Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Research article

Health care access dimensions and cervical cancer screening in South Africa: analysis of the world health survey

Authors: Tomi F Akinyemiju, Jasmine A McDonald, Paula M Lantz

Published in: BMC Public Health | Issue 1/2015

Login to get access

Abstract

Background

Cervical cancer is the most commonly diagnosed cancer and the leading cause of cancer mortality among women in sub-Saharan Africa. Recent recommendations for cervical cancer primary prevention highlight HPV vaccination, and secondary prevention through screening. However, few studies have examined the different dimensions of health care access, and how these may influence screening behavior, especially in the context of clinical preventive services.

Methods

Using the 2003 South Africa World Health Survey, we determined the prevalence of cervical cancer screening with pelvic examinations and/or pap smears among women ages 18 years and older. We also examined the association between multiple dimensions of health care access and screening focusing on the affordability, availability, accessibility, accommodation and acceptability components.

Results

About 1 in 4 (25.3%, n = 65) of the women who attended a health care facility in the past year got screened for cervical cancer. Screened women had a significantly higher number of health care providers available compared with unscreened women (mean 125 vs.12, p-value <0.001), and were more likely to have seen a medical doctor compared with nurses/midwives (73.1% vs. 45.9%, p-value = 0.003). In multivariable analysis, every unit increase in the number of health care providers available increased the likelihood of screening by 1% (OR = 1.01, 95% CI: 1.00, 1.01). In addition, seeing a nurse/midwife compared to a medical doctor reduced the likelihood of screening by 87% (OR = 0.13, 95% CI: 0.04, 0.42).

