Preventing Cervical Cancer in Karawang District, Indonesia, YKim, FIGO2012
Transcript of Preventing Cervical Cancer in Karawang District, Indonesia, YKim, FIGO2012
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Preventing Cervical Cancer in KarawangDistrict, Indonesia: Evaluation of a 5-Year Project
Young Mi Kim, Fransisca Lambe, DjokoSoetikno, Abigael Ati, Ricky Lu
Presented at FIGO 2012 Conference,
Rome, Italy
October 2012
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Background and Objectives
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Cervical cancer is thesecond leading causeof cancer deathin developing countries.
In Indonesia,
over13,700 newcases of cervical
cancer and almost7,500 deathsdue to the disease werereported in 2008.
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Ministry of Health(MOH)/Indonesialaunched a low-costCervical Cancer
Prevention (CECAP)project in 2007, inpartnership with Jhpiegoand the Ford Foundation.
A model project wasdeveloped and piloted inKarawang District at 17health centers.
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Study Objectives
To evaluate the 5-year CECAP project at 17health centers in Karawang District in terms ofscreening coverage and efficiency of
cryotherapy treatment To evaluate a quality improvement intervention,
Standards-Based Management and Recognition(SBM-R), at 11 health centers in Karawang
District
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Interventions
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Service Model
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Visual Inspection with DiluteAcetic Acid (VIA) for screening,
Cryotherapy, if women areVIA+ and eligible, or
Referral to a hospital for
advanced diagnosis and care.
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Developed guidelines, servicemodel, training package
Trained general practitionersand nurse midwives
Provided equipment andsupplies
Trained staff on recordkeeping
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Conducted communityadvocacy and mobileoutreach
ImplementedStandards-BasedManagement andRecognition (SBM-R)
Piloted task shifting:
nurse midwives givecryotherapy
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Study Methods
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Collected service data from July 2007 toDecember 2011 in 17 health centers
Calculated key indicators from service data
Observed on-the-job performance at 11 healthcenters to evaluate SBM-R intervention:
55 consultations before the intervention (March 2010)
66 consultations after the intervention (October 2011)
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Results
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Cumulative Number of Women Screened20072011
13
777
5,651
15,949
32,355
45,050
0
5,00010,000
15,000
20,000
25,000
30,000
35,000
40,000
45,000
50,000
2007 2008 2009 2010 2011
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24.4% Screening Coveragein 17 Sub-Districts
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24.4%
75.6%
Screening coverage among total femalepopulation age 3050 in catchment area
(n=123,508)
Percentage of populationscreened (n=30,138)
Percentage of population
not screened (n=93,370)
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Cryotherapy Treatment
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13%
74%
13%
Of women who returned forcryotherapy, interval
between VIA screening andcryotherapy
Treated on the same day
Treated within one month*
Treated within a few months
83.1%
16.9%
Percentage of VIA+women who returned for
cryotherapy
Returned for cryotherapy
Did not return for cryotherapy
* An average of 7.2 days passed between screening and treatment, if treated within one month.
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SBM-R Scores before and after theIntervention
86
70
52
85
39
9299
84
9590
0
20
40
60
80
100
Equipmentand supplies
Facilityreadiness
Infectionprevention
VIAscreening
Datamanagement
Intervention sites: Baseline Intervention sites: Endline
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Program Recommendations
Expand screening coverage:
Mobile outreach
In-reach within facilities
Community advocacy and mobilization
Involve private midwives
Improve quality of service:
Continuous quality improvement (on-the-job coaching,mentoring, refresher training, supervision, peer feedback)
Provision of cryotherapy by nurse midwives at multiple locations
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Conclusions
The low-cost CECAP model worked inKarawang District.
The model needs some refinement for scaling up.
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