An evaluation of the cervical screening programme in Johannesburg Metro District, Gauteng Province
Year: 2011
Type: dissertation
Abstract: INTRODUCTION: Cervical cancer continues to be a significant cause of morbidity \nand mortality, particularly in women in the developing world, due to the lack of \neffective population screening. It has proven difficult to implement and sustain \ncytological screening programmes as health systems in these settings are not \nfunctional. South Africa has adopted an organised cervical screening programme, and \nthe goal is to screen 70% of women over 30 years nationally, within ten years of \ninitiating the programme. However, it is also necessary to ensure that women with \nabnormal Pap smears are treated if we are to reduce cervical cancer incidence. \nEnsuring treatment of abnormal Pap smears is a challenge, and current data on this is \nneeded to inform service delivery. \nAIM: The study aims to assess the current status of the cervical screening programme \nin the Johannesburg Metro District, specifically looking at screening coverage, and \nreferral for treatment in women with abnormal Pap smears. \nMETHODOLOGY: Secondary analysis of data in the District Health Information \nSystem was done; and registers at a sample of primary health care clinics and their \nreferral colposcopy services were evaluated for the period April 2007 – March 2008. \nDescriptive statistics were employed to analyse the data. Multivariate analysis was \nalso done to evaluate factors associated with colposcopy attendance. \nvi \nRESULTS: Screening coverage for the district was 6.3% for 2008 and the cumulative \ncoverage from 2000 to 2008 was 35.8%, with significant variation between subdistricts. \nA high proportion (19%) of smears was done in women less than 30 years. \nOf 557 women with abnormal Pap smears requiring further treatment, 57% were \ninformed of their results and referred, 38% had appointments for colposcopy, and \nonly 28% attended these appointments. Women experienced long waiting times for \nappointments (up to 15 months), and there was inadequate record keeping and client \ntracing. HIV status and the sub-district and health authority where women were \nscreened were associated with colposcopy attendance; the referral hospital was \nassociated with length of waiting time between Pap smear and colposcopy. \nCONCLUSION: Cervical screening coverage is below target, and the referral for \ndiagnosis and treatment remains a challenge. Unless referral and access to \ncolposcopy services is improved, increasing screening coverage will not have an \nimpact on decreasing cervical cancer incidence and mortality. It is hoped that this \nstudy will provide the data to target interventions to improve cervical screening \ncoverage and effective referral and treatment in the district.
Author: Waasila Jassat
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2163489096