Performance of colposcopy in five sub-Saharan African countries.
OBJECTIVE
The performance of colposcopy provided in a screening study in five African countries was evaluated.


METHODS
Cross-sectional study.


METHODS
Burkina Faso, Congo Brazzaville, Guinea Conakry, Mali and Niger.


METHODS
Women aged 25-59 years.


METHODS
A total of 29 294 women participated in a cervical screening study in the five study sites, and newly trained local doctors performed colposcopy and directed biopsies as indicated. Using meta-analytical tools, four measures of colposcopy performance at different thresholds of colposcopic abnormalities were assessed. Sources of heterogeneity were also assessed.


METHODS
Proportions of women receiving biopsies, adequate biopsies and women diagnosed with cervical intraepithelial neoplasia (CIN).


RESULTS
Among 28 553 women with satisfactory colposcopy, 3101 had a colposcopic diagnosis of probable low-grade or worse lesions and 1128 probable high-grade or worse lesions. Overall, the measures that reached the set standards were proportion of biopsy taken at colposcopy threshold of probable high-grade or worse lesions (95%, 95% CI 90-100%) and proportion of adequate biopsy samples. The set standards were not met for the proportions of women diagnosed with CIN at different colposcopic abnormality thresholds. Detection of CIN2 or worse lesions increased with increasing colposcopic abnormality.


CONCLUSIONS
The performance of colposcopy in some of the African sites studied was comparable to that previously observed in other studies. With appropriate training, monitoring, continuing practice and quality assurance, adequate standards of colposcopy can be attained in sub-Saharan Africa.
Muwonge
R
R
Screening Group, Pathogenesis and Prevention Cluster (PPC), International Agency for Research on Cancer, Lyon, France.
Mbalawa
C G
CG
Keita
N
N
Dolo
A
A
Nouhou
H
H
Nacoulma
M
M
Malanda
J N
JN
Koulibaly
M
M
Bayo
S
S
Sankaranarayanan
R
R
D000328:Adult; D017954:Africa South of the Sahara; D001706:Biopsy / Q000706:statistics & numerical data; D002983:Clinical Competence; D003127:Colposcopy / Q000592:standards*; D003906:Developing Countries; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D015588:Observer Variation; D011786:Quality Control; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology