MMed, Community Medicine, Faculty of Health Sciences, University of the Witwatersrand / INTRODUCTION: Cervical cancer continues to be a significant cause of morbidity
and mortality, particularly in women in the developing world, due to the lack of
effective population screening. It has proven difficult to implement and sustain
cytological screening programmes as health systems in these settings are not
functional. South Africa has adopted an organised cervical screening programme, and
the goal is to screen 70% of women over 30 years nationally, within ten years of
initiating the programme. However, it is also necessary to ensure that women with
abnormal Pap smears are treated if we are to reduce cervical cancer incidence.
Ensuring treatment of abnormal Pap smears is a challenge, and current data on this is
needed to inform service delivery.
AIM: The study aims to assess the current status of the cervical screening programme
in the Johannesburg Metro District, specifically looking at screening coverage, and
referral for treatment in women with abnormal Pap smears.
METHODOLOGY: Secondary analysis of data in the District Health Information
System was done; and registers at a sample of primary health care clinics and their
referral colposcopy services were evaluated for the period April 2007 – March 2008.
Descriptive statistics were employed to analyse the data. Multivariate analysis was
also done to evaluate factors associated with colposcopy attendance.
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RESULTS: Screening coverage for the district was 6.3% for 2008 and the cumulative
coverage from 2000 to 2008 was 35.8%, with significant variation between subdistricts.
A high proportion (19%) of smears was done in women less than 30 years.
Of 557 women with abnormal Pap smears requiring further treatment, 57% were
informed of their results and referred, 38% had appointments for colposcopy, and
only 28% attended these appointments. Women experienced long waiting times for
appointments (up to 15 months), and there was inadequate record keeping and client
tracing. HIV status and the sub-district and health authority where women were
screened were associated with colposcopy attendance; the referral hospital was
associated with length of waiting time between Pap smear and colposcopy.
CONCLUSION: Cervical screening coverage is below target, and the referral for
diagnosis and treatment remains a challenge. Unless referral and access to
colposcopy services is improved, increasing screening coverage will not have an
impact on decreasing cervical cancer incidence and mortality. It is hoped that this
study will provide the data to target interventions to improve cervical screening
coverage and effective referral and treatment in the district.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/8998 |
| Date | 07 February 2011 |
| Creators | Jassat, Waasila |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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