Screening of cervical cancer in Eastern-Kazakhstan oblast: estimation of needs.

1. Screening of cervical cancer in Eastern-Kazakhstan oblast: estimation of needs. Kazbek Tulebayevprofessor,director of Public Health InstituteКазахстан.

2. PATH PROJECT Screening of cervical cancer in Eastern-Kazakhstan oblast: evaluation of needs Goal: Improvement of the prevention, early diagnostics and treatment of cervical cancer in Eastern-Kazakhstan oblast. Tasks: • Study the epidemiology of cervical cancer in Eastern-Kazakhstan oblast. • Study the policy on prevention, early diagnostics and treatment of cervical cancer. • Analysis of medical aid on cervical cancer and health infrastructure in region • Study of knowledge, behavior and attitude of medical workers and women in Eastern-Kazakhstan oblast. • Assessment and preparation of program on prevention and early diagnostics of cervical cancer in Eastern-Kazakhstan oblast. • Round table on cervical cancer prevention cancer in Eastern-Kazakhstan oblast.

3. Projects background • Healthy lifestyle policy is the priority of state’s development strategy “Kazakhstan 2030” • Healthy lifestyle development Services • High morbidity and mortality from cervical cancer • Lack of researches on cervical cancer issues • Disagreement on prevention, early diagnostics and treatment of cervical cancer between GP, gynecologists and oncologists

4. Cervical Cancer morbidity (per 100 thousand)

5. Mortality from Cervical Cancer (per 100 thousand)

6. Living more 5 years with Cervical Cancer (%)

7. Percentage of IV phase of Cervical Cancer

8. Why «Public Health Institute»? Since 2001 Goal: The study and implementation of public health principles in Kazakhstan Tasks: • ·Scientific researches on public health • ·Diseases prevention and healthy lifestyle development • ·Partnership creation and intesectoral activities • ·Conduction of seminars, trainings, courses etc.

9. Study method Object of study (maps of Kazakhstan and Eastern-Kazakhstan oblast): Territory of RK - 2.724,9 thousand sq. km. Territory EKO - 283,3 thousand sq. km.(10,4%) • Ust-Kamenogorsk • Semipalatinsk 15 rural rayons Population - 1.504,3 thousand (11% of whole population) 442,4 thousand of them are fertile age women (29,4%). Target groups and samples: • women, age 30-55 - # 968 • health policy makers - # 31 • medical professionals - # 336 • health managers - # 546

10. Main results of study Survey of policy makers : • 41,9% (# 13) don’t know about existing policy • only 25,8% (# 8) know about existing educational programs • 41,9% (# 13) clinics have lack of staff • 93,5% (# 29) clinics have the insufficient of equipment • lack of efficiency suggestions on cervical cancer prevention

11. Main results of study  Survey of medical workers :   • 43,8% (# 147) use contraceptives, 23,5% (# 79) of them prefer to use the intrauterine device • 2/3 (# 209) resorted to abortion, 36,8% (# 123) of them two times and more • 45,5% (# 153) visited the gynecologist 6 month ago • Lack of knowledge about risk factors • Lack of knowledge on early diagnostic • Main information resources on cervical cancer prevention are basic education in medical university (61,9% - # 208) and medical literature (60,4% - #203) • Only 3,3% (# 11) pressed one official document on cervical cancer prevention and early diagnostic

12. Main results of study Knowledge and behavior of women:  • 62,4% (# 604) - abortion, 37,9% (# 367) of them - twice and more • 2/3 (# 644) - sexually active, 25,8% (# 249) of them have more than one partners • 51% (# 494) use the contraceptives, 290 of them (30%) use the intrauterine device • 27,2% (# 263) visit to the gynecologist 1 time during 6 month • 68,5% (# 663) pressed, that the gynecological services isn’t free of charge • Lack of knowledge on risk factors • 66,3% (# 642) answered the cervical cancer is preventable • 77,2% (# 747) are of opinion that the early revealed cancer is curable.

13. Main results of study Opinions of health managers  • 19,5% (# 106) clinics have cancer prevention programs • 90,2% (# 492) refused to answer about paid medical service for women • Coverage women by examination – 43,3% (# 192559): of them • 84,4% (# 162519) - visual examination • 10,6% (# 20411) - Papanikolau scrape • 7,0% (# 13479) – biopsy • 2,2% (# 4236)- DNA- diagnostics of HPV • 58,7% (# 321) clinics have opportunities for use Papanikolau method • 45,9% (# 251) clinics have opportunities for DNA- diagnostics of HPV

14. Problems and priorities • Lack of trainings for medical workers • Lack of special programs, diagnostic’s and treatment’s protocols • Deficiency of simple and accessible methods of diagnostics • GP and nurses aren’t involved in prevention and early diagnostics • Weak material resource base of medical institutions • Need in the regional cervical cancer prevention and treatment program

15. Results Round table on strategy discussion «Prevention, early diagnostics and treatment of precancerous diseases and cervical cancer in Eastern-Kazakhstan oblast ». Participants: • Ministry of Health, Eastern-Kazakhstan Health department, National Centre for problems of healthy lifestyle development, Institute of oncology and radiology, Center for defense of motherhood and childhood, Institute of dermatovenerology, gynecologists, oncologists, GP • expert of Euro WHO (Gunta Lazdane) • representatives of Soros-Kazakhstan foundation, ZdravPlus(USAID) Support: • Ministry of Health, Republic of Kazakhstan • Eastern-Kazakhstan Health department

16. Acknowledgments Soros-Kazakhstan foundation – Jamilya Sadykova (coordinator on public health ) Ministry of Health – Saule Dikanbayeva (Vice-Minister) Eastern-Kazakhstan Health department – Aigul Kussainova (vice-director) EuroWHO - Gunta Lazdane (Expert on Reproductive health) NCPHLD – Aikan Akanov (General director ) PATH