DEVELOPING CAPACITY OF PRIMARY HEALTH CENTRES IN SCREENING, EARLY DIAGNOSIS AND APPROPRIATE REFERRAL OF CERVICAL CANCER IN A LOW-RESOURCE SETTING: A PILOT INTERVENTIONAL STUDY
2 Department of Obstetrics and Gynecology, Ahmadu Bello University Teaching, Hospital, Zaria, Kaduna State, Nigeria
3 Department of Obstetrics and Gynecology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
4 Department of Radiation and Clinical Oncology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
5 Department of Oncology/ Department of Nursing Sciences, Federal Medical Centre Gusau, Zamfara State
6 Department of Obstetrics and Gynaecology, Federal Medical Centre, Gusau, Zamfara State, Nigeria
7 Department of Community Medicine, College of Medical Sciences, Ahmadu Bello University, Zaria, Kaduna State
8 Department of Radiotherapy and Oncology, Federal Medical Centre, Abuja, FCT, Nigeria
* Corresponding author: shehuumar125@gmail.com
Abstract
Background: Despite cervical cancer being preventable and treatable if detected early, it is predominantly characterised by late presentation with advanced disease in low-resource settings. This is due to a poor level of awareness of cervical cancer in the population. The Primary Health Centres (PHCs), which constitute 85.4% of all registered health facilities in Nigeria, serve as the first level of care for most patients, especially in low-resource settings. They represent potential for delivering effective interventions for cervical cancer prevention and control, if their capacities are to conduct community campaigns, health education, screening and early detection of symptoms.
Objective: The study aimed to develop the capacity of PHCs towards primary cervical cancer care through baseline assesments, training and monitoring of activities.
Methods: This study was a mixed-method study consisting of a cross-sectional and quasi-experimental design. The pre-interventional phase involved assessing knowledge of risk factors, symptoms and screening of cervical cancer by health care workers (HCWs) and patients in eight PHCs within Gusau metropolis. The intervention involved training 18 selected HCWs on cervical cancer risk factors, symptoms, treatment, screening and appropriate referral from four selected PHCs, for six consecutive weeks; while leaving the other four PHCs as controls without any training. The post intervention phase involved assessing knowledge of risk factors, symptoms, and screening for cervical cancer among the previously identified HCWs in the 8 PHCs. Furthermore, the 8 PHCs were followed up on activities for primary cervical cancer care at the end of the 6th and 13th week post-training.
Results: At baseline, there was poor knowledge of cervical cancer among the 210 patients surveyed attending PHCs. With only 30(14.3%), 4(1.9%) and 15(7.1%) of them having good knowledge of symptoms, risk factors and screening for cervical cancer. Following training of HCWs, there was significant improvement in knowledge of symptoms (p= 0.00078), risk factors (p < 0.0001), and screening (p < 0.0001) for cervical cancer, among the HCWs compared to their pre-training levels. Furthermore, there were regular health education, identification of suspected cervical cancer cases or referrals from the PHCs in the intervention group within a follow-up period of 3 months post intervention, and none of these were found in the PHCs in the control group.
Conclusion: This pilot study shows promising tendencies that developing the capacity of PHCs towards cervical cancer primary care could be an effective strategy towards cervical cancer prevention and control in low-resource settings.
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