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Screening for cervical cancer in developing countries.

H S Cronjé
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Abstract

Cervical cancer is the most common malignancy amongst females in developing countries, mainly due to a lack of precursor screening. This absence of screening is the result of inherent disadvantages of the Pap smear: high cost, low sensitivity, the need for a laboratory with high human expertise and a complex screening program logistic system. The prerequisites for screening in a developing country include a screening method that is affordable, which can be effectively applied once in a lifetime at the age of 30-35 years, provide an immediate result and thereby allowing for on-site treatment of positive cases. None of the current screening methods comply with these prerequisites. More research is necessary into different combinations of tests, which improve sensitivity. On-site human papillomavirus (HPV) identification, alone or in combination with other tests, is promising. Another promising development is immunization against HPV infection, either as a preventative measure or for stimulating immunity in infected women.

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Developing CountriesFemaleHIV InfectionsHumansMass ScreeningPapanicolaou TestPrecancerous ConditionsSensitivity and SpecificitySouth AfricaUterine Cervical NeoplasmsVaginal SmearsUterine Cervical DysplasiaJournal ArticleReview

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BibTeXRIS

H S Cronjé. 2004. Screening for cervical cancer in developing countries.. https://doi.org/10.1016/j.ijgo.2003.09.009

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Costs of surgeries in low- and middle-income countries: a systematic literature review.

BACKGROUND: Surgical care is essential for achieving global health equity, yet low- and middle-income countries (LMICs) face major gaps in access and planning, partly due to limited evidence on the costs and resource requirements of surgical interventions. Understanding these costs is vital for designing efficient and equitable health systems. METHODS: We conducted a systematic literature review (covering MEDLINE, EMBASE, Global Health, EconLit and grey literature) to identify studies reporting the costs of surgeries in LMICs from January 2000 to June 2023. Minor and major surgical procedures were considered, focusing on therapeutic procedures (excluding diagnostic interventions). Studies that clearly identified, quantified and costed hospital resources and services deployed in the provision of surgical care, and included at least two of the surgical production factors (ie, consumables, diagnostics, personnel, infrastructure and overhead) in the costing were included. Costs were standardised to 2023 International dollars (I$) for comparability. RESULTS: A total of 74 studies from 29 countries met the inclusion criteria, with 210 cost estimates across 65 procedure groups. Costs varied widely: from I$1.54 for a caesarean section in Tanzania to I$618 098 for paediatric cataract surgery in Zambia. Full costing studies reported higher estimates than partial costing studies. Most studies (60%) originated from upper-middle-income countries, with limited data (10%) from low-income settings. CONCLUSION: This review provides a reference list of surgical procedure costs across LMICs, highlighting considerable cost variation by procedure, specialty and country. The findings underscore the need for better-quality, standardised cost data-especially from low-income countries-to inform national surgical plans, universal health coverage benefit packages and reimbursement policies.

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