EVALUATION OF UTILIZATION OF HEALTH-WORKERS FOR SECONDARY PREVENTION OF ORAL-CANCER IN KERALA, INDIA

The utilisation of primary health workers (HWs) for cancer control in developing countries has often been suggested, based on the experience of feasibility studies in India and Sri Lanka. We initiated a project in 1988 to evaluate the long-term feasibility of using trained HWs in secondary prevention of oral cancer, to bring about earlier detection of oral cancer in the communities served by them. Two hundred and eig hty-two HWs attached to 14 primary health centres (PHCs), serving appr oximately 0.92 million rural population in the northern half of Trivan drum district in Kerala, India, were trained in oral visual inspection to detect precancerous, malignant and other suspicious lesions of the oral cavity and refer them for confirmation and treatment. They were asked to examine subjects aged 35 years and above and to give person t o person health education on tobacco in their target population. The H Ws belonging to the PHCs serving approximately 1 million rural populat ion in the southern half of Trivandrum district were not trained, and this region served as the control area. In addition to several process measures, stage distribution of oral cancer in subjects reporting fro m the intervention and control areas, as well as oral cancers referred by the HWs, as a proportion of total oral cancers from the interventi on area, were the outcome measures evaluated. Only 9/282 (3.2%) traine d HWs were motivated and they examined 17812 eligible subjects in 3 ye ars and referred 408 subjects with lesions; 258/408 (63.2%) referred s ubjects reported for further examination and ten oral cancers were det ected among them. There were no differences in the proportions of vari ous clinical stages of the 302 oral cancer patients from the intervent ion area and the 287 patients from the control area who reported for t reatment between July 1989 and June 1992. Only ten (3.3%) of 302 oral cancers in the intervention area had been referred by trained HWs. The present study failed to motivate the HWs for oral cancer control. No trend towards earlier detection of oral cancers was observed in the in tervention area. Further research is needed to develop an appropriate primary healthcare model for cancer control in developing countries.