A mini-dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Nursing, Technikon Natal, 2002. / Cervical cancer is almost completely preventable, yet it is the second most prevalent cancer amongst women in South Africa. KwaZulu-Natal (KZN) in particular has a high mortality rate of cervical cancer and 1:40 women die from cancer of the cervix. Therefore, in 1997 a cervical screening. policyand-. programme was implemented in the province. The KZN Department of Health and the Sub-Directorate Maternal, Child and. Women's Health needed to know what was happening currently in terms of implementation of the cervical screening programme since it was first implemented three years ago. Therefore, the purpose of the study was to evaluate the implementation of the Provincial Cervical Screening Programme in selected Primary Health Care clinics in lIembe Region, KZN. This study took the form of formative evaluation research. The target population consisted of PHC clinics in KZN that have implemented the cervical screening policy and the programme. The accessible population for this study consisted of the clinics in the lIembe Region. A four-stage selection plan was applied to select the sample from the accessible population. The first stage involved a random selection of two clinics from an urban area and two from a rural area. Within each of the selected clinics, three types of evidence for the evaluation of the implementation of the cervical screening programme were sampled. Therefore, the second stage of the plan was the selection of records. A purposive sample of all records of clients who were diagnosed with abnormal smears was assessed. The third stage involved the selection of all Professional Nurses from each of the selected clinics. Lastly, the fourth stage involved the selection of the day for collecting data on the facilities and resources. The sources of evidence that were used to evaluate the implementation of cervical screening programme by the clinics were non-participant observation, which involved clinic audit, a review of abnormal smear records and self-reports from nurses regarding the cervical screening programme. Results indicated that there was a lack of resources needed for implementing the programme in rural clinics compared to urban clinics. However, all clinics in the study had an adequate supply of the drugs needed for the treatment of abnormal smears. The researcher also found that nurses lacked knowledge regarding the indications for taking smears. On reviewing the records, the researcher noted that most of the results indicated that smears had adequate cells needed for analysis. However, the results indicated that there was a problem with follow-up of clients with abnormal smears. There was lack of necessary resources such as telephones needed to do proper follow-up. Feedback to the clinics from the referral hospital regarding the outcome of the visit was inadequate. The results also indicated thatthe mechanisms of record keeping were poor. Nurses were of the opinion that women should have their first Pap smear at the age of 20 and thereafter at intervals of five years, once they start to be sexually active because of the high rate of sexually transmitted infections and HIV/AIDS in KZN. Therefore, the above results indicate that problems exist at the selected PHC clinics that may result in ineffective implementation of the cervical screening programme. / M

Thesis (MPA.) -- University of Limpopo, 2018 / Background: Cancer of the cervix is the fourth most common cancer affecting women worldwide and is currently considered as a sexually transmitted cancer. This type of cancer is caused in most cases by a viral infection, Human Papilloma Virus (HPV) strains 16 and 18. Cervical screening aims to prevent invasive cervical carcinoma by detection and treatment of its precursors cervical intraepithelial neoplasia grade 2 (CIN2) and, particularly, grade 3 (CIN3). The current study aimed at determining the distribution of cervical cancer and the association of cervical cancer with HIV infection in Limpopo Province. Methods: The current study used quantitative retrospective method to systematically review the available data on Papanicolaou (Pap) smears from National Health Laboratory Services at Polokwane hospital from the year 2013 to 2015. The data was kept anonymously by not using the names of the patients and ethical clearance was received from the Turfloop Research Committee of University of Limpopo in consideration of section 14, 15, 16, and 17 of National Health Act 61 of 2004. The data was exported to excel spreadsheet and cleaned before exported into SPSS 23.0 software which was used for data analysis. Results: The findings from the current study show a decline of 33% in the number of Pap smears that were submitted for cytology between 2013 (82 041) and 2015 (23 527) in Limpopo province. However, the study revealed that there is an increase in prevalence of cervical cancer from 16.7% in 2013 to 19.2% in 2015 in Limpopo Province. In the same period this rural province already demonstrates a high burden of cervical cancer among the middle aged women. The positive cervical smears were classified as cervical intraepithelial neoplasia (CIN) I, II, or III and therefore, 78.5% were CIN I, 21% CIN II and 0,5% CIN III. HIV infections have been found to be associated with cervical cancer as the prevalence of cervical cancer among HIV positive women was found to be 25% and most of the affected women are the middle aged group. vi Conclusion: The screening coverage for cervical cancer has decreased in Limpopo Province but the prevalence of cervical cancer has increased by 2.5% therefore, this translates to the need for community awareness about prevention of cervical cancer. Majority of the cases were classified as CIN 1 at 78.5% which can be cured if treatment started early. The Limpopo Province should therefore strengthen strategies to integrate HIV and cervical cancer services as it was found that there is a strong association between the HIV and cervical cancer.

