Preventing Cervical Cancer in Karawang District, Indonesia, YKim, FIGO2012

7/31/2019 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

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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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Documents

Preventing Cervical Cancer in Karawang District, Indonesia, YKim, FIGO2012