Availability, Maintenance, and Utilization of Cervical Cancer Screening Guidelines in Level II–V Healthcare Facilities in Tharaka Nithi County, Kenya: A Cross-Sectional Study

Abstract

Background: Cervical cancer remains a leading cause of cancer-related death among women in low- and middle-income countries, where screening coverage is critically low and 95% of women have never been screened. This study determined the availability, format, maintenance, and utilization of cervical cancer screening guidelines in Level II–V healthcare facilities in Tharaka Nithi County, Kenya.

Methods: A cross-sectional survey among healthcare  in charge of cervical cancer screening at all 191 Level II–V health facilities offering reproductive health services in Tharaka Nithi. Census  was adopted. Data were collected electronically using  the WHO Service Availability and Readiness Assessment (SARA) tool, via Google Forms. Data were analyzed in SPSS version 29.

Results: Guidelines were  available in 57.8% of facilities, most commonly Ministry of Health protocols (71.1%) and, secondarily, WHO guidelines (33.1%); county-specific (7.4%) and internally developed (8.3%) protocols were rare. Where present, guidelines were displayed as posters (63.6%) rather than printed manuals (19.8%) or digital copies (17.4%). Two-thirds of respondents (66.7%) reported that guidelines were not regularly reviewed or updated, and 80.7% had never received training on guideline use. Among the 19.3% ever trained, only 5.2% of the full sample had been trained within the past year. 66.0% of respondents rated available guidelines as "Very Useful" or "Somewhat Useful." A composite guideline-preparedness indicator was met by only 15.6% of facilities, with no statistically significant difference across facility levels (χ²(3) = 0.730, p = .866, Cramér's V = .074), including a low proportion even at Level V (33%).

Conclusion: Cervical cancer screening guideline preparedness in Tharaka Nithi County is low and uniformly distributed across facility levels. The guideline usefulness among those with access indicates that the core deficiency lies in dissemination, currency, and training systems rather than in the content of the guidelines themselves, pointing to the need for county-wide, rather than tier-specific, interventions.