Localizing Global Medicine: Challenges and Opportunities in Cervical Screening in an Indigenous Community in Ecuador

Nugus, Peter; Désalliers, Julie; Morales, Juana; Graves, Lisa; Evans, Andrea; Macaulay, Ann C.

doi:10.1177/1049732317742129

Cited by 8 publications

(20 citation statements)

References 43 publications

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“…Se debe destacar que el mayor porcentaje de las mujeres encuestadas no se habían realizado un estudio citológico anteriormente. La falta de instrucción, el poco acceso a los medios de comunicación y el habla en lengua quechua, limitan en gran medida sus conocimientos y la percepción de riesgo para su salud sexual, la cual comúnmente está sujeta a la decisión del jefe de hogar 15,16 .…”

Section: Resultados Y Discusiónunclassified

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Infección por Virus del Papiloma Humano y citología cérvico-vaginal en mujeres indígenas del Cañar, Ecuador.

Ordóñez

Brito

Antúnez

et al. 2019

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There are few studies on the circulation of Human Papilloma Virus (HPV) in indigenous Ecuadorian women. The aim of the study is to determine the circulation of HPV and identify cytological alterations in cervical samples of indigenous Ecuadorian women and to define the behavior of some socio-demographic and clinical-epidemiological variables. An analytical cross-sectional study was done between July 2017 and September 2018 to determine the presence of cytological alterations and HPV infection in 100 indigenous women between 15 and 55 years of age, residing in Cañar, Ecuador. The association between socio-demographic and clinical-epidemiological variables with viral infection was investigated. Was obtained a 98% of negative cytology for malignancy and 2% of cervical lesions. Cases with high-grade lesions were not diagnosed. In general, a 34% (34/100) tested was positive for HPV, predominating oncogenic genotypes. HPV 31 was the most frequent in 41.2% (14/34) of cases followed by HPV 16 in 20.6% (7/34). Women between 20 and 30 years of age were five times more likely to be infected with HPV (44.1%, 15/34). The frequency of infection was significantly higher in single women and in those who reported having 2 to 3 births. Infection with HPV 16 was associated with the use of hormonal contraceptives, in 57.1% (4/7) of the cases; p = 0.005, RP = 12.44 IC95% (2.40-64.62). The high prevalence of oncogenic HPV infection indicates the need to incorporate this indigenous population into early detection programs for cervical cancer.

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Section: Resultados Y Discusiónunclassified

“…No se detectaron lesiones de alto grado. Si bien las poblaciones indígenas no han sido ampliamente estudiadas tanto en Ecuador como en otros países de Latinoamérica, existen reportes donde el porcentaje de ASC-US varía entre 0,6 y 10,4%; mientras que se reporta LSIL entre 1,8 y 4,5% 15,16 .…”

Section: Resultados Y Discusiónunclassified

Infección por Virus del Papiloma Humano y citología cérvico-vaginal en mujeres indígenas del Cañar, Ecuador.

Ordóñez

Brito

Antúnez

et al. 2019

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“…Social scientists (Bureau-Point & Phan, 2016;Campbell, 2003) have shown how CHW programs intended to address health disparities might produce forms of structural violence unintended by CHW program designers as a result of failures in broader health system or design flaws embedded in CHW projects. Structural forces also shape the experiences of CHWs on the ground, as they experience disjunctures between accomplishing the goals of standardized health interventions designed by global actors and meeting the local health needs of patients (Djellouli & Quevedo-Gómez, 2015;Justice, 1987;Nugus et al, 2018). In terms of local factors, CHW programs assume low-resource communities to be coherent spatial, bureaucratic, and social units (De Wet, 2011).…”

Section: Introductionmentioning

confidence: 99%

Unintended Consequences of Community Health Worker Programs in South Africa

Ruit

2019

Qual Health Res

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Task shifting from trained clinicians to community health workers (CHWs) is a central, primary health care strategy advocated by global health policy planners in resource-poor settings where trained health professionals are scarce. The evidence base for the efficacy of these programs, however, is limited—in particular, research that identifies their potential unintended consequences. Based on sustained ethnographic study of CHWs working for AIDS projects in South Africa at the height of the country’s AIDS epidemic, this article identifies how structural and local factors produced unintended consequences for CHW programs. These consequences were (a) CHWs moonlighting for multiple organizations, (b) CHWs freelancing in communities without regulation, and (c) adverse patient outcomes resulting from uncoordinated care. These consequences stemmed from structural elements of a bureaucratically weak health system and from local grassroots dynamics that jeopardized long-term CHW program sustainability and eroded national health goals.

