Predictors of default from follow-up care in a cervical cancer screening program using direct visual inspection in south-western Nigeria

Background: Increasingly evidence is emerging from south East Asia, southern and east Africa on the burden of
default to follow up care after a positive cervical cancer screening/diagnosis, which impacts negatively on cervical
cancer prevention and control. Unfortunately little or no information exists on the subject in the West Africa sub
region. This study was designed to determine the proportion of and predictors and reasons for default from follow
up care after positive cervical cancer screen.
Method: Women who screen positive at community cervical cancer screening using direct visual inspection were
followed up to determine the proportion of default and associated factors. Multivariate logistic regression was used
to determine independent predictors of default.
Results: One hundred and eight (16.1%) women who screened positive to direct visual inspection out of 673 were
enrolled into the study. Fifty one (47.2%) out of the 108 women that screened positive defaulted from follow-up
appointment. Women who were poorly educated (OR: 3.1, CI: 2.0 – 5.2), or lived more than 10 km from the clinic
(OR: 2.0, CI: 1.0 – 4.1), or never screened for cervical cancer before (OR: 3.5, CI:3:1–8.4) were more likely to default
from follow-up after screening positive for precancerous lesion of cervix . The main reasons for default were cost of
transportation (48.6%) and time constraints (25.7%).
Conclusion: The rate of default was high (47.2%) as a result of unaffordable transportation cost and limited time to
keep the scheduled appointment. A change from the present strategy that involves multiple visits to a “see and treat”
strategy in which both testing and treatment are performed at a single visit is recommended.