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Barriers to Cervical Cancer Screening in Rural Kenya: Perspectives from a Provider Survey

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Abstract

Although cervical cancer is highly preventable through screening, it remains the number one cause of cancer-related death in Kenyan women due to lack of funding and infrastructure for prevention programs. In 2012, Family AIDS Care and Education Services in partnership with the Kenya Ministry of Health began offering free screening at eleven rural health facilities. We sought to explore why screening coverage remains low at some sites. We examined the barriers to screening through a survey of 106 healthcare staff. The most frequently cited barriers to service delivery included staffing shortages, lack of trained staff, insufficient space, and supply issues. The patient barriers commonly perceived by the staff included inadequate knowledge, wait time, discomfort with male providers, and fear of pain with the speculum exam. Despite multilateral efforts to implement cervical cancer screening, staff face significant challenges to service provision and increased education is needed for both providers and patients.

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References

  1. Human Papillomavirus and Related Cancers. Summary Report 2010: WHO/ICO Information Center on HPV and Cervical Cancer (HPV Information Centre) 2010.

  2. Jemal, A., Bray, F., Center, M. M., Ferlay, J., Ward, E., & Forman, D. (2011). Global cancer statistics. CA: A Cancer Journal for Clinicians, 61(2), 69–90.

    Google Scholar 

  3. Louie, K. S., de Sanjose, S., & Mayaud, P. (2009). Epidemiology and prevention of human papillomavirus and cervical cancer in Sub-Saharan Africa: A comprehensive review. Tropical Medicine & International Health, 14(10), 1287–1302.

    Article  Google Scholar 

  4. Huchko, M. J., Bukusi, E. A., & Cohen, C. R. (2011). Building capacity for cervical cancer screening in outpatient HIV clinics in the Nyanza province of western Kenya. International Journal of Gynaecology and Obstetrics, 114(2), 106–110.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Mwanahamuntu, M. H., Sahasrabuddhe, V. V., Kapambwe, S., et al. (2011). Advancing cervical cancer prevention initiatives in resource-constrained settings: Insights from the Cervical Cancer Prevention Program in Zambia. PLoS Medicine, 8(5), e1001032.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Were, E., Nyaberi, Z., & Buziba, N. (2010). Integrating cervical cancer and genital tract infection screening into mother, child health and family planning clinics in Eldoret, Kenya. African Health Sciences, 10(1), 58–65.

    CAS  PubMed Central  PubMed  Google Scholar 

  7. African Population and Health Research Center IAfRoC, World Health Organization. Prevention of cervical cancer through screening using visual inspection with acetic acid (VIA) and treatment with cryotherapy: A demonstration project in six African countries: Malawi, Madagascar, Nigeria, Uganda, the United Republic of Tanzania, and Zambia. 2012 (October 30, 2013). Available from: http://www.who.int/reproductivehealth/publications/cancers/9789241503860/en/.

  8. Arbyn, M., Sankaranarayanan, R., Muwonge, R., et al. (2008). Pooled analysis of the accuracy of five cervical cancer screening tests assessed in eleven studies in Africa and India. International Journal of Cancer, 123(1), 153–160.

    Article  CAS  Google Scholar 

  9. Stormo, A. R., Altamirano, V. C., Perez-Castells, M., et al. (2012). Bolivian health providers’ attitudes toward alternative technologies for cervical cancer prevention: A focus on visual inspection with acetic acid and cryotherapy. Journal of Women’s Health, 21(8), 801–808.

    Article  PubMed  Google Scholar 

  10. Kim, Y. M., Ati, A., Kols, A., et al. (2012). Influencing women’s actions on cervical cancer screening and treatment in Karawang District, Indonesia. Asian Pacific Journal of Cancer Prevention, 13(6), 2913–2921.

    Article  PubMed  Google Scholar 

  11. Liese, B. (2004). The state of the health workforce in Sub-Saharan Africa: Evidence of crisis and analysis of contributing factors. Washington, DC: World Bank Africa Region Human Development.

