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.