Uterine Cervical Cancer Prevention in Eritrea: Development and Results of a Pilot Project

Abstract

Background: Uterine cervical cancer (UCC) is the fourth most common cancer worldwide; almost 85%-90% of UCCs, and UCC-related deaths occur in low-income countries. No UCC prevention programs are currently running in Eritrea.Aims: This manuscript describes a stepwise initiative aiming to establish an UCC prevention project in Eritrea, which combines Pap-smear and colposcopy. Methods:In 2013, an Italian multidisciplinary team submitted a project to the Eritrean Ministry of Health with a view to establishing an Eritrean-Italian UCC prevention task force. The project's starting point was an educational initiative to train local technicians on both Pap-smear assessments and colposcopy.Results: An intensive academic course organized by the University of Padova (Italy) under the patronage of the Eritrean Ministry of Health was successfully held in Asmara to train Eritrean technicians, nurses and midwifes to conduct Pap-smear assessments. Two subsequent pilot projects (2014-2016; 2016-2018) monitored the diagnostic competence of the Eritrean cyto-screeners. These pilot schemes resulted in an initial assessment of 2,014 Pap-smears, which provided information on the main operative issues involved in newly establishing a cancer prevention initiative in a sub-Saharan country. They also generated preliminary data on the prevalence of cancer and precancerous cervical lesions. The second pilot study is additionally providing further insight on the problems faced in expanding the prevention project to the Asmara population as a whole.Conclusions: Anti-HPV vaccination, the most effi cient primary UCC prevention strategy, entails basic requirements that are not always available in low-income countries. In terms of secondary UCC prevention, this Eritrean experience suggests that the low cost of "Pap testing" and the availability of local human resources could lower the incidence of UCC and related deaths in Eritrea.

Knowledge, attitude and practice of cervical cancer and its screening (Pap smear) among female students of Orotta College of medicine and health sciences

“…The college itself has to be able to launch campaigns and distribute educational pamphlets and posters to raise the knowledge and perception of Pap test. In line with the previous population-based study done in Eritrea, 10 we recommend training of more health care workers on Pap smear testing and expansion of Pap smear test in various referral hospitals despite the ever competing health care priorities. Moreover, a further community-based study that integrates qualitative study design is suggested at a national level to increase the representation of all female population.…”

“…Secondly, it was the first study to assess knowledge, attitude and practice about cervical cancer and Pap smear among students in Eritrea, where the incidence of the diseases remains unknown. 10 Finally, the study used validated questionnaire with pretest and experts' advice. Limitations of the study were that i.…”

“…15 According to another study in Eritrea, secondary cervical cancer prevention (detection and treatment of precancerous lesions) is suggested an efficient strategy for low-income countries as the low cost of Pap test and availability of human resources could lower the incidence of cervical cancer and related deaths. 10 Results of the study also showed a high prevalence of cervical cancer in population of Asmara, the capital city of Eritrea, though no dependable evidence has been yet attained on the incidence of the disease in Eritrea. 10,16 The initiation and successful application of secondary prevention program hence needs a paved platform of well informed and educated female population.…”

“…10 Results of the study also showed a high prevalence of cervical cancer in population of Asmara, the capital city of Eritrea, though no dependable evidence has been yet attained on the incidence of the disease in Eritrea. 10,16 The initiation and successful application of secondary prevention program hence needs a paved platform of well informed and educated female population. This study aimed to provide information on cervical cancer awareness and factors associated with knowledge, attitude and practice of screening particularly among female undergraduate students in Orotta College of Medicine and Health Sciences (OCMHS).…”

“…2,7,9 Such marked differences can be explained by low preventive health-seeking behaviour and limited access to effective screening services due to cost, poor knowledge, lack of information and educational programs. 10,11 Survival rate turns out to be better if cervical cancer is diagnosed and treated at earlier phases. Generally, developing countries have a lower Pap smear coverage (19%) as compared to developed countries (63%).…”