Barriers to follow-up of abnormal Papanicolaou smears among women in Leon, Nicaragua

Trop Doct. 2010 Jan;40(1):22-6. doi: 10.1258/td.2009.090076. Epub 2009 Dec 11.


Cervical cancer screening programmes only succeed when the coverage, screening, treatment and follow-up of any abnormal results are of high quality. This study investigates the screening coverage and the quality of the follow-up of cervical cancer screening of women in León, Nicaragua, as well as the factors affecting coverage and barriers to follow-up. Two hundred and thirty-four sexually active women attending a public health centre (54), a public health post (63), or the gynaecology department of the public HEODRA hospital (117), were invited to answer an orally administered questionnaire. The screening coverage of cervical cancer was calculated and the follow-up after finding an abnormal screening result was assessed. The coverage was 60.6% (95% confidence interval 54.4-66.8%). One hundred and sixty-eight women (87%) were informed about the results. Eighteen (10, 7%) of the women who were informed about the results, were advised to have follow-up and 12 (66, 7%) of them did. Barriers to follow-up were financial constraints, pregnancy, postponement and absence of instruments/electricity. This study shows that the screening coverage and cytology services are adequate, but that there is insufficient follow-up and/or treatment after an abnormal screening result. In order to achieve a lower incidence and mortality of cervical cancer, follow-up and treatment after an abnormal screening result need to be improved. A visual inspection with acetic acid may be an attractive alternative.

MeSH terms

  • Acetic Acid
  • Adult
  • Cervical Intraepithelial Neoplasia
  • Continuity of Patient Care*
  • Early Detection of Cancer
  • Female
  • Hospitals, Public
  • Humans
  • Incidence
  • Mass Screening / methods*
  • Middle Aged
  • Nicaragua
  • Papanicolaou Test
  • Program Evaluation / methods*
  • Uterine Cervical Neoplasms / diagnosis*
  • Uterine Cervical Neoplasms / epidemiology
  • Uterine Cervical Neoplasms / pathology
  • Vaginal Smears / methods
  • Vaginal Smears / statistics & numerical data
  • Young Adult


  • Acetic Acid