    Google Scholar 

  12. National Coordinating Agency for Population and Development (NCAPD) [Kenya], Ministry of Medical Services (MOMS) [Kenya], Ministry of Public Health and Sanitation (MOPHS) [Kenya], Kenya National Bureau of Statistics (KNBS) [Kenya], ICF Macro. (2011). Kenya Service Provision Assessment Survey 2010. Nairobi, Kenya: National Coordinating Agency for Population and Development, Ministry of Medical Services, Ministry of Public Health and Sanitation, Kenya National Bureau of Statistics, and ICF Macro.

  13. Gatune, J. W., & Nyamongo, I. K. (2005). An ethnographic study of cervical cancer among women in rural Kenya: Is there a folk causal model? International Journal of Gynecological Cancer, 15(6), 1049–1059.

    Article  CAS  PubMed  Google Scholar 

  14. McFarland, D. M. (2003). Cervical cancer and Pap smear screening in Botswana: Knowledge and perceptions. International Nursing Review, 50(3), 167–175.

    Article  CAS  PubMed  Google Scholar 

  15. Nwankwo, K. C., Aniebue, U. U., Aguwa, E. N., Anarado, A. N., & Agunwah, E. (2011). Knowledge attitudes and practices of cervical cancer screening among urban and rural Nigerian women: A call for education and mass screening. European Journal of Cancer Care, 20(3), 362–367.

    Article  CAS  PubMed  Google Scholar 

  16. White, H. L., Mulambia, C., Sinkala, M., Mwanahamuntu, M. H., Parham, G. P., Moneyham, L., et al. (2012). ‘Worse than HIV’ or ‘not as serious as other diseases’? Conceptualization of cervical cancer among newly screened women in Zambia. Social Science and Medicine, 74(10), 1486–1493.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Districts of Kenya [database on the Internet]. Gwillim Law. 2013 [cited 14 April 2013]. Available from: http://www.statoids.com/yke.html.

  18. Open Data Kit. [September 2011]. Available from: http://www.opendatakit.org.

  19. Mutyaba, T., Mmiro, F. A., & Weiderpass, E. (2006). Knowledge, attitudes and practices on cervical cancer screening among the medical workers of Mulago Hospital, Uganda. BMC Medical Education, 6, 13.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Gichangi, P., De Vuyst, H., Estambale, B., Rogo, K., Bwayo, J., & Temmerman, M. (2002). HIV and cervical cancer in Kenya. International Journal of Gynaecology and Obstetrics, 76(1), 55–63.

    Article  CAS  PubMed  Google Scholar 

  21. Lyimo, F. S., & Beran, T. N. (2012). Demographic, knowledge, attitudinal, and accessibility factors associated with uptake of cervical cancer screening among women in a rural district of Tanzania: Three public policy implications. BMC Public Health, 12, 22.

    Article  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

This work was supported by a grant from the Doris Duke Charitable Foundation to the University of California, San Francisco to fund Clinical Research Fellow Joelle Rosser. While working on this project, M.J.H. was supported through a National Institutes of Health career development award (KL2 RR024130-04).

Conflict of interest

The authors do not have any conflicts of interest to report.

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Authors and Affiliations

  1. Department of Internal Medicine, University of Washington, 1959 NE Pacific Street, 356421, Seattle, WA, 98195-6421, USA

    Joelle I. Rosser

  2. Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya

    Sabina Hamisi & Betty Njoroge

  3. Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA, USA

    Megan J. Huchko

Authors
  1. Joelle I. Rosser
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  2. Sabina Hamisi
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  3. Betty Njoroge
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  4. Megan J. Huchko
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Correspondence to Joelle I. Rosser.

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Rosser, J.I., Hamisi, S., Njoroge, B. et al. Barriers to Cervical Cancer Screening in Rural Kenya: Perspectives from a Provider Survey. J Community Health 40, 756–761 (2015). https://doi.org/10.1007/s10900-015-9996-1

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  • DOI: https://doi.org/10.1007/s10900-015-9996-1

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