Role of print and audiovisual media in cervical cancer prevention in Bangladesh.

BACKGROUND: Visual inspection of cervix with acetic acid (VIA) is offered at 252 centers in 64 districts of Bangladesh. VIA+ve women are managed at colposcopy clinics of Bangabandhu Sheikh Mujib Medical University (BSMMU) and 14 Medical College Hospitals (MCHs). This research work has been supported by 'UICC Cancer Prevention Campaign' programme. OBJECTIVES: This study explored the role of print materials and electronic media to improve cervical cancer screening in the present socio-cultural context of Bangladesh. METHODS: This study was performed from January to August 2011 at two upazilas of Bangladesh (Singair with screening facility and Sonargaon without screening facility). Data were collected by focus group discussion (FGD) with women, husbands and community people before and after intervention. Information on cervical cancer screening and VIA camps was disseminated using advertisement through local cable line of the television, microphone announcement, service providers and leaflet throughout the week prior to a VIA camp. Three-day VIA camps were organized at the upazila health complex (UHC) of both upazilas. Quantitative data was gathered from women at the camps on source of information on VIA and the best method of awareness creation. RESULTS: The population was aware of "cancer" and a notable number knew about cervical cancer. Baseline awareness on prevention and VIA was low and it was negligible where screening services were unavailable. Awareness was increased fourfold in both upazilas after interventions and half of the women and the majority of the community people became aware of screening and available facilities. Cable line advertisement (25.5%), microphone announcement (21.4%), and discussion sessions (20.4%) were effective for awareness creation on VIA. Television was mentioned as the best method (37.4%) of awareness creation. CONCLUSION: Television should be used for nation-wide awareness creation. For local awareness creation, cable line advertisement, microphone announcements and health education at Uthan Baithaks/ EPI sessions can easily be adopted by the government.

Screening for cervical neoplasia in Bangladesh using visual inspection with acetic acid.

OBJECTIVE: To report the organization and early results of a visual inspection with acetic acid (VIA) screening program for cervical cancer prevention in Bangladesh. METHODS: Opportunistic VIA screening was offered by trained medical personnel to healthy women attending healthcare facilities in 44 districts. Colposcopy and/or directed biopsies were performed on VIA-positive women at Bangabandhu Sheikh Mujib Medical University (BSMMU) or medical college hospitals. The numbers of screened and VIA-positive women as well as the results of colposcopy, biopsy, and treatment of those with cervical intraepithelial neoplasia (CIN) attending BSMMU are reported. RESULTS: From January, 2005, to June, 2008, 104098 women underwent VIA screening. Among them, 5013 (4.8%) women were positive, of whom 4371 (87.2%) attended colposcopy clinics in different hospitals. Of the 2188 who underwent colposcopy at BSMMU, 157 were diagnosed with CIN 2-3 and 123 with invasive cancer. For 2065 women (excluding the cancer cases), results for sensitivity, specificity, and positive predictive value of VIA to detect CIN 2-3 lesions were 93.6%, 58.3%, and 15.6%, respectively. Almost half the women with CIN 2 or 3 lesions had treatment. CONCLUSION: A VIA-based program would facilitate the development of screening, diagnosis, and treatment of cervical neoplasia and improve awareness of cervical cancer prevention in Bangladesh.