Evaluation of utilisation of health workers for secondary prevention of oral cancer in Kerala, India.
The utilisation of primary health workers (HWs) for cancer control in developing countries has often been suggested, based on the experience of feasibility studies in India and Sri Lanka. We initiated a project in 1988 to evaluate the long-term feasibility of using trained HWs in secondary prevention of oral cancer, to bring about earlier detection of oral cancer in the communities served by them. Two hundred and eighty-two HWs attached to 14 primary health centres (PHCs), serving approximately 0.92 million rural population in the northern half of Trivandrum district in Kerala, India, were trained in oral visual inspection to detect precancerous, malignant and other suspicious lesions of the oral cavity and refer them for confirmation and treatment. They were asked to examine subjects aged 35 years and above and to give person to person health education on tobacco in their target population. The HWs belonging to the PHCs serving approximately 1 million rural population in the southern half of Trivandrum district were not trained, and this region served as the control area. In addition to several process measures, stage distribution of oral cancer in subjects reporting from the intervention and control areas, as well as oral cancers referred by the HWs, as a proportion of total oral cancers from the intervention area, were the outcome measures evaluated. Only 9/282 (3.2%) trained HWs were motivated and they examined 17,812 eligible subjects in 3 years and referred 408 subjects with lesions; 258/408 (63.2%) referred subjects reported for further examination and ten oral cancers were detected among them.(ABSTRACT TRUNCATED AT 250 WORDS)
Mathew
B
B
Regional Cancer Center (RCC), Trivandrum, India.
Sankaranarayanan
R
R
Wesley
R
R
Joseph
A
A
Nair
M K
MK
D000328:Adult; D000368:Aged; D000488:Allied Health Personnel; D003906:Developing Countries; D006266:Health Education; D006282:Health Personnel; D006801:Humans; D007194:India; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology / Q000517:prevention & control*; D009367:Neoplasm Staging; D015397:Program Evaluation; D012423:Rural Health; D000074606:Smoking Prevention