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. 2023 Sep 1;23(1):1688.
doi: 10.1186/s12889-023-16539-1.

Cervical cancer screening outcomes in public health facilities in three states in Nigeria

Olufunmilayo Lawson  1 , Lola Ameyan  2 , Zainab Tukur  2 , Sophia Dunu  2 , Matilda Kerry  2 , Oluwapelumi Ololade Okuyemi  2 , Zainab Yusuf  2 , Olufunke Fasawe  2 , Owens Wiwa  2 , Katharine Schilling Hebert  3 , Jessica Trenc Joseph  3 , Uchechukwu Emmanuel Nwokwu  4 , Okpikpi Okpako  4 , Christopher Ifeanyi Chime  5
Affiliations

Cervical cancer screening outcomes in public health facilities in three states in Nigeria

Olufunmilayo Lawson et al. BMC Public Health. .

Abstract

Background: Cervical cancer continues to generate a significant burden of disease and death in low- and middle-income countries (LMICs). Lack of awareness and poor access to early screening and pre-cancer treatment contribute to the high mortality. We describe here cervical cancer screening outcomes in public health facilities in three states in Nigeria.

Methods: We conducted an observational study in 177 government health facilities in Lagos, Kaduna, and Rivers State, Nigeria from January to December 2021, in which we reviewed programmatic data collected through the newly introduced Cervical Cancer Prevention Program. Women who received screening and provided consent were enrolled into the study. Data were extracted from registers in the health facilities using SurveyCTO and descriptive statistical analysis was conducted using StataSE 15 (StataCorp, College Station, TX, USA).

Results: Eighty-three thousand, five hundred ninety-three women were included in the analysis including 6,043 (7%) WLHIV. 67,371 (81%) received VIA as their primary screening while 16,173 (19%) received HPV DNA testing, with 49 (< 1%) receiving both at the same time. VIA positivity was 7% for WLHIV and 3% for general population, while HPV prevalence was 16% for WLHIV and 8% for general population. Following a positive HPV result, 21% of women referred, completed triage examination. 96% of women identified with precancerous lesions, received treatment. 44% of women with suspected cancer were successfully referred to an oncology center for advanced treatment. Following treatment with thermal ablation, seven adverse events were reported.

Conclusions: The Program has successfully increased women's access to screening and treatment of precancerous lesions. Almost all women who were eligible for pre-cancerous lesion treatment received it, often on the same day when screened using VIA. However, for women referred for a triage exam or due to suspected cancer, many did not complete their referral visits. More effort is required to ensure HPV positive women and women with suspected cancer are adequately linked to care to further reduce morbidity and mortality associated with cervical cancer in Nigeria. Implementation studies should be conducted to provide insights to improve the utilization of the existing centralized and point of care (POC) platforms to facilitate same day results, and to improve triage and treatment rates.

Keywords: Cervical cancer; Linkage; Precancerous lesions; Public facilities; Referral; Screening; Treatment.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Cervical cancer screening algorithm
Fig. 2
Fig. 2
Number of VIA screens and HPV DNA tests completed by month, January – December 2021
See this image and copyright information in PMC

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