The State of Cervical Cancer Screening in Imprisoned Women in Malawi: A Case of Maula Prison.

doi:10.21203/rs.3.rs-1532953/v1

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Research Article

The State of Cervical Cancer Screening in Imprisoned Women in Malawi: A Case of Maula Prison.

https://doi.org/10.21203/rs.3.rs-1532953/v1

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published 28 Apr, 2023

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Background: Malawi is one of the countries with the highest burden of cervical cancer in the world with less than ten percent of women screened for cervical cancer. The study aimed to investigate the state of cervical cancer screening among incarcerated women at Maula prison. Findings of this study provide knowledge of the challenges that prisoners face when accessing screening services so that relevant policies and strategies may be developed to address the challenges.

Methods: The study employed a cross-sectional qualitative study design. A total of 31 prisoners aged between 18 to 49 participated in the study. Among these, 15 women participated in in-depth interviews, while 16 women participated in two focused group discussions consisting of 8 women per group. All interviews were recorded and transcribed verbatim. Data was analysed using a thematic content analysis approach.

Results: All participants were knowledgeable of cervical cancer. Screening services were periodically provided in the prison. Early diagnosis and treatment were the key benefits for undergoing screening. Poor environment consisting of poor living conditions, sanitation and hygiene, Preference of female health practitioners during screening and poor treatment by prison officers & health care givers when accessing care were reported as challenges that affected screening uptake in the prison.

Conclusion: Incarcerated women experience gender-specific health-related challenges, including menstruation, pregnancy and development of certain forms of cancer that affect their sexual reproductive health. The prison culture hinders prisoners from receiving quality care while in incarceration. Better living conditions, environment and policies must be put in place to support screening uptake among this population.

Cervical Cancer

Prisoners

Screening

Malawi

Sub Saharan Africa

The global cancer burden is estimated to have risen to 18.1 million new cases and 9.6 million deaths in 2018 [1]. One in 5 men and one in 6 women worldwide develop cancer during their lifetime, and one in 8 men and one in 11 women die from the disease. It is projected that by 2030, the number of cancer cases will increase to 24.6 million and the number of cancer deaths, to 13 million [1]. In Africa alone, the burden is anticipated that it will double to 1.3 million new cases and 970,000 deaths by 2030 [2]. Malawi has the highest rate of cervical cancer in the world with an age-standardized rate (ASR) of 75.9 per 100 000 and HPV prevalence at 33.6% [3]. It is estimated that 3,684 women develop cervical cancer and 2, 314 die from the disease annually in Malawi [4]. As one of the leading causes of death among women in Malawi, cervical cancer is of primary focus for the Malawi health sector [5]. In the fight against cervical cancer, the Ministry of Health (MoH) in Malawi developed a four-year National Cervical Cancer Control Strategy (2016–2020) that outlines comprehensive interventions to be taken by the government and other partners in mitigating the burden of cervical cancer [6][7]. While cervical cancer screening services are provided adequately and for free to women by MoH, the situation varies in prisons, even though it is believed that the level of abnormal cervical smear results appears to be higher than normal among this population of women [8][9].

There were 12,598 prisoners in Malawi’s 30 prisons in 2016 [10]. Of these prisoners, female prisoners accounted for 2.7% of this population [10]. According to the Inspectorate of Prisons, the Malawi government remained largely noncompliant with the High Court’s requirement to improve prison conditions [11]. Detainees’ rights to access specific medical care depend upon the availability of the service to the general female public within a given country. This position is reflected in Rule 10 of the United Nations Rules for the Treatment of Women Prisoners and Non-custodial Measures for Women Offenders (Bangkok Rules of 2010) that states that gender-specific health care services in prisons must at least be equivalent to those available in the community [12]. Section 42 (1, b) of the Constitution of the Republic of Malawi provides for the right to be detained under conditions consistent with human dignity, which shall include at least the provision of reading and writing materials, adequate nutrition, and medical treatment at the expense of the State [13]. Although the legal framework safeguards the rights of prisoners, the prison conditions do not conform to the standards set by the Constitution or instruments of international law of which Malawi is part of [14]. It is to this view that the study sought to investigate the state of cervical cancer screening among women during incarceration. This study is based on the premise that there is inadequate understanding of female criminology and that the confinement of female prisoners raises several health care difficulties for the prisoners. The findings of this study highlights the key challenges that women in prison face to access cervical cancer screening and may inform policy and strategies to address them.

