Extent to which Visual Inspection with Acetic Acid Screening Guidelines are Adhered to in Selected Health Facilities in Embu County Kenya, Before and After

Abstract

Cervical cancer is one of the few diseases that reflect global inequities. In low and middle income countries, its incidence is nearly twice as high and death rates three times as high compared to high income countries. Visualizing with acetic acid encompasses vaginal examination using a speculum, followed with application of dilute (3 - 5%) acetic acid (vinegar) to the cervix. Presence of abnormal tissue often temporarily appears white when exposed to vinegar and then cervical color changes are observed with a naked eye. The outcome of Visual inspection with acetic acid is subjective and depends on the level of skill of health care provider, availability of supplies and adherence to procedure guidelines. This study sought to determine the extent to which visual inspection with acetic acid guidelines are adhered to in selected health facilities in Embu county prior to and after intervention. Fourteen health care providers were taken through a two-day intensive VIA didactic training and a four-day clinical practice with guidance of preceptors. The facilities where respondents were recruited from were selected using a purposeful sampling method. Prior to intervention, baseline data was taken that included use of questionnaires and observational checklist to determine adherence to VIA guidelines. The health care providers were then followed up for a period of four months and 434 women were screened. The study area was Embu County in Kenya and the target population was the health services providers who provided VIA services in government facilities. Primary data was collected through self-administered questionnaires and observational checklists and secondary from health facility records and KDHS 2014. Data was analyzed using quantitative techniques. Despite the respondents having prior training on cervical cancer screening using VIA/VILLI, positivity rate was low before intervention. The guidelines were poorly adhered to prior to training but improved adherence was recorded after training, and healthcare providers made correct diagnosis and identified precancerous lesions after intervention. Cervical cancer screening uptake also scaled up. Baseline positivity was 0.8% but rose to 14.1% after training. There is need to revise MOH VIA training guidelines and curriculum to accommodate clinical practice for at least 4 days after 2-day didactic training with use of preceptors and cervical images.