Overview of Cervical Cancer Prevention Services in Khartoum State – December 2018: A Case Study
Background: Although cervical cancer is largely preventable, it continues to be an important cause of morbidity and mortality in Sudan, due to the lack of national control programs. This study aimed to evaluate the availability of cervical cancer prevention services and assess the facility readiness in Khartoum state, as a base for future plans.
Methods: This study was an observational, mixed-method, health service research. Purposive sampling method was used to select focal persons to explore the current situation and the available services qualitatively. Observation through standardized checklists of screening and colposcopy centers was conducted, and service providers were interviewed. Thematic analysis and descriptive statistics were used to analyze data.
Results: Based on the qualitative interviews, Khartoum Oncology Hospital is the only specialized center providing chemotherapy and radiotherapy services for the state. Although six screening and nine diagnostic centers were surveyed, services were not available in most localities. Reasonable but unutilized resources in the secondary level exist at the time of the study, primary-level efforts to control cervical cancer are uncoordinated and ineffective, with no linked efforts at the community level. Since initiatives to reduce cervical cancer mortality need to adopt a holistic approach to the disease continuum, a comprehensive model was suggested and explained, the gaps and challenges were discussed.
Conclusion: Cervical cancer prevention still remains a highly unaddressed need in Sudan. Sustainable financing of robust programs is necessary to achieve elimination. Contextually relevant devices must be selected to improve resource allocation. These results might be useful for the establishment of cervical cancer control in Sudan.
Keywords: cervical cancer, screening, health system, developing countries, Sudan
 Basu, P., Meheus, F., Chami, Y. (2017). Management algorithms for cervical cancer screening and precancer treatment for resource-limited settings. International Journal of Gynecology & Obstetrics, vol. 138, no. 1, pp. 26–32.
 Ferlay, J., Soerjomataram, I., and Mea, E. (2012). GLOBOCAN 2012: Estimated cancer incidence and mortality worldwide in 2012 v1.0. IARC CancerBase No. 11.
 Carr, K. and Sellors, J. (2004). Cervical cancer screening in low resource settings using visual inspection with acetic acid. Journal of Midwifery & Women’s Health, vol. 49, no. 4, pp. 329-337.
 Sharma, M., Ortendahl, J., van der Ham, E., et al. (2012). Cost-effectiveness of human papillomavirus vaccination and cervical cancer screening in Thailand. British Journal of Obstetric and Gynaecology, vol. 119, no. 2, pp. 166–176.
 Santesso, N., Mustafaa, R. A., Schünemann, H. J., et al. (2016). World Health Organization Guidelines for treatment of cervical intraepithelial neoplasia 2–3 and screen-and-treat strategies to prevent cervical cancer. International Journal of Gynecology and Obstetrics, vol. 132, no. 3, pp. 252–258.
 Nakisige, C., Schwartzb, M., and Ndira, A. O. (2017). Cervical cancer screening and treatment in Uganda. Gynecologic Oncology Reports, vol. 20, pp. 37–40.
 Arbyn, M., Weiderpass, E., Bruni, L., et al. (2020). Estimates of the incidence of cervical cancer 2018. Lancet Glob Health, vol. 8, no. 2, pp. E191–E203.
 Ibrahim, A., Rasch, V., Pukkala, E., et al. (2011). Predictors of cervical cancer being at an advanced stage at diagnosis in Sudan. International Journal of Women's Health, vol. 3, pp. 385–389.
 Black, E., Hyslop, F., and Richmond, R. (2019). Barriers and facilitators to uptake of cervical cancer screening among women in Uganda: a systematic review. BMC Women's Health, vol. 19, article 108.
 Paz-Soldána, V. A., Bayerb, A. M., Nussbaumc, L., et al. (2012). Structural barriers to screening for and treatment of cervical cancer in Peru. Reprod Health Matters, vol. 20, no. 40, pp. 49–58.
 Mukakalisa, I., Bindler, R., Allen, C., et al. (2014). Cervical cancer in developing countries: effective screening and preventive strategies with an application in Rwanda. Health Care for Women International, vol. 35, no. 7–9, pp. 1065–1080.
 WHO. (2014). Comprehensive Cervical Cancer Control: A Guide to Essential Practice (second ed.). Switzerland: WHO.
 Finocchario-Kessler, S., Wexler, C., Maloba, M., et al. (2016). Cervical cancer prevention and treatment research in Africa: a systematic review from a public health perspective. BMC Women's Health, vol. 16, article 29.
 WHO. (2015). Service Availability and Readiness Assessment (SARA) | Reference Manual. Geneva: WHO.
 Bowling, A. (2009). Investigating health and health services: the scope of research In: A. Bowling (Ed.), Research Methods in Health - Investigating Health and Health Services. New York, NY: McGraw-Hill Education.
 Bryman, A. (2006). Integrating quantitative and qualitative research: how is it done? Qualitative Research, vol. 6, no. 1, pp. 97–113.
 National-Centre-for-Health-Informatics. (2018). Annual Statistic Report. Khartoum, Sudan: MoH.
 WHO. (2018). Improving Data For Decision-Making: A Toolkit For Cervical Cancer Prevention and Control Programmes. Geneva: World Health Organization. Available from: https://www.who.int/ncds/surveillance/data-toolkit-for-cervical-cancer-prevention-control/en/
 Clarke, M. and Kurinczuk, J. (1992). Health services research: a case of need or special pleading? The Committee of Heads of Academic Departments of Public Health. BMJ, vol. 304, no. 6843, pp. 1675–1676.
 Unitaid. (2019). Cervical Cancer: Screening and Treatment of Pre-cancerous Lesions For Secondary Prevention of Cervical Cancer Technology Landscape. WHO.
 WHO. (2020). Global Strategy Towards Eliminating Cervical Cancer as a Public Health Problem. Retrieved from: https://www.who.int/publications/i/item/9789240014107
 Canfell, K. (2019). Towards the global elimination of cervical cancer. Papillomavirus Research, vol. 8, p. 100170.
 Gupta, R., Gupta, S., Mehrotra, R., et al. (2017). Cervical cancer screening in resource-constrained countries: current status and future directions. Asian Pacific Journal of Cancer Prevention, vol. 18, no. 6, pp. 1461–1467.
 Anorlu, R. I. (2008). Cervical cancer: the sub-Saharan African perspective. Reproductive Health Matters, vol. 16, no. 32, pp. 41–49.
 Agurto, I., Sandoval, J., Dela, M. R., et al. (2006). Improving cervical cancer prevention in a developing country. International Journal for Quality in Health Care, vol. 18, no. 2, pp. 81–86.
 Haider, I., Kumar, R., and Tanwar, P. (2017). HPV: infection, prevention and vaccination in India. International Journal of Medical Laboratory Research, vol. 2, no. 1, pp. 35–40.
 Cubie, H. A. and Campbell, C. (2020). Cervical cancer screening – the challenges of complete pathways of care in low-income countries: focus on Malawi. Women’s Health, vol. 16, pp. 1–19.
 Fresier, C., Chirwa, M. M. L., and Muula, A. S. (2015). Health systems challenges in cervical cancer prevention program in Malawi. Global Health Action, vol. 8, no. 26282.