Study Design, Target population and study period

The study employed a cross-sectional qualitative study design in order to obtain an in-depth understanding of the situation and an overall ‘picture’ at the time of the study[15]. The study targeted all female prisoners at Maula prison that were above 18 years of age and within the reproductive age group (18–49 years) who were either sentenced or on remand. The study was conducted from January 2018 to August 2020.

Inclusion Criteria

The study targeted women between 18 to 49 years of age, who were in incarceration and had at least attended primary school education and had undergone screening before and were on remand (detained awaiting sentencing) or were serving their sentence.

Exclusion Criteria

The study did not target any women over 49 years of age, who had not attended formal education and were on transfer.

Sample selection

The prison wardens were available throughout the study, monitoring and supervising the prisoners as mandated. During the entry meeting, the wardens, clinic officers and the Officer in Charge were briefed of the purpose and inclusion criteria of the study in order to effectively support the identification of the target group since prisoners live in confined areas with limited access by the researcher. There was a total of 84 female prisoners as at 22 February 2020 at Maula prison. The female prisoners were briefed of the aim and purpose of the study. The prisoners were given a chance to walk away if they were uninterested or unavailable to participate, 44 prisoners requested to be excused. A total of 31 individuals who were eligible out of 40 were selected to participate in the survey by the researcher. The participants were purposively and conveniently sampled. 15 participants were purposively selected to participate in in-depth interviews based on their age (≥ 18 to 49 years), voluntariness, knowledge of cervical cancer and their education background in order to differentiate the group’s level of understanding of Cervical cancer. A total of 16 women were selected to participate in FGDs. The participants were divided into 2 groups of 8 participants in each group, using convenient sampling due to their convenient accessibility and proximity [16]. The sample deliberately included women who had undergone screening before, either in prison or before incarceration with the aim of enhancing and enriching discussions over experiences, perceptions and exploring unanticipated issues that may arise during the discussion [16].

Sample Size

The sample size was determined by the number of prisoners who met the inclusion criteria and were willing to participate in the study. Out of 84 qualified participants, 40 were willing to participate in the study while 31 met the inclusion criteria. Both IDIs and FDGs took into consideration the concept of data saturation, a principle widely used for determining sample size and evaluating its sufficiency [17].

Data Collection

The study used interview guides to collect data through IDIs and FDGs. The tools consisted of questions including the socio-demographic profile, knowledge of cervical cancer, access to screening services, prison conditions in relation to health, benefits of screening and challenges faced in the prison in accessing health care and screening. Interview guides were developed in English and translated into the local language, Chichewa for easy communication and interaction. The interview guide developed for this study is provided as Additional File 1.

Data Management and Analysis

All interviews and FGD were recorded verbatim and transcribed using Express Scribe Transcription software. Manual transcription was also done to ensure all the information was captured accurately. The study adopted Inductive Content Analysis to the data analysis process. Inductive content analysis is a method for identifying, analysing and reporting patterns or themes within the data [18]. Through a process of coding; patterns, categories and themes were identified, grouped and compared[18]. Initial codes were developed and closely examined to check whether they reflected the contents of the data material. The data was further re-read and re-organised by the researcher to ensure alignment and logic flow of the data set. The themes were re-checked to see if they were relating well with the data set and if they were capturing true reflection of the findings [18].

The following are the characteristics of the participants for the study, women aged between 18 and 35 years of age with majority as married with children. Half the participants had completed their primary school education before incarceration. The participants reported their sentences ranging from 1 to 36 months in incarceration. The study did not record any reasons of imprisonment of its participants, because the characteristic was not contributing to any of the study objectives and therefore would not have added any value to the study findings.

Knowledge of cervical cancer and its associated risk factors

The majority of the women in both in-depth interviews and FGDs reported having heard about cervical cancer at least more than once. The most commonly reported source of knowledge was from attending Primary school education and from media awareness messages that were heard over the radio and television. Some women described cervical cancer as;

“A disease where a woman is found to have sores around the cervix and is caused by having sexual intercourse from a very young age” (IDI Participant 8).