Conclusions

Our findings suggest that cost issues (affordability component) and other patient level factors (captured in the acceptability, accessibility and accommodation components) were less important predictors of screening compared with availability of physicians in this population. Meeting cervical cancer screening and HPV vaccination goals will require significant investments in the health care workforce, improving health care worker density in poor and rural areas, and improved training of the existing workforce.
Literature
1.
Kamangar F, Dores GM, Anderson WF. Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol Off J Am Soc Clin Oncol. 2006;24(14):2137–50.CrossRef
2.
Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer J Int Du Cancer. 2015;136(5):E359–386.CrossRef
3.
Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55(2):74–108.CrossRefPubMed
4.
Denny LA, Sankaranarayanan R, De Vuyst H, Kim JJ, Adefuye PO, Alemany L, et al. Recommendations for cervical cancer prevention in sub-saharan Africa. Vaccine. 2013;31 Suppl 5:F73–74.CrossRefPubMed
5.
Awolude OA, Morhason-Bello IO, Denny LA, Adewole IF. Human papillomavirus infection and related cancers in sub-Saharan Africa: burden and tools for prevention. Vaccine. 2013;31 Suppl 5:vii–x.CrossRefPubMed
6.
Comfort AB, Peterson LA, Hatt LE. Effect of health insurance on the use and provision of maternal health services and maternal and neonatal health outcomes: a systematic review. J Health Popul Nutr. 2013;31(4 Suppl 2):81–105.PubMed
7.
Adinma ED, Brian DAJI, Obionu CC, Asuzu MC. Effect of government-community healthcare co-financing on maternal and child healthcare in Nigeria. West Afr J Med. 2011;30(1):35–41.PubMed
8.
Smith KV, Sulzbach S. Community-based health insurance and access to maternal health services: evidence from three West African countries. Soc Sci Med. 2008;66(12):2460–73.CrossRefPubMed
9.
Nanda P. Gender dimensions of user fees: implications for women's utilization of health care. Reprod Health Matters. 2002;10(20):127–34.CrossRefPubMed
10.
Bradley J, Risi L, Denny L. Widening the cervical cancer screening net in a South African township: who are the underserved? Health Care Women Int. 2004;25(3):227–41.CrossRefPubMed
11.
Abrahams N, Wood K, Jewkes R. Barriers to cervical screening: women's and health workers' perceptions. Curationis. 1997;20(1):50–2.PubMed
12.
13.
World Health Organization. Human Papillomavirus vaccines: WHO position paper, October 2014. Wkly Epidemiol Rec. 2014;43(89):465–92.
14.
15.
Ojinnaka CO, Choi Y, Kum HC, Bolin JN. Predictors of colorectal cancer screening: does rurality play a role? J Rural Health. 2015; Jan 19. [Epub ahead of print]
16.
Chor JS, Lam HC, Chan A, Lee HM, Fok E, Griffiths S, et al. Socioeconomic disparity in breast cancer detection in Hong Kong–a high income city: retrospective epidemiological study using the breast cancer registry. PLoS One. 2014;9(10):e107630.CrossRefPubMedPubMedCentral
17.
McKinnon B, Harper S, Moore S. Decomposing income-related inequality in cervical screening in 67 countries. Int J Public Health. 2011;56(2):139–52.CrossRefPubMed
18.
Ayanian JZ, Weissman JS, Schneider EC, Ginsburg JA, Zaslavsky AM. Unmet health needs of uninsured adults in the United States. Jama. 2000;284(16):2061–9.CrossRefPubMed
19.
Thomas JW, Penchansky R. Relating satisfaction with access to utilization of services. Med Care. 1984;22(6):553–68.CrossRefPubMed
20.
Penchansky R, Thomas JW. The concept of access: definition and relationship to consumer satisfaction. Med Care. 1981;19(2):127–40.CrossRefPubMed
21.
Jit M, Brisson M, Portnoy A, Hutubessy R. Cost-effectiveness of female human papillomavirus vaccination in 179 countries: a PRIME modelling study. Lancet Glob Health. 2014;2(7):e406–414.CrossRefPubMed
22.
Parry J. Vaccinating against cervical cancer. Bull World Health Organ. 2007;85(2):85–160.
23.
Markowitz LE, Tsu V, Deeks SL, Cubie H, Wang SA, Vicari AS, et al. Human papillomavirus vaccine introduction–the first five years. Vaccine. 2012;30 Suppl 5:F139–148.CrossRefPubMed
24.
25.
Manthalu G, Nkhoma D, Kuyeli S. Simple versus composite indicators of socioeconomic status in resource allocation formulae: the case of the district resource allocation formula in Malawi. BMC Health Serv Res. 2010;10:6.CrossRefPubMedPubMedCentral
26.
Howe LD, Hargreaves JR, Huttly SR. Issues in the construction of wealth indices for the measurement of socio-economic position in low-income countries. Emerg Themes Epidemiol. 2008;5:3.CrossRefPubMedPubMedCentral
27.
Vyas S, Kumaranayake L. Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan. 2006;21(6):459–68.CrossRefPubMed
28.
Mwaka AD, Wabinga HR, Mayanja-Kizza H. Mind the gaps: a qualitative study of perceptions of healthcare professionals on challenges and proposed remedies for cervical cancer help-seeking in post conflict northern Uganda. BMC Fam Pract. 2013;14:193.CrossRefPubMedPubMedCentral
29.
Paul P, Winkler JL, Bartolini RM, Penny ME, Huong TT, le Nga T, et al. Screen-and-treat approach to cervical cancer prevention using visual inspection with acetic acid and cryotherapy: experiences, perceptions, and beliefs from demonstration projects in Peru, Uganda, and Vietnam. Oncologist. 2013;18(Suppl):6–12.CrossRefPubMed
