Audit on Well-women Clinic Attendance and Cervical Screening in Mahaoya MOH Area

Introduction: Cervical cancer can be successfully treated if identified early, considering its long pre-malignant phase. Sri Lanka has the lowest incidence of cervical cancer in South Asia owing to strong public health screening programmes and universal vaccination. Despite that, the participation in the screening of susceptible women is only around 50 –70%, which is lesser in rural areas and the majority (70%) of Sri Lankan cervical cancer is identified at advanced stages. Pap smear is offered to all women between 35 & 45 years at multiple delivery points, free of charge.
Methodology: This audit was conducted in the Mahaoya MOH area, a rural farming community, with poor socio-economic & educational background. MOH data suggest that women in Mahaoya are exposed to sexual activities in their teen years and remain sexually active until the sixth decade. Data were extracted from an audit conducted by the same team on perimenopausal contraceptive practice among women attending the Mahaoya Base hospital, who were above 45 years.
Results: Majority (n=51, 77.3%) of the women attending the gynaecology clinic were active recipients of the services provided by the well-woman clinic (WWC). A considerable amount of perimenopausal women (n=24, 34.6%) had never undergone a Pap smear, despite being freely offered at 35 & 45 years at WWC and at gynaecology clinics in government hospitals. Only a minority (n=9, 13.6%) of the women who had regularly attended WWC but had never undergone a Pap smear. This was attributed to a poor understanding of the importance of the screening test and the fear of undergoing an invasive procedure.  
Discussion and Conclusions: Despite pap smears being offered freely and widely in the Sri Lankan public health system, the utilization of cervical screening seems to be at a low rate. Certain gaps in knowledge on cervical cancer need to be filled and an effective method of knowledge transfer on Pap smear procedure is in need in the rural areas of the country.  
Suggestions: Implementing opportunistic screening programmes, educating and motivating women at all possible occasions on the need for cervical screening, training health care staff to counsel and perform cervical screening, provision of infrastructure and necessary equipment for WWC and conducting mobile screening clinics more frequently can enhance the cervical screening in the community.