“This cancer disease is worse than HIV, because when you are found to be HIV positive, you can still live a long full life with the ARVs which are provided by the government for free, but cancer I have heard that you have to go to India to get treatment, otherwise here in Malawi, you will die”. (FDG1 participant 3)

Upon exploring the possible risk factors associated with cervical cancer, the women reported the following risk factors: - use of vaginal muscle tightening chemicals and soaps, reoccurring vagina infections, having multiple sexual partners, and use of contraceptives.

“You know women talk and share tips about making a man feel good when they are in bed with you. One of my friends was putting muscle tightening chemicals and soaps in the vagina to keep it small for men. She got very sick. I believe It is those medicines that can also cause cervical cancer” (FDG 2, Participant 8)

While over half of the participants agreed that inserting chemicals was a possible contributing factor to cervical cancer, some of the women believed that cervical cancer is mainly caused by a general lack of personal hygiene of genitals.

Access to cervical cancer screening services at Maula prison

During the interaction with the Officer in Charge of the Prison to assess the environment of the female prison in terms of health care provision and the availability of screening services, it was discovered that Maula prison had a total of 84 female prisoner’s in incarceration, a functional dispensary, and a consultation room. It was also reported that cervical cancer screening services were made available in the prison randomly depending on the availability of the screening entity (both government and NGOs). When asked about the willingness of prisoners to participate in the screening exercises, it was reported that there was good representation with more women agreeing to screen than those that did not agree to. Similarly, interaction with the prisoners also revealed that Cervical cancer screening services are not readily available at the prison clinic and they are outsourced just as described by the Officer in Charge. Women who show cervical cancer-like symptoms at the prison clinic are referred to Kamuzu Central Hospital (KCH) for screening and treatment.

“Screening is only available when organizations come to do the screening. It is not available at the prison clinic. And it is difficult to go for screening while we are here, in prison.” (FDG1, Participant 3).

“There was a time I was suspecting that I have cancer of the cervix. I was bleeding but yet I have already reached menopause. I was also experiencing sharp back and abdominal pain. This was during the time I was already here in prison.” I reported to the clinic to request for screening, the clinic was unable to do so, but they arranged for me to go for a check-up at Central hospital”. (IDI participant 7).

Perception of prisoner’s health status.

The study explored women’s perception of their health status before and while in prison, the different circumstances that women face in the prison and how that affects their sexual reproductive health. Results show that most inmates believed their health status was declining during the period of incarceration as compared to the time they were not in prison. They cited poor diet and hygiene, limited access to health services, extended length of time to process hospital referral requests and pro-longed scheduled visits for some medical procedures, as some of the factors affecting their health. Some prisoners expressed interest to go to private hospitals for better treatment, but that is not allowed even if the prisoner and their family are willing to meet the cost. Hospital referrals in the prison usually take time to process and are made only to the government hospitals.

“It takes a minimum of 7 days to process a hospital referral. Unless it’s an emergency, the internal processes to finalize a referral takes long. The issue is presented to the officer on duty and the officer has to contact the Police who were responsible of bringing me to the prison, after that then they arrange for me to go to the hospital. By the time they come to get me to the hospital, I have suffered for a long time.” (FDG2, Participant 7)

Other than ordinary consultations, some medical services have specific dates to be provided to the prison population and not basing on demand or need. These include cancer screening services, HIV and Tuberculosis testing and treatment among others. Periodic provision of these services contributes to an unhealthy prison population all together.

“You might have come into prison with the disease and because there is no good screening here, the problem may be worsening.” (FDG1 participant 4)

“I have been diagnosed of cervical cancer, and I had scheduled visits to review my health. While I am here, I have no idea if the situation is worsening or the same since we are not allowed to go out for check-up visits.” (FDG2 participant 5)

Other than the environment, the prison dietary conditions was also perceived to affect women’s health while in prison, especially women with pre-existing conditions such as HIV.

“for me who is HIV positive, while I was at home, I made sure I ate food and fruits that would boost my immune system and compliment my diet, while here in prison, we have no choice but eat what is provided for us and eating fruits is considered a luxury here in prison”. (IDI participant 5).

Benefits of cervical cancer screening

The participants reported early diagnosis and early treatment for prevention of cervical cancer as some of the benefits of screeningSome women explained during the FDGs that going for screening was good for in order to know their status and be assisted accordingly.

