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Evaluating barriers of Pap smear test in rural Nepal and effectiveness of free screening programs
The objective of the present study was to find out incidence of precancerous lesions/ cervical cancer among women living in remote villages of Nepal where health care resources are limited and also find out challenges of lacking health services like Pap smear in such areas and its possible solution. Cervical cancer is ranked 1st among women in Nepal. A number of socioeconomic, cultural, ethical challenges, geographically difficult terrain of Nepal and insufficient/inefficient health care resources are associated with ineffective cervical screening programs in Nepal. There is a very low (2.8%) coverage rate for cervical cancer screening services in Nepal. Hence, we attempted to provide Pap smear cervical screening test to those women who were deprived of this service. A cross sectional observational study was done in married women attending the free health camps for cervical screening conducted by Chitwan Medical College Teaching Hospital, Bharatpur, Nepal in 2016. Three health camps were conducted at three different rural regions of Chitwan district on separate days. The data of 1,108 women who attended the free cervical screening programs was obtained from the Pathology Department record registers. Frequency analysis of precancerous lesions and cervical cancer among those women was carried out using SPSS 16. The challenges and barriers of Pap screening service in the remote regions of Nepal were evaluated. Abnormal cytology was observed in 1% of cytology; 0.5% of low grade and high grade lesions each. Most high-grade lesions were in 41-50 age group. Cervical carcinoma was detected in 0.1% of Pap specimens. The emphasis of free cervical screening camps should be given to reduce burden of cervical cancer in rural areas. Barriers should be addressed by government for proper implementation of cervical screening policy.
Abstract: Nicaragua has some of the highest rates of cervical cancer in Latin America and the world. In 2003, the Nicaraguan Ministry of Health, the Central American Institute of Health and the Maria Luisa Ortiz Clinic combined efforts to create an effective remote rural service network, with centralized quality-controlled cytology, and coordinated treatment.Data was taken from the clinic Pap log, tracking records, patient charts, and pathology reports. Patients were stratified by age (25 and older, and under 25). Standard indicators addressing key components in the entire continuum of an effective screening program were adapted from suggestions by a work group of the Pan American Health Organization.A total of 2132 women received Pap screening. 68% (N = 1448) were 25 and older and 32% (N = 684) were under 25. The proportion of high-grade abnormal screens was 3.7% for women over 25 and 0.4% for women under 25. The proportion of women with high-grade abnormal results who received diagnostic work-up and needed treatment was 94% for women over 25 and 100% for women under 25. The proportion of high-grade squamous cell Pap tests resulting in histologically confirmed disease was 68%. The ratio of pre-invasive disease to invasive disease was 1.9. The invasive cancer detection rate was 0.62%.This program evaluation demonstrates that outreach to high-risk women, quality cytology screening and high rates of diagnostic follow-up and treatment can be conducted in remote, low-resource settings when coordinated efforts are made to remove barriers and ensure quality.
Pub.: 04 Oct '05, Pinned: 28 Aug '17
Abstract: The development of successful policies to reduce income-related inequalities in cervical cancer screening rates requires an understanding of the reasons why low-income women are less likely to be screened. We sought to identify important determinants contributing to inequality in cervical screening rates.We analyzed data from 92,541 women aged 25-64 years, who participated in the World Health Survey in 2002-2003. Income-related inequality in Pap screening was measured using the concentration index (CI). Using a decomposition method for the CI, we quantified the contribution to inequality of age, education level, marital status, urbanicity and recent health-care need.There was substantial heterogeneity in the contributions of different determinants to inequality among countries. Education generally made the largest contribution (median = 15%, interquartile range [IQR] = 23%), although this varied widely even within regions (e.g., 5% in Austria, 28% in Hungary). The contribution of rural residence was greatest in African countries (median = 10%, IQR = 13%); however, there was again substantial within-region variation (e.g., 26% in Zambia, 2% in Kenya).Considerable heterogeneity in the contributions of screening determinants among countries suggests interventions to reduce screening inequalities may require country-specific approaches.
Pub.: 18 Feb '11, Pinned: 28 Aug '17
Abstract: Women who have not had a Papanicolaou test in five years or more have increased risk of developing invasive cervical cancer. This study compares Appalachian women whose last screening was more than one year ago but less than five years ago with those not screened for the previous five years or more.Using PRECEDE/PROCEED as a guide, factors related to obtaining Pap tests were examined using cross-sectional data from 345 Appalachian Kentucky women. Bivariate and multivariate analyses were conducted to identify predictors of screening.Thirty-four percent of participants were rarely- or never-screened. In multiple logistic regression analyses, several factors increased those odds, including belief that cervical cancer has symptoms, and not having a regular source of medical care.The findings from this study may lead to the development of effective intervention and policies that increase cervical cancer screening in this population.
