An evaluation of the cervical screening programme in Johannesburg Metro District, Gauteng Province
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. vi 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.
MMed, Community Medicine, Faculty of Health Sciences, University of the Witwatersrand
pap smear, cervical screening, cervical screening coverage