“when they catch the cancer at an early stage, it can be treated before it spreads to the other parts of the body. I lost my uterus after giving birth to my first born, lucky enough they found that I had cancer while it was still early and now, I am fine” (IDI participant 8)

“It is also good to do the screening especially for young girls who are about to start having families, it’s good for their planning” (FDG2 participant 5)

The participants further explained that they were more willing to go for screening when they were advised by medical doctors to do so. They believe if the advice was coming from the medical doctor, then there could be significant reasons why, meaning they may be carrying the signs and symptoms of the disease. On the other hand, some women described their willingness to undergo screening after a friend had recommended it and has undergone screening with a negative outcome (no cervical cancer). They continued to say the topic was less fearsome when someone they knew gave them assurance.

“when I was growing up, my mother told me there are two people who I must never lie to, a doctor and a teacher. So, if a doctor says you need screening, I cannot refuse or hide my condition. Those people know a lot about the body.” (IDI participant 10)

Challenges faced by inmates in accessing cervical cancer screening services

The study explored some challenges that the women face when accessing cervical cancer screening services and how this affects their willingness to go for screening in the prison. There were several factors including, pain during the screening process, presence of male practitioners conducting screening, poor treatment by authorities and health workers and favouritism.

Pain during the Process

Half of the women in one of the FGDs mentioned that screening was a painful process. The extent of the pain varied among the participants, from extreme pain to a mere discomfort. The women perceived that contracted muscles of the vagina wall due to sexual inactivity and use of cold water when cleaning genitals was the cause of the pain. Additionally, continuous bleeding for 48 hours after undergoing screening and elongated menstruation with heavy bleeding following screening was another issue’s participants experienced and shared after undergoing screening. These issues negatively affected their life in prison since sanitary pads in the prison were scarce.

“after I came back from screening, I started bleeding continuously for a week, this happened while I had already had my menstruation the previous week” (IDI participant 1)

Presence of male practitioners conducting screening,

Some of the women reported that they felt uncomfortable to undress and undergo the procedure with male health service providers. The women therefore opted to shun away from undergoing screening when it’s conducted by men. The women described the matter as embarrassing and scary because it’s easy to get raped.

“It is easy to undress in front of another female and it is also less scary because women don’t rape each other.” FDG 1

“It is embarrassing for a man to see my private parts after a long time.” (IDI Participant 15)

Poor treatment by authorities and health workers

Additionally, the study also revealed that despite the availability of the screening services from time to time, one of the barriers to accessing screening services was due to poor treatment of the prison authorities and health workers providing the services. The treatment instils fear in the inmates, and they tend to look away from seeking care. Most of the women believed that prison authorities and the medical personnel in the prison feel that prisoners are bad people who have lost their rights as long as they are serving their sentence.

“The officer was harsh and shouted at me during the screening process. The equipment they use is very good, but it is painful when it is inserted. I was not allowed to express any pain or discomfort during the process because I am a prisoner.” (IDI participant11)

Favouritism

For most women at the prison, access to cervical cancer screening services was not easy, not all inmates are screened and informed of the outcome of the screening, only a selected few have this access to the services due to favouritisms by prison officers. While most of the long-sentenced prisoners (more than 24 months incarceration) described the access of the service as free to the public (for all who wish to access in the prison), short- sentenced inmates had a different view of this. The study revealed that inmates that have been in the prison longer tend to gain favours from the prison authorities and benefit from interventions that come to the prison most often unlike the others.

“Sometimes we are forced to participate in events that we don’t want to and other times, we are refused to participate in events that we were willing to take part in.” (IDI participant 9)

“I was told I have the virus for cervical cancer a year after the time I was screened” (IDI participant 12)

While lack of knowledge of screening programmes is the most common reason for not being screened for cervical cancer among women in the society [18, 19] the situation is not different among imprisoned women at Maula Prison. In this study, lack of information did not come out as a hindrance to screening at all. Knowledge of the disease was universal, while some of the women were well-informed about its source as a sexually transmitted virus, others reported misconceptions and myths about the disease. The participants in this study perceived cervical cancer as dangerous, common and may affect any woman of childbearing age. Earlier studies, from Malawi suggest trends of increasing knowledge about cervical cancer and a heightened sense of susceptibility [20]. The Malawi National Cervical Cancer Control Strategy of 2016–2020 outlines comprehensive interventions to be taken by government and other partners in mitigating the burden of cervical cancer such as awareness of the disease through mass media across the country, this may have contributed to the increase in knowledge of cervical cancer among others [6],[7].

