Data, University of North Carolina Project, Lilongwe, Central Region, Malawi
Obstetrics and Gynecology Department, University of North Carolina System, Chapel Hill, North Carolina, USA.
BMJ Open. 2021 Sep 14;11(9):e049901. doi: 10.1136/bmjopen-2021-049901.
Cervical cancer is the leading cause of cancer deaths among women in Malawi, but preventable through screening. Malawi primarily uses visual inspection with acetic acid (VIA) for screening, however, a follow-up for positive screening results remains a major barrier, in rural areas. We interviewed women who underwent a community-based screen-and-treat campaign that offered same-day treatment with thermocoagulation, a heat-based ablative procedure for VIA-positive lesions, to understand the barriers in accessing post-treatment follow-up and the role of male partners in contributing to, or overcoming these barriers.
We conducted in-depths interviews with 17 women recruited in a pilot study that evaluated the safety and acceptability of community-based screen-and-treat programme using VIA and thermocoagulation for cervical cancer prevention in rural Lilongwe, Malawi. Ten of the women interviewed presented for post-treatment follow-up at the healthcare facility and seven did not. The interviews were analysed for thematic content surrounding barriers for attending for follow-up and role of male partners in screening.
Transportation was identified as a major barrier to post-thermocoagulation follow-up appointment, given long distances to the healthcare facility. Male partners were perceived as both a barrier for some, that is, not supportive of 6-week post-thermocoagulation abstinence recommendation, and as an important source of support for others, that is, encouraging follow-up attendance, providing emotional support to maintaining post-treatment abstinence and as a resource in overcoming transportation barriers. Regardless, the majority of women desired more male partner involvement in cervical cancer screening.
Despite access to same-day treatment, long travel distances to health facilities for post-treatment follow-up visits remained a major barrier for women in rural Lilongwe. Male partners were identified both as a barrier to, and an important source of support for accessing and completing the screen-and-treat programme. To successfully eliminate cervical cancer in Malawi, it is imperative to understand the day-to-day barriers women face in accessing preventative care.
宫颈癌是马拉维女性癌症死亡的主要原因，但可以通过筛查来预防。马拉维主要使用醋酸视觉检查（VIA）进行筛查，然而，农村地区对阳性筛查结果的后续跟进仍然是一个主要障碍。我们采访了参加社区筛查和治疗活动的女性，该活动为 VIA 阳性病变提供了即时的热凝治疗，以了解在获得治疗后随访方面的障碍，以及男性伴侣在克服这些障碍方面的作用。
我们对 17 名在马拉维利隆圭农村地区评估使用 VIA 和热凝治疗进行社区筛查和治疗宫颈癌预防的安全性和可接受性的试点研究中招募的女性进行了深入访谈。接受访谈的 17 名女性中有 10 名在医疗保健机构接受了治疗后随访，7 名没有。对访谈内容进行了主题分析，内容围绕着参加随访的障碍以及男性伴侣在筛查中的作用。
由于距离医疗保健机构较远，交通被认为是治疗后随访预约的主要障碍。男性伴侣被认为是一些人的障碍，即不支持 6 周后热凝治疗的禁欲建议，也是其他人的重要支持来源，即鼓励随访就诊，提供情感支持以保持治疗后禁欲，并在克服交通障碍方面提供资源。尽管如此，大多数女性希望男性伴侣更多地参与宫颈癌筛查。
尽管可以进行当天治疗，但对于利隆圭农村地区的女性来说，前往医疗设施进行治疗后随访仍然是一个主要障碍。男性伴侣被认为既是获得和完成筛查和治疗计划的障碍，也是支持的重要来源。为了在马拉维成功消除宫颈癌，了解女性在获得预防保健方面面临的日常障碍至关重要。
