KNOWLEDGE AND UTILIZATION OF CERVICAL CANCER SCREENING AMONG WOMEN OF REPRODUCTIVE AGES IN GENERAL HOSPITAL IKOT EKPENE, AKWA IBOM STATE
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ABSTRACT
The study was conducted to investigate on the knowledge and utilization of cervical cancer screening among women of reproductive ages in General Hospital, Ikot Ekpene, Akwa Ibom State. Three research objectives were formulated to guide the study which were: to assess the level of awareness of cervical cancer screening, to examine the factor that influence the utilization of cervical cancer screening and to assess the level of practice of cervical cancer screening among women of reproductive ages in General Hospital, Ikot Ekpene Akwa Ibom State. Literature related to this study were reviewed and theoretical framework applied which was Health belief Model Theory by Rosenstock in 1960. Descriptive survey research design was adopted for this study. A convenience sampling technique was used to obtain a sample size of 109 women of reproductive age from a target population of 150 using Taro Yamane’s Formula. Data was collected with researcher made questionnaire. The reliability coefficient of 0.8 was established using Kuder Richardson’s formula. Data was analyzed using frequencies, percentages and the result presented in table and chart. Findings from this study reveals that 85 (77.9%) of the respondents says yes that cervical cancer can be preventable while 90 (82.6%) says that screening of the cervix is painful thereby not utilizing the services, whereas 65 (59.6%) of the respondent agrees that screening the cervix with pap smear is the useful test. It was therefore concluded that although most of the respondent had good knowledge about cervical cancer screening service, they failed to utilize it. The researcher therefore recommended that Government should carry out more sensitization on the women to screen their cervix.
CHAPTER ONE
INTRODUCTION
1.1 Background of the Study
Cancer of the cervix, a potentially preventable disease is the second most common cancer among women worldwide and the most common malignancy of the female genital tract in the developing countries.
Cervical cancer is a malignant tumor that occurs in the cells of the cervix – the lower part of the uterus that connects to the vagina.
Worldwide, cervical cancer accounts for about 500,000 new diagnosis and 273,000 death every year of the new cases. In Nigeria, the national incidence of cancer of the cervix is 250/100,000. Each year approximately 10,000 women develop cervical cancer and about 8,000 women die from cervical cancer in Nigeria.
It is worrisome as all sexually active women are at risk for the development of cervical cancer.
Sexually transmitted Human Papilloma Virus (HPV) infection leads to the development of cervical intraepithelial neoplasia and cervical cancer. Women with many sexual partners and those whose partners have had many sexual consorts or have been previously exposed to the virus are mostly at risk of developing the disease.
Early detection and prompt treatment of precancerous condition provides the best possible protection against cancer.
In developing countries with a well Established screen programmes, the incidence of cervical cancer have been reduced to (a minimum). Sporadic screening is being carried out in Nigeria using opportunistic method for those who visit certain clinics. Also there is no standard policy or protocol for cervical cancer screening in Nigeria. The different methods of cervical cancer screening include papanicolaou (pap) smear, Visual Inspection of the cervix with Acetic acid (VIA), HPV, DNA test and colposcopy.
Colposcopy is not used as a primary screening test, but it is combined with other test. The high burden of cervical cancer in developing countries like Nigeria is due both to a high prevalence of HPV infection and the lack of effective cervical cancer screening programmes.
In cases where effective screening programmes are available, poor knowledge and negative health seeking behaviour of the populace have led to poor utilization of such services.
An important strategy towards the reduction of the incidence and mortality associated with cervical cancer is by increasing screening rate of women that have not screened or those that screen infrequently.
Knowledge about cancer of the cervix and its screening uptake is important. Women with low level of knowledge about cervical cancer and its prevention are less likely to access screening services. (Ifemelumma,Anikwe, Okorochukwu, Onu, Ejikeme and Ezeonu, 2019).
There are hindrances in utilizing screening centres. This could be fear of having the cancer, poor knowledge, embarrassment, screening by a male physician, far distance, lack of screening services in some health centres. However, there are efforts made by government and Non-Governmental Organization in improving awareness on the need of women of reproductive ages to screening their cervix.
According to Bhatla, Meena and Natarajan, (2021) cervical cancer prevention efforts by both the governments and voluntary organizations have been ongoing since several decades but are yet to make an impact. While only screening and treatment of precancerous lesion was possible initially, presently there is an additional option of human Papillomavirus (HPV) vaccination.