Despite having most of the participants undergone screening once or never, most of the women understood the benefits of screening and diagnosis at an early stage of which they believed avoids adverse effects of the disease. The main barrier that affected the women’s access to screening while in prison was the inconsistency of the services. Recent studies in Malawi have reported high knowledge of cervical cancer against low screening among women in Malawi[20] One of the studies in Malawi discovered high awareness of cervical cancer with about half of the participants as screening-inexperienced (never screened or screened for the first time) while all of the women understood the benefits of screening and the importance of early identification before the cancer progresses [20].

Poor diet and hygiene prolonged scheduled visits and poor referral system were contributing factors to poor women’s health in the prison. The women perceived being in prison has a negative impact on their health. Unsanitary conditions of the prison made the health conditions worse for the women as they often resulted into recurrent infections and transmission of communicable diseases[21]. It is of this view that the government of Malawi must consider and look beyond correction purposes of prisons and begin to focus on wellbeing of its prisoners since health of the prisoners [22].

Despite having knowledge and willingness to undergo screening, the women expressed concern over favouritism and poor treatment by prison officers and health care givers as a barrier contributing to low screening. This was described as demotivating and demeaning for the women. It’s believed that the poor treatment of inmates was as a result of increasing pressure on the human resource to manage the increasing numbers of inmates at the prison. A 2018 Malawi Inspectorate of Prisons Report to the Malawi Parliament indicated to have 630% over capacity with a total of 3026 inmates against 480 recommended capacity of the Maula Prison and an overall 260% over capacity in Malawi prisons, with 14,778 prisoners occupying spaces built for only 5,680 persons [23]. With the prisons at overcapacity, workload of prison officers may be overwhelming which may result to poor service provision and treatment to the inmates. This therefore calls for mindset change interventions by channelling information about prisoner’s health to prison authorities with the aim of improving their attitudes and in return improve the prisoners’ access to health care.

It was clear from the participants that screening was essential in preventing Cervical Cancer, however, the findings of this study revealed that the participants experienced and perceived cervical cancer screening as unpleasant, uncomfortable and painful resulting into refraining from the exercise[24]. This finding explained why there is good knowledge of the disease with low screening levels. Misconceptions of the screening processes that the women shared among themselves in the prison affected their participation in screening. Similarly, Women who received negative results from screening previously, were likely to recommend screening to others and it was highlighted that confidence and relief was a guarantee after undergoing screening particularly after a negative result. This therefore, emphasised the importance of interpersonal relationships for promoting cervical cancer screening[20] [25, 26]. The study participants that underwent screening before incarceration disclosed to have known someone who was diagnosed of cervical cancer as one of the reasons they underwent screening [24].

Preference of having female practitioners conducting the screening exercise other than male health practitioners was another barrier to screening in the prison. The participants described the presence of a male practitioner as a hindrance to women’s willingness to access screening. Due to the nature and sensitivity of the exercise, the women reported to have felt shy and uncomfortable to undress in the presence of a male unlike fellow women. In the attempt to increase the screening culture among women prisoners, use of female health practitioners may significantly impact the practice [25].

Incarcerated women generally experience gender-specific health-related challenges, which include menstruation, pregnancy and childbirth, care of their children within and outside of prison, development of certain forms of cancer, and are often exposed to gender-based violence in the form of physical/sexual abuse by prison officers and male prisoners [27]. The Maula prison was not exceptional over these conditions. In light to the general sexual reproductive health of the women prisoners, toilets and bathrooms used in the prison were not to the best hygienic and sanitary condition. There was inadequate provision of disinfectants for regular cleaning of floors, utensils and toilets. It was discovered during the study that disinfectants are usually on low supply or at all not available for months in the prison with insufficient, overflowing, non-functional toilets and bathing facilities with some water points close to sanitation outflows, and bathing buckets sometimes used as toilet facilities in the night[28]. This was assumed to increase the spread of infectious diseases among the women prisoners. Furthermore, the medication to treat infections such as Candidiasis among others, are also inadequate and often not available at Maula Prison. This therefore indicates that cases of disease infections may be persistent, reoccurring and usually untreated among the prisoners. This finding is in line with a study that conducted a systematic review of dynamic models of infectious disease transmission in prisons and the general population. In this study, it was perceived that Incarcerated populations experience elevated burdens of infectious diseases, which are exacerbated by limited access to prevention measures. The study revealed that prison-based screening and treatment may be highly effective strategies for reducing the burden of HIV, TB, HCV, and other sexually transmissible infections among prisoners[29].

