Recruitment strategies to promote uptake of cervical cancer screening in the West Region of Cameroon

Abstract

Objectives The World Health Organization’s (WHO) global strategy for cervical cancer elimination has set the target of 70% of women screened in all countries by 2030. Community sensitization through media is often used, but community health workers’ (CHW) involvement may contribute to improving screening coverage. We aimed to assess effectiveness and costs of two cervical cancer screening recruitment strategies conducted in a low-resource setting. Methods The study was conducted in the West Region of Cameroon, in the Health District of Dschang, a community of 300,000 inhabitants. From September 2018 to February 2020, we recruited and screened women for cervical cancer in a single-visit prevention campaign at Dschang District Hospital. During the first 9 months, recruitment was only based on Community Information Channels (CIC) (e.g.. street banners). From the tenth month, participation of CHW was added in the community after training for cervical cancer prevention counselling. Population recruitment was compared between the two strategies by assessing the number of recruited women and direct costs (CHW costs included recruitment, teaching, certification, identification badge, flyers, transport, and incentives). The intervention’s cost-effectiveness was expressed using an incremental cost-effectiveness ratio (ICER). Results and discussion During the period under study, 1940 women were recruited, HPV positive rate was 18.6% (n = 361) and 39 cases of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) were diagnosed. Among included participants, 69.9% (n = 1356) of women were recruited through CIC as compared to 30.1% (n = 584) by CHW. The cost per screened woman and CIN2+ diagnosed was higher in the CHW group. The ICER was 6.45 USD or 16.612021Int’l$ per screened woman recruited by CHW. Recruitment in rural areas increased from 12.1 to 61.4% of all women included between CIC-led and CHW-led interventions. These outcomes highlight the importance of training, preparing, and deploying CHW to screen hard-to-reach women, considering that up to 45% of Cameroon’s population lives in rural areas. Conclusion CHW offer an important complement to CIC for expanding coverage in a sub-Saharan African region such as the West Region of Cameroon. CHW play a central role in building awareness and motivation for cervical cancer screening in rural settings.

Role of mass media in understanding about cervical cancer and its screening among married women.

“…In this study, respondents also suggests that telemedicine can be used as effective tool in early detection of cancer by sharing pictures of cervix with consultants via digital cameras; was wellsupported with Arviliana and his co-associates 24 findings. Also, community information channels such as radio, television and advertisements raises cervical cancer awareness and engages large population in short period of time 25 ; well supports our findings i.e. cervical cancer screening programs must be advertised through mass media.…”

Disparities in cervical cancer screening programs in Cameroon: a scoping review of facilitators and barriers to implementation and uptake of screening

“…A cross-sectional, interventional study conducted in the Dschang health district observed a 30.1% (584/1940) increase in women’s attendance at the cervical cancer screening program following recruitment by community health workers (CHWs) [ 33 ]. These findings are similar to women’s participation in screening programs at 35.9% (1292/3600) in another study in where Community Mother and Child Aids (CoMCHAs) sensitized women about cervical cancer screening [ 25 ].…”

“…These findings are similar to women’s participation in screening programs at 35.9% (1292/3600) in another study in where Community Mother and Child Aids (CoMCHAs) sensitized women about cervical cancer screening [ 25 ]. Farmers and housewives, who are sometimes difficult to reach were more represented in the CHW-led recruitment at 42.6% and 25.2% [ 33 ].…”

“…Specific roles with clearly defined responsibilities played an important role in the success of WHP and Dschang cervical cancer screening programs [ 27 ]. CHWs in Dschang distributed invitation vouchers to each woman they approached, such that these vouchers were presented by women at their cervical cancer screening visits [ 33 ]. It enabled traceability to distinguish between the impact of CHWs and communication and information channels [ 33 ].…”

“…CHWs in Dschang distributed invitation vouchers to each woman they approached, such that these vouchers were presented by women at their cervical cancer screening visits [ 33 ]. It enabled traceability to distinguish between the impact of CHWs and communication and information channels [ 33 ]. In the WHP, nurses screened and treated women for premalignant lesions of the cervix, performed biopsies and referred women in need of higher level of care to the appropriate facilities [ 9 , 27 ].…”