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Implementing a Cervical Cancer Awareness Program in Low-income Settings in Western China: a Community-based Locally Affordable Intervention for Risk Reduction

  • Simayi, Dilixia (Department of Pathology, Shihezi University School of Medicine) ;
  • Yang, Lan (Department of Pathology, Shihezi University School of Medicine) ;
  • Li, Feng (Department of Pathology, Shihezi University School of Medicine) ;
  • Wang, Ying-Hong (The Joint Key Laboratories for Xinjiang Endemic and Ethnic Diseases, Shihezi University and the Chinese Ministry of Education) ;
  • Amanguli, A. (Department of Obstetrics and Gynecology, the First Affiliated University Hospital, Shihezi University School of Medicine) ;
  • Zhang, Wei (Department of Pathology, Shihezi University School of Medicine) ;
  • Mohemaiti, Meiliguli (Department of Obstetrics and Gynecology, the First Affiliated University Hospital, Shihezi University School of Medicine) ;
  • Tao, Lin (Department of Pathology, Shihezi University School of Medicine) ;
  • Zhao, Jin (Department of Pathology, Shihezi University School of Medicine) ;
  • Jing, Ming-Xia (Department of Preventive Medicine, Shihezi University School of Medicine) ;
  • Wang, Wei (Institute of Humanities, Shihezi University School of Medicine) ;
  • Saimaiti, Abudukeyoumu (Kashi Prefecture First People's Hospital, Kashi Prefecture Health Bureau) ;
  • Zou, Xiao-Guang (Kashi Prefecture First People's Hospital, Kashi Prefecture Health Bureau) ;
  • Maimaiti, Ayinuer (Jiashi County Health Bureau) ;
  • Ma, Zhi-Ping (Department of Pathology, Shihezi University School of Medicine) ;
  • Hao, Xiao-Ling (Department of Pathology, Shihezi University School of Medicine) ;
  • Duan, Fen (Department of Obstetrics and Gynecology, the First Affiliated University Hospital, Shihezi University School of Medicine) ;
  • Jing, Fang (Department of Obstetrics and Gynecology, the First Affiliated University Hospital, Shihezi University School of Medicine) ;
  • Bai, Hui-Li (Department of Pathology, Shihezi University School of Medicine) ;
  • Liu, Zhao (Department of Pathology, Shihezi University School of Medicine) ;
  • Zhang, Lei (Department of Pathology, Shihezi University School of Medicine) ;
  • Chen, Cheng (Department of Pathology, Shihezi University School of Medicine) ;
  • Cong, Li (Department of Pathology, Shihezi University School of Medicine) ;
  • Zhang, Xi (Renhe Hospital, Three Gorges University School of Medicine) ;
  • Zhang, Hong-Yan (Department of Immunization, Center for Disease Control and Prevention) ;
  • Zhan, Jin-Qiong (Department of Laboratory Medicine, Jiangxi Mental Health Center) ;
  • Zhang, Wen Jie (Department of Pathology, Shihezi University School of Medicine)
  • Published : 2013.12.31

Abstract

Background: Some 60 years after introduction of the Papanicolaou smear worldwide, cervical cancer remains a burden in developing countries where >85% of world new cases and deaths occur, suggesting a failure to establish comprehensive cervical-cancer control programs. Effective interventions are available to control cervical cancer but are not all affordable in low-income settings. Disease awareness saves lives by risk-reduction as witnessed in reducing mortality of HIV/AIDS and smoking-related cancers. Subjects and Methods: We initiated a community-based awareness program on cervical cancer in two low-income Muslim Uyghur townships in Kashi (Kashgar) Prefecture, Xinjiang, China in 2008. The education involved more than 5,000 women from two rural townships and awareness was then evaluated in 2010 and 2011, respectively, using a questionnaire with 10 basic knowledge questions on cervical cancer. Demographic information was also collected and included in an EpiData database. A 10-point scoring system was used to score the awareness. Results: The effectiveness and feasibility of the program were evaluated among 4,475 women aged 19-70 years, of whom >92% lived on/below US$1.00/day. Women without prior education showed a poor average awareness rate of 6.4% (164/2,559). A onetime education intervention, however, sharply raised the awareness rate by 4-fold to 25.5% (493/1,916). Importantly, low income and illiteracy were two reliable factors affecting awareness before or after education intervention. Conclusions: Education intervention can significantly raise the awareness of cervical cancer in low-income women. Economic development and compulsory education are two important solutions in raising general disease awareness. We propose that implementing community-based awareness programs against cervical cancer is realistic, locally affordable and sustainable in low-income countries, which may save many lives over time and, importantly, will facilitate the integration of comprehensive programs when feasible. In this context, adopting this strategy may provide one good example of how to achieve "good health at low cost".

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