of cervical cancer screening. Improvements in existing limitations of the device, such as ability to focus, could potentially increase its accuracy.

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Implementation strategies to improve cervical cancer prevention in sub-Saharan Africa: a systematic review

Cited by 58 publications

References 85 publications

Interventions to increase uptake of cervical screening in sub-Saharan Africa: a scoping review using the integrated behavioral model

Interventions to increase uptake of cervical screening in sub-Saharan Africa: a scoping review using the integrated behavioral model

Knowledge and awareness of cervical cancer in Southwestern Ethiopia is lacking: a descriptive analysis

Evaluating the performance of a low-cost mobile phone attachable microscope in cervical cytology

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