Background: Worldwide, it is poor women who are at greatest risk of cervical cancer. These patterns are resonated in South Africa where black women, particularly in rural areas are at heightened risk for cervical cancer. The rate of morbidity and mortality due to cervical cancer has increased and in the year 2000, deaths as a result of cervical cancer in South Africa exceeded maternal deaths. This increase in morbidity and mortality has been associated with the emergence of HIV and AIDS. Cancer of the cervix was listed as an HIV-related opportunistic infection and an AIDS defining illness by the Centers for Diseases Control in 1993. This research documents the challenges of implementing cervical cancer services in the context of HIV. It explores structural, gender, societal, social exclusion and practical barriers to implementing these services. Methodology: The study was conducted using qualitative methods of enquiry which employed in-depth interviews to collect data from participants. Interviews were held with government officials, Section Nine institutions, non -governmental organisations working in the fields of cervical cancer and HIV/AIDS. Results: The study found that South Africa does not have a comprehensive policy to address cervical cancer in women living with HIV neither does it have plans to enact such a policy. It found that cervical cancer was a marginalised disease. It also found that cervical cancer does not always form part of health priorities as it falls outside women as mothers‟ brackets. The study found that the social status and the level of participation and active citizenship of women living with HIV might be one of the reasons for lack of prioritisation of cervical cancer policies. Conclusion: Cervical cancer is a marginalised disease because it affects women outside of their reproductive roles, can be defined as an STI and it affects women who live in the margins of society. Cervical cancer marginalisation could be linked to the discourse of lack of political will, advocacy and action in relation to women‟s health. Policies need to be nuanced from the perspectives of women living with HIV. / Thesis (M.Dev.Studies)--University of KwaZulu-Natal, Durban, 2013.

Submitted in fulfillment of the requirements of the degree of the Master of Technology : Radiography, Durban University of Technology, 2014. / Research Aims The purpose of this study is to compare 2D HDR Brachytherapy planning and 3D HDR Brachytherapy planning in terms of dose distribution in order to accurately determine bladder and rectal doses. Further research questions were explored to determine whether relationships existed between Computer Tomography volumes and bladder and rectum dose. Methodology The 30 female patients that volunteered for the study were conveniently selected. Their age and ethnic group did not contribute to their selection. All participants were prepared for cervical HDR Brachytherapy. The Brachytherapy templates were computer generated and treatments were given based on the templates. They then had a Computer Tomography (CT) scan (3D data set) of the pelvis. The computer generated templates for 2D Brachytherapy planning were applied to the CT data set i.e. 2DBP. The plans were optimised to take into consideration the dose to the bladder and the rectum i.e. 3DBP. The 2DBP and the 3DBP were then evaluated in order to determine which method of planning yielded more acceptable dose distributions to the bladder and rectum. Results Significant differences in dose distribution were noted on comparison of 2DBP and 3DBP. A significant relationship was noted in respect of bladder mean dose and rectum mean dose. 3DBP proved to be more efficient in yielding lower mean dose to the bladder and the rectum. Whilst a significant relationship was noted in respect of bladder maximum dose, an insignificant relationship was noted for rectum maximum dose. Therefore, the efficiency of 3DBP to yield lower bladder maximum dose was established but its efficiency to yield lower rectum maximum dose is questionable. This has implications for the management of patients’ with cervical cancer who require cervical Brachytherapy. Recommendations It is imperative that imaging modalities be used for the accurate planning of cervical Brachytherapy. This study recommends that CT be used for HDR Brachytherapy planning by proving its greater efficiency compared to template planning.

