Implementing visual cervical cancer screening in Senegal: a cross-sectional study of risk factors and prevalence highlighting service utilization barriers

Dykens, J. Andrew; Linn, Annē; Irwin, Tracy; Peters, Karen; Pyra, Maria; Traoré, Fatoumata Tata; Diarra, Mariama Touré; Hasnain, Memoona; Wallner, Katie; Linn, Patrick; Ndiaye, Youssoupha

doi:10.2147/ijwh.s115454

Cited by 6 publications

(13 citation statements)

References 19 publications

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“…Studies revealed an incidence rate of precancerous lesions that ranged from 5.7% to 28% in Senegal, which is comparable to a 10.1% incidence rate in similar low-income countries [40]. A cohort of Senegalese women revealed that the incidence of cervical cancer peaked between the ages of 45 and 54 years of age.…”

Section: Senegalmentioning

confidence: 83%

Eliminating Cervical Cancer in Mali and Senegal, Two Sub-Saharan Countries: Insights and Optimizing Solutions

Haque

Kouriba

Aïssatou³

et al. 2020

Vaccines

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Background: The number of cases with cervical cancer is rapidly increasing in Sub-Saharan Africa driven by inadequate rates of human papilloma virus (HPV) vaccination and screening programs and accompanied by poor health delivery systems. There are other factors to contend with such as lack of awareness, social myths, reluctance to vaccine acceptance and stigma with sexually transmitted diseases. Here, we formulate strategies to implement intervention programs against HPV infections and other risk factors for cervical cancer in these countries. Methods: We searched PubMed, Web of Science, and African Journals Online for this review. The current status of anti-HPV vaccination and precancerous screening programs in Mali and Senegal has been assessed by onsite visits. Collaborators from Mali and Senegal collected data and information concerning HPV vaccination and screening programs in these countries. Findings: We found that anti-HPV vaccination and cervical cancer screening have been conducted sporadically mainly in urban areas of Mali and Senegal. No known population-based programs are in progress in either of the two countries. We highlighted the advantages and drawbacks of currently available screening tests and proposed that screening by visual inspection with acetic acid (VIA) accompanied by self-sampling is the most cost-effective, culturally acceptable and most feasible strategy to implement in primary care settings. In addition, HPV DNA testing would be affordable, if local laboratory facilities could be established. We found that many of the factors that increase HPV acquisition and promote the oncogenic effect of the virus are largely widespread in both Senegal and Mali. These include infections with HIV and other sexually transmitted infections (STIs), immunosuppression, polygamous marriages, high parity, early sexual activities, early pregnancies, and multiple sexual partners. Interpretation: Neither vaccines nor screening tests are within the reach of the population in Mali and Senegal because of the high cost. The effective intervention measure would be to integrate anti-HPV vaccines into the Extended Program for Immunization (EPI), which has saved 3 million young lives per year in Africa with the support of GAVI, to implement cost control mechanisms for HPV vaccinations via price negotiations with manufacturing companies, as has recently been done by Rwanda. The collective efforts by local governments, researchers, private sector, and donors may lead to the introduction of affordable screening tests. A robust awareness campaign coupled with sustained and regular engagement of local communities about the prevention and risk factors is extremely important. The projected solutions may be well applicable to other Sub-Saharan countries that face similar challenges containing cervical cancer.

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Section: Senegalmentioning

confidence: 83%

Eliminating Cervical Cancer in Mali and Senegal, Two Sub-Saharan Countries: Insights and Optimizing Solutions

Haque

Kouriba

Aïssatou³

et al. 2020

Vaccines

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“…The Sénégal-Peace Corps-UIC partnership has conducted implementation research on capacity building and quality improvement activities to achieve partnership, community, and research objectives that include informing priorities, improving health outcomes, and building knowledge. 19,20 In 2014, the partnership began to study the impact of a QI program on the supply-side (health service-level) determinants of cervical cancer screening and the implementation of regional health programmatic strategy.…”

Section: Global Disparities In Cervical Cancer Prevention and Controlmentioning

confidence: 99%

“…Furthermore, although women ages 40 + are at highest risk of cervical cancer, they are the least likely to seek cervical cancer screening services. 19 An important aim for this participatory QI approach is to improve health equity through a heightened community voice.…”

Section: Demand-side Barriersmentioning

confidence: 99%

Multi-site community-engaged quality improvement to inform regional cervical cancer screening implementation and sustainment in rural Sénégal