There are approximately 59.7 million girls and 272.8 million women in india in the eligible age group for cervical cancer vaccination and screening, respectively.
As at May 2018, the World Health Organization (WHO) issues a call for elimination of cervical cancer as a public Health Problem through widespread HPV vaccination, screening, early diagnosis and treatment of cervical precancer and cancer. On November 17 2020, the world Health Assembly (WHA) formally launched a global strategy for its implementation. Even in the midst of the COVID-19 pandemic, 194 countries around the world confirmed their support this important task. (WHO, 2020). The elimination programmes aims to achieve the following targets by 2030:
90% girls fully vaccinated by 15 years at age with two doses of HPV vaccine.
70% women screened with a high performance test at 35 and 45 years of age.
90% of women with cervical precancer and cancer receive treatment to achieve a goal of less than four cases per 100,000 women.
Here, the United Nations sustainable Development goals for 2030 aim to reduce the premature mortality from non-communicable disease by one third (1/3) through prevention and treatment.
Achieving the elimination targets will help to achieve this goal.
The National programmes for cancer control has the implementation of both arms of cervical cancer prevention, i.e HPV vaccination and screening linked with treatment of precancers can leads to significant reduction in incidence and mortality to a level where it will no longer be a public health problem. Also factors like cultural barriers lack of awareness, low socio-economic status, poor access and infrastructure also need to be addressed.
The National cancer control programme (NCCP) was first started in 1976. The primary objectives was prevention of cancers through health education and secondarily, prevention of cervical oral and breast cancers by screening, screening, strengthening the existing cancer treatment facilities and providing palliative care to patients at terminal stage.
The programme was implemented across 21 states in 100 district during the year 2010-2012. The review of initial phase of programme helped in identifying the bottle necks and accordingly the programme was re-strategized and scaled-up.
Primary levels its involves door to door information education and communication (IEC) by Accredited social Health Activist (ASHA) and provision of IEC materials. Monthly visit by medical officer (MO) to sub centre to monitor ASHA’s work and record keeping.
Periodic training of health workers in screening.
Mass recruiting campaign and periodical screening camps by MO/health staff of each subcentre.
Utilization of laboratory technician and health workers for screening with cytology/HPU at Primary Health Centres.(PHCs).
Secondary level consist of
A gynaecologist trained in colposcopy at community health centre (CHC) level.
Colposcopy equipment (1-3 per district and a thermal/ cryoablation unit, a pathologist, district level of periodic monitoring and data keeping.
Tertiary Level: Here at this level, government has also improve training through regional cancers centres (RCC) and training institutes (emphasis on surgical skills) infrastructure for radiation and imaging techniques.
Moreover, eradicating ignorance, having good knowledge, having screening services in most health centres detecting the precancerous cells at early stage will go a better way of decreasing high morbidity and mortality rate caused by cervical cancer, thus improving the wellbeing of individual, family and the society as a whole.
Therefore, the impetuses for this study on the same knowledge and utilization of cervical cancer screening emanated from the researcher’s observation during clinical experiences aims at addressing three (3) objectives as respect; level of awareness of cervical cancer screening, factors influencing the utilization of cervical cancer screening and level of practice of cervical cancer among women of reproductive ages in General Hospital, Ikot Ekpene, AkwaIbom State.
1.2 Statement of Problem
Cervical cancer remains one of the leading health hazard affecting majority of women across the globe. The situation is even more preoccupying particularly in areas where screening programme and services are absent. The World Health Organization (WHO) says that cervical cancer is the fourth-most frequent cancer in women with an estimated 570,000 new cases diagnosed in 2018 (Brayf, Ferlay and Soerjomataram, 2018) cervical cancer is a leading public health concern globally. Although a decline has been observed in cervical cancer incidence and deaths in the developed world, over the past 20 years, there has not been a significant change in the same key indicators in poor resource setting. In Ghana, cervical cancer is the most common cancer affecting women, with 50.5% attributed to human papilloma virus (HPV) type 16 and 18 and is the cause of 16% of mortality due to cancer (WHO, 2014). Persistent infection of high risk human papilloma virus (HPV) has been clarified to be the necessary cause of Cervical Cancer. (Jacobs, Walboomers, and Manos, 2010).
