KNOWLEDGE, ATTITUDE AND PRACTICE CONCERNING CERVICAL CANCER SCREENING AMONG MARKET WOMEN
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ABSTRACT
Background: cervical cancer is a spectrum that ranges from dysplasia to invasive cancer. The late stage of the disease result with distant metastasis involving surrounding tissues and deposits in organs like the liver, lungs and bones. Poor public health awareness has contributed to late diagnosis of this disease, therefore there is need to assess the knowledge, attitude and practice with regards to cervical cancer screening. Market women continue to be the economic driving force of families in many parts of Nigeria. The awareness will therefore reduce the burden of the disease.
Methodology: A cross-sectional descriptive study was carried out by using systematic sampling to collect data through administered questionnaires to 253 market women in Yola metropolis.
Result: The result showed majority of the market women have heard about cervical cancer (74.0%), 74.9% of them heard about screening, there was also good attitude, however the practice was poor. Women with formal education have taken up cervical cancer screening than those with non formal education, it was statistically not significant (x2 = 4.248, P = 0.120). As only 72 women have carried out cervical cancer screening.
Conclusion: The study established that level of knowledge on cervical cancer screening was high but practice was low as 28.5% of the respondents ever had cervical cancer screening. Therefore, sustained public health awareness should be encouraged in order to increase the utilization of screening service in all health facilities.
CHAPTER ONE
INTRODUCTION
Background to the study
Cervical cancer is a spectrum that ranges from Dysplasia to invasive cancer. Dysplasia describes an abnormal organization of cells i.e. premalignant changes in the squamous epithelium. It is graded as mild, moderate or severe. Cervical intraepithelial neoplasia is a closely related nomenclature that covers the entire spectrum of changes are graded CIN 1, CIN 2, and CIN 3 according to the third of the epithelium (Upper, Middle, Lower) respectively in which changes occur; corresponding to mild, moderate and severe.
Invasive cancer is characterized by invasion of deeper tissues. It usually takes three forms; fungating (commonest), ulcerating and infilterating. Histologically, 95% of cells are large cell type either keratinized (well differentiated) or non keratinized (moderately differentiated). Adenocarcinoma arises from endocervical glance, situated anywhere from the internal to the external os. The late stage of the disease usually results into distant metastasis but however, local spread can occur either upward to involve all the cervix, downward to extend into the vaginal vault, laterally, it involves the ureters and anteriolly to involve the bladder, posteriolly to involve the rectum. Lymphytic spread occurs early, while haematogenous spread occurs through systemic circulation mainly depositing in the liver, lungs and bones.
Cervical cancer arises in the so-called transformation zone of the uterine cervix. This is the area which undergoes physiological metaplasia from glandular to squamous epithelium at the onset of adolescence. Human Papiloma Virus (HPV) is very common after the onset of sexual activity, and when it persists, the viral oncoprotein produce perturbation of the cell-cycle controls.
The research done in Namibia by Zahedi, Sizemore, Malcolm, Grossniklaus, and Nwosu, (2014) indicates that every year, 132 women are diagnosed with cervical cancer and 59 die from the disease. The risk factors known to increase the incidence of cervical cancer are early marriage (child marriage), delivery of the first baby before the age of 20, too many or too frequent childbirths, multiple sexual partners, poor practice of personal hygiene, low socio-economic. status, Human Papilloma Virus infection , Herpes Simplex Virus type II infection, HIV positive status, use of oral contraceptives, and smoking .(“CDC – What Are the Risk Factors for Cervical Cancer?,” n.d.)
The ideal age for cancer screening is 30–40 years. This is the age when women are at the highest risk of having precancerous lesions (International Agency for Research on Cancer, 2005) however, younger women who have been sexually active should also be screened earlier as they may have lesions and even cancer especially if they have HIV infection (Maggwa, Hunter, Mbugua, Tukei, and Mati, 1993).
