Academic journal article Bulletin of the World Health Organization

Situation Analysis for Cervical Cancer Diagnosis and Treatment in East, Central and Southern African Countries

Academic journal article Bulletin of the World Health Organization

Situation Analysis for Cervical Cancer Diagnosis and Treatment in East, Central and Southern African Countries

Article excerpt

Voir page 131 le resume en francais. En la pagina 132 figura un resumen en espanol.

Introduction

Cancer of the cervix is having a devastating impact on women's health around the world, especially in developing countries, where it is the most common cancer and the leading cause of death from cancer in women. It is estimated that 500 000 new cases occur every year worldwide, the majority (80%) being in the developing world (1).

Although cervical cancer is a preventable disease, it still remains a major burden on public health resources in sub-Saharan Africa. Countries in this region have some of the world's highest age-standardized death rates from cervical invasive cancer, e.g. 67 per 100 000 people in Harare, Zimbabwe (2) and 40.8 per 100 000 in Kampala, Uganda in 1997 (3). Data from hospital-based registers in Nairobi, Kenya have indicated that cancer of the cervix accounted for 70-80% of all cancers of the genital tract and 8-20% of all cancer cases for the period 1981-90. It has been reported that there are 10-15 new cases of cervical cancer in Nairobi, Kenya each week (4). These findings are similar to data from Zimbabwe where cancer of the cervix accounted for 30% of all registered cancers and 80% of gynaecological cancers in the entire country in 1995 (2).

The effectiveness of cervical cancer screening by exfoliative cytology was demonstrated in the Scandinavian countries, where a substantial fall in incidence of cervical cancer occurred 5-10 years after the introduction of screening programmes (5). The Canadian Cancer Institute has also shown that there was a threefold reduction in the age-standardized death rate from invasive cervical cancer between 1969 and 1990, thanks to the national screening programme (6).

Accurate data on the magnitude of morbidity and mortality from cervical cancer in the countries of East, Central and Southern Africa (ECSA) are scanty and usually hospital based. Cancer registration in most of the low-resource countries is difficult because of inadequate sources of information within the health delivery system, and lack of reliable population data for estimating accurate incidence rates. To facilitate the proper planning of services for the prevention, early diagnosis and treatment of cervical cancer in the ECSA countries, a situation analysis was carried out. The objective of the study was to establish which factors influence cervical cancer diagnosis and treatment in the ECSA region.

Materials and methods

A multicentre cross-sectional study was carried out in Kenya, Lesotho, Uganda, United Republic of Tanzania, and Zimbabwe between 1 May and 31 December 1997. For each participating country, data were collected from tertiary hospitals, provincial hospitals, district hospitals, and primary health care (PHC) centres selected at random by computer.

Definitions of health care facilities in ECSA countries

Primary health care (PHC) centres are the basic operational facilities in the health care delivery system, focusing mainly on disease prevention and health promotion. Each centre usually serves a catchment area of 10 000 people living within a radius of 8-10 km from the centre. In this study, dispensaries, health centres, maternity homes and clinics were classified as PHC centres. District hospitals usually have surgical facilities, are headed by a medical officer and are the first referral unit for the PHC centres in the district. Provincial hospitals have specialists such as gynaecologists and general surgeons, and are referral centres for patients from the district hospitals in the province. Tertiary hospitals provide highly specialized care and usually have subspecialities in various disciplines (e.g. renal medicine, cardiology, and gynaecological oncology).

Data collection

Interviews were conducted at each level of health care facility, and were carried out by pre-trained health workers, using a questionnaire. …

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