Worldwide, cervical cancer accounts for about 500,000 new diagnosis and 273,000 death every year of the new cases. In Nigeria, the national incidence of cancer of the cervix is 250/100,000. Each year approximately 10,000 women develop cervical cancer and about 8,000 women die from cervical cancer in Nigeria.
According to WHO and international Agency for Research on Cancer (IARC) estimates the year 2008 saw 529,000 new cases of cervical cancer globally. In developing countries, the number of new cases of cervical cancer was 452,000 and ranked second among malignancies in females patients. Conversely the number of new cases of cervical cancer was 77,000 in developed countries and ranked tenth among female malignancies. (Ferlay, Shin & Bray, 2010).
During the researcher’s experience and interaction with the patients in the clinical setting, the researcher observed that most patients were diagnosed of cervical cancer when admitted in the hospital at an advanced stage and this leads to poor prognosis of cervical cancer.
This therefore prompted the researcher to take interest in investigating on the level of awareness on cervical cancer, examining the factors that influence, the utilization of cervical cancer screening and ascertaining the level of practice of cervical cancer screening among women of reproductive ages in General Hospital, Ikot Ekpene, AkwaIbom State.
1.3 Objective of the Study
To assess the level of awareness of cervical cancer screening among women of reproductive ages in General Hospital, IkotEKpene, AkwaIbom State.
To examine factors influencing the utilization of cervical cancer screening among women of reproductive ages in General Hospital, Ikot Ekpene, Akwa Ibom State
To ascertain he level of practice of cervical cancer screening among women of reproductive ages in General Hospital, Ikot Ekpene Akwa Ibom State.
1.4 Research Questions
What is the level of awareness of cervical cancer screening among women of reproductive ages in General Hospital, Ikot Ekpene Akwa Ibom State?
What are the factors that influences the utilization of cervical cancer screening among women of reproductive ages in General Hospital, Ikot Ekpene Akwa Ibom State?
What is the level of practice of cervical cancer screening among women of reproductive ages in General Hospital, Ikot Ekpene Akwa Ibom State?
1.5 Significance of the Study
To women of reproductive age: The findings of the study will improve women’s awareness and utilization of cervical cancer screening early, thereby reducing the incidence and prevalence rate of cervical cancer.
It will also improve the health status of women as early detection and diagnosis will prevents complication such as post coital bleeding, vaginal bleeding etc which at times its been mistaken by some women as menstrual flow.
To the Hospital: This study would increase the knowledge of health providers on the need to conduct a routine cervical cancer screening and also develop guidelines and programmes to improve health for all women of reproductive ages which will be within the community’s reach and at affordable rate.
To the Nursing Profession: This study would equip the nurses on how to expand their care with patient who have cervical cancer and also display their nursing responsibility in the management, prevention and treatment of patients with this condition, and also it will increase the nurses knowledge to recognize the signs and symptoms early managed and promptly referred, if necessary.
To the Society at Large: The findings of this study would help women of reproductive ages who are sexually active to modify their life style by not having multiple sex partners, practicing abstinence until marriage, thus reducing cervical cancer rate in the society.
1.6 Scope of the Study
This research work is delimited to 109 women of reproductive ages in General Hospital Ikot Ekpene to investigate the level of awareness, examining the factors that influences the utilization of cervical cancer screening and ascertaining the level of practice of cervical cancer screening among women of reproductive ages in General Hospital Ikot Ekpene, Akwa Ibom State.
1.7 Operational Definition of Terms
Knowledge: Awareness and understanding towards cervical cancer screening among women of reproductive ages in General Hospital Ikot Ekpene, Akwa Ibom States.
Utilization: The practice and effective use of cervical cancer screening services among women of reproductive ages in General Hospital, Ikot Ekpene, Akwa Ibom State.
Cervical Cancer: A malignant tumour of the lower most part of the uterus of women of reproductive women in General Hospital, Ikot Ekpene, Akwa Ibom State.
Screening: The act of detecting and removing abnormal cell tissue among women of reproductive women in General Hospital, Ikot Ekpene, Akwa Ibom State
Women: A girl, female child or adolescent; that is every female counterpart of reproductive women in General Hospital, Ikot Ekpene, Akwa Ibom State
Reproductive ages: A stage in life in which women can get pregnant and bear children from puberty when they start getting their menstrual period in General Hospital Ikot Ekpene, Akwa Ibom State.
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