Pub.: 15 Feb '11, Pinned: 28 Aug '17
Abstract: Reproductive tract infection (RTI) represents a major public health problem in India. Women are either not aware of the symptoms of RTI or refuse to seek health care due to economic and time constrains unless suffering from alarming symptoms.To find out the prevalence of women with suggestive symptoms of RTI; to identify clinical and cytological abnormalities among the symptomatic women and to find out association between socio-demographic profile and risk factors with RTI symptomatic and cytology positive patients.A total of 385 married women in reproductive age group residing in Baligori sub-center area in Tarakeswar block of Hooghly district, West Bengal, India, were screened for symptom suggestive of RTI; symptomatic women went through gynecological examination and cancer cervix screening by Pap smear. Analysis of results was done by Odds ratio and multivariate logistic regression.Overall, 23.6% of the study population had symptoms suggestive of RTI. Most of them (68.1%) had abnormal vaginal discharge. Among the symptomatic women, cytology proved that 24.4% were suffering from acute cervicitis, 4.7% from A Squamous Cell of Undetermined Significance (ASCUS) and 2.3% from Low Grade Intra epithelial Lesion (LSIL) Squamous. Statistically significant association was observed for age, number of children, contact history of husband, pond bathing, menstrual hygiene, intra uterine device insertion, non-usage of barrier method, and history of abortion among women symptomatic for RTI and asymptomatic women.Prevalence of suggestive symptoms of RTI in women was found to be high (23.6%), and among them 7% had cervical dysplasia. Therefore, enhancing awareness and organizing screening camps are absolute necessity and must be held at frequent intervals to curb the menace due to cervical cancer.
Pub.: 12 Dec '12, Pinned: 28 Aug '17
Abstract: Although cervical cancer rates in the United States have declined sharply in recent decades, certain groups of women remain at elevated risk, including middle-aged and older women in central Appalachia. Cross-sectional baseline data from a community-based randomized controlled trial were examined to identify barriers to cervical cancer screening. Questionnaires assessing barriers were administered to 345 Appalachian women aged 40-64, years when Papanicolaou (Pap) testing declines and cervical cancer rates increase. Consistent with the PRECEDE/PROCEED framework, participants identified barriers included predisposing, enabling, and reinforcing factors. Descriptive and bivariate analyses are reported, identifying (a) the most frequently endorsed barriers to screening, and (b) significant associations of barriers with sociodemographic characteristics in the sample. Recommendations are provided to decrease these barriers and, ultimately, improve rates of Pap tests among this traditionally underserved and disproportionately affected group.
Pub.: 28 Nov '12, Pinned: 28 Aug '17
Abstract: We sought to examine changes in the magnitude of social inequality in the uptake of cervical cancer screening between 2001 and 2009 in Taiwan.We used data from the 2001 and 2009 Taiwan National Health Interview Surveys to calculate the absolute (slope of index of inequality, SII) and relative (relative index of inequality, RII) summary measures of social inequality in the uptake of Pap smear tests to indicate the magnitude of social inequality.The prevalence of having had a Pap smear during the previous 3 years increased in each age and socioeconomic group from 2001 to 2009. The SII and RII by urbanization and education level decreased significantly, while the SII and RII by income level increased significantly between the two study years. The largest increase in inequality of prevalence from 2001 to 2009 was between women living in suburban and rural areas with highest income level and women live in metropolitan areas with lowest income level.The changes in magnitude of social inequality in the uptake of cervical cancer screening differed by indicators of socioeconomic position. Further studies are needed to explore the mechanisms that result in social inequality by different indicators of socioeconomic position.
Pub.: 11 Jan '14, Pinned: 28 Aug '17
Abstract: The objectives of this study were to evaluate: Mexican women's knowledge about cervical cancer prevention; psychosocial barriers to screening; and the relation of both to cervical cancer screening behavior. Three hundred and eighty-four rural and urban women who had achieved a basic or higher educational level were surveyed. Almost 80% of the women had a Pap test but rural women were less likely to have done so. Although most women had received their most recent Pap within the last three years, only 29% had had their first Pap in accordance with the official Mexican norm. Participants showed inadequate knowledge about the risk factors for cervical cancer, especially women with only a basic educational level, irrespective of residence in an urban or rural area. Factors associated with non-screening were poor knowledge about Pap testing and about the risk factors for cervical cancer, as well as the following barriers: believing that Pap testing is too embarrassing; believing that men do not want them to have a Pap test; and believing that the test is painful. In light of these socio-cultural influences, our findings could be helpful in designing effective programs to increase Pap screening.
Pub.: 26 Oct '13, Pinned: 28 Aug '17
Abstract: To examine the risk factors associated with never being screened for cervical cancer (CC) in Brazil.Using the National Household Sample Survey 2008 (PNAD), we analyzed data from 102,108 Brazilian women ages 25-64years. The patients were analyzed as having been or never having been screened with a Pap smear (Yes/No). Age-adjusted prevalence of never-screening was analyzed using a Chi-squared test. Crude and adjusted models using Poisson regression were performed.The prevalence of never-screened women for CC was 12.9%, 11.5% and 22.2% in Brazil in general, urban and rural areas, respectively. The Brazilian region with the highest prevalence of never-screening was the North (17.4%, 14.7% and 27.3% in general, urban and rural areas, respectively). The factors associated with a higher risk for never being screened were the following: poverty, younger age, lower educational level, non-white skin color, a greater number of children, no supplemental health insurance and not having visited a doctor in the past 12months.Socioeconomic and demographic conditions lead to inequalities in access to Pap smear screening in Brazil. Public health policy addressing these risk groups is necessary.
