KNOWLEDGE, ACCEPTABILITY AND UPTAKE OF CERVICAL CANCER SCREENING AMONG WOMEN OF CHILD BEARING AGE (15-49YEARS) ATTENDING POSTNATAL CLINIC IN CENTRAL HOSPITAL

KNOWLEDGE, ACCEPTABILITY AND UPTAKE OF CERVICAL CANCER SCREENING AMONG WOMEN OF CHILD BEARING AGE (15-49YEARS) ATTENDING POSTNATAL CLINIC IN CENTRAL HOSPITAL

ABSTRACT

Cancer of the cervix is said to be the commonest cancer second to breast cancer worldwide yet it causes the highest cancer deaths occurring among women. Cervical cancer prevalence rate remains very high in most developing countries including Nigeria despite the introduction of its prevention as well as treatment options. The study therefore sought to assess the knowledge and awareness of cervical cancer and cervical cancer screening among these women in the Warri, Delta State.

The study was a cross-sectional study which was carried out at the Central Hospital employing a quantitative approach. Three hundred and forty one women were randomly selected to be part of the study. The data was collected using an interview with a structured questionnaire and analyzed using STATA version 15. Continuous variables such as age were summarized using descriptive statistics and were expressed as means as well as standard deviation, whilst categorical variables were summarized into frequencies and percentages.

To assess the relationship and strength of association between the independent and the dependent variables, the Fisher’s exact test analysis was used.

Based on the responses received, cervical cancer and screening awareness level was low with a percentage of 20.4% and the percentage of women with adequate knowledge among those who were aware of cervical was equally low with 25.0%. The main source of cervical cancer information as elicited by the study was the media consisting of radio, television and internet. The study also reported low cervical cancer screening uptake with a percentage of 2.9% and also found out that majority of the women (54.4%) did not intend or had not decided to go for the cervical cancer screening which was largely due to low cervical cancer and screening knowledge and awareness. The results show that educational status, type of occupation as well as access to information and services are statistically significant in determining the individual respondents’ awareness and knowledge level regarding cervical cancer and screening, with a Pvalue of 0.001, 0.000 and 0.011 respectively.

Cervical cancer knowledge and awareness level is low among reproductive aged women attending the Central Hospital. Hence there is the need to implement strategic interventions to help increase the awareness and knowledge level among women in the Warri, Delta State and its environs.

 

 

CHAPTER ONE

INTRODUCTION

1.1. Background

Cervical cancer is said to be the number one cause of cancer death among Nigeriaian women. Williams and Amoateng, (2012), reported that cervical cancer prevalence and its associated death rates in the country include the highest rates in the world. They mentioned that the rapidly increasing rates are in contrast with rates in the developed countries which have been decreasing.

The World Health Organization (WHO) reported that about more than a million women all over the world are currently having Cervical Cancer. It also documented that 528,000 new cases of the cervical cancer were diagnosed in 2012 and 266,000 women died out of the disease and also an estimated 90% of all cancer cases and death occurs in the Low-to-Middle-income countries, with a projected rise of about 25% over the next 10 years (WHO, 2014).

The knowledge of cervical cancer and seeking help early could decrease the morbidity and mortality associated with the disease. The correct knowledge and awareness level as well as proper attitudes are important factors for embracing healthy lifestyles that will affect human behaviours and cause people to accept newly introduced preventive measures (Azam, 2016).

With regards to cervical cancer, deficits in knowledge of signs and symptoms, risk factors as well as prevention at both the primary and secondary level has been established in studies conducted in most developed and developing countries (Mutambara et al., 2017; Ebu et al., 2015; Adanu et al., 2013). Adequate knowledge of cervical cancer remains relatively low with percentages as low as 28% in Nigeria; (Ziba et al., 2015; Ebu et al., 2015; Adanu et al., 2013); 31% in Ethiopia (F. Getahun et al., 2013, Shiferaw et al., 2016; Mulatu et al., 2017 ) and 23% in Nigeria (Ingwu et al., 2016; Mwaka, 2016).

Lack of cervical cancer and screening knowledge and awareness is said to be a major setback to the timely detection and treatment or prevention of cervical cancer and its associated complications (Kessler, 2017). Majority of women report cases of cervical cancer to the hospital when the disease have progressed due to inadequate knowledge on cervical cancer, its seriousness and available interventions. A study conducted in Elmina reported that majority (68.4%) of the respondent were not aware of  cervical cancer, 93.6% did not know about cervical cancer risk factors whilst 92% had no knowledge with regards to the prevention and treatment of cervical cancer (Ebu et al., 2015).

