Cervical Cancer Screening, Adherence to and Challenges of Follow-Up in Resources Poor Setting

Background: Organized cervical cancer screening program has contributed to the reduction in incidence of cervical cancer in developed countries. Follow up, to ensure adherence to regular screenings, still poses challenges in poor resource settings. Objective: This study aims at determining the cervical cancer screening uptake, adherence to follow up instructions and interval cervical cancer screening and intervention to improve adherence through personalized reminders (phone calls and text messages). Methods: This was a prospective study of clients screened for cervical cancer at the University of Nigeria Teaching Hospital, Enugu from January 2012 to December 2016. The participants were studied for adherence to interval follow-up screening. Eligible participants were followed up using phone calls and text messages and the outcome noted. The data was analysed using statistical software for social sciences (SPSS) version 17. Results: The mean age and parity of 1146 participants screened for cervical intra-epithelial abnormalities within the study period was 44.18 ± 11.08 years and 3.78 ± 2.08 respectively. Most of the subjects (91.8%) screened negative to squamous intra-epithelial lesion (SIL) or malignancy, 8.2% (94/1146) had various grades of SIL. Thirty-five (37%), 29 (31%), 16 (17%) and 14 (15%) of the 94 SIL positive cases had atypical cells of unknown significance (ASCUS), low-grade squamous intra-epithelial lesion (LGSIL), high-grade squamous intra-epithelial lesion (HGSIL) and cervical carcinoma respectively. Adherence to instructions for repeat cytology was only 37.7% while that for 3 yearly interval rescreening was 17.5%. Phone calls and messages to clients improved adherence to appreciable extent. Conclusion: Adherence to interval and follow-up screening for cervical cancer was low. The use of phone calls and short message services (SMS) to remind clients of screening appointments increased adherence and should be employed in developing countries.