African Journal of Primary Health Care & Family Medicine

A qualitative study exploring the primary health care nurses’ lived experiences of cervical cancer screening

Background: In the low- and middle-income countries (LMICs), cervical cancer is the primary cause of cancer-related female deaths. Lesotho has a cervical cancer incidence that is 2.7 times higher than the global average. This disease can be prevented by vaccination, which is not available in all countries, and through screening, which has been shown to have low uptake even among health professionals. Aim: To explore primary health care (PHC) nurses’ lived experiences of cervical cancer screening in Lesotho. Thus, to better understand how these experiences can impact nurses’ subsequent screening or their goal of offering screening services to their patients. Setting: The study was conducted at four PHC centres in the selected district. Methods: This is a qualitative study in which a phenomenological design was used. Ten nurses were purposively selected and participated in the in-depth interviews. The data were analysed thematically. Results: The findings revealed participants’ positive and negative experiences with cervical cancer screening. Positive experiences, including good nursing services, freedom of choice and pain prevention, influenced the nurses’ intentions to continue to test in the future and to strongly recommend screening to other women. The negative experiences included a lack of privacy, the absence of counselling and receiving results late. These negative experiences had a detrimental effect on nurses’ intentions to undergo screening in the future. However, they had no impact on their goal of offering screening to other women. Conclusion: The findings provided essential insights into why cervical cancer screening uptake is low among nurses. Contribution: This evidence is critical for augmenting the knowledge of how cervical cancer screening programmes could be improved to enhance nurses’ screening uptake and invariably facilitate higher screening rates within the general population.

Expanding the case for gender-neutral human papillomavirus vaccination in South Africa: Emerging neonatal and ethical considerations

Human papillomavirus (HPV) is widely recognised for its role in causing cervical cancer, prompting many countries, including South Africa, to prioritise girls in school-based vaccination programmes. This short report presents an exploratory case for expanding HPV vaccination to adolescent boys as well, drawing on emerging, but still limited evidence of maternal and paternal HPV transmission to neonates. Although current data on neonatal risks are preliminary, the possibility of vertical transmission and associations with respiratory papillomatosis, preterm birth and fertility issues warrant further investigation. Beyond neonatal outcomes, gender-neutral HPV vaccination offers ethical and public health benefits by promoting equitable protection, enhancing herd immunity and addressing transmission dynamics. Recent advances, including the World Health Organization-endorsed single-dose schedules and the availability of affordable vaccines, provide opportunities to revisit cost-effectiveness analyses. We recommend further context-specific research and modelling to quantify the long-term benefits of gender-neutral strategies in South Africa and similar settings.

Health system constraints in cervical cancer prevention in rural Namibia: A qualitative study

Background: Cervical cancer remains a pressing public health concern in Namibia, with significant barriers to prevention, particularly in rural areas. Aim: This study explored health system’s challenges and their impact on cervical cancer prevention efforts. Setting: This study was conducted in the Ohangwena and Kavango West regions of Namibia. Methods: A qualitative exploratory design was employed, focusing on healthcare workers directly involved in cervical cancer prevention. In-depth interviews were utilised to collect data from 11 participants from four district hospitals. Thematic analysis, guided by the World Health Organisation’s six health system framework pillars, was used. Results: Key service gaps were identified across critical areas of cervical cancer prevention, including a lack of awareness, a lack of human papillomavirus vaccines and referral screening equipment that limited local outreach services. Other significant findings included the shortage of trained personnel and the manual data systems, which resulted in deficiencies in decision-making. Financial constraints, including reliance on non-governmental organisation funding and weak community engagement, exacerbated by cultural stigma, presented leadership challenges. Conclusion: Investing in human resources for health, decentralising budget trends and enhancing data systems are critical for cervical cancer prevention in rural Namibia. Equally important is the active involvement of the community in these efforts. Contribution: This study highlights key health system constraints in the Ohangwena and Kavango West regions.

