Cryotherapy Following Visual Inspection with Acetic Acid and Lugol's Iodine (Via/Vili) in Khwisero, Western Kenya: Lesson from the Field Affecting Policy and Practice

Abstract

Background: Cervical cancer can be prevented and mortality/morbidity reduced by early detection and referral. Developing countries are likely to benefit from more cost effective methods of screening and treatment. Visual inspection with acetic acid and Lugol`s iodine (VIA/VILI) offers a see and treat solution thus an affordable and efficient way to identify pre-malignant lesions. Immediate treatment with cryotherapy can be offered if pre-malignant lesions are found on visual inspection. Cryotherapy is a simple procedure that is curative for dysplasia; it is likely to benefit cervical dysplasia cases picked early in resource poor settings, however there are several factors that hinder patients’ access to this noble technique.
Objective: Determine hindrances to cryotherapy for patients following  positive results of VIA/VILI after referral.
Design: Cross sectional Study
Setting: Khwisero, Western Kenya.
Subjects: Women attending a medical camp, willing to get screened for cervical cancer.
Results: One hundred and nine patients were screened; seventy three (66.97%) were negative for VIA/VILI, twenty one (19.26%) were positive and referred for cryotherapy. Reasons for lack of follow up were financial constraints, lack of medical personnel at referral centres and poor access to the referral facilities.19.26% of women identified with positive lesions required intervention. No patient received cryotherapy following referral.
Conclusion: There is urgent need for availability of cryotherapy machines and training of personnel who can perform cryotherapy at the primary care level. Regional studies on knowledge attitudes and practices about  VIA/VILI and cryotherapy are required to provide reasons for the poor uptake of this procedure.