# Assessing the Quality of the Endocervical Component: Pitfalls to Cervical Cancer Screening in Limpopo Province, South Africa

## TL;DR

This study examines issues in cervical cancer screening in rural South Africa, finding that poor specimen collection and training lead to high rates of inadequate Pap smears.

## Contribution

The study identifies specific operational and training challenges in rural health facilities affecting cervical cancer screening quality.

## Key findings

- Inadequacy rates of Pap smears ranged between 38% and 50% across districts.
- Professional nurses lacked proper training in collecting and handling Pap smears.
- Poorly coordinated in-service training and low screening motivation contributed to health risks for women.

## Abstract

Specimen adequacy is an essential indicator of screening programme performance. The effectiveness and efficiency of Pap tests are classified in the laboratory based on their adequacy for interpretation as satisfactory or unsatisfactory.

The purpose of the study was to determine the processes of collecting, storing, transporting, and evaluating Pap smears in rural health facilities in Limpopo Province, South Africa.

A mixed-method research approach was used for the study. An exploratory sequential mixed-methods design was employed to collect and analyse qualitative data, and then use the findings to develop an instrument in a subsequent quantitative phase, thereby increasing the breadth and depth of understanding of the phenomena under study. The population comprised professional nurses, operational managers, and laboratory technicians. The qualitative strand explored challenges to cervical cancer screening, while the quantitative strand described factors contributing to the inadequacy of the cervical component. The study was conducted from July 2019 to February 2020. The results were merged for triangulation.

The inadequacy rates reported by districts ranged between 38% and 50%. The findings revealed that professional nurses lacked adequate knowledge of the skills required for collecting, labelling, and storing Pap smears before dispatch. Furthermore, the in-service training provided was poorly coordinated and unstructured, and other professional nurses were not keen on screening for cervical cancer, resulting in poor health outcomes for women in the community who had to return for repeat smears.

Inadequacy of the transformation zone component and unsatisfactory smears have a higher risk of progression to cervical cancer or pre-cancer lesion than adequacy of the transformation zone.