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“…In order to improve this picture, attention should be paid to indigenous people's needs as they constitute 1.1 million of the 16.4 million people in Ecuador, yet are often marginalised in health matters [24]. Indigenous women face multiple forms of discrimination when accessing screening provided in health centres: language is a barrier for non-Spanish speakers to access care and these women may experience judgement by healthcare providers [25,26]. Individual barriers are also at play, such as gender norms, cultural customs, and a mistrust of Western medicine (that are possibly related to past mistreatment), which inhibit these women from undergoing a Pap test [26,27].…”

Section: Screening That Reaches Every Womanmentioning

confidence: 99%

“…Indigenous women face multiple forms of discrimination when accessing screening provided in health centres: language is a barrier for non-Spanish speakers to access care and these women may experience judgement by healthcare providers [25,26]. Individual barriers are also at play, such as gender norms, cultural customs, and a mistrust of Western medicine (that are possibly related to past mistreatment), which inhibit these women from undergoing a Pap test [26,27]. Although these factors can have a chilling effect on women's screening attendance, it is most telling that information promoting screening has failed to reach indigenous women.…”

Section: Screening That Reaches Every Womanmentioning

confidence: 99%

Universal cervical cancer control through a right to health lens: refocusing national policy and programmes on underserved women

Perehudoff

Vermandere

Williams

et al. 2020

BMC Int Health Hum Rights

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Background: Cervical cancer claims 311,000 lives annually, and 90% of these deaths occur in low-and middleincome countries. Cervical cancer is a highly preventable and treatable disease, if detected through screening at an early stage. Governments have a responsibility to screen women for precancerous cervical lesions. Yet, national screening programmes overlook many poor women and those marginalised in society. Under-screened women (called hard-to-reach) experience a higher incidence of cervical cancer and elevated mortality rates compared to regularly-screened women. Such inequalities deprive hard-to-reach women of the full enjoyment of their right to sexual and reproductive health, as laid out in Article 12 of the International Covenant on Economic, Social and Cultural Rights and General Comment No. 22. Discussion: This article argues first for tailored and innovative national cervical cancer screening programmes (NCSP) grounded in human rights law, to close the disparity between women who are afforded screening and those who are not. Second, acknowledging socioeconomic disparities requires governments to adopt and refine universal cancer control through NCSPs aligned with human rights duties, including to reach all eligible women. Commonly reported-and chronically under-addressed-screening disparities relate to the availability of sufficient health facilities and human resources (example from Kenya), the physical accessibility of health services for rural and remote populations (example from Brazil), and the accessibility of information sensitive to cultural, ethnic, and linguistic barriers (example from Ecuador). Third, governments can adopt new technologies to overcome individual and structural barriers to cervical cancer screening. National cervical cancer screening programmes should tailor screening methods to under-screened women, bearing in mind that eliminating systemic discrimination may require committing greater resources to traditionally neglected groups.

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Localizing Global Medicine: Challenges and Opportunities in Cervical Screening in an Indigenous Community in Ecuador

Cited by 8 publications

References 43 publications

Infección por Virus del Papiloma Humano y citología cérvico-vaginal en mujeres indígenas del Cañar, Ecuador.

Infección por Virus del Papiloma Humano y citología cérvico-vaginal en mujeres indígenas del Cañar, Ecuador.

Unintended Consequences of Community Health Worker Programs in South Africa

Universal cervical cancer control through a right to health lens: refocusing national policy and programmes on underserved women

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