Table 2 Summary of included studies

Gutnik et al. 2016 [18]

1220 women age ≥ 30

5 urban health clinics in Lilongwe

Level 3.e

Pilot study evaluating feasibility and acceptability of CBE screening performed by laywomen. 4 months (January to April 2015) quantitative descriptive study.

Laywomen were paid, so success may not be comparable to unpaid volunteers. Urban area, may not be applicable to rural areas. The intervention targeted participants already attending clinics so already demonstrating health-seeking behaviours, may not be applicable to the entire population. Transport reimbursements and telephoning referred women was likely to have contributed to the high rates of completed referrals. No control group. Performance in rural areas, effects on cancer stage and mortality, and cost effectiveness require evaluation.

Kohler et al. 2017 [19]

25 women screened for breast cancer

5 urban health clinics in Lilongwe

Level 3.e

Qualitative study to explore perceptions and experiences of Malawian women who underwent CBE screening performed by laywomen.

Participants were already attending clinics already demonstrating health-seeking behaviours, so may not be applicable to the entire population. Most participants lived in urban/peri-urban areas and were more educated compared to the general population, so may not be applicable to the entire population. No data was collected prior to the educational talk, therefore changes in knowledge could not be formally assessed. Interviews took place up to 5 months after a participant’s screening, so could be subject to recall bias. Interviews were conducted by the same laywomen participating in the intervention delivery, with some risk of response bias

Maseko et al. 2015 [20]

41 service providers and 9 district health coordinators

1 central hospital, 7 health centres and 13 district hospitals

Level 3.e

Mixed methods study exploring health system gaps responsible for the poor performance of cervical cancer screening and treatment services in Malawi

Only 14 out of the 29 administrative health districts in Malawi were in the sample, may not be generalisable. Participants filled the questionnaires under the guidance of trained research assistant, possible response bias

Maseko et al. 2014 [21]

120 women screened for cervical cancer

16 public health facilities

Level 3.e

Descriptive study to examine the experience of women who have been screened for cervical cancer at public health clinics. Data collection Mar-Jun 2013 using a semi-structured questionnaire

Exit interviews were conducted only over 1 day at each facility. Clinics had multiple service providers and it was possible for facility managers to allocate the best health care provider to do the screenings on that day when the researcher conducted the interview. Patient satisfaction surveys prone to response bias, especially in the form of face-to-face interviews and low education level of respondents. Participants were not randomly chosen

Msyamboza et al. 2016 [8]

145,015 women screened for cervical cancer

All clinics participating in the national cervical cancer control programme across Malawi

Level 3.e

Cohort study assessing the national cervical cancer control programme, for the period 2011–2015

Limitations related to use of health facility data, including incompleteness and bias (it includes only information obtained from people who come to health facilities or clinics). High loss to follow up, missing data.

Pfaff et al. 2018 [22]

957 HIV-positive women screened for cervical cancer

1 HIV clinic in Zomba Central Hospital

Level 3.e

Descriptive analysis of an NGO-led intervention. Study period May 2016 to March 2017. The methodology seems to suggest only a quantitative analysis of patient data, but anecdotal evidence about the service reported across the document

Participants recruitment process not clear in the paper. Authors mention that screening services were offered by Expert Clients (ECs), who are patients on ART, but no details on when/how women were approached, if EC were trained, if informed consent was sought etc. Another part of the document suggests that it is the clinicians who refer women to the cancer screening service, while the ECs accompany them to the screening room. No cost effectiveness evaluation of the intervention or information on sustainability. All participants were already demonstrating health seeking behavior as they were already attending the HIV clinic, thus this may not be generalisable to the entire HIV positive population in Malawi. The study reports the number of HIV-positive women attending the clinic who were screened for cervical cancer, but does not report what is the share out of the total number of clients in the HIV clinic. Also, according to the authors a number of HIV-uninfected women were screened for cervical cancer at the clinic, but omitted from evaluation. Therefore, it is difficult to make final conclusions about actual coverage of the initiative.