Leveraging primary healthcare workers in under-resourced rural communities to reach the unreached in cervical cancer screening

Abstract

Background: Low- and middle-income countries have a higher burden of cervical cancer but low implementation of preventive programs. Cheap and effective screening services are often limited to tertiary hospitals where requisite manpower exists. This study investigated the adaptability of traditional screening methods among female primary healthcare workers (PHCW) in a northeastern Nigeria rural setting.

Method: Eighteen female PHCW from six health centers (HC) in Azare, Bauchi state Nigeria, were trained on cervical cancer screening, emphasizing the risk factors for cervical cancer, methods of prevention, and hands-on skill on pap smear sampling technique. Eighteen-item pre- and post-training questionnaires scored 1 for correct and 0 for wrong responses, were administered to determine the training’s impact on their knowledge about cervical cancer. Papanicolaou-stained slides of smears made by the participants were examined by a pathologist for adequacy and satisfactoriness. Derived data was analyzed using summary, paired t-test, and chi-square statistics.

Results: The participants were comprised of 11 community health extension workers (CHEWs), 2 nurses, and 5 midwives. The majority (11/18; 61.1%) had good knowledge about cervical cancer pre-test, being able to correctly identify HPV as a cause, sexual intercourse, and HIV infection as risk factors, vaginal discharge and bleeding as symptoms, and pap smear as an effective screening method. Post-training, 88.9% (16/18) showed good knowledge, the mean score improving from 12.2 ± 1.2 pre-tests to 13.6 ± 1.4 (p = 0.011). Overall, the level of knowledge was independent of the professional cadre (p = 0.784). Smear performance was adequate and satisfactory in 26/30 (86.7%) smears, and 4 (13.3%) smears requiring repeat sampling.

Conclusion: This study shows that trained PHCWs (including CHEWs) in under-resourced communities can bridge the care gap in cervical cancer screening through cervical smear sampling and sending them to the nearest cyto-screening center for interpretation, giving every woman a chance to be free of cervical cancer.