Community Empowerment of Early Detection of Cervical Cancer

P. Eyanoer

, S. Sarumpaet

Department of Community and Preventive Medicine, Universitas Sumatera Utara, Medan, Indonesia

Department of Epidemiology, Faculty of Public Health, Universitas Sumatera Utara, Medan, Indonesia

Keywords: Early detection, IVA test, Cadres.

Abstract: Cervical cancer is ranked 7th as the leading cause of death in Indonesia with a percentage of 7.5 of all causes

of death. Nine out of ten, or about 87% of cervical cancer deaths occur in countries that are less developed.

Up to 2014, early detection of cervical and breast cancer program organized by the government has been

running at 1,986 health centers in 304 districts / cities located in 34 provinces in Indonesia. However, the

coverage from 2007 to 2014 is still low, which is only 2.45% by means the screening is conducted for only

904.099 women. Therefore the aim of this community service is to seek the community empowerment in the

early detection of cervical cancer among women of childbearing age. The activities begin with a survey within

the location named Rusunawa Seruwai and Kayu Putih, Medan. Then proceed with coordination with the two

partners. The activity is in the form of training for local cadres and 20 women who were then received IVA

inspection. In addition to understand the success of the training we conducted pretest and posttest on the

material given as well. Results showed that there is an increasing knowledge of cadres and mothers about the

implementation and benefits of IVA test. Of all mothers who are examined, 5 with IVA test positive, 7

withleucorrhea. We expectedthe socialization of IVA test can be sustain with the support of partners and local

cadres in order to reduce the incidence of cervical cancer.

1 INTRODUCTION

Cancer is a major disease in many countries in the

world. Based on GLOBOCAN data, the International

Agency for Research on Cancer (IARC), it is known

that in 2012 there were 14,067,894 new cases of

cancer and 8,201,575 cancer deaths worldwide.

Based on WHO and World Bank data in 2005, an

estimated 7.5 million people die from cancer, and

more than 70% of deaths occur in poor and

developing countries. In Indonesia, cancer is the

seventh cause of death with a percentage of 5.7

percent of all causes of death. Based on Basic Health

Research (Riskesdas) in 2013, the prevalence of

cancer in the population of all ages in Indonesia was

1.4 percent or estimated at 347,792 people. In North

Sumatra, the prevalence of cancer in all age

population by 2013 is 1 percent (DirektorJenderal,

2014) (GLOBOCAN, 2014).

World Health Organization (WHO), in 2012

stated that cervical cancer or cancer of uterine neck is

the number seventh most common cancer in the

world.Cervical cancer case in the world continues to

increase. It is estimated; in 2012 there were 528,000

new cases of cervical cancer.Cervical cancer is also

the fourth most common cancer of women in the

world, where nearly 12 percent of all women with

cancer are cervical cancer.The death rate from

cervical cancer in the world in 2012 is estimated at

266,000, i.e. 7.5% of all numbers death of women due

to cancer. Nine out of ten or about 87% of deaths from

cervical cancer occur in less developed countries

(Direktor Jeneral, 2014)

Based on the Hospital Information System (SIRS)

in 2010, cervical cancer was the second highest type

of cancer in inpatients and outpatients in all hospitals

in Indonesia with a total of 5,349 patients (12.8%).

Estimated incidence of cervical cancer in Indonesia in

2012 was 17 per 100,000 women, which increased

from 2002 at 16 per 100,000 women (GLOBOCAN,

2014).

In North Sumatra, the incidence of cervical cancer

from 2010 to 2012 continues increasing. Based on

data obtained from the Provincial Health Office of

North Sumatra, the incidence of cervical cancer in

2010 was recorded as 475 cases, in 2011 as many as

548 cases, and in 2012 as many as 681 cases. The

prevalence of cancer is 0.063 per 100,000

794

Eyanoer, P. and Sarumpaet, S.

Community Empowerment of Early Detection of Cervical Cancer.

