Program Boosts Secondary Prevention of Cervical Cancer in Northern Bangladesh

Training Thermal Coagulator

The prevention and early detection of cervical cancer were stepped up in Northern Bangladesh recently with a field visit by experts for the launch of a thermal coagulator and orientation of field staff.

The visit took place in December 2021 as part of the Early detection and The Prevention and Screening Innovation Project Towards Elimination of Cervical Cancer (PRESCRIP-TEC) project with the support of their partners in Bangladesh.

The PRESCRIP-TEC project

PRESCRIP-TEC is conducting implementation research into improving coverage for secondary prevention of cervical cancer. Factors being considered include the availability, accessibility, acceptability and quality of services.

Visual inspection with acetic acid (VIA) is a well-validated tool for identifying cervical lesions in low resource areas. It is an effective method for reducing cervical cancer incidence and mortality.

Improving coverage of secondary prevention of cervical cancer in Bangladesh

It is very important to undertake initiatives for screening and prevention of Cervical Cancer among women in the 30-60 age group. That is why FRIENDSHIP, one of the PRESCRIP-TEC consortium partners, has been implementing a cervical cancer screening and treatment program in the Northern region of Bangladesh at two Floating Hospitals (EFH & LFH), two clinics in Gaibandha and Chilmari, and at the Friendship Hospital Shaymnager (FHS) in the South. They are using a standard protocol including VIA, Colposcopy and Thermal Ablation.

In December 2021, a week-long visit by eight experts from Dhaka was arranged. The purpose of the visit was to gain an overview of the field activities and the situation in the field, launch a thermal coagulator, conduct a VIA camp, and provide the Medical and Technical mHealth training.

Eligible women coming for VIA Screening in EFH using a serial Boat.

Launch of thermal coagulator

FCMs mHealth Orientation and Thermal Coagulator Launching.

Service providers were invited to EFH for training on the thermal coagulator. The Female Cancer Foundation, a PRESCRIP-TEC consortium partner, generously provided FRIENDSHIP with six Liger thermal coagulators. The World Health Organization (WHO) and The Bangabandhu Sheikh Mujib Medical University (BSMMU) had recommended that FRIENDSHIP provide treatment with the thermal coagulator, which is easy to handle.

The six donated thermal coagulators have been distributed in the geographical locations covered by the PRESCRIP-TEC project. Two were given to EFH, one each to Kurigram and Gaibandha clinics, while two went to FHS.

The EFH thermal coagulators were launched on December 6, 2021. A cervical cancer camp was organized during which a total of 40 patients were screened for Cervical Cancer. Thirty-seven of the patients were VIA Negative, two were VIA positive and one was referred on suspicion of cancer.

Successful event which resulted in a very interactive session

Counselling on Thermal Coagulator before application to the 2 VIA positive woman.

The mHealth Friendship community medicaids (FCMs) of North Chilmari, were invited for medical and technical orientation and training.

It should be noted that mHealth is a mobile application used by the FCMs. The app covers 68 algorithms for providing various Health Care Services. One of which is cervical cancer. There are disease topics and those topics are discussed by the FCMs with the beneficiaries in the courtyard sessions. Household IDs are entered in the app and then, using the ID, FCMs collect and store information about the beneficiaries. The PRESCRIP-TEC project will be using variables collected in the mHealth EMR tool for data analysis.

Thirty mHealth FCMs were included in the participatory and interactive sessions. Various topics were discussed, including details of the PRESCRIP-TEC project, AI-DSS, EMR, and HPV Targets. The application development team provided a demonstration of the algorithm Survey and research questions were discussed.

Mr. Awlad and his team helped the attendees with any problems they were experiencing with the mHealth mobile application. The timing has never been better for using technology to enable and improve learning at all levels.

The mHealth platform will also be used in Slovakia and Uganda as electronic medical tools. FCMs of FRIENDSHIP will be supporting throughout the PRESCRIP-TEC project in Bangladesh.

Next Steps

The Thermal coagulator was successfully inaugurated together with the orientation and training of health care providers. This will be repeated at the FHS in Southern Bangladesh. FRIENDSHIP will be providing training to Stitching Land Ontwikkelings Project Bangladesh (SLOPB) in the 1st week of February 2022. If it is not possible the training will be conducted in the North . This training will augment the existing knowledge, skills, and competencies of the Service Providers.

All of this has been made possible through the guidance, strong vision and leadership of the teams supporting the PRESCRIP-TEC project.

More about cervical cancer

Globally, cervical cancer numbers are increasing. In 2018 approximately 570,000 women were diagnosed with cervical cancer worldwide. Deaths from the disease were 311,000, of whom 90% occurred in low- and middle-income countries (LMICs). In high income countries (HICs) the infection rate is lower, but the most affected are women from vulnerable communities.

Cervical cancer is largely preventable through vaccination and screening programs. WHO’s global strategy towards eliminating cervical cancer outlines three key steps, namely vaccination, screening, and treatment. To eliminate cervical cancer we must:

Fully vaccinate 90% of girls with HPV vaccine by age 15
Screen 70% of women with a high-performance test by 35 years of age and again by 45 years of age.
Treat 90% of women identified with cervical disease (treat 90% of women with precancerous lesions and manage 90% of women with invasive cancer).

Reaching the targets outlined in the above strategy by 2030 would put the world on the path towards eliminating the disease within this century.

Event details

Area: North
Location: EFH and FC-Chilmari
Project: PRESCRIP-TEC
Participants: FRIENDSHIP Health and Application Development
Date: 6th, 7th and 8th December 2021