Background/Methodology External quality assurance for the National Cervical Cancer Screening Programme of Bangladesh was done in June 2008 by the United Nations Population Fund (UNFPA). The programme, initiated in 2004, has set up screening facilities in 44 districts of Bangladesh. Women aged over 29 years are screened using visual inspection after acetic acid application (VIA) by trained paramedics. Independent consultants not involved in strategic planning or implementation of the programme were engaged to review the ongoing activities. They visited different service delivery set-ups, collected data using a structured proforma, interviewed the service providers, and held discussions with the programme managers. This paper summarises the observations and recommendations of the experts performing the quality control process. Results/Conclusions IntroductionEvery year an estimated 13 000 women are diagnosed with cervical cancer and 6600 die from the disease in Bangladesh. 1 Population-based cervical cancer screening was initiated in Bangladesh in 2004 as a pilot study and in 2005 as a national programme. 2 Visual inspection after application of acetic acid (VIA) is a simple and affordable screening test with acceptable sensitivity and specificity in the range 56-77% and 64-86%, respectively, in a research setting. 3,4 A population-based study conducted in Bangladesh observed that the sensitivity and the specificity of VIA performed by trained paramedics were 79% and 57.4%, respectively. 5 Bangladesh is one of the first countries in the world to introduce VIA as the screening test for its national cervical cancer screening programme.The national cervical cancer screening guidelines of Bangladesh were formulated previously by an advisory board composed of national and international experts. 6 Following establishment of the guidelines, VIA is being done by trained nurses at the District Hospitals and by trained health workers at the maternal and child welfare centres (MCWCs), both situated at the district headquarters. Women aged 30 years and above are expected to be screened

A VIA-based program would facilitate the development of screening, diagnosis, and treatment of cervical neoplasia and improve awareness of cervical cancer prevention in Bangladesh.

BackgroundIn Bangladesh, female paramedics known as Family Welfare Visitors (FWVs), conduct normal deliveries in first-level primary care facilities, or Union Health and Family Welfare Centres (UH&FWC). Utilization of partographs allow for early identification of abnormal labour and referral for advanced care to Emergency Obstetric Care (EmOC) facilities. A systematic assessment of the quality of partograph utilization in clinical-decision making will contribute to understanding the use of the tool by health workers.MethodsIn 2013, the USAID supported MaMoni HSS project, led in country by Save the Children, trained FWVs on the use of partographs in five UH&FWCs in Habiganj district. As part of the follow-up after training, intrapartum case record forms, accompanying partographs, and referral registers for all obstetric cases managed in these five facilities from July 2013 to June 2014 were reviewed. Partographs were reviewed to identify abnormal labour cases based on pre-defined indications. All referred cases were ascertained from the case records in the referral registers. Five health workers were interviewed to assess their knowledge, attitude and experience in partograph use and to explore the challenges for referral decision making associated with the tool.ResultsA total of 1,198 deliveries were managed at the study sites, of which 663 presented with cervical dilatation of 8 cm or less. Partographs were initiated in 98% of these cases. Indication of abnormal labour was found in 71 partographs (11%) and among them, only 1 was referred to a higher-level facility. Foetal heart rate and cervical dilatation were appropriately recorded in 61% and 70% of the partographs, respectively. Interviews with health workers revealed poor interpretation of referral indications from the partographs. Limited accessibility to the nearest EmOC facility, inadequate time for referral, and non-compliance to referral by clients were identified by the interviewed health workers as the key barriers for referral decision making.ConclusionsSupporting the health workers at first-level primary care facilities to better interpret and act on partograph data in a timely manner, and strengthening the referral systems are needed to ensure that women in labour receive the prompt quality care they and their babies require to survive.

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