eC3--a modern telecommunications matrix for cervical cancer prevention in Zambia.
OBJECTIVE
Low physician density, undercapacitated laboratory infrastructures, and limited resources are major limitations to the development and implementation of widely accessible cervical cancer prevention programs in sub-Saharan Africa.


METHODS
We developed a system operated by nonphysician health providers that used widely available and affordable communication technology to create locally adaptable and sustainable public sector cervical cancer prevention program in Zambia, one of the world's poorest countries.


RESULTS
Nurses were trained to perform visual inspection with acetic acid aided by digital cervicography using predefined criteria. Electronic digital images (cervigrams) were reviewed with patients, and distance consultation was sought as necessary. Same-visit cryotherapy or referral for further evaluation by a gynecologist was offered. The Zambian system of "electronic cervical cancer control" bypasses many of the historic barriers to the delivery of preventive health care to women in low-resource environments while facilitating monitoring, evaluation, and continued education of primary health care providers, patient education, and medical records documentation.


CONCLUSIONS
The electronic cervical cancer control system uses appropriate technology to bridge the gap between screening and diagnosis, thereby facilitating the conduct of "screen-and-treat" programs. The inherent flexibility of the system lends itself to the integration with future infrastructures using rapid molecular human papillomavirus-based screening approaches and wireless telemedicine communications.
Parham
Groesbeck P
GP
Center for Infectious Disease Research in Zambia, Lusaka, Zambia. groesbeck.parham@cidrz.org
Mwanahamuntu
Mulindi H
MH
Pfaendler
Krista S
KS
Sahasrabuddhe
Vikrant V
VV
Myung
Daniel
D
Mkumba
Gracilia
G
Kapambwe
Sharon
S
Mwanza
Bianca
B
Chibwesha
Carla
C
Hicks
Michael L
ML
Stringer
Jeffrey S A
JS
D002584:Cervix Uteri / Q000473:pathology; D003906:Developing Countries; D055088:Early Detection of Cancer / Q000379:methods*; D004493:Education; D005260:Female; D006801:Humans; D009726:Nurses; D010781:Photography / Q000379:methods; D017216:Telemedicine / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control*; D015024:Zambia