Journal of Cancer Education

, Volume 34, Issue 1, pp 124–129 | Cite as

Needs for Professional Education to Optimize Cervical Cancer Screenings in Low-Income Countries: a Case Study from Tanzania

  • Anne E. Lavelle
  • Dejun Su
  • Crispin Kahesa
  • Amr S. SolimanEmail author


Cervical cancer is a significant health problem in many developing countries. Due to limited treatment facilities for cancer in Tanzania, a screening referral program was developed between two urban clinics and Ocean Road Cancer Institute (ORCI), the only cancer treatment center in Tanzania. This study aimed to evaluate the effectiveness of the program and to identify opportunities for professional education. The study included 139 patients who were referred to ORCI from the screening clinics of Magomeni and Temeke between January 2015 and May 2016. Abstracted data from the medical records included patient age, screening results, and treatment. Eight nurses performing screening at the three locations were interviewed about their screening experience. Over half of the referrals (51.9%) were false positives. False positive diagnosis was more common among younger patients (35.68 ± 8.6 years) (p < 0.001) and those referred from Magomeni (59.8%) (p < 0.01) than referrals of older patients (42.46 ± 11.1 years) or those from Temeke (33.3%). Interviews of nurses showed differences among clinics, including resources, experience, and documentation of screening results. The high false positive rates and the variation of accuracy of screening between the two clinics showed a need for professional education of nurses and improvement in the health systems. Continuous education of nurses may increase the effectiveness of cervical screening. Health system enhancement of screening facilities such as provision of Lugol’s iodine, more space for screening, and consistency and completion of screening records are needed to increase the accuracy of cervical screening and referrals in Tanzania and other similar low-income countries.


Cervical cancer Professional education Screening Developing countries 



Anne Lavelle was funded by the Cancer Epidemiology Education in Special Populations (CEESP) Program of the National Cancer Institute, Grant R25 CA112383. We would like to acknowledge the nurses at each clinic for providing a wealth of information that made this project possible—Sr. Jesca, Happy, Beatrice, Rehema, Sr. Francisca, Rose, Sr. Raya, and Hadija.


  1. 1.
    National Institute of Health (2013) Cervical cancer. U.S. Department of Health and Human Services. Accessed 14 March 2017
  2. 2.
    Centers for Disease Control and Prevention (2014) Fighting cervical cancer worldwide. Accessed 14 March 2017
  3. 3.
    World Cancer Research Fund International (2014). Cervical cancer statistics. Accessed 22 February 2017
  4. 4.
    Sauvaget C, Fayette J, Muwonge R, Wesley R, Sankaranarayanan R (2011) Accuracy of visual inspection with acetic acid for cervical cancer screening. Int J Gynecol Obstet 113(1):14–24. CrossRefGoogle Scholar
  5. 5.
    Peters LM, Soliman AS, Bukori P, Mkuchu J, Ngoma T (2010) Evidence for the need of educational programs for cervical screening in rural Tanzania. J Cancer Educ 25(2):153–159. CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Carr KC, Sellors JW (2004) Cervical cancer screening in low resource settings using visual inspection with acetic acid. J Midwifery and Women’s Health 49(4):329–337. doi: CrossRefGoogle Scholar
  7. 7.
    Gard AC, Soliman AS, Ngoma T, Mwaiselage J, Kahesa C, Chamberlain RM, Harlow SD (2014) Most women diagnosed with cervical cancer by a visual screening program in Tanzania completed treatment: evidence from a retrospective cohort study. BMC Public Health 14:910. CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Ocean Road Cancer Institute (2015) Ocean Road Cancer Institute. Accessed 30 March 2017
  9. 9.
    Ocean Road Cancer Institute (2012) Cervical cancer training manual. In: Sankaranarayanan R, Wesley RS (eds) (2003). Adapted from: A practical manual on visual screening for cervical neoplasia. IARC Technical Publication No. 41. Tanzania: Dar es SalaamGoogle Scholar
  10. 10.
    Ministry of Health and Social Welfare [United Repulic of Tanzania] (2011) Tanzania service delivery guidelines for cervical cancer prevention and control. Tanzania: Dar es Salaam, pp 1–78Google Scholar
  11. 11.
    National Bureau of Statistics and Regional Commissioner’s Office (2014). Dar es Salaam region socio-economic profile. The United Republic of Tanzania Prime Minister’s Office Regional Administration and Local Government. Accessed 30 March 2017
  12. 12.
    Lafata JE, Simpkins J, Lamerato L, Poisson L, Divine G, Johnson CC (2004) The economic impact of false-positive cancer screens. Cancer Epidemiol Biomark Prev 13(12):2126–2132Google Scholar
  13. 13.
    Lerman C, Miller SM, Scarborough R, Parviz H, Nolte S, Smith D (1991) Adverse psychological consequences of positive cytologic cervical screening. Am J Obstet Gynecol 165(3):658–662. CrossRefPubMedGoogle Scholar
  14. 14.
    Saleh HS (2014) Can visual inspection with acetic acid be used as an alternative to pap smear in screening cervical cancer? Middle East Fertil Soc J 19(3):187–191. CrossRefGoogle Scholar
  15. 15.
    Davis-Dao CA, Cremer M, Felix J, Cortessis VK (2008) Effect of cervicitis on visual inspection with acetic acid. J Low Genit Tract Dis 12(4):282–286. CrossRefPubMedGoogle Scholar
  16. 16.
    Parashari A, Singh V (2013) Reasons for variation in sensitivity and specificity of visual inspection with acetic acid (VIA) for the detection of pre-cancer and cancer lesions of uterine cervix. Asian Pac J Cancer Prev 14(12):7761–7762. CrossRefPubMedGoogle Scholar
  17. 17.
    Chung MH, McKenzie KP, De Vuyst H, Richardson BA, Rana F, Pamnani R et al (2013) Comparing papanicolau smear, visual inspection with acetic acid and human papillomavirus cervical cancer screening methods among HIV-positive women by immune status and antiretroviral therapy. AIDS 27(18):2909–2919. CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Isaac RC, Ramamurthy P, Finkel M, Kunjuvareed AI, Trevena L (2014) An educational training on cervical cancer screening program for rural healthcare providers in India. Indian J Community Health 26(1):115–118Google Scholar

Copyright information

© American Association for Cancer Education 2017

Authors and Affiliations

  1. 1.Department of Health Promotion, Social and Behavioral HealthUniversity of Nebraska Medical CenterOmahaUSA
  2. 2.Ocean Road Cancer InstituteDar es SalaamTanzania
  3. 3.Department of EpidemiologyUniversity of Nebraska Medical CenterOmahaUSA

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