Epicentre / Médecins Sans Frontières (MSF), Paris, France.
Médecins Sans Frontières (MSF), Paris, France.
BMC Public Health. 2022 Feb 14;22(1):295. doi: 10.1186/s12889-022-12547-9.
Cervical cancer (CC) is the fourth most common cancer among women worldwide and Malawi has the world's highest rate of cervical cancer related mortality. Since 2016 the National CC Control Strategy has set a screening coverage target at 80% of 25-49-year-old women. The Ministry of Health and Médecins Sans Frontières (MSF) set up a CC program in Blantyre City, as a model for urban areas, and Chiradzulu District, as a model for rural areas. This population-based survey aimed to estimate CC screening coverage and to understand why women were or were not screened.
A population-based survey was conducted in 2019. All resident consenting eligible women aged 25-49 years were interviewed (n = 1850) at households selected by two-stage cluster sampling. Screening and treatment coverage and facilitators and barriers to screening were calculated stratified by age, weighted for survey design. Chi square and design-based F tests were used to assess relationship between participant characteristics and screening status.
The percentage of women ever screened for CC was highest in Blantyre at 40.2% (95% CI 35.1-45.5), 38.9% (95% CI 32.8-45.4) in Chiradzulu with supported CC screening services, and lowest in Chiradzulu without supported CC screening services at 25.4% (95% CI 19.9-31.8). Among 623 women screened, 49.9% (95% CI 44.0-55.7) reported that recommendation in the health facility was the main reason they were screened and 98.5% (95% CI 96.3-99.4) recommended CC screening to others. Among 1227 women not screened, main barriers were lack of time (26.0%, 95% CI 21.9-30.6), and lack of motivation (18.3%, 95% CI 14.1-23.3). Overall, 95.6% (95% CI 93.6-97.0) of women reported that they had some knowledge about CC. Knowledge of CC symptoms was low at 34.4% (95% CI 31.0-37.9) and 55.1% (95% CI 51.0-59.1) of participants believed themselves to be at risk of CC.
Most of the survey population had heard about CC. Despite this knowledge, fewer than half of eligible women had been screened for CC. Reasons given for not attending screening can be addressed by programs. To significantly reduce mortality due to CC in Malawi requires a comprehensive health strategy that focuses on prevention, screening and treatment.
宫颈癌（CC）是全球女性中第四常见的癌症，而马拉维的宫颈癌相关死亡率位居世界第一。自 2016 年以来，国家 CC 控制战略将 25-49 岁女性的筛查覆盖率目标设定为 80%。卫生部和无国界医生组织（MSF）在布兰太尔市设立了一个 CC 项目，作为城市地区的典范，在奇拉朱卢区设立了一个 CC 项目，作为农村地区的典范。这项基于人群的调查旨在估计 CC 筛查的覆盖率，并了解女性接受或未接受筛查的原因。
2019 年进行了一项基于人群的调查。所有符合条件的 25-49 岁的居住同意的女性在通过两阶段聚类抽样选择的家庭中接受访谈（n=1850）。根据年龄分层计算筛查和治疗覆盖率，并根据调查设计进行加权。卡方检验和基于设计的 F 检验用于评估参与者特征与筛查状况之间的关系。
曾接受 CC 筛查的女性比例最高的是布兰太尔，为 40.2%（95%CI 35.1-45.5），奇拉朱卢有支持的 CC 筛查服务的比例为 38.9%（95%CI 32.8-45.4），而奇拉朱卢没有支持的 CC 筛查服务的比例最低，为 25.4%（95%CI 19.9-31.8）。在 623 名接受筛查的女性中，49.9%（95%CI 44.0-55.7）报告说，在医疗机构的推荐是她们接受筛查的主要原因，98.5%（95%CI 96.3-99.4）向其他人推荐 CC 筛查。在 1227 名未接受筛查的女性中，主要障碍是缺乏时间（26.0%，95%CI 21.9-30.6）和缺乏动力（18.3%，95%CI 14.1-23.3）。总体而言，95.6%（95%CI 93.6-97.0）的女性表示对 CC 有一定的了解。CC 症状的知晓率较低，为 34.4%（95%CI 31.0-37.9），55.1%（95%CI 51.0-59.1）的参与者认为自己有患 CC 的风险。
大多数调查人群都听说过 CC。尽管有这些知识，但不到一半的符合条件的女性接受了 CC 筛查。未参加筛查的原因可以通过项目来解决。要显著降低马拉维因 CC 导致的死亡率，需要制定一项注重预防、筛查和治疗的全面卫生战略。