DOI: 10.5220/0010091207940798

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

794-798

ISBN: 978-989-758-449-7

populations. This figure is higher than the prevalence

rate nationally (0.043 per 100,000 population), it

shows cervical cancer is a health problem that needs

attention.

Based on previous research, cervical cancer cases

in RSUP H. Adam Malik Medan in 2011 were quite

high, as many as 357 cases, where this number had

increased compared to 2009, which was 121 cases. In

this study it was found that the most cervical cancer

patients were in the age group 40-55 as many as 214

patients (58.3%) and all patients with cervical cancer

had been married, namely married (Prandana DA,

2013).

WHO estimates that by 2030 there will be a global

incidence of cancer incidents of 300% globally, and

70% of the surge will occur in developing countries

including Indonesia. Thus, it can be estimated that

there will be a surge in the number of cancer sufferers

in developing countries by ± 500% by 2030, if no

promotional or preventive measures are taken. One of

the prevention measures for cervical cancer is by

early detection of cervical cancer. Early detection of

cervical cancer can be done by Visual Inspection

method with Acetic Acid (IVA) and Pap smear

method.

Until 2014, the government's cervical cancer and

breast cancer early detection program has been

running on 1,986 Puskesmas in 304 regencies / cities

in 34 provinces in Indonesia. The coverage of early

detection of cervical cancer and breast cancer from

2007 to 2014 is still low, amounting to 2.45 percent

or just screening of 904,099 people.

The results of previous studies of the knowledge

and attitudes of married women towards IVA

examination (Radiah, 2009) in the Medan Area South

Health Center in 2009 showed that WUS still had a

low awareness of conducting an IVA examination,

with only 22% of respondents receiving IVA

examinations and 78% of respondents did not conduct

IVA examination. Based on previous research at the

Padang Bulan Health Center, Medan in October 2013,

the final report of 2013 from the KIA / KB Program

officers, from 5954 targets, had only 1,786 (30%) of

PUS mothers, 594 (10%) other PUS mothers. perform

pap smear checks to other facilities, and 3,572 (60%)

PUS mothers have not conducted an IVA

examination. Also at the time of the survey in the

field, 10 PUS mothers obtained 3 PUS mothers who

had already done IVA examinations, while 7 PUS

mothers had never done an IVA examination for

different reasons, including, not yet knowing about

IVA examinations, feeling reluctant because they

have to open their nakedness during IVA

examination, do not feel any symptoms of cervical

cancer.

The Pap ‘smear program for the detection of

cervical cancer in women of childbearing age (WUS)

carried out at the Medan City Health Center has also

not been able to increase service coverage. The report

on the implementation of the Pap ‘smear activity at

the Medan City Health Office shows that the

percentage of WUS who conducted examinations was

only around 43.7% of all puskesmas that provided

Pap’ smear service. Pap’ smear service coverage at

the Petisah Health Center is a low one because below

the coverage rate in Medan City is 32.4%.

Various factors can influence the participation of

WUS in examining IVAs or pap smears. Based on

previous research by Yuliwati in 2012, the factors that

influenced it were knowledge, attitudes, and

affordability of service providers, exposure to

information / mass media, husband's support, health

worker support, and support from health cadres.

While the results of previous research conducted

by Pertiwi in 2015 showed that the factors that

affected were age, occupation, parity, health

insurance, access to health services, and knowledge.

Where is the result of WUS aged> 35 years as many

as 153 people (80.1%), high school education as

many as 90 people (47.1%), the work of IRT as many

as 94 people (49.2%), the age of marriage 21-35 years

is 125 people (65.4%), low economic status as many

as 97 people (50.8%), parity 1- 3 times as many as

160 people (83.8%), have health insurance of 153

people (80.1%), access to services health with a

medium distance of 80 people (41.9%), and those

who received husband support as many as 150 people

(78.5%).

1.1 Partner Problems

Medan Tembung sub-district is the third highest

population in the city of Medan with a population of

around 150,000. Therefore the problems in the region

represent the existence of problems in the city of

Medan.