STUDY LIMITATIONS

The study did not interview Prison Clinic Officers to discuss their view of the matter due to limited human and financial resources, and this was considered as one of the study limitations. Furthermore, the study did not review prison clinic records to establish the level of participation and frequency of availability of cervical cancer screening exercises at the prison. Future research is needed to establish the factors that affect cervical cancer screening in imprisoned women from the Prison Management’s perspective. This literature may contribute into policy and intervention approaches for prison health. However, the strengths of the study dwell on the thoroughness of the data collection and analysis for the women prisoners. The methods used in obtaining data supports and provides insights to the qualitative aspect of cervical cancer screening in imprisoned women.

The study revealed that the women at Maula prison had knowledge of cervical cancer and its associated risk factors even though some women reported misconceptions. The women perceived their health was deteriorating during the period of incarceration as a result of poor prison conditions and environment. The women expressed interest to undergo screening in the prison with a few challenges described as hindrance to the screening process. Improving the challenges would significantly increase screening uptake among the population. Recommendations to improve screening uptake in the prison are as follows, inclusion of cervical cancer screening to the mandatory health screening exercise that is conducted upon entry into the prison by all prisoners and ensuring consistent provision of cervical cancer screening services at the prison which should be conducted by female health practitioners. Secondly, conducting in-depth awareness and sensitization with participants before screening in order to eradicate fears, provide assurance and clarification of the screening process and lastly, channelling information and conducting awareness and sensitisation sessions to prison officers and health workers may improve the prisoners’ access to health care during incarceration.

Ethics Approval and Consent to participate.

Ethical consideration issues were strictly observed during this study. Ethics approval was obtained from the College of Medicine Research and Ethics Committee (COMREC:P.11/19/2890). Permission to conduct this study and a support letter was sought from the Malawi Prisons Authority. To ensure that the subjects had ethical protection, the researcher obtained informed consent from each participant before conducting data collection. To do this the participants were made aware that participating in the study was entirely voluntary and no one was obliged to participate unwillingly, and that if they chose not to participate, they were not going to be affected in any way. In addition, the subjects were informed of their right to terminate participation in the study at any time without any penalty. The study used written informed consent forms to show participant’s willingness to participate, ensure confidentiality and safety during the study period. The information that was gathered was not accessible to those not directly involved in the study except the statistician and supervisor. Interview guides were administered by the researcher in a private setup. The subjects’ right to anonymity and confidentiality of the data collected during the study was protected. Individual interviews were conducted in a private place to ensure privacy. Code numbers were used to hide the subjects’ identity. Participants were asked to give consent to have their conversations tape-recorded. Any personal identifying information was removed from the interview and FGD transcripts. The research did not intend to pose any potential physical or emotional harm to the participants through adoption of third-party monitoring by having prison officers always present during interactions.

Consent for Publication

Not Applicable.

Availability of data and material

The datasets used and/or analysed during the current study are available from the corresponding author on request through email at [email protected].

Competing interests.

The authors declare that they have no competing interests.

Funding

No funds, grants, or other support was received.

Author’s Contribution

R.M. conceived the idea and carried out the study with supervision from I.K.C. Both R.M. and I.K.C. contributed to the final version of the manuscript.

Acknowledgements

The authors thanks all the participants for their support and the staff of the Maula Prison. Special appreciation to Ibrahim Emmanuel Sinde S/SUPT, current Officer in Charge of Nkhatabay prison who organised logistics in relation to the study at the Maula prison.

Authors Information

Corresponding Author: Regina Mendulo, Email: [email protected], Kamuzu University of Health Sciences, Department of Public Health, Blantyre Malawi.
Isabel Kazanga Chiumia, Email: [email protected] , Kamuzu University of Health Sciences, Department of Health Systems and Policy, Blantyre, Malawi.

