Can visual cervical screening be sustained in routine health services? Experience from Mali, Africa
- 6 September 2011
- journal article
- research article
- Published by Wiley in BJOG: An International Journal of Obstetrics and Gynaecology
- Vol. 119 (2), 220-226
- https://doi.org/10.1111/j.1471-0528.2011.03122.x
Abstract
Please cite this paper as: Teguete I, Muwonge R, Traore C, Dolo A, Bayo S, Sankaranarayanan R. Can visual cervical screening be sustained in routine health services? Experience from Mali, Africa. BJOG 2012;119:220–226. Objective To assess the feasibility of sustaining visual cervical screening and treatment services in Mali, and to evaluate their performance and impact in improving the provision of cervical cancer control, following an initial cross‐sectional study. Design Descriptive study. Setting Bamako area, Mali. Population Women aged 30–59 years. Methods Routine visual screening and treatment services were organised through two hospitals and 14 health centres. Patients with positive visual screening tests underwent colposcopy and/or directed biopsies, and ablative or surgical excision treatment was offered to those with cervical intraepithelial neoplasia (CIN). Main outcome measures Test positivity, detection and treatment rates for CIN and the sustainability of screening services. Results Of the 14 141 women screened, 1682 (11.9%) were positive and were referred for further investigations and treatment. Over 75% of the screen‐positive women underwent colposcopy and/or biopsy. CIN 1 was detected in 383 women, CIN 2 in 88, CIN 3 in 37 and invasive cervical cancer in 497. More than 80% of women with CIN and 35% of those with invasive cancer received treatment. The test performance characteristics and treatment coverage of routine screening were similar to those observed in the preceding cross‐sectional study. Conclusion Visual screening and treatment services are sustainable and effective in improving cervical cancer control provision by health services in Bamako, Mali. It is essential to organise and sustain several point‐of‐care services in order to extend cervical cancer prevention in low‐income African countries.Keywords
This publication has 15 references indexed in Scilit:
- Efficacy of human papillomavirus-based screen-and-treat for cervical cancer prevention among HIV-infected womenAIDS, 2010
- Human Papillomavirus–Based Cervical Cancer Prevention: Long-term Results of a Randomized Screening TrialJNCI Journal of the National Cancer Institute, 2010
- Reduced acquisition and reactivation of human papillomavirus infections among older women treated with cryotherapy: results from a randomized trial in South AfricaBMC Medicine, 2010
- Cancer survival in Africa, Asia, and Central America: a population-based studyThe Lancet Oncology, 2010
- Performance of colposcopy in five sub-Saharan African countriesBJOG: An International Journal of Obstetrics and Gynaecology, 2009
- Cervical cancer prevention: safety, acceptability, and feasibility of a single-visit approach in Accra, GhanaAmerican Journal of Obstetrics and Gynecology, 2007
- Effectiveness, safety and acceptability of ‘see and treat’ with cryotherapy by nurses in a cervical screening study in IndiaBritish Journal of Cancer, 2007
- Cancer survival in a southern African urban populationInternational Journal of Cancer, 2004
- Accuracy of visual screening for cervical neoplasia: Results from an IARC multicentre study in India and AfricaInternational Journal of Cancer, 2004
- Safety, acceptability, and feasibility of a single-visit approach to cervical-cancer prevention in rural Thailand: a demonstration projectThe Lancet, 2003