Challenges To Visual Cervical Cancer Screening Service Intergration And Utilization In Imenti South Sub-County Reproductive Health Care System, Meru County, Kenya

ABSTRACT

Cancer is among the leading causes of morbidity and mortality worldwide with approximately fourteen million new cases and eight million cancer related deaths annually with an approximated 60 per cent of these new cases and 70 percent of these deaths occurring in Africa and other developing countries. Cervical cancer in particular has contributed a fair share of this burden. In Kenya, cervical cancer incidence and prevalence is second to breast cancer and leading cause of cancer related deaths among Kenyan women with most cases being diagnosed when it is too late for any interventions. The solution lies in early screening of women, with visual cervical cancer screening approach being the most feasible for low resource settings in developing countries. Kenya, in recognition of this piloted and adopted this screening approach in the year 2002 in efforts to integrate the screening approach in all the reproductive health clinics through formation of national cervical cancer prevention strategic plan with an aim of raising screening coverage to over 70 per cent. Despite this effort, the population of women screened remains alarmingly low with an estimated screening prevalence of only 3.2 per cent nationally. This crosssectional study sought to identify challenges to visual cervical cancer screening service integration and utilization in Imenti South Sub-County, Kenya with the specific objectives of determining the proportion of respondents utilizing visual cervical cancer screening service, how respondents socio-demographic and reproductive health factors, facility based and system based factors influence integration and utilization of visual cervical cancer screening service. Six reproductive clinics were sampled for the study out of the nineteen in the Sub-County and a total of 354 respondents visiting the sampled reproductive health clinics. Questionnaires, checklist and key informant interviews were used to collect data. Chisquare and Fisher exact test were used to test significant associations with a P ≤ 0.05 being considered significant while qualitative data was analyzed and discussed in key thematic areas. The sampled reproductive health clinics had the required screening resources, however only 20 per cent of the respondents had ever been screened for cervical cancer at the time of this study. The opportunistic screening approach, Low level of awareness, inexistence of a functional referral system, poor reporting, monitoring and supervision on visual screening were key screening challenges among others. The study concluded that, establishing clinical services alone will not achieve the desired screening target unless critical components are put in place to address the observed challenges in this study.