Pub.: 06 Jul '13, Pinned: 28 Aug '17
Abstract: To identify factors associated with whether women in Colombia have had a Pap test, evaluate differences in risk factors between rural and urban residence, and evaluate the contextual effect of the lack of education on having ever had a Pap test.Data used were from the 2010 Colombian National Demographic and Health Survey; 40,392 women reported whether they have had a Pap test. A multilevel mixed logistic regression model was developed with random intercepts to account for clustering by neighbourhood and municipality. The model evaluated whether having a rural/urban area of residence modified the effect of identified risk factors and if the prevalence of no education at the neighbourhood level acted as a contextual effect.Most women (87.3%) reported having at least one Pap test. Women from lower socioeconomic quintiles (p=0.002), who were unemployed (p<0.001), and whose final health decisions depended on others (p<0.001) were less likely to have had a Pap test. Women with children were more likely to have had the test (p<0.001), and the effects of education (p=0.03), type of health insurance (p=0.01), age (p<0.001), and region (p<0.001) varied with having a rural/urban area of residence. Women living in rural areas (specifically younger ones, with no health insurance, living in the Atlantic and Amazon-Orinoquía regions, and with no education) were less likely to have had a Pap test when compared to those living in urban areas. Furthermore, women living in a neighbourhood with a higher prevalence of no education were less likely to have ever had a Pap test (p=0.005).In Colombia, the probability of having had a Pap test is associated with personal attributes, area of residence, and prevalence of no education in the neighbourhood. Efforts to improve access to cervical cancer screening should focus on disadvantaged women with limited education, low socioeconomic status, and no health insurance or subsidised insurance, especially those in rural/isolated areas.
Pub.: 25 Feb '15, Pinned: 28 Aug '17
Abstract: Rural Mexican immigrant women in the U.S. are infrequently screened and experience health disparities from cervical cancer. We explored cancer-related cultural beliefs in this population. We administered a cross-sectional survey to 39 Mexican immigrant women due for screening. We conducted univariate and bivariate analyses of participants' characteristics, Pap test history, cancer-related knowledge and beliefs, and cultural consensus analysis about causes of cervical cancer and barriers to screening. For all the cultural consensus tasks, there was consensus (Eigenratios >3:1) among survey participants. Comparing the rankings of risk factor clusters, clusters related to sexual behaviors were ranked more severely than clusters related to genetic or other behavioral factors. There was agreement on ideas of cervical cancer causation and barriers to screening among these women. Hence, improved methods of disseminating important health information and greater access to care are needed, particularly in relationship to stigma about sex and birth control practices.
Pub.: 03 Oct '14, Pinned: 28 Aug '17
Abstract: Peru has high cervical cancer incidence and mortality rates compared to other Andean countries. Therefore, partnerships between governmental and international organizations have targeted rural areas of Peru to receive cervical cancer screening via outreach campaigns. Previous studies have found a relationship between a person's social networks and cancer screening behaviors. Screening outreach campaigns conducted by the nonprofit organization CerviCusco created an opportunity for a social network study to examine cervical cancer screening history and social network characteristics in a rural indigenous community that participated in these campaigns in 2012 and 2013. The aim of this study was to explore social network characteristics in this community related to receipt of cervical cancer screening following the campaigns.An egocentric social network questionnaire was used to collect cross-sectional network data on community participants. Each survey participant (ego) was asked to name six other women they knew (alters) and identify the nature of their relationship or tie (family, friend, neighbor, other), residential closeness (within 5 km), length of time known, frequency of communication, topics of conversation, and whether they lent money to the person, provided childcare or helped with transportation. In addition, each participant was asked to report the nature of the relationship between all alters identified (e.g., friend, family, or neighbor). Bivariate and multivariate analyses were used to explore the relationship between Pap test receipt at the CerviCusco outreach screening campaigns and social network characteristics.Bivariate results found significant differences in percentage of alter composition for neighbors and family, and for mean number of years known, mean density, and mean degree centrality between women who had received a Pap test (n = 19) compared to those who had not (n = 50) (p's < 0.05). The final logistic regression model was statistically significant (χ2 (2) = 20.911, p < .001). The model included the variables for percentage of family alter composition and mean density, and it explained 37.8 % (Nagelkerke R (2)) of the variance in Pap test receipt, correctly classifying 78.3 % of cases. Those women with higher percentages of family alter composition and higher mean density in their ego networks were less likely to have received a Pap test at the CerviCusco campaigns.According to this exploratory study, female neighbors more than family members may have provided an important source of social support for healthcare related decisions related to receipt of a Pap test. Future studies should collect longitudinal social network data on participants to measure the network effects of screening interventions in rural indigenous communities in Latin American countries experiencing the highest burden of cervical cancer.
