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COMPREHENSIVE CERVICAL CANCER CONTROL C4

COMPREHENSIVE CERVICAL CANCER CONTROL C4. Country: MALAYSIA Presenters: DR LILI ZURYANI / DR SHAHRANIZA. 1. Status of National Programme. Year of starting: Pap smear screening available since 1969 1995 – nationwide programme to w omen age 20 – 65 (sexually active)

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COMPREHENSIVE CERVICAL CANCER CONTROL C4

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  1. COMPREHENSIVE CERVICAL CANCER CONTROLC4 Country: MALAYSIA Presenters: DR LILI ZURYANI / DR SHAHRANIZA

  2. 1. Status of National Programme • Year of starting: • Pap smear screening available since 1969 • 1995 – nationwide programme to women age 20 – 65 (sexually active) • Responsible unit: Family Health Development Division, Ministry of Health • Financing: Budget allocated RM 3.3 million per year • Components: health promotion, screening, referral of symptomatic patients, treatment • Current status: On-going

  3. 2. Screening for cervical cancer • Test used: cytology – conventional (health clinics) and liquid based cytology (mainly in hospitals) • Coverage: Prevalence of pap smear examination among women ≥ 20 years ever had pap smear :- • 26 % (NHMS II ,1996) • 45.7 % (NHMS III, 2006) • Annual coverage – 18 to 20 % • Number screened per year: approx. 400,000 per year for the past 10 years • Limitations: • Low participation by women – opportunistic screening • Limited resources for laboratory services

  4. 3. Cancer treatment • Number of centres offering treatment for cervical cancer – Government Hospital (10), Academic Institution (2) and Private (3) • Radiotherapy availability : Government (8), private (5) • Brachytherapy: available in all the centres with radiotherapy. • Most common stage at presentation : Stage 2 : 34% (stage 1:21%, stage 3: 26%, stage 4: 19%) – NCR 2007

  5. 4. Monitoring and evaluation • Cancer registry: National Cancer Registry originated in Penang and covered the population in the northern States in peninsular Malaysia. The 1st national Cancer Report was published in 2002. The latest publication is in 2007 • The population-based cancer registry in Malaysia was started as Regional Cancer Registry in 1993. • National roll out in 2007 • Population covered by cancer registry: Nationwide • Incidence rate of cervical cancer: 7.8/100,000 (NCR 2007)

  6. 5. Challenges for cervical cancer control • COVERAGE: • Target group – • Lack of knowledge awareness and wrong perception “No risk of cancer’ • IMPACT: • Programme approach • Opportunistic activity • Inadequate budget • Not capturing high risk groups • QUALITY Healthcare provider • unsatisfactory smears (1.23% - 2010) Laboratory support • 60.0% outsourced to non-MOH labs (2010) • Inadequate numbers of cyto-screeners • Career structure of MLTs • Equipment and lab space • Inadequate budget • Long TAT • De-centralized services

  7. 5. Opportunities for cervical cancer control • Opportunity • Availability of government/ private health facilities nationwide • Established health care delivery system • Established organization to oversee the screening programme • Dedicated budget for screening

  8. HPV VACCINATION

  9. HPV vaccination: Decision-making and planning • RATIONAL • Cervical cancer is the second most common cancer among Malaysian women • Acceptance rate of pap smear screening programme is not very encouraging • NHMS III (2006): 43.3% women aged 18 and above ever had Pap Smear • Local study showed prevention of cervical cancer through vaccination is cost effective

  10. HPV vaccination: Decision-making and planning • Funding sources • Approved 2010 MOH budget • Vaccine procurement • Health promotion and campaigns • Additional consumables • Existing Operational Budget at state and districts • School Health Teams • Vehicle maintenance and petrol

  11. HPV vaccination: Decision-making and planning • Vaccine selected • Human papillomavirus bivalent (type 16 and 18) vaccine • Communications with community, schools, health staff and others to prepare for vaccine introduction • Electronic media • Posters • Local radio stations and newspapers

  12. POSTERS

  13. PAMPHLETS

  14. HPV vaccination: Immunization systems • Locations: School-based community health centers • Vaccination given by nurses (school health teams) • Immunization system: • Parental Consent • Monitoring vaccine coverage • Follow up of absent and missed girls

  15. Parental Consent • Parents are given consent forms together with the information on the importance of HPV vaccination

  16. Monitoring Vaccine Coverage

  17. Follow up – HPV Immunization Card

  18. HPV vaccination: Challenges in implementation and solutions found • Started in 2010 and continue as part of school health services • Challenges on “halal” status and vaccine safety • MOE collaboration • Consent form • Halal certification • Vaccine storage – adequate storage - vaccine supply with WHO certified fridges

  19. HPV IMMUNIZATION PROGRAMME IN MALAYSIA • Strong political will and leadership drive • Availability of School Health teams/clinic teams • Childhood and School Health Immunization programme are widely accepted by parents in Malaysia

  20. THANK YOU FOR YOUR KIND ATTENTION

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