Background Cervical cancer is the most common female cancer in Malawi with high mortality. Cervical cancer can be averted if pre-cancerous lesions are detected early and treated. Visual Inspection with Acetic Acid (VIA) is an effective screening method for resource-limited settings. In an STI Clinic in Lilongwe, Malawi, VIA screening implementation was assessed through the NIH-funded Medical Education Partnership Initiative. In this setting, 20% of women have reactive VIA results.
Methods Females attending the Kamuzu Central Hospital STI Clinic from October 2012 to January 2013 were included. Screening was recommended for women 25–45 years and women < 25 years at clinician discretion. We explored the proportion of women who were screened, characterised write-in reasons for non-screening, and conducted binomial regression to explore screening predictors.
Results During this 3.5 month period, 956 women presented for 1240 STI clinic visits. Four percent of women < 25 and 19% of women 25–45 received VIA screening. Among women 25–45, common reasons for not screening included postponement (19%) (often due to STI treatment or cervical pain), recent screening (14%), menses (8%), and pregnancy (3%). Few refused (3%). Many did not have reasons recorded (44%). Screening was less common among women presenting through partner-referral (0.3; CI 0.1, 1.1) and among women who did not receive pelvic exams as part of STI assessment (0.6, CI: 0.3, 0.9).
Conclusions In this high risk setting, VIA implementation was feasible and acceptable. On the day of presentation, many women were not screened due to cervical pain, STI treatment, menses, or pregnancy. Ensuring that these women return for screening is important. Offering VIA to all women is essential, even those not otherwise receiving a pelvic exam. Clear guidelines on whether and when to screen women < 25 years are needed. Such measures will help detect precancerous lesions and avert cervical cancer.
- cervical cancer
- Visual Inspection with Acetic Acid
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