Pub.: 26 Feb '16, Pinned: 28 Aug '17
Abstract: To compare women who recall being informed of an abnormal Pap to those not having this experience relative to attitudes and beliefs pertaining to screening for cervical cancer.Four hundred women were recruited from eight rural Appalachian counties, in 2013 and 2014. Women completed a paper-and-pencil survey after providing written informed consent. Bivariate associations and age-adjusted associations were calculated between the self-reported experience of being told of an abnormal Pap test result and eight attitudes/beliefs relative to the prevention of cervical cancer. Data analyses were performed in 2014.The mean age was 40.2 years (range 30–64 years). Eighteen women chose not to answer the question asking about ever having an abnormal Pap test result, leaving n = 382. Of the 382 women who did answer, 122 (30.6 %) indicated having an abnormal Pap test result and the remaining 260 (65.2 %) indicated never having this experience. With the exception of one item assessing knowledge that HPV is the cause of cervical cancer, between-group differences in attitudes, beliefs, and intent to have a Pap test the next time one is due were not observed.Although we hypothesized that women ever having an abnormal Pap test may have actively sought to learn more about cervical cancer and its prevention, findings suggest that this is not the case. Informing women of an abnormal result could be coupled with a high-intensity counseling designed to improve attitudes and beliefs relative to women’s role in protecting themselves from cervical cancer.
Pub.: 13 Jun '16, Pinned: 28 Aug '17
Abstract: Multiple intrapersonal and structural barriers, including geography, may prevent women from engaging in cervical cancer preventive care such as screening, diagnostic colposcopy, and excisional precancer treatment procedures. Geographic accessibility, stratified by rural and nonrural areas, to necessary services across the cervical cancer continuum of preventive care is largely unknown.Health care facility data for New Mexico (2010-2012) was provided by the New Mexico Human Papillomavirus Pap Registry (NMHPVPR), the first population-based statewide cervical cancer screening registry in the United States. Travel distance and time between the population-weighted census tract centroid to the nearest facility providing screening, diagnostic, and excisional treatment services were examined using proximity analysis by rural and nonrural census tracts. Mann-Whitney test (P < .05) was used to determine if differences were significant and Cohen's r to measure effect.Across all cervical cancer preventive health care services and years, women who resided in rural areas had a significantly greater geographic accessibility burden when compared to nonrural areas (4.4 km vs 2.5 km and 4.9 minutes vs 3.0 minutes for screening; 9.9 km vs 4.2 km and 10.4 minutes vs 4.9 minutes for colposcopy; and 14.8 km vs 6.6 km and 14.4 minutes vs 7.4 minutes for precancer treatment services, all P < .001).Improvements in cervical cancer prevention should address the potential benefits of providing the full spectrum of screening, diagnostic and precancer treatment services within individual facilities. Accessibility, assessments distinguishing rural and nonrural areas are essential when monitoring and recommending changes to service infrastructures (eg, mobile versus brick and mortar).
Pub.: 24 Aug '16, Pinned: 28 Aug '17
Abstract: Because cervical cancer is the leading cause of cancer mortality in Honduras, this study assessed knowledge, attitudes and barriers to cervical cancer screening services by Papanicolaou smear (pap smear) for women in rural, remote Honduras served by Virginia Commonwealth University's Global Health and Health Disparities Program (GH2DP).Two interviewers administered an institutional review board approved, 20 question survey by convenience sample methodology to adult female patients visiting GH2DP clinics in June 2014. A total of 146 surveys were completed. Of the respondents, 30 were living in La Hicaca, the largest and wealthiest village in the region, and 116 were living in surrounding, less affluent, villages.On average, women from La Hicaca had 2.9 children whereas women from surrounding villages had 4.3 children (<i>p=</i>0.0095). There were no significant differences between La Hicaca and surrounding villages in average respondent age, age of first intercourse and number of sexual partners. Seventy three percent (22/30) of women from La Hicaca and 60% (70/116) from surrounding villages reported undergoing cervical cancer screening by pap smear (<i>p=</i>0.1890). Eighty-two percent (18/22) of the respondents from La Hicaca and 84% (59/70) from surrounding villages were screened in the past two years (<i>p=</i>0.7846). The majority of the women from surrounding villages (81%, 57/70) and 23% (5/22) from La Hicaca traveled >1 h to receive a pap smear (<i>p</i>≤0.0001). Women from La Hicaca (86%, 19/22) were more likely to receive their pap smear results than women from surrounding villages (60%, 42/70) (<i>p=</i>0.0225). Although 17% (5/30) of respondents from La Hicaca and 11% (13/116) (<i>p=</i>0.4175) from surrounding villages were aware of the cause of cervical cancer, 60% (18/30) of women in La Hicaca and 82% (95/116) in surrounding villages (<i>p=</i>0.0106) believed it is preventable. Of the 106 women (73%) who had heard of cervical cancer screening, only 92 women (63%) had been screened (<i>p</i><0.0001). Women undergoing cervical cancer screening were more likely to believe that cervical cancer is preventable (<i>n=</i>78, <i>p=</i>0.0054). The most common screening barriers were lack of awareness and fear (19/54, 35%; 15/54, 28%).Although yearly screening services are available in this community, knowledge and access barriers exist for increased implementation. Notification of pap smear results is suboptimal. These findings will guide regional and collaborative effort to improve cervical cancer screening services.
