eC3--a modern telecommunications matrix for cervical cancer prevention in Zambia

Abstract

Objectives: 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.

Materials and 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.

Figure 1

Ideal image. The entire cervix can be visualized without any shadow and only minimal glare.

Figure 2

Inadequate use of magnification. The zoom feature was not used properly, resulting in too much of the speculum and the vaginal walls being included in the cervigram.

Figure 3

Obstructed view of the cervix. To optimize visualization, the largest available speculum should be used. If the vaginal walls continue to obstruct the view, a vaginal wall retractor should be used. In the absence of a vaginal wall retractor, place a condom with the tip cut off over the speculum before insertion. As the speculum is opened, the condom will help retract the vaginal walls.

Figure 4

Orange coloring that can occur on digital cervigrams when camera batteries are low and need recharging.

Figure 5

Inadequate lighting leading to shadows. This is an inadequate digital cervigram. The entire cervix cannot be visualized, and shadow obstructs the view. A flashlight (torch) or spotlight should be used to increase lighting, or the floor lamp should be readjusted.