AN APPROACHES TO CONTROLLING CANCER AMONG FEMALE STUDENTS IN NIGERIAN UNIVERSITY
ABSTRACT
The study adopted a cross sectional, descriptive study design with the population consisting of female student of reproductive age 18-49 years attending health care services in the targeted facilities in UNIBEN. The study employed simple random sampling technique to select a sample of female student seeking healthcare services in healthcare facilities in UNIBEN. The total available population was 450 out of whom a sample of 45 was selected from the three facilities on the basis of proportion. Questionnaires were used to collect data from the respondents and the data analyzed through the use of SPSS. The study findings showed that female student of reproductive age lacked the knowledge on various aspects of cervical cancer. The uptake of screening services has however remained low with the female student’s education, attitude and knowledge contributing significantly to the level of uptake. The study therefore recommended that there is need for the Ministry of Health to enhance education at the health facilities especially lower cadre facility to promote awareness for cervical cancer and cervical cancer screening. There is need also to make a deliberate effort to invest in the well trained personnel and equipment. The Ministry of Health should also provide more training and health education services to the female student in Nigeria on the cervical cancer.
CHAPTER ONE
INTRODUCTION
- Background of the study
Worldwide documentation has it that cancer of cervix is in the second position of the most common cancer among female student and consequently main cause of mortality in less developed countries. In the year 2008, approximation has it that 529,409 new cases of cancer of cervix occurred worldwide with 52 percent (274,883) of the reported succumbing to death. About 86% of all the new cases reported every year emanate in less developed world, with 80-90% deaths related to cervical of cancer occurring (GLOBOCAN, 2008). Cancer of cervix claims lives when female student are at the peak of their age-35-45 years. A time when they are most productive socially and economically. Averagely, 25.3 life years are lost as a result of cervical cancer ((MOPHS and MOMS, 2012-2015)
Despite cervical cancer being curable and easily noticeable in the early phase, merely 5% of female student in less developed countries undertake routine check-up for cancer of cervix against over 40% that of countries that are developed. Countries that have manifested a reduction in rates of cervical cancer, over 70% of female student undergo screening for cervical cancer. This explains why in African where access to screening is dismal most female student go to health facility when the disease has advanced to invasive stage. Only 3.2% of female student are reported to have undergone screening (WHO, 2010).
Cancer of ervix is said to be the most widespread cancer within the developing countries; where more than 75 percent of the projected 500,000 new incidents of cancer of cervix are reported yearly. The highest case is seen in less developed countries comprising sub-Saharan Africa. The high cases result from the inadequate programs for screening and also from the lack of knowledge of cervical cancer in developing countries. The condition remains to be a big health concern of the reproductive system amongst female student and especially in less developed countries where services for screening services are wanting or not accessible for most of people.
In Nigeria, cancer of cervix is major source of death in female student of reproductive age (WRA) and also remains second amongst all kinds of cancer affecting female student folk. Presently in Nigeria, the predictable annual testified cases of cervical cancer are 2454 and fatalities associated with it every year 1676. By year 2025, projections has it that Nigeria will report about 4261 new diagnoses (WHO, 2010). Data from registries in the hospitals here in Nigeria suggest that close to 80 percent of illness related with the genital tract are resultant from cancer affecting the cervix. Estimates has it that Edo state records between 10-15 new cases. This is according to the Nigeria Cancer registry occurrence report (2006).
Only 3.2% of female student age 18 to 49 years are estimated to have had access to screening in any 3- year period in Nigeria (WHO, 2010). This notwithstanding the degree of the problem, and the fact it is certainly avoidable. In HIV infection, cervix cancer is also renowned as an AIDS-defining disease. However, with female student accessing Ante Retroviral Therapy hence have this becomes a lifestyle disease that affects their daily lives. Cancer of cervix burden rate stands at 15 percent in HIV positive against 7 percent that of the national. From a research done amongst female student that were HIV positive in Nigeria clinics, based on the screening done 43% of them had abnormal cervical outcome from the tests. The abnormal results gotten from HIV-positive female student was higher than of average female student within the population which stands at 3.6 percent. Based on the fact and awareness that HIV-positive female student lose lives resulting from, efforts have been made to have screening as part of primary care.