Thesis (M. A. (Social Work)) --University of Limpopo, 2018 / Cancer of the cervix is second type of cancer among women in developing countries, and a common problem among women of low socio-economic status in rural communities. The spiral increase of the problem is aggravated by some socio-economic, structural, cultural and political factors. Understanding the risk factors associated with the disease is a step forward towards effective prevention and treatment. Numerous studies have been conducted on knowledge and perceptions of cervical cancer however the information on cervical cancer is still not reaching the majority of women. The study explored the perceptions and attitudes of rural women of Matebeleng village towards cervical cancer, the risk factors, screening tests and the HPV vaccines. A qualitative exploratory case study was conducted. Self-reported data was collected from 22 women. Two focus groups of 7 and 9 and 6 face-face individual interviews were conducted using a semi-structured interview guide. Data was analysed thematically. The research findings revealed that the majority of women in the rural area where the study was conducted never heard of cervical cancer and only few received inadequate information. Few highlighted some of the risk factors but some information was incorrect. Very few participants had only once been screened and the majority have never been tested for cervical cancer. Some became aware of the vaccine through the consent forms from school even though they did not exactly understand the content. The sources of information were the radio, health clinic and random women. The concerns of those who were screened were lack of feedback from the clinic nursing staff after the test, lack of adequate preparation and information before been screened to allay fear and doubt of the unknown and lack of reach out programmes to rural communities. The methods of disseminating information to rural women in their distinct contexts should be examined. Conventional traditional ways of reaching out to rural women could perhaps produce improved results through the integrated approach involving multi-disciplinary teams in educating communities. Key Words: Perceptions, attitudes, rural-based women, cervical cancer, risk factors, screening tests, HPV vaccine

Cervical cancer remains the leading cause of cancer mortality among women worldwide, a burden in the developing countries and commonly detected through symptoms at later invasive stages. The study aimed at establishing knowledge and awareness of the importance of cervical cancer screening in the Makhuduthamaga Sub-district by exploring the perceptions of women and professional nurses and through the review of the National Cervical Cancer Screening Policy (2013). Recommendations to address the gap in knowledge and to inform the National Cervical Cancer Screening Policy were developed based on the study findings. A mixed-method approach was used in this study through a sequential explanatory design, which is quantitatively driven was used. Quantitative data were obtained by using a researcher developed checklist. The checklist was developed from variables stated in the National Cervical Cancer Screening Policy and was used to review its implementation. Qualitative data was obtained through in-depth interviews with individual women and focus group discussions with professional nurses. The study was conducted in ten randomly selected clinics of Makhuduthamaga Sub-district. Purposive sampling was done to obtain qualitative data. An average score of 9.7 was obtained for all ten clinics that participated in the study with regard to the evaluation of the implementation of the National Cervical Cancer Screening Policy. Only 6 (60%) clinics implemented the policy whereas 4 (40%) clinics did not implement the policy. Women and professional nurses perceived cervical cancer screening as important. Lack of knowledge among women regarding cervical cancer screening contributed to the majority of women not screening for cervical cancer. Lack of resources, the 10 year interval of normal cervical cancer screening, the use of disposable vaginal speculums and brushes, lack of standardized cervical cancer screening training, centralization of cytology laboratories came out as factors that negatively influence the uptake of cervical cancer screening. Cervical cancer screening awareness campaigns, availability of resources and standardized in-service trainings on cervical cancer screening were recommended to enhance the cervical cancer screening uptake. / Health Studies / D. Litt. et Phil. (Health Studies)

