Abstract:
Cancer of the cervix is the second most common cancer in women worldwide and
the leading cause of cancer deaths in women in developing countries. The prevalence
is highest in the developing countries, one of the reasons being lack of good
screening programs. Cervical cancer can be dramatically reduced by screening of
Pap or cervical smears in order to detect dysplasia or precancerous changes which
can be treated to prevent development of invasive cancer. The risk factors associated
with the development of cervical cancer include age at first sexual intercourse,
multiple sexual partners, sexually transmitted infections (especially human
Papilloma virus), smoking and not taking a Pap test, among others. The incidence of
cervical cancer is also highest among poor women in developing countries. The
objective of this study was to determine the prevalence of cervical dysplasia and
inflammatory changes in Pap smears taken from women attending Family Health
Options Kenya (FHOK) clinics in Nairobi. Family Health Options Kenya has been
carrying out cervical smear screening program in various parts of the country for
more than 12 years. Participants in this study were women who voluntarily went to
the Nairobi clinics to have Pap smear tests. Written informed consent was obtained
from each participant and a questionnaire administered by the clinician. The
clinicians also routinely took the smears and filled in the Pap smear laboratory form.
The Pap smears were processed and screened in the cytology laboratory by the
researcher and the results given to the participants by the clinicians. The data
collected was analyzed using Epi Info version 3.3 statistical software (Atlanta,
xv
Georgia). A total of 194 Pap smears were collected and screened between the month
of April and June 2008. The combined prevalence of cervical cell abnormalities and
inflammatory changes was 91 (46.9%). From these cases, 27 (13.9%) were
inflammatory due to various infections while 6 (3.1%) were cervical cell
abnormalities and 58 (29.9%) of the rest were inflammatory changes due to other
causes, mainly the use of IUCD contraception (33 cases), 1 case of atrophic cervicitis
and 24 cases of non specific causes. One hundred and three (53.1%) Pap smears
were negative for either inflammation or cervical cell abnormalities. The study
demonstrates that cervical dysplasia and inflammatory changes are present in women
attending FHOK clinics in Nairobi. However, the socio demographic characteristics
of the women in these clinics indicate that the screening program was capturing
women from high socio economic status. Women from poor socio economic
background, low literacy and other related risk factors were not captured in the
FHOK screening program. The study recommends that for a screening program to be
successful, all women should have access to Pap test and that both the private and
public healthcare facilities should be equipped for the same.