Pub.: 28 May '17, Pinned: 28 Aug '17
Abstract: The main purpose was to assess associations between HBM variables and participation in cervical cancer screening programs in a sample of Iranian women.A total of 333 married women of childbearing age were recruited with cluster sampling. The study was conducted from spring 2002 to spring 2003 and a self-report questionnaire and structured interview were designed to measure the four HBM constructs and Iranian women's knowledge about Pap smear screening.A total of 68.5% reported having undergone at least one Pap test. Women were more likely to participate in Pap smears when they had access to knowledge about cervical cancer and screening programs. Furthermore, the perceived benefit and barrier variables of the Health belief model were two factors related to participation in Pap smear testing.Health care professionals must provide women with more information about cervical cancer and the benefits of participating in cervical cancer screening programs.
Pub.: 22 Aug '08, Pinned: 27 Aug '17
Abstract: In Argentina, the unequal distribution of the burden of cervical cancer is striking: the mortality rate of the province of Jujuy (15/100,000) is almost four times higher than that of the city of Buenos Aires (4/100,000). We aimed to establish the socio-demographic profile of women who were under-users of Pap smear screening, based on an analysis of a representative sample of Argentinean women from the First National Survey on Risk Factors in 2005. We found that in Argentina, women who are poor, unmarried, unemployed or inactive, with lower levels of education and reduced access to health care, and women over the age of 65, were under-users of screening. Screening must not remain opportunistic. Strategies must incorporate the needs and perceptions of socially disadvantaged women, and increase their access to screening. Of utmost importance is to provide good quality screening and treatment services that reach women who are at risk. Pilot projects using new, alternative technologies should be encouraged in less developed parts of the country. Promotion among health professionals of the scientific basis and effectiveness of each screening modality is essential to reduce wasteful practices such as annual screening and screening of young women that waste resources and fail to reduce cervical cancer incidence and mortality rates.
Pub.: 26 Nov '08, Pinned: 27 Aug '17
Abstract: This integrated review was conducted to evaluate the factors that inhibit or promote decisions by African American and Hispanic women to obtain cervical cancer screening.Research articles were identified using MEDLINE, PubMed, and Cumulative Index to Nursing and Allied Health literature, published between 1999 and 2005.Cervical cancer screening practices of African American and Hispanic women were influenced by extrinsic motivators including lack of insurance, no usual source of health care, acculturation, and socioeconomic factors. Intrinsic motivators were related to beliefs and perceptions of vulnerability, such as ignoring cervical cancer screening when no symptoms were present; believing that not knowing if one had cervical cancer was better; and thinking that only women who engage in sexual risk-taking behaviors need to obtain Papanicolaou (Pap) smear testing.Nurse practitioners (NPs) have an opportunity to impact the incidence and mortality of cervical cancer by improving screening practices of minority women. They can emphasize the importance of obtaining Pap smears regularly, teach patients the risks for and signs and symptoms of cervical cancer, and provide recommendations for obtaining screening at low cost or no cost to the patient. To improve cancer screening practices, NPs need to address minority women's beliefs about cervical cancer and provide information and services in a culturally sensitive manner at an appropriate level of learning.
Pub.: 01 Nov '07, Pinned: 27 Aug '17
Abstract: The Cervical Health Implementation Project was initiated with the aim of developing and evaluating health system interventions for improving public sector cervical screening services. The project was conducted between January 2001 and May 2003 in three districts in South Africa. This paper describes the districts, interventions and their evaluation, and discusses the implications of these findings for the roll out of a national cervical screening program.A pretest/post-test study design was employed. The following interventions were developed and implemented: health worker training workshops, health system tools and protocols and a community awareness program. Pre- and post-intervention facility audits, key informant interviews, staff knowledge, attitude and practice (KAP) surveys and client KAP surveys were conducted. Clinic records and cytology laboratory data were reviewed.Service organization, availability of screening equipment and education and communication materials improved. The proportion of staff who knew the screening policy increased from 43% to 82%; and 68% of staff agreed with the screening policy after, as opposed to 23% before the intervention. In two of the districts, cytology turnaround times continued to be long. Only 50% of women with a high-grade squamous intraepithelial lesion had a colposcopy and biopsy within 6 months of a Pap smear. Although the number of new smears performed in the three districts increased from 1544 in 2001 to 2801 in 2002, overall the coverage remained less than 4%.This project highlights the considerable challenges that need to be addressed to effectively implement the national screening policy.
Pub.: 12 Sep '06, Pinned: 27 Aug '17
Abstract: Introduction. A number of new technologies including cervical cancer screening and vaccination have introduced new tools in the fight against cervical cancer. Methods. This study was set in Odisha, India, at the Acharya Harihar Regional Cancer Center and study research infrastructure at the Asian Institute of Public Health. IRB approvals were obtained and a research assistant recruited 286 women aged 18-49 years, who provided informed consent and completed a survey tool. Data were entered into EpiData software and statistical analysis was conducted. Results. 76.3% women participants were married, 45.5% had sexual debut at age 21 or greater, 60.5% used contraception, 12.2% reported having a Pap smear in the past, and 4.9% reported having prior genital warts. Most, 68.8% had never heard of HPV and 11.9% were aware that HPV is the main cause of cervical cancer. 82.9% women thought that vaccinations prevent disease, and 74.8% said they make the decision to vaccinate their children. Conclusion. The Odisha community demonstrated a low level of knowledge about cervical cancer prevention, accepted vaccinations in the prevention of disease and screening, and identified mothers/guardians as the key family contacts.
