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. 2016 Oct 19;3(4):849-862.
doi: 10.3934/publichealth.2016.4.849. eCollection 2016.

Choropleth Mapping of Cervical Cancer Screening in South Africa Using Healthcare Facility-level Data from the National Laboratory Network

Caroline B T Makura  1 , Kathryn Schnippel  1   2 , Pamela Michelow  3   4 , Carla J Chibwesha  1   5 , Bridgette Goeieman  1 , Suzette Jordaan  4 , Cynthia Firnhaber  1   2
Affiliations

Choropleth Mapping of Cervical Cancer Screening in South Africa Using Healthcare Facility-level Data from the National Laboratory Network

Caroline B T Makura et al. AIMS Public Health. .

Abstract

Background: In South Africa, cervical cancer remains among the most common cancers and a leading cause of cancer death. Co-infection with HIV increases the risk of developing cervical pre-cancer and cancer. We analysed National Health Laboratory Service cervical cytology data to investigate geographic variations of Pap smear coverage, quality, and high grade lesions.

Methods: Facility-level data were extracted from the NHLS for April 2013-March 2014. We present results and choropleth maps detailing coverage, adequacy and high-grade Pap smear cytology abnormalities defined as Pap smears suspicious for invasive carcinoma, high-grade squamous intraepithelial lesions (HSIL) or atypical squamous cells: cannot exclude HSIL (ASC-H).

Results: 4,562 facilities submitted 791,067 cytology slides. The interquartile range (IQR) for Pap smear coverage among HIV-infected women was 26-41%; similar to coverage in women aged 30 and older (IQR: 26-42%). 6/52 districts had adequacy rates above the national standard (70%) and 2/52 districts had adequacy rates below 35%. We observed marked variation in Pap smear abnormalities across the country, with the proportion of high-grade cytology abnormalities ≥0.3% in 17/52 districts.

Conclusion: Using district-level choropleth maps, we are able to display variations in Pap smear coverage, quality, and results across South Africa. This approach may be used to improve resource allocation, achieving better equity in cervical cancer prevention.

Keywords: High grade squamous intraepithelial lesion (HSIL); Pap smear; South Africa; cervical cancer screening; choropleth map.

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Conflict of interest statement

Conflict of Interest: The authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.. Pap smear coverage: In women aged 30 years and older.
Figure 2.
Figure 2.. Pap smear coverage: HIV-infected women as a proportion of women aged 25 years and older.
Figure 3.
Figure 3.. Pap smear adequacy: All women.
Figure 4.
Figure 4.. High-grade cytology abnormalities: All women as a proportion of women aged 25 years and older.
See this image and copyright information in PMC

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