Clinical Training of Visual Inspection With Acetic to Influence the Accuracy of Outcome in Cervical Precancer Screening in Selected Facilities at Embu County, Kenya.
Abstract
Cervical cancer ranks as the prevalent cancer, among women in developing nations. The World
Health Organization (WHO) has highlighted the lack of resources for prevention programs.
Despite efforts to screen for cancer and training on VIA/VILLI the number of deaths from this
disease remains alarmingly high. It's worth noting that Kenyas VIA/VILI training guidelines do
not place emphasis on the importance of practice in improving screening results, which is crucial
due to the subjective nature of the VIA test. As a result Embu County in Kenya has only
observed a 1% positivity rate for pre cancer whereas WHO standards indicate that it should be
around 10 15% within any given population (as per their 2010 report). The objective of this
study was to assess how effective VIA clinical training is in influencing outcomes related to
inspection with acid for cervical pre cancer screening at selected facilities in Embu County,
Kenya. This research aimed to contribute to existing literature and nursing studies while aligning
with policies on controlling diseases. Moreover it sought to determine the training approach, for
VIA that would enhance the effectiveness of cervical cancer screening outcomes using this
method. To achieve these objectives we employed an embedded mixed method study design.
Fourteen healthcare professionals who participated in the study underwent a training program for
two days of instruction and four days of hands on clinical practice, under the guidance of
experienced mentors. The selection of facilities where the respondents were recruited followed a
sampling approach. Subsequently these healthcare providers were closely monitored for a
duration of four months during which 434 women underwent screening. The research took place
in Embu County, focusing on healthcare providers who offer VIA services, in government
facilities. We collected data by using questionnaires conducting observations and interviewing
informants (referred to as KII). In addition we gathered data from health facility records and the
KDHS 2014. Our analysis included both techniques. We examined the data through univariate.
Bivariate analyses to understand the characteristics of the study population. To measure
agreement we used Cohens Kappa Coefficient (K). The qualitative data obtained from the
interviews underwent analysis. The studys findings indicated that even though all respondents
had received training on cervical cancer screening using VIA/VILLI, the positivity rate, before
intervention was 0.8%. Adherence to cervical cancer screening guidelines was poor prior to
training. Improved significantly after intervention. Cohens Kappa Co-efficient was 0.54 on day
one of clinical training. Post-training, there was near-perfect agreement at (k) 0.9, with the
Probability of agreement (Po) at 0.86 and Probability of random agreement (Pe) 0.74. The t-test
for pre/post-test was P< 0.001. This showed significant learning had been achieved. Following
the intervention healthcare providers demonstrated improved skills and ability to identify lesions.
There was also an increase in cancer screening uptake. The post training pre cancer positivity
rate stood at 14.1%. It is recommended that proper acquisition of VIA skills be prioritized as it
positively impacts outcomes. The guidelines and curriculum, for VIA training by the Ministry of
Health should be updated to include hands on practice sessions for four days after classroom
training. These practice sessions should involve experienced mentors and the use of images.
Additionally it is crucial for the Ministry of Health (MOH) and local health departments to
provide support and supervision to healthcare workers who have been trained in VIA with, at one
session every quarter. Additionally they should ensure the provision of VIA supplies, to these
healthcareprofessionals.
Publisher
University of Nairobi
Subject
Clinical Training,Visual Inspection With Acetic,Cervical Precancer Screening, Embu County, Kenya.Rights
Attribution-NonCommercial-NoDerivs 3.0 United StatesUsage Rights
http://creativecommons.org/licenses/by-nc-nd/3.0/us/Collections
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