Borno H, George DJ, Schnipper LE, Cavalli F, Cerny T, Gillessen S. All men are created equal: addressing disparities in prostate cancer care. Am Soc Clin Oncol Educational Book. 2019;39(39):302–8.
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. A Cancer Journal for Clinicians [Internet]. 2018 Nov;68(6):394–424. Available from: https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21492.
World Health Organization. Comprehensive cervical cancer prevention and control: a healthier future for girls and women [Internet]. Geneva: WHO; 2013. 1–12 p. Available from: https://www.who.int/publications/i/item/9789241505147.
World Health Organization. International classification of diseases for oncology. Geneva: WHO; 2013. 402–3 p.
Malawi Prisons Regulatins (CAP. 09.02). 1st ed. Vol. 1. Zomba: Malawi Government; 1963. 83 p.
Msyamboza KP, Phiri T, Sichali W, Kwenda W, Kachale F. Cervical cancer screening uptake and challenges in Malawi from 2011 to 2015: retrospective cohort study. BMC Public Health [Internet]. 2016 Dec 17;16(1):806. Available from: https://link.springer.com/article/10.1186/s12889-016-3530-y?utm_source=getftr&utm_medium=getftr&utm_campaign=getftr_pilot.
Malawi Ministry of Health, UNFPA. Malawi national cervical cancer control strategy 2016–2020 [Internet]. Lilongwe: UNFPA; 2017. 60 p. Available from: http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L71343074%5Cnhttp://dx.doi.org/10.1158/1538-7445.AM2013-ADV01%5Cnhttp://fq5np7af6j.search.serialssolutions.com?sid=EMBASE&issn=00085472&id=doi:10.1158/1538-7445.AM2013-ADV01&atitle=N.
Temmerman M, Khosla R, Say L. Sexual and reproductive health and rights: A global development, health, and human rights priority [Internet]. Vol. 384, The Lancet. 2014. p. e30-1. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25043387.
World Health Organization, ICRC. Mental health and prisons [Internet]. Geneva: WHO; 2005. 6 p. Available from: https://www.who.int/mental_health/policy/mh_in_prison.pdf.
Moloko HB, Ng DH, Dzanja J, Chilongo T. Socioeconomic characteristics of prisoners and food insecurity occurrence and prevalence in Malawi’s prisons. Journal of African Studies and Development [Internet]. 2017 [cited 2022 Apr 21];9(6):82–8. Available from: https://academicjournals.org/journal/JASD/article-abstract/2FA3CA665065.
Malawi Human Rights Commission. Malawi 2017 human rights report [Internet]. Lilongwe: MHRC; 2017. 45 p. Available from: https://www.state.gov/wp-content/uploads/2019/01/Malawi.pdf.
Kleinig J. United Nations rules for the treatment of women prisoners and non-custodial measures for women offenders (the Bangkok Rules). In: Prisoners’ Rights [Internet]. 1st ed. London: Routledge; 2018. p. 23. Available from: https://doi.org/10.4324/9781315089461-21.
de Greiff P. Constitution of the Republic of Malawi [Internet]. The handbook of reparations. Lilongwe: Malawi Government; 2006. 93 p. Available from: http://www.sdnp.org.mw/constitut/dtlindx.html.
van den Bergh Brenda, Plugge E, Aguirre IY. Women’s health and the prison setting. Prison and Health. 2014;53(1):159–70.
Williams DG, Babbie ER. The practice of social research. Contemporary Sociology [Internet]. 1976 Mar;5(2):163. Available from: http://www.jstor.org/stable/2062956?origin=crossref.
Caroline Tynan A, Drayton JL. Conducting focus groups: a guide for first-time users. Marketing Intelligence & Planning [Internet]. 1988 Jan;6(1):5–9. Available from: https://www.emerald.com/insight/content/doi/10.1108/eb045757/full/html.
Saunders B, Sim J, Kingstone T, Baker S, Waterfield J, Bartlam B, et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Quality and Quantity [Internet]. 2018;52(4):1893–907. Available from: https://pubmed.ncbi.nlm.nih.gov/29937585/.
Elo S, Kyngäs H. The qualitative content analysis process. Journal of Advanced Nursing [Internet]. 2008 Apr;62(1):107–15. Available from: https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2648.2007.04569.x.