MPH / Department of Public Health / See the attached abstract below

MPH / Department of Public Health / Despite the availability of the South African cervical cancer screening guidelines at clinics, women are still seen in the out-patient department of selected rural district hospital in Thulamela Municipality, referred from Primary Health Care (PHC) facilities with no cervical cancer screening results. Thus, cervical cancer screenings are done at a hospital and results often came back positive for cervical cancer. Such practices pose a risk of delayed cervical cancer diagnoses and its discovery at an advanced stage, increasing cervical cancer mortality rates. The purpose of this study was to investigate the compliance of professional nurses at primary health care facilities to the South African cervical cancer screening guidelines in Thulamela Municipality. This study adopted a qualitative approach as it aimed to get a better understanding on compliance of professional nurses regarding South Africa’s cervical cancer screening guidelines. Nonprobability sampling was used to select primary health care facilities including interested participants who were judged to possess the information that was required to answer the research question of this study. The sample size of the study was determined by data saturation. Trustworthiness was ensured by four criteria of Guba and Linclon, namely credibility, transferability, dependability and confirmability. A digital recorder was used to log individual responses during interview sessions. Data from the digital recordings were transcribed verbatim. Results were analysed and interpreted thematically. This study established that clinic professional nurses are non –compliance to the South African cervical cancer screening guidelines; nurses face several challenges such as inadequate knowledge of the cervical cancer screening guidelines, shortage of resources and shortage of staff. Recommendations that emanated from the discussion of the findings and the conclusion of this study are likely to have implications and applications for supporting and advancing the cervical cancer screenings. / NRF

Cervical cancer is reported to be the first among the five leading cancers affecting women in South Africa and the leading cancer among Black females. There is a high incidence and mortality rate among underserved and under-screened women presenting with cervical cancer as they are often unable to access screening facilities. Very little has been done to establish the factors in private health care provision that influence the implementation of cervical screening programmes. The study investigates factors influencing cervical cancer screening programme implementation among private medical practitioners in Soshanguve to establish whether private practitioners assume their roles in cervical screening. The intention is to provide guidelines for a screening programme that could be implemented in private health facilities. The study is qualitative, explorative, descriptive and contextual, using interviews and observation as the main data-collection methods. Lack of awareness and interest, failure to inform patients about cervical screening, age and gender of medical practitioners were among the factors identified. The study concluded that awareness programmes about cervical screening and materials containing information on cervical cancer and predisposing factors should be designed. The utilization of cheaper laboratory service providers could increase participation by making the test affordable and accessible to cash patients. The establishment of a private Pap clinic within medical practices or even as an independent entity is also recommended. / Health Studies / M.A. (Public Health)

Cervical cancer is reported to be the first among the five leading cancers affecting women in South Africa and the leading cancer among Black females. There is a high incidence and mortality rate among underserved and under-screened women presenting with cervical cancer as they are often unable to access screening facilities. Very little has been done to establish the factors in private health care provision that influence the implementation of cervical screening programmes. The study investigates factors influencing cervical cancer screening programme implementation among private medical practitioners in Soshanguve to establish whether private practitioners assume their roles in cervical screening. The intention is to provide guidelines for a screening programme that could be implemented in private health facilities. The study is qualitative, explorative, descriptive and contextual, using interviews and observation as the main data-collection methods. Lack of awareness and interest, failure to inform patients about cervical screening, age and gender of medical practitioners were among the factors identified. The study concluded that awareness programmes about cervical screening and materials containing information on cervical cancer and predisposing factors should be designed. The utilization of cheaper laboratory service providers could increase participation by making the test affordable and accessible to cash patients. The establishment of a private Pap clinic within medical practices or even as an independent entity is also recommended. / Health Studies / M.A. (Public Health)