Exploring primary health care nurses’ perceptions of cervical cancer screening in Leribe, Lesotho

Background: Cervical cancer ranks fourth among cancers recorded globally and is the second most common cause of cancer-related morbidity and mortality in women. Although cervical cancer is fatal, the early discovery of precancerous cells by extensive and recurrent screening could lead to a significant decline in incidence. However, the acceptance of cervical cancer screening is low, even among healthcare workers. Aim: To explore the perceptions of primary care nurses about cervical cancer screening. Setting: The study was carried out in four primary health care centres (PHCCs) in the Leribe district. Methods: This is an exploratory qualitative study. The researcher purposively selected and interviewed 10 nurses at the selected PHCCs. The data were analysed thematically. Results: Nurses’ perceptions of cervical cancer screening influenced whether they routinely detect the disease. Certain perceptions, such as being susceptible to cancer, fear of cancer consequences, feeling relieved by negative results, high self-efficacy, training and witnessing deaths, all encouraged routine screening. Those that discouraged routine screening included fear of positive testing, lack of results, perceived lack of confidence and privacy in screeners and low self-efficacy. Conclusion: These findings show that nurses’ decisions to undergo a regular screening are either encouraged or discouraged by their perceptions about cervical cancer screening. They also imply that the general public may be impacted by these perceptions as well. Contribution: These findings add significantly to the body of knowledge about how policies can be improved to improve nursing screening programmes, which can improve screening rates among the general population.

Challenges regarding the implementation of cervical cancer screening guidelines in Limpopo province, South Africa

The World Health Organization's (WHO) call to eliminate cervical cancer is essential in improving structures and processes at primary healthcare facilities by galvanising change in providing cervical cancer screening services. The main objective of this study was to explore challenges affecting the implementation of cervical cancer screening guidelines in selected districts in Limpopo Province. The study was carried out at primary health care services (PHCs) in Vhembe and Mopani districts, Limpopo province. Qualitative non-experimental research design of an exploratory, descriptive and contextual nature of a qualitative paradigm to understand cervical cancer screening programme challenges from healthcare professionals' perspectives. The study population comprised two males and 16 female professional registered nurses working in Limpopo province's PHC services. The sample size was 18 professional nurses. A face-to-face interview guided by unstructured questionnaires was undertaken to elicit information regarding the implementation of cervical cancer screening services. Captured data were analysed using Tesch's open-coding method. The study revealed that the cervical cancer guidelines were not effectively implemented as there were contradictions and gaps when applying the guidelines about the management of HIV and AIDS, age restrictions and gestation. Furthermore, structural factors contributed to the inadequacy rate and failure to reach the set targets. Primary health care is an essential health care and human right; therefore, the government should ensure that guidelines and policies are supported financially and that professional nurses are capacitated for the efficient implementation of services.Contribution: Addressing the inequalities in the implementation of social policies for the prevention of cervical cancer prevention and improving the nurses' knowledge and practice behaviour regarding cervical cancer prevention are imperative.

Knowledge and attitudes relating to cervical and breast cancer among women in Maseru, Lesotho

Cancer has remained one of the leading causes of death worldwide. In Lesotho, breast and cervical cancers contribute about 43% of all the cancer cases annually. This study is aimed at comparing knowledge, attitudes, and practices between breast and cervical cancers among females in Maseru. This study consists of women residing in five study sites which have clinics that offer cervical and breast cancer-screening services. A cross-sectional study was conducted in June 2021 in Maseru, the Capital city of Lesotho. The participants were interviewed using a pre-tested questionnaire, through which their knowledge, practices about, and attitudes towards breast and cervical cancers were assessed. A total of 228 women aged 15-75 years participated in the study and the majority were aged 30 years and above. Of the women interviewed for cervical cancer, 89.5% had heard of it, 11.8% had heard of its screening, and 7.4% had at least one examination. Similarly, for breast cancer, 77.6% of women who had heard of it, 72.9% had heard of screening, and 40.1% of women did at least one examination. The majority of women were more knowledgeable about cervical cancer than breast cancer. However, more women had heard about breast cancer screening than cervical cancer screening. Therefore, there is a need for awareness campaigns related to cervical cancers' screening.Contribution: There is an urgent need to intensify awareness about cervical and breast cancer screening and availability of services at the nearby clinics.