Visual Inspection with Acetic Acid (VIA) and Factors Associated with it for Cervical Cancer Screening in Nepal

Abstract

Background: In Nepal, cervical cancer remains a significant public health issue. When combined with simple treatment methods for treating early cervical lesions, visual inspection of the cervix with acetic acid (VIA) is an effective, affordable screening test for cervical cancer. VIA is effective in many underdeveloped regions where it is challenging to maintain high-quality cytology programs. This study aims to detect the precancerous lesion in women having clinically unhealthy cervix by using the VIA test.

Methods: The study was carried out in five districts of Nepal i.e., Sindhuli, Jhapa, Mahottari, Bara, and Dhanusa. Applying the VIA test, qualified health workers opportunistically examined eligible women between the ages of 15 to 60. Also, a ring pessary was inserted, and pelvic organ prolapse was observed among patients. Women who tested positive in VIA underwent additional evaluation, and those who had cervical lesions received either cryotherapy in the screening clinic or were referred to a more advanced facility.

Results: Altogether, 6994 visual inspections of the cervix with VIA were done in five districts. Nearly half of the patients i.e. 47.26% VIA were done in the Bara district. Around one-fourth of the VIA i.e., 26.45% was done in the Sindhuli district. 11.60% VIA was done in the Mahottari district. In the Jhapa district, 10.64% VIA was done followed by 4.03% in Dhanusa. Among the total VIA being done, positive VIA was found in 259 (3.07%) patients. Nearly one-third i.e. 34.74% of the positive VIA was found in the Bara district and the least 2.3% of positive VIA was found in the Dhanusa district. 234 cryotherapy/ Thermo coagulation and a total of 117 referrals were done in five districts. Pelvic inflammatory disease (PID) was found among 3901 patients. A total of 579 ring pessary was inserted and a total of 1762 pelvic organ prolapsed (POP) was observed in the given five districts.

Conclusion: Even in rural areas that have limited resources, VIA administered by skilled female health professionals is a safe, reliable, and effective test that can save people from cervical cancer. These findings have significant implications for the effective provision of services in cervical screening programs in settings with limited resources.