Pub.: 20 Jan '16, Pinned: 26 Aug '17
Abstract: Objectives To identify socioeconomic and regional inequalities of pap smear coverage in the state of Rio Grande do Sul. Methods An ecological study based on data of the 2011-2012 national health information system to estimate the annual coverage of pap smears for the overall female population of the state and for women without private health insurance. We estimated annual pap smear coverage according to the Municipal Social Vulnerability Index and health macro-regions and regions of the state. Results The percentage of women without private health insurance ranged from 38.1% to 94.2% in the health regions. Pap smear coverage was 17.3% for the overall female population and 23.8% for women without private health insurance. Pap smear coverage was higher in more socially vulnerable municipalities and regions with a higher percentage of women with private health insurance. Conclusions The prevalence of private health insurance should be considered in studies that address the coverage of the Brazilian Unified Health System (SUS).
Pub.: 17 Mar '16, Pinned: 26 Aug '17
Abstract: This study aimed to identify major barriers to Papanicolaou (Pap) test uptake and human papillomavirus (HPV) vaccine acceptability. Three focus groups with 16 young Korean immigrant women residing in a community in the Midwest were conducted. Braun and Clarke's six phases of thematic analysis were used to develop themes. Three major themes emerged as barriers: (a) limited knowledge about cervical cancer and preventive behaviors, (b) culture-specific barriers, and (c) low accessibility to health care services. These themes were multifactorial and interrelated barriers to Pap test uptake and HPV vaccine acceptability among young Korean immigrant women. These findings indicate that culturally tailored cervical cancer education is needed to promote Pap test uptake and HPV vaccination in this underserved population.
Pub.: 20 May '16, Pinned: 26 Aug '17
Abstract: Abstract Background The delay in detection of premalignant and malignant lesions can have an adverse impact on the outcome of carcinoma cervix. In spite of relatively good healthcare facilities, women in Kerala continue to report in advanced stages of cervical malignancy. Objective To analyze factors associated with delayed reporting and to evaluate awareness about screening and vaccination programs for prevention of carcinoma cervix. Method A cross-sectional study design was used to evaluate the subjects diagnosed to have carcinoma cervix in the outpatient Department of Obstetrics and Gynecology, Government Medical College, Thrissur, Kerala for a period of two years. One-hundred and fifteen women diagnosed to have invasive carcinoma during the study were evaluated. Data analysis was done and expressed as means and percentages. Results One-hundred and fifteen women participated in the study. Only 26 (21.7 %) of the subjects were diagnosed in a relatively early stage, i.e., up to stage 2a. Most of them were from families living below poverty line (63.9 %) and were either widowed or divorced (57.3 %). Illiteracy was common (48.9 %) among them, and many (71.3 %) worked as manual laborers. None of the subjects was aware about the availability of screening and vaccination programs for prevention of carcinoma cervix. Conclusions There is a wide gap between the awareness of availability of healthcare and its proper utilization by the poor. Scaling up of public awareness of preventive programs and the availability of healthcare facilities are essential to enable the timely utilization of such services to facilitate early detection of invasive carcinoma cervix. Abstract Background The delay in detection of premalignant and malignant lesions can have an adverse impact on the outcome of carcinoma cervix. In spite of relatively good healthcare facilities, women in Kerala continue to report in advanced stages of cervical malignancy. BackgroundThe delay in detection of premalignant and malignant lesions can have an adverse impact on the outcome of carcinoma cervix. In spite of relatively good healthcare facilities, women in Kerala continue to report in advanced stages of cervical malignancy. Objective To analyze factors associated with delayed reporting and to evaluate awareness about screening and vaccination programs for prevention of carcinoma cervix. ObjectiveTo analyze factors associated with delayed reporting and to evaluate awareness about screening and vaccination programs for prevention of carcinoma cervix. Method A cross-sectional study design was used to evaluate the subjects diagnosed to have carcinoma cervix in the outpatient Department of Obstetrics and Gynecology, Government Medical College, Thrissur, Kerala for a period of two years. One-hundred and fifteen women diagnosed to have invasive carcinoma during the study were evaluated. Data analysis was done and expressed as means and percentages. MethodA cross-sectional study design was used to evaluate the subjects diagnosed to have carcinoma cervix in the outpatient Department of Obstetrics and Gynecology, Government Medical College, Thrissur, Kerala for a period of two years. One-hundred and fifteen women diagnosed to have invasive carcinoma during the study were evaluated. Data analysis was done and expressed as means and percentages. Results One-hundred and fifteen women participated in the study. Only 26 (21.7 %) of the subjects were diagnosed in a relatively early stage, i.e., up to stage 2a. Most of them were from families living below poverty line (63.9 %) and were either widowed or divorced (57.3 %). Illiteracy was common (48.9 %) among them, and many (71.3 %) worked as manual laborers. None of the subjects was aware about the availability of screening and vaccination programs for prevention of carcinoma cervix. ResultsOne-hundred and fifteen women participated in the study. Only 26 (21.7 %) of the subjects were diagnosed in a relatively early stage, i.e., up to stage 2a. Most of them were from families living below poverty line (63.9 %) and were either widowed or divorced (57.3 %). Illiteracy was common (48.9 %) among them, and many (71.3 %) worked as manual laborers. None of the subjects was aware about the availability of screening and vaccination programs for prevention of carcinoma cervix. Conclusions There is a wide gap between the awareness of availability of healthcare and its proper utilization by the poor. Scaling up of public awareness of preventive programs and the availability of healthcare facilities are essential to enable the timely utilization of such services to facilitate early detection of invasive carcinoma cervix. ConclusionsThere is a wide gap between the awareness of availability of healthcare and its proper utilization by the poor. Scaling up of public awareness of preventive programs and the availability of healthcare facilities are essential to enable the timely utilization of such services to facilitate early detection of invasive carcinoma cervix.
