Cervical cancer screening data from the case-based national electronic registry in Bangladesh

The Government of Bangladesh established a visual inspection with acetic acid (VIA)-based cervical cancer screening programme at 600 primary, secondary and tertiary health facilities following a pilot programme in 2005. An aggregated data collection system was initiated using District Health Information System 2 (DHIS2) software in 2013 and a case-based electronic data registry system was developed utilising its "tracker" component since January 2018. The purpose of this study is to review the cervical cancer surveillance situation based on the data of the national cervical cancer screening, treatment and follow-up through the DHIS2-based electronic registry.

Women aged 30 to 60 were enrolled in the DHIS2 electronic registry in health facilities of all tiers including the community clinics and screened for cervical cancer using the VIA method at Upazila Health Complexes and upper tiers. The VIA-positive women were referred for colposcopy in the nearest colposcopy centres. The screen-positive women were offered treatment and followed up at certain intervals following the national standard protocol. During each encounter, required data were captured in DHIS2. Anonymised data from the DHIS2 covering January 2018 to May 2023 were extracted and analysed for this study.

A total of 1,562,963 women were enrolled in 497 screening facilities and 6398 community clinics. Among them, 1,557,002 (99.6%) availed VIA tests, and primary health facilities performed 74.4% enrolments and 72% VIA tests. Among screened women, 51,913 (3.3%) were VIA positive, of which only 20,954 (40.4%) attended for colposcopy. Among colposcopy-positive women, 6.3% (1,327) and 6.2% (1,302) women had cervical intraepithelial neoplasia (CIN) II/III and cervical carcinoma, respectively. Among women who received treatment for cervical precancer, 81.6% (5062) had thermal ablation, and 17.6% (1089) had loop electrosurgical excision procedure. Histopathology reports (n = 3079) revealed 16.1% (n = 495) of women had squamous cell carcinoma, 4.0% (n = 123) had micro-invasive squamous cell carcinoma, 11.7% (n = 36) had CIN II, and 8.1% (n = 250) had CIN III.

The National Cervical Cancer Screening and Treatment Programme for women in Bangladesh using a DHIS2-based electronic case-based tracking system is effective in understanding the screening situation and can be a valuable lesson for other countries.