Healthcare partnerships (7) Cervical cancer prevention (3)

8 June, 2018

It is great to read about Ngozi Osuchukwu's initiative on cervical cancer screening by VIA method in Nigeria. Nigeria has no national screening for any cancer, therefore individuals and groups knowing the importance of catching cancers early, introduce their own screening. Like Ngozi the effort is always supported by donors, partners and self. We thank Ngozi for her effort to fill a big gap in Nigeria's weak health system on cancer care.

We would like to know more about Ngozi's initiative such as: Is it a screen and treat programme?, how is follow up done and how successful is it?, how is referral arranged and how is adherence to referral by the women ensured?, Is there a working relationship with the pathology and gynaecology departments of a neigbouring hospital? or do cytology and gynaecology experts visit the centre?

We ask these questions because some previous reports, even though recognising the importance of self help community efforts to fill gaps, because of the lack of national or local public health cancer screening programme, and most of the women at risk reside in rural parts of Nigeria, have adviced against the VIA method because of risk of under treatment or over treatment and the consequences of both. Especially in a country where follow up is froth with high rates of default.

A recent paper is worth reading : 'Int J Gynecol Cancer. 2013 Mar; 23(3): 507?512.. doi: 10.1097/IGC.0b013e318280f395 [*see note below]

Joseph Ana.

Africa Center for Clin Gov Research & Patient Safety

@ HRI West Africa Group - HRI WA

Consultants in Clinical Governance Implementation

Publisher: Health and Medical Journals

8 Amaku Street Housing Estate, Calabar

Cross River State, Nigeria

Phone No. +234 (0) 8063600642

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HIFA profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria. In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007. Website: Joseph is a member of the HIFA Steering Group:

jneana AT

[*Note from HIFA moderator (Neil PW): Abstract below. The full text of this paper is available here:


Objective: Cervical cancer is the most common gynecological cancer in developing countries. Visual inspection with acetic acid (VIA) was introduced to screen for cervical premalignant lesions in developing countries owing to the inability of many countries to implement high-quality cytologic services. We sought to compare VIA performance among different health workers in Nigeria.

Methods: In a population-based project, 7 health workers who had been screening women with VIA for approximately 2 years at local government health centers in rural Nigeria were retrained in a 2-week program using the International Agency for Research on Cancer training manual. Women from a rural village who had never had cervical cancer screening were recruited into the study. Each woman had cervical cancer screening by VIA, liquid-based cytologic test, and oncogenic human papillomavirus (HPV) DNA test.

Results: Despite similar participant characteristics, across all age groups, providers had wide ranges of VIA results; 0% to 21% suspect cancer and 0% to 25% were VIA positive. Visual inspection with acetic acid was insensitive compared to a combination of cytologic and HPV tests.

Conclusion: In our study, VIA was not reproducible, nor was it sensitive compared to cytologic and HPV tests.]