Pub.: 01 Oct '16, Pinned: 26 Aug '17
Abstract: Papanicolaou test screening remains an effective approach for the control of cervical cancer. However, for successful control of the disease, patients need to have access to the test results and complete the treatment. The aim of this study was to investigate the factors associated with lack of access to results from the most recent Papanicolaou test in women living in the municipality of Rio de Janeiro who used the Brazilian Unified Health System. Overall prevalence of lack of access to test results was 18.4%. Access to test results was lower for younger women of Black race/skin color origin, those who had difficulties in making an appointment, those who received no information about when to pick up the test results, and those who evaluated the assistance provided by the health professional who collected the Papanicolaou test. Issues related to the organization and infrastructure of the health unit were the most frequently reported cause by the interviewees. The Brazilian Unified Health Service should improve its knowledge of users and service conditions to prevent interruption of the screening flow.
Pub.: 11 Nov '16, Pinned: 26 Aug '17
Abstract: The study was conducted to determine the challenges and suggest solutions to conducting free cervical cancer screening among Nigerian women.Awareness was created among women groups and mass media in Osun State for women to undergo free cervical cancer screening programme. Consenting women had their socio-demographic characteristics, awareness and uptake of HPV vaccine documented and papanicolaou smear procedure done with adequate referral for treatment given where necessary.A total of 287 women had cervical cancer screening. Mean (SD) age was 51.6 (14.3) years. Most participants were urban based (87.1%), married (63.1%), had secondary education (39%) and were traders (79.1%). None of the women were aware of the preventive HPV vaccine or had been vaccinated against HPV. About 6% were pre-invasive while 0.7% had invasive cervical cancer. The highest proportions of respondents affected were young, married and had lower education. Challenges identified included poor attendance, low risk perception and logistic issues.Most participants were urban based. There is need to decentralize cancer of cervix screening through mobile clinics and establishment of screening centres in the rural areas. Neighbour to neighbour sensitization is essential. Also, HPV vaccine should be available and affordable to all girls before sexual maturity.
Pub.: 06 Feb '17, Pinned: 26 Aug '17
Abstract: Saurabh Bobdey, Jignasa Sathwara, Aanchal Jain, Ganesh Balasubramaniam Indian Journal of Medical and Paediatric Oncology 2016 37(4):278-285 Background: Cervical cancer is a major cause of cancer mortality in women and more than a quarter of its global burden is contributed by developing countries. In India, in spite of alarmingly high figures, there is no nationwide government-sponsored screening program. This study was conducted to assess the burden of cervical cancer in India and review the performance characteristics of available cervical cancer screening tools, so as to provide evidence-based recommendations for application of most practically suited screening test to be used in resource-poor field settings. Materials and Methods: MEDLINE and Web of Science electronic database were searched from January 1990 to December 2015, using the keywords such as “cervical cancer”, “screening”, “early detection”, “cervical cytology” and “visual inspection”, and their corresponding MeSH terms in combination with Boolean operators “OR, AND.” Two authors independently selected studies that are published in English and conducted in India. A total of 11 studies were found to be relevant and eligible to be included in the present study. Results: In India, cervical cancer contributes to approximately 6–29% of all cancers in women. The age-adjusted incidence rate of cervical cancer varies widely among registries; highest is 23.07/100,000 in Mizoram state and the lowest is 4.91/100,000 in Dibrugarh district. The pooled estimates of sensitivity and specificity of visual inspection with acetic acid (VIA), magnified VIA, visual inspection with Lugol's iodine (VILI), cytology (Pap smear), and human papillomavirus DNA were found to be 67.65% and 84.32%, 65.36% and 85.76%, 78.27% and 87.10%, 62.11% and 93.51%, and 77.81% and 91.54%, respectively. Conclusions: In developing countries because of lack of necessary infrastructure and quality control, high-quality cytology screening may not be feasible for wide-scale implementation. Hence, cervical cancer screening program based on visual screening test such as VIA/VILI should be adopted as an integral part of primary health-care setup in resource-poor countries like India.
