Quality of breast cancer early detection services in the well women clinics in the district of Gampaha

Abstract

AIMS: To evaluate selected aspects of breast cancer early detection services implemented through well woman clinics (WWCs) in the Gampaha District. METHODS: Clinical breast-examination(CBE) coverage of target age group women(TGW) of 35-59 years was assessed in all the WWCs in Gampaha district from 2003-2007. Quality assessment of breast cancer early detection services was done using Lot Quality Assurance Sampling. The lot size and threshold value computed were twenty and six clinics respectively. Checklists were used in assessing coverage, physical facilities and clinic activities. Client-satisfaction on WWC services was assessed among 200 TGW attending 20 WWCs using an interviewer-administered questionnaires. RESULTS: CBE coverage in the Gampaha district increased from 1.1% (3389/318711) to 2.2% (7248/326271) from 2003-2007. With regard to physical facilities, the number of clinics that were rated substandard varied between 7-18 (35% - 90%). Adequacy in relation to notice boards, stationery, furniture and linen, and cleanliness outside premises and toilets were identified as substandard. With regard to services, punctuality of staff arrival and in commencement of clinics, provision of healtheducation, availability of supervision and CBE and breast self-examination (BSE) services were observed as substandard in 7-20 clinics (35%-100%). Median satisfaction score among TGW was 45.2% (IQR: 38.7 - 54.8%). Only 11% had a score of >70%; the threshold for satisfaction. CONCLUSIONS: Coverage of breast cancer early detection service in the Gampaha district in 2007,11 years after commencing WWC services, was still very low (2.2%). All 20 clinics were substandard for overallCBEand BSE services.