Cervical precancer screening coverage survey in Blantyre City and Chiradzulu District, Malawi

Cervical cancer is the third most common cancer among women worldwide, with more than 500,000 new cases and more than 300,00 deaths in 2018. The 20 most affected countries are in Africa. Malawi has the second-highest rate of cervical cancer in the world (72.9 cases per 100 000 persons per year), which is surpassed only by Swaziland.

In 2018, Médecins Sans Frontières (MSF) began a comprehensive cervical cancer programme that includes HPV vaccination, screening, and treatment of precancerous lesions, cancer treatment and palliative care in Blantyre city and Chiradzulu District.

To better prevent cervical cancer, MSF wants to better understand the needs for precancer and cancer screening. These needs are best evaluated by estimating the coverage of cervical precancer screening and describing barriers to screening uptake, so MSF asked Epicentre to perform an epidemiological survey.

The survey’s main objective was to measure the proportion of women aged 25-49 living in Blantyre city and Chiradzulu district who had been screened for cervical cancer and to assess their knowledge and awareness of the disease in order to improve the coverage of the cervical precancer screening program.

A two-stage cross-sectional sampling scheme was used to include a sample of households representative of Blantyre city and Chiradzulu district where MSF is working. Cervical precancer screening status was determined by interviews and examining women’s health passports.

In collaboration with MSF, Epicentre is exploring the feasibility of another study that would measure the effectiveness of an alternative treatment for cervical pre-cancer lesions and the accuracy of a related test of cure. 

This study might lead to a more scalable screening strategy and more effective follow-up protocols.