Cancer has continued to be gradually fatal more so in young female student. This results from the thought in female student that cancer leads to unavoidable death. Thus Female student choose to keep away from screening and remain unconscious of their state of health. Awareness and sensitization regarding cancer affecting the cervix as well as breast continued to reduce and fatality risen as a result of female student being ignorant (Powe, 2006).
Cervix cancer results from the Human Papilloma Virus (HPV) passed through sex, commonly the male is a carrier of the virus that is passed to females. Both the females and males do not seem to be alert of the virus and the dangers associated with it. (Roland et al, 2009).
Problem Statement
In Nigeria, second after cancer of breast among female student of ages 18-49 years is cancer of the cervix. Close to 10.32 female student aged 15 years and above within the population are said to at risk of contracting HPV leading to development of cervix cancer. and above It is projected that Nigeria has 10.32 million female student of ages 15 years and above and all are at a risk of getting HPV contagions and developing cancer of cervix (WHO, 2010). Estimates as of current show yearly in Nigeria, 2454 new incidences of cancer of cervix are registered and 1676 deaths from the disease (WHO, 2010).
Cancer of cervix is easily avoidable by way of vaccination before it sets on using HPV vaccine. It can also be averted through regular screening to detect any abnormality in the cervix. Inspection of the cervix is accessible in most of the health facilities in Nigeria through use of VIA/VILI and Pap smear. Though, screening levels remain low at just 3.2 per cent of among female student of age 18-69 years in against 70 per cent of female student in the advanced countries (WHO, 2010).
The low uptake for screening has been observed as a cause for illness and death. Through consistent cervix screening and timely management, mortality and morbidity resulting from the condition can be greatly achieved. Uptake of cervical cancer screening services still remain low despite efforts made by the government to incorporate screening programs in the regular patient care through the nationwide cervical cancer prevention strategy that is focusing on primary avoidance, screening and early detection and treatment (MOPHS and MOMS, 2012-2015).
Existing gaps need attention to help combat enhance cervix cancer in Nigeria (Henley, 2012). For timely checkup and timely detection, it helps to have knowledge. Female student with a better familiarity of cancer of cervix were highly likely to seek screenings. Lack of knowledge about cancer of cervix remains a critical barrier in female student’s access to the screening servies (Terefe & Gaym, 2008). Knowledge level regarding cancer of cervix and screening, perceived behavior in health is higher in the city compared to the country side (Eze, et. al., 2012), however, little is known regarding level of knowledge regarding cancer of cervix in the urban informal settlement such as UNIBEN.
Most study findings show practice of screening is followed by awareness of cancer of cervix and knowledge of screening (Terefe & Gaym, 2008). This all show the need of information touching on aspects that are linked with cervix cancer, awareness and promoting screening uptake for cancer of cervix.
Globally female student of that are resource poor have a higher chance of having cancer of cervix. Cancer of cervix has been termed as a condition for the poor. Hence, this study is intended to assess the awareness, behavior and attitude on cancer of cervix test and factors related with it. Determining the knowledge, attitude and practices concerning cervical cancer screening uptake and non-uptake among female student visiting primary healthcare facilities is of utmost importance in governing the disease. This information will hopefully inform the related authorities of the possible interventions that need to be made in order to deter death and suffering that is linked with cervical cancer especially in the urban slums such as UNIBEN.
Research Questions
This study sought to answer the following research questions:
- What is the level of knowledge on cancer of the cervix and screening among female student attending primary health care services in UNIBEN?
- What is the attitude towards screening for premalignant cervical lesions among female student attending primary health care services in UNIBEN?
- What is the control mechanism of female student attending primary health care services on cervical cancer screening?
- What are the approach for controlling uptake and non-uptake of screening for cancer of cervix among female student attending primary health care services in UNIBEN?
Research Objectives
- General objective
The general objective of the study was to determine the knowledge, atitude, and practice connecting to cancer of cervix among female student seeking healthcare services in primary health facilities in UNIBEN.