Jesus

Thiam

Sagna³

et al. 2020

Preprint

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BackgroundThe improvement of quality at the primary health care level in low resource settings is key to addressing health equity challenges around the world. In 2014, a Sénégal-Peace Corps-University of Illinois at Chicago partnership began to study the impact of a community-engaged quality improvement program on health services and regional health system determinants to prevent cervical cancer, the leading cause of cancer deaths among women in Sénégal. The purpose of this paper is to describe how a multi-site participatory quality improvement (QI) approach can identify access barriers and provide contextualized programmatic recommendations to strengthen the cervical cancer screening program in the rural Kédougou region of Sénégal and inform higher-level program implementation and sustainment.Methods: We adapted a facility-level quality improvement process by involving community health committee representatives. Using a mixed methods case study approach, we collected data at nine demonstration sites in the Kédougou region from quality improvement program action plans, client surveys, health leader interviews, and service guidelines discussions at the regional level from January 2015 through June 2019. We calculated the demand and supply-side barriers and organized them into the Levesque Patient-Centered Access to Health Care Framework.ResultsDuring the study period, 27 quality improvement meetings took place. There was a total of 50 (14 unique) stated access barriers to cervical cancer prevention across all sites. The health service barriers were concentrated in approachability (5) and availability and accommodation (16), whereas the demand-side barriers were concentrated in the ability to perceive (14) and ability to seek care (3). Individual health facilities responded with increased community outreach among other interventions while regional programmatic recommendations led to strategic partnership initiatives such as social mobilization and peer-to-peer education activities. ConclusionsThe community-engaged QI process has meaningfully contributed to strategic planning of the implementation and sustainment of a cervical cancer screening program within the context of rural Kédougou, Sénégal. The iterative and patient-focused nature of QI has allowed health personnel to continually strengthen how they deliver their health services to meet the community’s needs while data aggregated from QI action plans across multiple sites has helped inform responsive health policies to ensure program sustainment. The parallel and iterative application of participatory capacity building and QI activities across multiple sites provides a useful approach for implementing sustainable cervical cancer programs.

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“…Only 509, or 5% of eligible women targeted through a mass campaign that year, were screened and only 10% were 45 years or older. 16 The highest risk women, therefore, were the ones least likely to seek screening services. Despite a robust educational campaign that focused only on cervical cancer and screening service-related knowledge, screening rates through this focused effort were suboptimal.…”

Section: Cervical Cancer Screening Program Implementationmentioning

confidence: 99%

“…Given that a prior study in this region indicated that older women are less likely to seek cervical cancer screening, this is a notable knowledge gap. 16 Increased cervical cancer education is needed, including strategies and messages targeted to each gender.…”

Section: Risk Factors and Knowledgementioning

confidence: 99%

Informing equitable access to cervical cancer screening in rural Sénégal: a cross-sectional study of uptake determinants

Dykens

Thiam²,

Peterson

et al. 2020

Preprint

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Background: Equitable access to women’s health services, including cancer prevention programs, is lacking in many countries. Sénégal ranks 17 th in the world in the age-standardized incidence rate of cervical cancer. The Kédougou region is located in the southeastern corner of Sénégal and has many structural barriers to preventive care, including economic disadvantage, a low literacy rate, and a shortage of healthcare workers. The goal of this study was to investigate the barriers and facilitators of cervical cancer screening uptake in this region. Methods: We conducted a cross-sectional survey of 158 participants, 101 women and 57 men (ages 30 - 59) across nine non-probability-sampled communities located throughout three districts in the Kédougou region of Sénégal from October 2018 through January 2019. We collected demographic information and data on health service utilization, cervical cancer knowledge, and experience of cervical cancer screening. Associations were tested using the Fisher’s Exact test statistic. Results: The majority of our study population speaks one or both of the prevalent local languages, Malinké (62.7%) and Pulaar (59.5%), with fewer Wolof (26.6%) and French (31%) speakers. Among the women in our sample, 84.2% had never been screened for cervical cancer. Among men, 78.9% stated that they have the final say at home regarding healthcare decisions. In contrast, only 16.0% of women made their own healthcare decisions. For those who speak Malinké, 48.0% received services in another language. We found significant gender differences between women and men in the knowledge that a woman is at risk if she has multiple sexual partners (p = 0.010) and that a woman is at increased risk if her partner has multiple sexual partners (p < 0.001). Conclusions: This study demonstrates the critical need to overcome both clinical and informational barriers, as well as structural barriers, to ensure the implementation and sustainment of an equitable health service. In this highly underdeveloped region where workforce challenges are extraordinary, innovative solutions are needed to address these underlying social determinants of health while simultaneously improving quality of care at the point of service. Trial registration: This study is registered on clinicaltrials.gov with the Clinical Trials Study Identifier: NCT03540069

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Implementing visual cervical cancer screening in Senegal: a cross-sectional study of risk factors and prevalence highlighting service utilization barriers

Cited by 6 publications

References 19 publications

Eliminating Cervical Cancer in Mali and Senegal, Two Sub-Saharan Countries: Insights and Optimizing Solutions

Eliminating Cervical Cancer in Mali and Senegal, Two Sub-Saharan Countries: Insights and Optimizing Solutions

Multi-site community-engaged quality improvement to inform regional cervical cancer screening implementation and sustainment in rural Sénégal

Informing equitable access to cervical cancer screening in rural Sénégal: a cross-sectional study of uptake determinants

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