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. 2022 Sep;56(3):141-151.
doi: 10.4314/gmj.v56i3.3.

Mobile colposcopy by trained nurses in a cervical cancer screening programme at Battor, Ghana

Kofi Effah  1 , Mawusi C Wormenor  1 , Ethel Tekpor  1 , Joseph E Amuah  1   2 , Hayford B Atuguba  1 , Essel N O Mensah  3 , Ewoenam S Badzi  4 , Stephen Danyo  1 , Dominic Agyiri  1 , Gifty B Klutsey  1 , Patrick K Akakpo  5
Affiliations

Mobile colposcopy by trained nurses in a cervical cancer screening programme at Battor, Ghana

Kofi Effah et al. Ghana Med J. 2022 Sep.

Abstract

Objectives: Cervical precancer screening programs are difficult to establish in low resource settings partly because of a lack of human resource. Our aiming was to overcome this challenge. We hypothesized that this could be done through task shifting to trained nurses.

Design: Descriptive retrospective cross-sectional review.

Setting: Training was at the Cervical Cancer Prevention and Training Center (CCPTC) and screening was carried out at the clinic and at outreaches / peripheral facilities.

Participants: All women who reported to the clinic for screening or were recruited during outreaches.

Interventions: All 4 nurses were trained for at least 2weeks (module 1). A total of 904 women were screened by the trained nurses using the EVA system. Quality assurance was ensured.

Main outcome measures: Primary screening and follow-up were carried out by the trained nurses with quality assured through image sharing and meetings with peers and experienced gynaecologists.

Results: 828 women had primary screening and 76 had follow-up screening. 739 (89.3%) were screened at the clinic and 89 (10.7%) at outreaches/peripheral facilities. Of all screened, 130 (14.5%) had cervical lesions, and 25 (2.8%) were treated, 12 (48.0%) by Loop Electrosurgical Excision Procedure (LEEP) performed by a gynaecologist, 11 (44.0%) with thermal coagulation by trained nurses except one, and 2 (8.0%) with cryotherapy by trained nurses.

Conclusion: We demonstrate the utility of a model where nurses trained in basic colposcopy can be used to successfully implement a cervical precancer screening and treatment program in low-resource settings.

Funding: None indicated.

Keywords: Colposcopy; cancer; cervix; enhanced; nurses; screening.

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Conflict of interest statement

Conflict of interest: The authors declare no conflict of interest

Figures

Figure 1
Figure 1
Nurses and midwives being trained to use the mobile colposcope at the CCPTC, Battor
Figure 2
Figure 2
39 years, para 4, careHPV Positive. Colposcopy with EVA system by a nurse: major change - dense aceto-whitening (‘inner border sign’ - ‘lesion within a lesion’), transformation zone type 3. Pap smear: High-grade Squamous Intraepithelial Lesion (HSIL). Treatment by LEEP. Histopathology: CIN 3. a. Before acetic acid. b. After acetic acid. c. After Lugol's iodine
Figure 4
Figure 4
Flow chart of primary screening using mobile colposcopy (EVA) by nurses
Figure 5
Figure 5
Flow chart of follow-up screening using mobile colposcopy (EVA) by nurses.
Figure 3
Figure 3
Quality assurance meeting
Figure 6
Figure 6
Algorithm for cervical cancer screening developed by the CCPTC, Battor.
Figure 7
Figure 7
Algorithm for cervical cancer screening using the mobile colposcope.
Figure 8
Figure 8
Algorithm for cervical cancer screening with the mobile colposcope for known HIV-positive patients.
See this image and copyright information in PMC

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