Plugge E, Douglas N, Fitzpatrick R. Patients, prisoners, or people? Women prisoners’ experiences of primary care in prison: a qualitative study. British Journal of General Practice [Internet]. 2008 Sep 1;58(554):e1–8. Available from: http://bjgp.org/lookup/doi/10.3399/bjgp08X330771.
Moucheraud C, Kawale P, Kafwafwa S, Bastani R, Hoffman RM. “It is big because it’s ruining the lives of many people in Malawi”: women’s attitudes and beliefs about cervical cancer. Preventive Medicine Reports [Internet]. 2020;18(April):101093. Available from: https://doi.org/10.1016/j.pmedr.2020.101093.
Gadama L, Thakwalakwa C, Mula C, Mhango V, Banda C, Kewley S, et al. ‘Prison facilities were not built with a woman in mind’: an exploratory multi-stakeholder study on women’s situation in Malawi prisons. Int J Prison Health. 2020;16(3):303–18.
Colbert AM, Sekula LK, Zoucha R, Cohen SM. Health care needs of women immediately post-incarceration: a mixed methods study. Public Health Nursing [Internet]. 2013 Sep;30(5):409–19. Available from: https://onlinelibrary.wiley.com/doi/10.1111/phn.12034.
Chafulumira BW. Congestion gets worse in prisons. 2019 Jan 19;1. Available from: https://times.mw/congestion-gets-worse-in-prisons/.
Olsen C. MD. Cross-sectional study design and data analysis. In: Board CEE, editor. College Entrance Examination Board [Internet]. 2004th ed. New York: College Entrance Examination Board; 2004. p. 53. Available from: http://cdn.physioblasts.org/f/public/1355667773_1_FT0_4297_module_05.pdf.
Malhotra J, Rotter D, Tsui J, Llanos AAM, Balasubramanian BA, Demissie K. Impact of patient–provider race, ethnicity, and gender concordance on cancer screening: findings from Medical Expenditure Panel Survey. Cancer Epidemiology Biomarkers & Prevention [Internet]. 2017 Dec;26(12):1804–11. Available from: http://cebp.aacrjournals.org/lookup/doi/10.1158/1055-9965.EPI-17-0660.
Getachew S, Getachew E, Gizaw M, Ayele W, Addissie A, Kantelhardt EJ. Cervical cancer screening knowledge and barriers among women in Addis Ababa, Ethiopia. PLoS One [Internet]. 2019 May 10;14(5):e0216522. Available from: https://dx.plos.org/10.1371/journal.pone.0216522.
Ackermann M. Women in detention in Africa: a review of the literature. Agenda [Internet]. 2015 Oct 2;29(4):80–91. Available from: https://acjr.org.za/resource-centre/WomenInPreTrialDetention_V2.pdf/view.
Van Hout M-C, Mhlanga-Gunda R. Prison health situation and health rights of young people incarcerated in sub-Saharan African prisons and detention centres: a scoping review of extant literature. BMC International Health and Human Rights [Internet]. 2019 Dec 22;19(1):17. Available from: https://bmcinthealthhumrights.biomedcentral.com/articles/10.1186/s12914-019-0200-z.
Ndeffo-Mbah ML, Vigliotti VS, Skrip LA, Dolan K, Galvani AP. Dynamic models of Infectious disease transmission in prisons and the general population. Epidemiologic Reviews [Internet]. 2018 Jun 1;40(1):40–57. Available from: https://academic.oup.com/epirev/article/40/1/40/4939385.

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The State of Cervical Cancer Screening in Imprisoned Women in Malawi: A Case of Maula Prison.

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Journal Publication

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Abstract

Background

METHODS

Study Design, Target population and study period

Inclusion Criteria

Exclusion Criteria

Sample selection

Sample Size

Data Collection

Data Management and Analysis

Results

Knowledge of cervical cancer and its associated risk factors

Access to cervical cancer screening services at Maula prison

Benefits of cervical cancer screening

Challenges faced by inmates in accessing cervical cancer screening services

Pain during the Process

Poor treatment by authorities and health workers

Favouritism

Discussion

STUDY LIMITATIONS

Conclusion

Declarations

References

Supplementary Files

Status:

Journal Publication

Version 1