Lavelle Anne E, Su Dejun, Kahesa Crispin, Soliman Amr S
Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, Omaha, NE, USA.
Ocean Road Cancer Institute, Dar es Salaam, Tanzania.
J Cancer Educ. 2019 Feb;34(1):124-129. doi: 10.1007/s13187-017-1276-6.
Cervical cancer is a significant health problem in many developing countries. Due to limited treatment facilities for cancer in Tanzania, a screening referral program was developed between two urban clinics and Ocean Road Cancer Institute (ORCI), the only cancer treatment center in Tanzania. This study aimed to evaluate the effectiveness of the program and to identify opportunities for professional education. The study included 139 patients who were referred to ORCI from the screening clinics of Magomeni and Temeke between January 2015 and May 2016. Abstracted data from the medical records included patient age, screening results, and treatment. Eight nurses performing screening at the three locations were interviewed about their screening experience. Over half of the referrals (51.9%) were false positives. False positive diagnosis was more common among younger patients (35.68 ± 8.6 years) (p < 0.001) and those referred from Magomeni (59.8%) (p < 0.01) than referrals of older patients (42.46 ± 11.1 years) or those from Temeke (33.3%). Interviews of nurses showed differences among clinics, including resources, experience, and documentation of screening results. The high false positive rates and the variation of accuracy of screening between the two clinics showed a need for professional education of nurses and improvement in the health systems. Continuous education of nurses may increase the effectiveness of cervical screening. Health system enhancement of screening facilities such as provision of Lugol's iodine, more space for screening, and consistency and completion of screening records are needed to increase the accuracy of cervical screening and referrals in Tanzania and other similar low-income countries.
宫颈癌在许多发展中国家都是一个重大的健康问题。由于坦桑尼亚癌症治疗设施有限，在该国仅有的癌症治疗中心——海洋路癌症研究所（ORCI）与两家城市诊所之间开展了一项筛查转诊项目。本研究旨在评估该项目的有效性，并确定专业教育的机会。该研究纳入了2015年1月至2016年5月期间从马戈梅尼和特梅克筛查诊所转诊至ORCI的139名患者。从病历中提取的数据包括患者年龄、筛查结果和治疗情况。对在这三个地点进行筛查的八名护士就其筛查经验进行了访谈。超过一半的转诊（51.9%）为假阳性。与老年患者（42.46±11.1岁）或来自特梅克的患者（33.3%）的转诊相比，假阳性诊断在年轻患者（35.68±8.6岁）（p<0.001）和来自马戈梅尼的转诊患者（59.8%）（p<0.01）中更为常见。对护士的访谈显示各诊所之间存在差异，包括资源、经验以及筛查结果的记录。两个诊所之间高假阳性率和筛查准确性的差异表明需要对护士进行专业教育并改善卫生系统。对护士进行持续教育可能会提高宫颈癌筛查的有效性。需要加强卫生系统的筛查设施，如提供卢戈氏碘、增加筛查空间以及确保筛查记录的一致性和完整性，以提高坦桑尼亚及其他类似低收入国家宫颈癌筛查和转诊的准确性。