Pub.: 14 Dec '16, Pinned: 26 Aug '17
Abstract: The main objective of the project was the evaluation of the organizational and financial aspects of midwives in primary health care (PHC), functioning under The Population Program for the Early Detection of Cervical Cancer two years after the implementation of new law regulations, which enable this occupational group to collect cytological material for screening.Under this project, the data of the Program's Coordinating Centre, affecting midwives' postgraduate education in the field of pap smear tests, was taken into analysis. Furthermore, The National Health Fund (NFZ) reports on contracts entered in the field of the discussed topics, taking into consideration the value of health services performed within the Program in respect of ambulatory care and primary care units.NFZ concluded contracts for the provision of PHC service with 6124 service providers in 2016, including the contracts in the field of providing health services under the cervical cancer prevention program by PHC midwifes, which were entered into by 358 institutions (5.85%). The value of the basic services under the Program, carried out under NFZ contracts in 2014, amounted to approx. PLN 12.3 million, while the value of services performed by PHC midwives represented only 0.38% of this sum.The introduction of legislative changes, allowing PHC midwives to collect cytological material for screening, did not cause, in the period of the observation on a national scale, the expected growth of availability of basic stage services within the cervical cancer prevention program.
Pub.: 19 Jan '17, Pinned: 26 Aug '17
Abstract: To report the results of a pilot study for a service for cervical cancer screening and diagnosis in north-western Tanzania.The pilot study was launched in 2012 after a community-level information campaign. Women aged 15-64 years were encouraged to attend the district health centres. Attendees were offered a conventional Pap smear and a visual inspection of the cervix with acetic acid (VIA).The first 2500 women were evaluated. A total of 164 women (detection rate 70.0/1000) were diagnosed with high-grade cervical intraepithelial neoplasia and invasive cervical cancer. The performance of VIA was comparable to that of Pap smear. The district of residence, a history of untreated sexually transmitted disease, an HIV-negative status (inverse association), and parity were independently associated with the detected prevalence of disease. The probability of invasive versus preinvasive disease was lower in HIV-positive women and in women practicing breast self-examination.The diagnostic procedure had an acceptable level of quality. Factors associated with the detected prevalence of disease will allow for a more targeted promotion of the service. Cervical screening should be coordinated with sexually transmitted disease and HIV infection control activities.
Pub.: 21 Apr '17, Pinned: 26 Aug '17
Abstract: Pap smear coverage in Chile has gradually decreased in the last years, from 67% to 59%, making it necessary to determine the causes of this decline.To analyze the relationship between the characteristics of the cervical cancer screening target population in the public health care system and the percentage of PAP coverage.This study was carried out in women aged between 25 and 64 years, belonging to a public health care system and registered in any of the eight primary healthcare centers of a Metropolitan Santiago low income community. The analysis considered information from the recruitment database (n = 6,058) and interviewed women database (n = 1,042).In 52% of cases there were difficulties in recruiting women, mainly due to wrong addresses. Among contacted women, 4.1% had a hysterectomy or had cervical cancer and 1.4% were dead. When analyzing the variable "adherence to cervical cancer screening" in the interviewed women, 76.8% reported to comply with the ministerial guidelines. From that group, 20.5% reported to attend screening at the private health care system. Seventy seven percent of women who had timely screening visits, reported attending screening periodically every 3 years or less.Pap smear coverage must be analyzed considering the different factors that affect it. Among the latter, the exclusion of some women from the target population and performing the screening in private clinics stand out.
Pub.: 11 Apr '17, Pinned: 26 Aug '17
Abstract: Bhutanese-Nepali refugees are one of the largest refugee groups to be resettled in the U.S. in the past decade. Cervical cancer is a leading cause of cancer disparity in this population, yet screening rates are suboptimal. Nepali-speaking interviewers administered a community health needs questionnaire to a convenience sample of Bhutanese-Nepali refugees in a Midwestern city between July to October of 2015. Descriptive statistics were used to describe socio-demographic characteristics, Pap smear beliefs, post-migration living difficulties, and screening status. Differences in Pap test uptake between groups were tested using t test and Chi square statistics. Of the 97 female participants, 44.3% reported ever having had a Pap smear. Screening rates were lowest among women who did not know English at all. Most women had positive perceptions of Pap smears (80%) and 44.4% had received a Pap test recommendation from their healthcare provider, family, or friends. Pap testing was significantly higher among those who had positive perceptions (58.3 vs. 11.1% for women of negative perception, p = 0.01) and those who had received a recommendation (87.5 vs. 18.6% for women who had no recommendations, p < 0.001). Significant predictors of having a Pap smear were having a healthcare provider/family/friends recommendation (OR 65.3, 95% CI 11.4-373.3) and greater number of post-migration living difficulties (OR 1.18, 95% CI 1.02-1.37). The results of this study have important implications for the development of cervical cancer prevention programs targeting Bhutanese-Nepali refugees. Providing cancer prevention interventions early in the resettlement process could impact Pap test uptake in this population.
Pub.: 30 Apr '17, Pinned: 26 Aug '17
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