The specific objective
The specific objectives that the study sought to achieve include the following:
- To establish knowledge level on cervix cancer and screening among female student seeking care in UNIBEN health
- To determine the atitude towards screening for precancerous lesions among female student seeking care in UNIBEN health
- To find out the control mechanism of female student seeking care in UNIBEN health
- To determine the uptake and non-uptake of screening for cancer of cervix among female student attending primary health care services in
Justification
There has been notably better accessibility of treatment for patients with infectious diseases such as malaria, tuberculosis and AIDs due to an increase in global and national attention to these diseases and afterward an increase in financial resources towards their fight.
It is important to note that, in Nigeria there are 2454 new cervical cancer cases each year with 1676 annual deaths (WHO/ ICO,2010). This mortality figure is approximately 68% of new cases and goes to show the effect of cervical cancer on affected female student. For a cancer that can be easily controlled, the high cervical cancer mortality points to a gap in admittance to screening and treatment of giving cases at an early stage.
Cancer of the cervix is avoidable disease; one of the ways through which it can be prevented is through screening and detection and treatment before development to high grade level of the disease. Screening for cervical cancer before it advances to high grade level through the visual approaches is deemed to be a practice and cost effective alternative for control of cancer of cervix in set ups that are poor resource wise. Discovery of the precancerous cells however needs awareness regarding the condition to improve acceptance to screening and make people more informed.
Information derived from this project should inform health authorities so as appropriate steps can be seized to save female student’s lives by educating them and provide several screening opportunities. Of importance, this study may be helpful to the health care providers to organize awareness program associated to CC and its inspection and finally lessening affliction of cancer of cervix amongst female studentfolk in UNIBEN. Further the results can facilitate the evaluation of current cervical cancer screening programs particularly those that target resource poor settings.
Study Scope and Limitation
The research was limited to female student visiting primary health care in UNIBEN drawn only in three community units.
The tool was not translated to Swahili; this may have led to some misunderstanding of some questions or words by research assistants. To alleviate this, the research assistants were selected who understood Swahili and were also trained how to ask questions and probe where necessary. The responses by the interviewed screening uptake was self-reported and there was no way of verifying the responses.
Despite the fact that UNIBEN has several villages, the study was limited to health facilities in Gatwekera and Soweto West villages of UNIBEN.
The distribution of the selected respondents did not take into contemplation factors such as literacy and financial status.
The study did not consider interviewing clinical staff to corroborate the data.
Limitations of the Study
Although the study was successfully undertaken, some challenges (limitations) were encountered during the study execution period. These included; financial limitations where the research required much funds for the data collection as well as other costs in the study event. The study was also limited to the female student attending health services at UNIBEN. The study was further faced with the limitation of the use of questionnaire tool for the data collection. This is because the respondents only answered the given questions without giving extra information which would be sought using other data collection techniques like the use of interviews where the researcher would have asked for more information.
Definition of Significant terms and Concepts
Atitude: the certainty and sensation of the respondents about screening for cancer of cervix.
Awareness: Knowing that something does exist and is of importance, being captivated in something (Cormack, 1987).
Cancer: A disease characterized by malignant tumor formation or proliferation of a plastic cell (James, 2008).
Cervix Cancer: This is a malignant condition that occurs when the cells of the cervix proliferate to abnormal cells and can upset layers of cell that are deeper or increase to other parts of the body and cause harm.
Abnormal cells: This is when the cervix begins as slight abnormal squamous cellular change which may develop into severe dysplasia if left untreated (Ferlay, 2004).
Human Papilloma Virus: This is a virus that triggers alterations at the cells of the cervix, which can trigger the growth of cancer of the cervix (Cormack, 1987).
Knowledge: the understanding the respondents have regarding cancer of cervix in relation to disposing factors, signs, prevention and treatment, screening method.
Pap smear: A test in which cervix cells are taken and inspected underneath a microscope (James, 2008)
Practice: the action taken by individual respondents to go for screening
Precancerous cells: These are cells that may become cancer if not managed (Ferlay, 2004)
Social stigma: A feeling of disapproval that female student with cancer feel (Cormack, 1987)
Uptake: This is the rate or number of times of which female student undertake Pap smear test (Ferlay, 2004).
Female student of Reproductive Age: All female student from ages 18-49 years
