Table 1.
Summary of study characteristics for articles/reports included in the review
| Authors | Study characteristics | Outcomes reported by authors | Authors’ conclusions |
|---|---|---|---|
| Journal articles in Nigerian settings (including reviews) | |||
| Bassey et al (2008)30 | Descriptive study | Poor uptake of services | There are no organised cervical cancer screening programmes although there are facilities for cytology in some Nigerian hospitals, which serve a limited number of women |
| Chukwuali et al (2003)28 | Descriptive study | Poor uptake of services: only 815 women participated in the highly subsidised screening service in Enugu over a 10-y period | Due to reasons such as poor awareness and sociocultural barriers, subsidised cervical cancer screening was not adequately utilised |
| Adepoju et al (2016)26 | Descriptive study | Challenges to accessing cervical cancer screening: disparity of location in favour of urban tertiary facilities, low risk perception and logistical issues in rural areas | Since most participants were urban-based, there is need to decentralise cancer of cervix screening through mobile clinics and establishment of screening centres in the rural areas |
| Obi et al (2007)27 | Descriptive study | Poor participation as <1% (932 women) of target population participated | It was not enough to provide cervical cancer screening services but there is a need to follow up these services by sustained awareness campaigns and motivation of healthcare providers to offer appropriate information to patients |
| Nnadi et al (2016)29 | Descriptive study | Participation was extremely poor compared with similar studies conducted in other parts of the country. Indication for cervical screening was mostly symptom-based referrals from facilities without screening services within and outside the state | Only through formulation and implementation of an organised national screening programme (while maximising opportunistic screening in the interim) can screening be performed more effectively and efficiently |
| Okeke et al (2012)32 | Randomized experimental study | Barriers to access include distance and travel costs; women who were randomly selected to receive the conditional cancer treatment subsidy were about 4% more likely to accept cervical cancer screening | The optimal set of subsidies should include treatment subsidies (if the client is screened positive) in addition to screening price subsidies |
| Alfonzo et al (2016)33 | Population-based randomized controlled trial | Participation was not affected by the absence or presence of a fee | Other strategies could be employed in socially disadvantaged urban districts as abolishing fees did not increase attendance in the short term |
| Journal articles in Nordic settings (including reviews) | |||
| Jensen et al34 (2009) | Cluster randomized controlled trial | Improved participation and improved coverage when women were targeted with invitations and enhancement of GPs’ attention to cervical cancer programmes in Denmark | Using a special targeted invitation to non-attendees combined with increasing GPs’ attention to the programmes could improve women's participation and increase coverage of cervical cancer screening |
| Elfstrom et al (2016)31 | Population-based descriptive study | Analysing key quality indicators formed the basis for quality improvement of the organised cervical screening programmes in Sweden | Regular registry-based monitoring and evaluation of quality indicators can provide an evidence base for prioritisation of improvement strategies |
| Vaccarella et al (2016)44 | Cohort study | In the absence of screening, incidence rates for 2006–2010 in Nordic countries would have been fivefold higher than observed rates | The organised screening programs in these four Nordic countries have resulted in the low incidence of cervical cancer |
| Dillner (2000)35 | Review article | Cervical cancer screening in Sweden is heterogeneous in quality, i.e. some counties practise organised screening and others are opportunistic | More studies need to be conducted to assess the effect of organised screening vs spontaneous screening on cervical cancer mortality |
| Hortlund et al (2018)39 | Research article | 2278 000 cervical samples collected in Sweden in 2014–2016 with 69% coming from the organised screening programme. Screening coverage was 82% (an average of 71–92% within counties); cervical cancer showed an increasing trend | Key quality indicators such as population coverage and follow-up rates were stable or improving, but nevertheless there was a cervical cancer increase suggesting that current efforts for measuring and reporting quality indicators are insufficient |
| Anttila et al (2000)36 | Review article | Incidence of cervical cancer has decreased in Finland and this is attributed to organised screening activities | The 30-y-old organised screening programmes have resulted in a decrease of >70% cervical cancer incidence and a reduction in cervical cancer mortality |
| Nygård et al38 (2002) | Review article | The Norwegian coordinated programme introduced in 1995 collected a total of 4744 967 pap smears from >1.4 million women aged 25–69 y recommended to have a conventional pap smear every 3 y | The screening programme provides a low-cost way to increase coverage as the number of women who had a pap smear was higher after implementation of the coordinated programme of women aged 23–59 y |
| Bigaard et al (2000)37 | Review article | Danish screening programmes had good coverage as a total of 650 000 smears were taken annually, which corresponds to screening of all Danish women aged 25–59 y on average every second year, even although the guidelines recommend screening every third year. There was a decrease in incidence from 15.3 per 100 000 women during 1987–1992 to 12.9 per 100 000 women during 1993–1995 | Organised screening has a better preventive effect than opportunistic screening; they recommend a move towards a longer screening interval than the 3-y interval currently practised |
| Grey literature | |||
| WHO (2012)40 | Project report | Observation of poor uptake and coverage in Nigeria | There is a need for effective monitoring and evaluation system to track key performance indicators such as coverage and incidence |
| Ponti et al (2017)41 | Meeting report | The Finnish programme has proven to be very effective in reducing the incidence of and mortality from cervical cancer | The Finnish cervical cancer screening programme is an example of a cost-effective way to run an organised programme |