30.
Perng P, Perng W, Ngoma T, Kahesa C, Mwaiselage J, Merajver SD, et al. Promoters of and barriers to cervical cancer screening in a rural setting in Tanzania. Int J Gynaecol Obstetrics. 2013;123(3):221–5.CrossRef
31.
Francis SA, Leser KA, Esmont EE, Griffith FM. An analysis of key stakeholders' attitudes and beliefs about barriers and facilitating factors in the development of a cervical cancer prevention program in South Africa. Afr J Reprod Health. 2013;17(1):158–68.PubMed
32.
Hyacinth HI, Adekeye OA, Ibeh JN, Osoba T. Cervical cancer and pap smear awareness and utilization of pap smear test among Federal civil servants in North Central Nigeria. PLoS One. 2012;7(10):e46583.CrossRefPubMedPubMedCentral
33.
Ngugi CW, Boga H, Muigai AW, Wanzala P, Mbithi JN. Factors affecting uptake of cervical cancer early detection measures among women in Thika, Kenya. Health Care Women Int. 2012;33(7):595–613.CrossRefPubMed
34.
Wamai RG, Ayissi CA, Oduwo GO, Perlman S, Welty E, Manga S, et al. Assessing the effectiveness of a community-based sensitization strategy in creating awareness about HPV, cervical cancer and HPV vaccine among parents in North West Cameroon. J Community Health. 2012;37(5):917–26.CrossRefPubMed
35.
Were E, Nyaberi Z, Buziba N. Perceptions of risk and barriers to cervical cancer screening at Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. Afr Health Sci. 2011;11(1):58–64.PubMedPubMedCentral
36.
Sudenga SL, Rositch AF, Otieno WA, Smith JS. Knowledge, attitudes, practices, and perceived risk of cervical cancer among Kenyan women: brief report. Int J Gynecol Cancer. 2013;23(5):895–9.CrossRefPubMedPubMedCentral
37.
Maree JE, Wright SC. Cervical cancer: does our message promote screening? A pilot study in a South African context. Eur J Oncol Nurs. 2011;15(2):118–23.CrossRefPubMed
38.
Fonn S, Bloch B, Mabina M, Carpenter S, Cronje H, Maise C, et al. Prevalence of pre-cancerous lesions and cervical cancer in South Africa--a multicentre study. S Afr Med J. 2002;92(2):148–56.PubMed
39.
Morema EN, Atieli HE, Onyango RO, Omondi JH, Ouma C. Determinants of cervical screening services uptake among 18–49 year old women seeking services at the Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya. BMC Health Services Res. 2014;14:335.CrossRef
40.
Tchounga BK, Jaquet A, Coffie PA, Horo A, Sauvaget C, Adoubi I, et al. Cervical cancer prevention in reproductive health services: knowledge, attitudes and practices of midwives in Cote d'Ivoire. West Afr BMC Health Services Res. 2014;14:165.CrossRef
41.
Maree JE, Lu XM, Wright SC. Combining breast and cervical screening in an attempt to increase cervical screening uptake. An intervention study in a South African context. Eur J Cancer Care. 2012;21(1):78–86.CrossRef
42.
Adonis L, An R, Luiz J, Mehrotra A, Patel D, Basu D, et al. Provincial screening rates for chronic diseases of lifestyle, cancers and HIV in a health-insured population. S Afr Med J. 2013;103(5):309–12.CrossRefPubMedPubMedCentral
43.
Mobley LR, Kuo TM, Clayton LJ, Evans WD. Mammography facilities are accessible, so why is utilization so low? Cancer Causes Control. 2009;20(6):1017–28.CrossRefPubMedPubMedCentral
44.
DuBard CA, Schmid D, Yow A, Rogers AB, Lawrence WW. Recommendation for and receipt of cancer screenings among medicaid recipients 50 years and older. Arch Intern Med. 2008;168(18):2014–21.CrossRefPubMed
45.
Kasper J, Bajunirwe F. Brain drain in sub-Saharan Africa: contributing factors, potential remedies and the role of academic medical centres. Arch Dis Child. 2012;97(11):973–9.CrossRefPubMed
46.
Khozaim K, Orang'o E, Christoffersen-Deb A, Itsura P, Oguda J, Muliro H, et al. Successes and challenges of establishing a cervical cancer screening and treatment program in western Kenya. Int J Gynaecol Obstetrics. 2014;124(1):12–8.CrossRef
47.
Kawonga M, Fonn S. Achieving effective cervical screening coverage in South Africa through human resources and health systems development. Reprod Health Matters. 2008;16(32):32–40.CrossRefPubMed
Metadata
Title
Health care access dimensions and cervical cancer screening in South Africa: analysis of the world health survey
Authors
Tomi F Akinyemiju
Jasmine A McDonald
Paula M Lantz
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-1686-5

Other articles of this Issue 1/2015

BMC Public Health 1/2015 Go to the issue

Research article

Motor development following in utero exposure to organochlorines: a follow-up study of children aged 5–9 years in Greenland, Ukraine and Poland

Research article

Quantifying the contribution of changes in healthcare expenditures and smoking to the reversal of the trend in life expectancy in the Netherlands

Research article

Frequency of HIV-testing and factors associated with multiple lifetime HIV-testing among a rural population of Zambian men

Research article

Is population structure sufficient to generate area-level inequalities in influenza rates? An examination using agent-based models

Research article

Food habits, physical activities and sedentary lifestyles of eutrophic and obese school children: a case–control study

Research article

Forecasting Tunisian type 2 diabetes prevalence to 2027: validation of a simple model