In Medan City one of the most prominent

problems is the low participation of the community in

the early detection of the disease. The report on the

implementation of the Pap’ smear activity at the

Medan City Health Office shows that the percentage

of WUS who conducted examinations was only

around 43.7% of all puskesmas that provided Pap’

smear service. For early detection with IVA self-

examination only reached 30% of target. In

interviews with several mothers of productive age in

the initial survey, they admitted that they had never

Community Empowerment of Early Detection of Cervical Cancer

795

tested IVA at all. They do not know the benefits of

the test despite knowing that cervical cancer is a

deadly cancer.

This low awareness of IVA causes people to often

come for treatment when the cancer has entered its

final stage. According to interviews with their stages

of cervical cancer development they do not know.

1.2 Solution Offered

As a way of dealing with low public awareness,

especially mothers of childbearing age in early

detection of cervical cancer, this activity will seek to

change awareness about the importance of health.

Activities will begin by identifying the main figures

of the community, especially those associated with

the fertile-age mothers of cadres in Rusunawa

Seruwai and Kayu Putih. Furthermore, the training

activities will be carried out on cadres chosen to then

together with the dedication team conduct

socialization to women of childbearing age. In the

training activities will be explained about cervical

cancer in general, etiology and modes of transmission

and prevention efforts at the individual level. All

materials will be prepared in the form of modules to

be prepared by the implementing team. For

socialization activities, the implementing team

together with the trained cadres will present

information and distribute pocket book containing

practical information about cervical cancer and IVA

examination. Knowledge, attitude and behavior

assessment activities will be carried out before and

after training and socialization activities for the

community to measure the effectiveness of the

service activities carried out.

The expected partner participation is in the form

of willingness, willingness and cooperation in the

implementation of each step of service to realize the

program objectives. In this regard, the Head of

Rusunawa and cadres have expressed their

willingness to cooperate.

2 IMPLEMENTION METHOD

This activity is carried out by carrying out the

following stages:

 First, program socialization to partners. This

activity is carried out by visiting community

leaders, health workers and government

officials at the site of activities. The goal is to

reach agreement on what the target of the

devotion team is.

 Secondly, recruitment of health cadres. To

improve the sustainability of activities at

partner locations, the team will recruit cadres

so that they can later do the recruitment work

of community members. These cadres will be

trained on cervical cancer, IVA examination

techniques, communication with the

community and become ideal cadres.

 Third, as a follow-up, the cadres were asked to

recruit women of productive age. These

mothers will be trained together with the

cadres to become trained cadres in the field of

cervical cancer. Fourth is the IVA

examination. This check will be done to the

cadres and mothers they recruit. It is planned

to conduct this examination for 40 cadres and

mothers.

To find out the success of the activity, the activity

implementing team will conduct evaluation

measurements by comparing the knowledge, attitudes

and actions of the cadres and mothers before and after

the training activities.

3 RESULTS OF SERVICE

ACTIVITIES

3.1 Results Planning

The activities undertaken at the planning stage are as

follows:

3.1.1 Socialization of Community Service

Programs for Both Partners

After the community service proposal was approved

the team conducted a socialization program on the

two partners, namely Rusunawa Seruwai and Kayu

Putih as well as cadre team on the implementation of

community service and the selection of cadres that

will be included in the socialization program of the

IVA examination program in an effort to early

detection of cervical cancers in women of

childbearing age at the location of service. In

addition, there is also the availability of facilities and

infrastructure in the area of service implementation.

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

796

3.1.2 Preparation of Pocket Books and

Leaflet as Part of the Material That

Will Be Delivered to Community

Service Activities

This activity began with a literature review of health

promotion materials published by the Indonesian

Ministry of Health to ensure that the information

provided did not deviate or contradict. This also

remembers that the IVA test activity is already

running in the puskesmas that has a trained midwife.

3.1.3 Preparation of a Questionnaire to

Measure Participants’ Knowledge,

Attitudes and Actions

This activity begins by conducting a literature review

of previous research results that measure mother's

knowledge, awareness and action on the IVA test,

then adjusted to the activities to be performed in the

field. Questions in the questionnaire were made in as

simple a language as possible so that they could be

easily understood by mothers.

