Impact of introduction of a colposcopy service in a rural South African sub-district on uptake of colposcopy

Abstract

Objectives. To describe the establishment of a colposcopy service at a district hospital in a rural sub-district of the Western Cape, South Africa, and assess its impact on colposcopy uptake.

Design. A retrospective double-group cohort study using a laboratory database of cervical cytology results, clinical records and colposcopy clinic registers.

Setting. The Overstrand sub-district, where 80 000 people are served by seven clinics and a district hospital in Hermanus, 120 km from its referral hospitals in Cape Town and Worcester. A colposcopy service was established at Hermanus Hospital in 2008.

Subjects. All women in the sub-district who required colposcopy on the basis of cervical smears done in 2007 and 2009.

Outcome measures. Numbers of women booked for colposcopy at distant referral hospitals in 2007 and at the district hospital in 2009, the proportions who attended colposcopy, the time from cervical smear to colposcopy, and comparison between the two years.

Results. Uptake of colposcopy booked at distant referral hospitals was 67% in 2007. Uptake improved by 18% to 79% for the district hospital colposcopy service in 2009 (p=0.06). When patients from an area with no public transport to the district hospital were excluded from analysis, the improvement was more marked at 22% (p=0.02). The delay from cervical smear to colposcopy improved significantly from 170 to 141 days (p=0.02).

Conclusion. Establishment of a colposcopy service in a rural sub-district increased uptake of colposcopy and decreased the delay from cervical smear to colposcopy. The service removed 202 booked patients in one year from the colposcopy load of the referral hospitals.