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Needs for Professional Education to Optimize Cervical Cancer Screenings in Low-Income Countries: a Case Study from Tanzania

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Abstract

Cervical cancer is a significant health problem in many developing countries. Due to limited treatment facilities for cancer in Tanzania, a screening referral program was developed between two urban clinics and Ocean Road Cancer Institute (ORCI), the only cancer treatment center in Tanzania. This study aimed to evaluate the effectiveness of the program and to identify opportunities for professional education. The study included 139 patients who were referred to ORCI from the screening clinics of Magomeni and Temeke between January 2015 and May 2016. Abstracted data from the medical records included patient age, screening results, and treatment. Eight nurses performing screening at the three locations were interviewed about their screening experience. Over half of the referrals (51.9%) were false positives. False positive diagnosis was more common among younger patients (35.68 ± 8.6 years) (p < 0.001) and those referred from Magomeni (59.8%) (p < 0.01) than referrals of older patients (42.46 ± 11.1 years) or those from Temeke (33.3%). Interviews of nurses showed differences among clinics, including resources, experience, and documentation of screening results. The high false positive rates and the variation of accuracy of screening between the two clinics showed a need for professional education of nurses and improvement in the health systems. Continuous education of nurses may increase the effectiveness of cervical screening. Health system enhancement of screening facilities such as provision of Lugol’s iodine, more space for screening, and consistency and completion of screening records are needed to increase the accuracy of cervical screening and referrals in Tanzania and other similar low-income countries.

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Acknowledgements

Anne Lavelle was funded by the Cancer Epidemiology Education in Special Populations (CEESP) Program of the National Cancer Institute, Grant R25 CA112383. We would like to acknowledge the nurses at each clinic for providing a wealth of information that made this project possible—Sr. Jesca, Happy, Beatrice, Rehema, Sr. Francisca, Rose, Sr. Raya, and Hadija.

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Authors and Affiliations

  1. Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, Omaha, NE, USA

    Anne E. Lavelle & Dejun Su

  2. Ocean Road Cancer Institute, Dar es Salaam, Tanzania

    Crispin Kahesa

  3. Department of Epidemiology, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA

    Amr S. Soliman

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  1. Anne E. Lavelle
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  2. Dejun Su
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  3. Crispin Kahesa
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  4. Amr S. Soliman
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Correspondence to Amr S. Soliman.

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Lavelle, A.E., Su, D., Kahesa, C. et al. Needs for Professional Education to Optimize Cervical Cancer Screenings in Low-Income Countries: a Case Study from Tanzania. J Canc Educ 34, 124–129 (2019). https://doi.org/10.1007/s13187-017-1276-6

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  • DOI: https://doi.org/10.1007/s13187-017-1276-6

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