title: Ethical issues evolving from patients' perspectives on compulsory screening for syphilis and voluntary screening for cervical cancer in Kenya.
abstract: BACKGROUND
  Public health aims to provide universal safety and progressive opportunities to populations to realise their highest level of health through prevention of disease, its progression or transmission. Screening asymptomatic individuals to detect early unapparent conditions is an important public health intervention strategy. It may be designed to be compulsory or voluntary depending on the epidemiological characteristics of the disease. Integrated screening, including for both syphilis and cancer of the cervix, is a core component of the national reproductive health program in Kenya. Screening for syphilis is compulsory while it is voluntary for cervical cancer. Participants' perspectives of either form of screening approach provide the necessary contextual information that clarifies mundane community concerns.
  
  
  METHODS
  Focus group discussions with female clients screened for syphilis and cancer of the cervix were conducted to elicit their perspectives of compulsory and voluntary screening. The discussions were audiotaped, transcribed and thematic content analysis performed manually to explore emerging ethics issues.
  
  
  RESULTS
  The results indicate that real ethical challenges exist in either of the approaches. Also, participants were more concerned about the benefits of the procedure and whether their dignity is respected than the compulsoriness of screening per se. The implication is for the policy makers to clarify in the guidelines how to manage ethical challenges, while at the operational level, providers need to be judicious to minimize potential harms participants and families when screening for disease in women.
  
  
  CONCLUSIONS
  The context for mounting screening as a public health intervention and attendant ethical issues may be more complex than hitherto perceived. Interpreting emerging ethics issues in screening requires more nuanced considerations of individuals' contextual experiences since these may be contradictory to the policy position. In considering mounting screening for Syphilis and cervical cancer as a public heal intervention, the community interests and perspectives should be inculcated into the program. Population lack of information on procedures may influence adversely the demand for screening services by the individuals at risk or the community as a collective agent.
authors.affiliation: School of Public Health, Maseno University, Maseno, Kenya. omondisda@yahoo.com.
authors.forename: Dickens S
authors.initials: DS
authors.lastname: Omondi Aduda
authors.forename: Nhlanhla
authors.initials: N
authors.lastname: Mkhize
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D003142:Communication; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006301:Health Services Needs and Demand; D006801:Humans; D007258:Informed Consent; D007630:Kenya / Q000453:epidemiology; D008403:Mass Screening / Q000458:organization & administration; D008875:Middle Aged; D011369:Professional-Patient Relations; D011634:Public Health; D036301:Qualitative Research; D034121:Reproductive Health Services / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D013587:Syphilis / Q000175:diagnosis* / Q000517:prevention & control; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control