Implementing visual cervical cancer screening in Senegal: a cross-sectional study of risk factors and prevalence highlighting service utilization barriers.
BACKGROUND
Senegal ranks 15th in the world in incidence of cervical cancer, the number one cause of cancer mortality among women in this country. The estimated participation rate for cervical cancer screening throughout Senegal is very low (6.9% of women 18-69 years old), especially in rural areas and among older age groups (only 1.9% of women above the age of 40 years). There are no reliable estimates of the prevalence of cervical dysplasia or risk factors for cervical dysplasia specific to rural Senegal. The goals of this study were to estimate the prevalence of cervical dysplasia in a rural region using visual inspection of the cervix with acetic acid (VIA) and to assess risk factors for cervical cancer control.


METHODS
We conducted a cross-sectional study in which we randomly selected 38 villages across the Kédougou region using a three-stage clustering process. Between October 2013 and March 2014, we collected VIA screening results for women aged 30-50 years and cervical cancer risk factors linked to the screening result.


RESULTS
We screened 509 women; 5.6% of the estimated target population (9,041) in the region. The point prevalence of cervical dysplasia (positive VIA test) was 2.10% (95% confidence interval [CI]: 0.99-3.21). Moreover, 287 women completed the cervical cancer risk factor survey (56.4% response rate) and only 38% stated awareness of cervical cancer; 75.9% of the screened women were less than 40 years of age.


CONCLUSIONS
The overall prevalence of dysplasia in this sample was lower than anticipated. Despite both overall awareness and screening uptake being less than expected, our study highlights the need to address challenges in future prevalence estimates. Principally, we identified that the highest-risk women are the ones least likely to seek screening services, thus illustrating a need to fully understand demand-side barriers to accessing health services in this population. Targeted efforts to educate and motivate older women to seek screenings are needed to sustain an effective cervical cancer screening program.
Department of Family Medicine, College of Medicine; Center for Global Health; Institute for Health Research and Policy; Cancer Center, Hospital and Health Sciences System, University of Illinois at Chicago, IL, USA.
J Andrew
JA
Dykens
Master's International Graduate School Program, Peace Corps, Dakar, Senegal; Rutgers School of Nursing, Newark, NJ.
Annē M
AM
Linn
Department of Obstetrics and Gynecology.
Tracy
T
Irwin
School of Public Health, University of Illinois at Chicago, IL, USA.
Karen E
KE
Peters
School of Public Health, University of Illinois at Chicago, IL, USA.
Maria
M
Pyra
Regional Ministry of Health and Social Affairs, Kédougou, Senegal.
Fatoumata
F
Traoré
Regional Ministry of Health and Social Affairs, Kédougou, Senegal.
Mariama
M
Touré Diarra
Department of Family Medicine, College of Medicine; Foundation for Advancement of International Medical Education and Research, Philadelphia, PA, USA.
Memoona
M
Hasnain
Peace Corps, Dakar.
Katie
K
Wallner
Peace Corps, Dakar.
Patrick
P
Linn
Regional Ministry of Health and Social Affairs, Sédhiou, Senegal.
Youssoupha
Y
Ndiaye
cervical cancer screening; global health; gynecologic cancer; implementation; risk factors; visual inspection of the cervix with acetic acid