Cervical cancer screening and early detection and treatment of precancerous lesions shows to decrease the morbidity and mortality, the psychological burden, and economic costs to the individual and society (Bradley et al., 2008).This entails the organization of cervical cancer screening services that requires, among other things, the training and deployment of health care workers at the various levels of the health care delivery system. Low utilization of cervical cancer screening has been a challenge in most of the developing countries (Akinyemiju, Mcdonald, & Lantz, 2015; Najdi A et al., 2016; Oyebode et al., 2015; Suoma, 2009). There are several reasons a for low uptake of cervical cancer screening practice in developing countries among which health care providers and other related factors play important roles (Lim & Ojo, 2016). Lack of knowledge, lack of positive attitude and practice by health care workers on cervical cancer screening may also contribute to missed opportunities of the patients who visit health facilities regularly for other medical services (Van Bogaert & Knapp, 2001). The missed opportunity may result in delayed early detection of pre-cancerous lesions and treatment, which leads to a poor prognosis of the disease.
1.2 STATEMENT OF THE PROBLEM
The Nigerian Ministry of Health and Social Services recommends Pap Smear Testing to be done annually to HIV positive patients who are sexually active and every three (3) years by women who are below or over the age of 21 who are HIV negative . The 2013 Demographic Survey included cervical cancer screening tests response among women aged 15-49 and only 25% were screened for cervical cancer (Demographic and Health Survey 2013 [FR298] – FR298).
At University of Nigeria teaching Hospital, it has been observed that very few out-patient women take advantage of Pap smear screening service that is available. Records from OPD, ART clinic and ANC showed that an average of only 45 patients had a Pap Smear done out of the 6,600 women who visited the clinics per month in the year 2014.Given the state of affairs as discussed above it is fair to conclude that, there are missed opportunities and many hindrances to cervical cancer screening with regards to the community and this worsens the problem, which is a public concern. There are several factors associated with low usage of cervical cancer screening in developing countries; lack of awareness on availability of cervical cancer screening services, women fears of screening procedure and negative outcome, social stigmatisation, cost of accessing services, inadequate infrastructure, waiting time, health care personnel attitudes and possible violation of privacy (Lim & Ojo, 2016a).
market women are entrusted by the community to bridge the gap of knowledge on cervical cancer disease prevention. Their knowledge and attitudes on cervical cancer screening practices would influence the uptake of cervical cancer screening practices if properly harnessed or embraced and reduction of mortality caused by cervical cancer related disease. However, little is known about the market women’s knowledge and attitudes on cervical cancer screening practices in Nigeria and this fact can also inhibit effective action to shoot down the negative impact or effects of cervical cancer and spontaneous action.
Evidence has shown that the major source of information on cervical cancer screening comes from hospitals and healthcare facilities (Nayak, Murthy, Swarup, Dutt, & Muthukumar, 2016) . Consequently, health care providers play a big role in creating awareness and promoting cervical cancer screening to the community. Thus, their attitude is often crucial in gaining women’s confidence and influence on screening practices.
1.3 PURPOSE OF THE STUDY
The purpose of this study was to determine the knowledge, attitudes and practices on cervical cancer screening among market women
- To assess the knowledge of and attitudes towards cervical cancer screening of market women in Yola metropolis.
- To explore the extent to which market women engage their patients/clients in cervical cancer screening practices.
- To identify market women’ perceived reasons for low utilization of available cervical cancer screening services by women in Yola metropolis.
1.4 SIGNIFICANCE OF THE STUDY
The Knowledge, Attitudes, and Practices (KAP) survey in northern Namibia aimed to collect data on what is known, believed and done in relation to cervical cancer screening practices among market women.
The study findings might contribute to the understanding of the gaps in knowledge of cervical cancer and cervical cancer screening practices among market women, which could inform the Yola metropolis Health Management Team and Ministry of Health and Social Services in designing interventions aimed at making market women become champions in the fight against cervical cancer disease and its related effects and implications.
It is believed that the findings will facilitate the process of identifying areas for potential health service quality improvement, and revitalize implementation of existing national guidelines, contributing to an increase in cervical cancer screening uptake that will hopefully lead to a decrease in cervical cancer morbidity and mortality rates.
To date, there has been no study in Nigeria to determine the knowledge and attitudes on cervical cancer screening practices among market women. Therefore, to address the issue, the researcher thought it was significant to understand market women’ levels of knowledge, their attitude and screening practices. Understanding the levels of knowledge, attitudes and practices among health professionals will play a key role in identifying some of the barriers hindering success in the fight against cervical cancer and design interventions to address the identified challenges.
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