3.2 Implementation of Activities

Activities undertaken in the implementation of

community service programs are as follows:

3.2.1 Socialization of Community Service

Programs

This activity started with recruitment of cadres,

especially in health sector. This is done in an effort to

improve the sustainability of activities at partner sites,

The cadres will be trained on cervical cancer, IVA

examination techniques, communication with the

community and become ideal cadres..

3.2.2 Identification of Mothers of Productive

Age

Search of productive age mothers as many as forty

(40) people who meet the criteria for IVA test, where

the determination is done by the cadres after being

trained. These mothers were then presented with

matters related to cervical cancer, including primary

and secondary prevention. Then it is expected that the

selected mothers can help the cadres in disseminating

information about the importance of early detection

of cervical cancer after understanding and getting

IVA test.

3.2.3 Efforts to Emppower the Community

by Increassing Knowledge, Attitudes

and Action Regarding Early Detection

of Cervical Cancer

This activity is in the form of delivery of material

about cervical cancer and early detection efforts

conducted, especially IVA test, conducted by the

team leader. The outcome of this activity is expected

to increase the post test score and public willingness

to undergo IVA test. This activity was conducted on

June 25, 2018 in Rusunawa Seruwai, witnessed by the

Head of Rusunawa and cadres selected.

3.2.4 Implementation of IVA Test

Examination

This activity was carried out by a trained midwife

midwife who was assisted by 2 nurses and supervised

by the head of the team. Before the examination was

carried out, the mothers were asked to sign pre-

prepared informed consent. The examination also

begins with a simple breast examination to detect the

possibility of a lump. From the examination results

found one (1) mother with a lump in the breast to the

left of the upper lateral quadrant. Then proceed with

the IVA test and recording if the mother has

leucorrhea or not. From the results of the examination

all mothers gave negative results for the IVA test and

nineteen (19) mothers suffered from leucorrhea.

Every mother who was diagnosed with leucorrhea

was then given Mycoral drugs to treat Candida and

Baquinor infections to overcome bacterial and

parasitic infections while all mothers were given

vitamin for a week of use

4 DISCUSSION

The dedication to the community of BOPTN mono

year held in Rusunawa Seruwai and Kayu Putih to

cadres and community has been going well. This is

evident from the high interest of PKK cadres who

follow socialization activities. This proved the

number of questions raised during the activity, the

questions submitted not only to the material presented

but to the discussion of appropriate delivery

techniques in the field adapted to local customs. The

input given by the cadres becomes a consideration

before the decision is made.

The public interest in following the extension

activities and examination of early detection of

cervical cancer in the form of IVA test is very high.

This is evidenced by the presence of the community,

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797

in which case the mothers who meet the criteria at the

time of the implementation of the test reached 100%

until the end of the event, although had to wait quite

long during the implementation of the IVA test. This

indicates that the cadres and the community

welcomed positive activities that have been

implemented. In accordance with the expectation of

the Head of Rusunawa and cadres who are looking

forward to activities that are providing health

promotion to the community so as to raise their desire

in seeking medical treatment when needed, not only

rely on alternative medicine as it has so far. Head of

Rusunawa and cadres welcomed the enthusiasm

related to the implementation of community service

and hope to do activities continuously for the material

and other matters relating to health. Likewise, people

who are involved with this activity feel very helpful

with this activity especially for early detection of

cervical cancer.

In the counseling and IVA test examination of

mothers who underwent tests in this activity, it was

seen that the mother was interested in the various

information conveyed. Almost every mother asked

for counseling material, especially about the tests

carried out. Some mothers also ask about the

symptoms and signs they have experienced all this

time which are allegedly related to reproductive and

genital devices. Increased knowledge made mothers

feel more calm and comfortable so that no one refused

the examination, even though at first there were those

who felt hesitant, afraid and ashamed. In addition, the

implementing team also stated the importance of

moral support from fellow friends when it comes to

reproductive health, given that our culture still

regards this as taboo.

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