Challenges to early detection of cervical cancer at primary healthcare level in Resource limited settings; a descriptive study.

Abstract Objectives To assess the healthcare system related factors that cause delayed cervical cancer diagnosis at the primary healthcare level. Methods This was a descriptive study of healthcare providers in outpatient clinics at 10 health centers in Kigali city and the Eastern province of Rwanda. Care providers completed a survey questionnaire. Results Eighty-seven (87) health care providers participated. Of respondents, 85 (97.7%) were nurses and midwives, 81.6% being nurses. Only 15 (17.2%) reported to have received training on visual inspection with acetic acid (VIA) cervical cancer screening; and were distributed in 6/10 of the health centers surveyed. However, 75.9% of respondents reported that there was at least one person trained in VIA at their health center. Necessary basic equipment for cervical cancer evaluation was reported to be generally available. Overall, 49 (56.3%) participants were found to have adequate basic knowledge on cervical cancer symptoms and appropriate next step in the case of symptoms. We found no association between respondents’ knowledge of cervical cancer screening and profession or education level, work experience or reported prior training on VIA (p= 0.592, 0.384, 0.174 and 0.404, respectively). Conclusion There is a large gap in number of care providers with enough skills to perform cervical cancer VIA screening at health centers in Rwanda. As health centers are patients’ first point of contact with the healthcare system, there is a need to empower them in human resources and infrastructure if effective cervical cancer screening and prevention program is to be established.