Studies have suggested that, various factors including marital status, occupation and level of education among some other factors such as misconceptions, negative beliefs and other social barriers including partner refusal and cost have a stronger relationship with knowledge on cervical cancer and screening among women (Chinaka et al., 2013; Ebu et al., 2015).

The study therefore sought to assess the knowledge and awareness of cervical cancer and cervical cancer screening among women attending the Central Hospital.

1.2. Problem Statement

Cervical cancer is the cancer that affects the uterine cervix of women. Studies conducted worldwide have shown the grave consequences of cervical cancer on women’s health and on the world’s population as a whole.  Globally, as reported by the ICO HPV (2017a), cervical cancer is ranked fourth among the most common cancers that affects women. A worldwide population of

2,784 women aged 15years and above stands the risk of contracting cervical cancer. The present estimated annual incidence as well as mortality figures of cervical cancer are 527,624 and 265,672 respectively (ICO/ HPV, 2017a).

Cervical cancer epidemics is said to affect one of the most vulnerable population worldwide, thus women living in the Low-to-Middle-Income-Countries (Huchko et al., 2015); with annual incidence and mortality of 27,326 and 16,546 respectively (ICO/HPV,  2017a).

The cervical cancer incidence  and  associated mortality rates in Nigeria is ranked highest among all cancer cases, with annual incidence of 3,052 as well as annual mortality of 1556 (28.3%), thus cervical cancer is the  leading cause of female cancer and also the commonest female cancer among women aged 15 to 44 (ICO/HPV, 2017b).

A research conducted to determine the cervical cancer prevalence and the challenges of expanding cervical cancer screening in the Ashanti Region, established that Agogo in the Asante

Akim North District has a higher cervical cancer prevalence rate of 12.6% as compared to that of Nkawie in the Atwima  Nwabiagya District who had prevalence rate of 3.5% (Roberts & Maclaughlin, 2016).

Nigeria as a developing country faced with increased cervical cancer incidence and mortality rates have major issues regarding knowledge and awareness on cervical cancer which is believed to have contributed to the reduced patronage of cervical cancer screening programmes as well as late treatment of the disease (Williams & Amoateng, 2012; Ziba et al., 2015).

In Nigeria, several researches have established that the knowledge and awareness level of cervical cancer and screening is low even though there is high prevalence and mortality rates of cervical cancer (Adanu et al., 2013; Ebu et al., 2015; Ziba et al., 2015). These and other studies have reiterated the fact that lack of appropriate knowledge and information on cervical cancer, it’s prevention and treatment options significantly leads to late reporting to health facilities resulting in reduced prevention of the disease and high prevalence  and mortality rates of cervical cancer in the country (William & Amoateng, 2012; Roberts & Maclaughlin, 2016).

The various studies that have been conducted in Nigeria on cervical cancer knowledge and awareness, concentrated much in the major cities in the country such as Accra, Kumasi, Bolgatanga, and Elmina among others, with most studies among university students, healthcare workers and among men. There is therefore not much information regarding the level of knowledge and awareness among women in the peri urban communities. And with the relatively high cervical cancer prevalence in Agogo and its environs, there is the need to assess the level of cervical cancer knowledge and awareness as well as the influencing factors in these areas, hence the study sought to assess the knowledge and awareness of cervical cancer and cervical cancer screening among women attending the Central Hospital, in the Warri, Delta State of the Ashanti region, Nigeria.

1.3. Conceptual Framework

A conceptual framework outlines the interaction of a number of factors which influences a programme, situation or an action. This conceptual framework was created by the author to suit the purpose of the study. The variables in this framework have been classified into dependent and independent variables for easy measuring of these variables. The dependent variable from the diagram is the knowledge and awareness of cervical cancer and cervical cancer screening among women and the independent variables are the various factors influencing cervical cancer knowledge and awareness. To lower the high incidence of cervical cancer morbidity and mortality, there is the need for women to undertake various preventive measures. The knowledge and awareness on cervical cancer is the most significant factor that influences the adoption of these cervical cancer preventive measures.

The knowledge and awareness on cervical cancer and cervical cancer screening among women can be influenced by various factors such as; socio-demographic factors, access to information and health services, social norms, myths and misconception regarding cervical cancer as well as intentions to screen for cervical cancer.

Factors such as socio-demographic characteristics including age, marital status as well as educational status may expose women to health care information which may include information on cervical cancer and their utilization of cervical cancer preventive interventions. People with higher educational status may have more access to information channel like television (TV), internet, radio and other information media than people with lower educational status.  Moreover, experiences such as pregnancy, child bearing, seeking for treatment for children or other medical conditions that a woman is likely to suffer from, which is associated with age and marital status increases women’s visit to the health facility and this can also expose them more to information regarding cervical cancer. Women who are currently suffering from the condition or suffering from similar conditions, may have more knowledge on the condition than those who have not experienced it. Also the availability of healthcare personnel and facilities providing services regarding cervical cancer can influence a woman’s knowledge and awareness of the condition. Furthermore some social norms including religious restrictions and cultural beliefs and practices causes fear and create some form of myths or misconceptions regarding cervical cancer among women. The community attitude and practices toward healthcare intervention may also influence their intention to seek for cervical cancer information. This could also affect their acceptance of information given to them regarding cervical cancer. In addition women’s intention to prevent cervical cancer will cause them to seek for information regarding cervical cancer.

All these individual factors influences women’s the knowledge and awareness of cervical cancer.

The figure below presents the interrelation of the various factors that influence the knowledge and awareness on cervical cancer and cervical cancer screening among women.

CONCEPTUAL FRAMEWORK

Figure 1: Conceptual framework

 

 

1.4. Justification

The consequences of cervical cancer morbidity and mortality in Nigeria are very enormous as the incidence keeps increasing. Women within the reproductive age group, thus ages between 15 and 49 years stand a greater risk of developing cervical cancer. The In view of this burden, strategies for preventing and reducing cervical cancer incidence and its associated mortalities must be geared towards early detection of the disease at its precancerous state before it progresses to the cancerous state where the prognosis is very poor and treatment is very expensive. In most developed countries where people have better knowledge about cervical cancer and seek help early, the incidence have decreased significantly, where as in the developing countries including Nigeria, where there is inadequate knowledge and awareness regarding cervical cancer, its prevention and treatment options; the incidence and mortalities rates keeps on increasing at alarming rates. To achieve massive prevention and reduction in cervical cancer prevalence and mortality rates in the country, educating as well as creating awareness on cervical cancer and its prevention or early treatment must be first on the action plan.

In Nigeria, even though studies suggest low level of knowledge regarding cervical cancer, there is still limited data on the knowledge and awareness cervical cancer, its cause, risk factors, symptoms and intervention among women in most peri urban communities including Agogo in the Warri, Delta State where there is a relatively high incidence of cervical cancer. The purpose of this study therefore was to explore the knowledge and awareness level of women attending the Agogo Hospital on cervical cancer, its cause and risk factors, symptoms, complications, prevention and treatment options and outcomes.

The study findings may apprise policy makers and stakeholders to help develop specific evidence-based interventions or strategies to promote and increase the education and sensitization of women on cervical cancer and cervical cancer prevention and treatment options which will be aimed at reducing cervical cancer prevalence and mortality rates in Agogo, the entire Warri, Delta State and in the country as a whole. Moreover with the paucity of information regarding awareness and knowledge on cervical cancer and cervical cancer screening in the periurban communities, the findings of this study have as well add to literature.

1.5. Research Objectives

1.5.1 General Objective

To assess the knowledge and awareness level of cervical cancer and cervical cancer screening and its influencing factors among women attending Central Hospital.

1.5.2 Specific Objectives

1. To assess the knowledge and awareness level of women on cervical cancer and cervical cancer screening.
2. To identify the sources of information on cervical cancer among women.
3. To examine women’s perception on social norms, myths and misconceptions regarding cervical cancer.
4. To examine the barriers to cervical cancer screening uptake.

1.5.3 Research Questions

1. What is the level of knowledge of cervical cancer among women attending Agogo

Presbyterian Hospital?

2. What are the various sources of information on cervical cancer?
3. What are the perceptions of women on social norms, myths and misconceptions regarding cervical cancer?
4. What are the barriers to cervical cancer screening uptake?
5. KNOWLEDGE, ACCEPTABILITY AND UPTAKE OF CERVICAL CANCER SCREENING AMONG WOMEN OF CHILD BEARING AGE (15-49YEARS) ATTENDING POSTNATAL CLINIC IN CENTRAL HOSPITAL

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