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| Format: Ms Word | 1-5 Chapters | Table of Content|


Study Level: BTech, BSc, BEng, BA, HND, ND or NCE

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Cervical Cancer: Screening, Recognition, and Treatment

                                                 CHAPTER ONE


1.1 Background to the study

       Cervical cancer is the commonest gynaecological cancer affecting women especially in low and middle-income countries ‘LMICs’ (Sowemimo, Ojo and Fasubaa, 2017). Although this disease is largely preventable and curable especially when early detected, it remains the second most common cancer in Nigeria and fifth in the United Kingdom as opined by (Ahmed, Sabot and Iris, 2013). Globally, cervical cancer was ranked in 2018, as the 4th most common cancer and cause of cancer-related deaths in women with an estimated 570,000 new cases and 311,000 deaths (Bray et al. 2018). Africa has the highest incidence and mortality rates of cervical cancer in the world, which is approximately ten times higher than that seen in western countries (Bray et al. 2018). In Nigeria, cervical cancer is the 2nd most common cancer in the country and in women, where it accounts for 16.4% of all female malignancies in 2020, with estimated new cases of 12,075 (GLOBOCAN,2020).

        Cervical cancer is a sexually transmitted disease caused by the human papillomavirus (HPV), especially HPV-16 and -18. It is a cancer that forms in tissues of the cervix (the organ connecting the uterus and vagina). It is usually a slow-growing cancer that may not have symptoms but can be found with regular Pap tests (a procedure in which cells are scraped from the cervix and looked at under a microscope). The incidence of cervical cancer begins to rise at age 20-29 years, reaches a peak around 55-64 years, and declines somewhat after 65 years. The high rate of cervical cancer in Nigeria is due both to a high prevalence of Human Papillomavirus (HPV) infection and the lack of effective cervical cancer screening programs. In cases where effective screening programs are available, poor knowledge and negative health seeking behaviour of the populace have led to poor utilization of such services (Sankaranarayanan and Budukh, 2001).

       A large proportion of cervical cancers are diagnosed in advanced stages in developing countries, but with poor rates of survival (Sankaranarayanan, Thara; Ngoma; Naud & Keita, 2010). An early detection and prompt treatment of cancer and pre-cancerous conditions provide the best possible protection against cancer. Well organized screening has been shown to be effective in the reduction of both mortality and morbidity from cancer of the cervix (NHS (2009). Cervical cancer is preventable, and has a lengthy precancerous stage during which screening can be done and any premalignant lesion found could be treated so as to stop the progression of the disease to the invasive stage (Sowemimo and Fasubaa, 2017). There is compelling evidence indicating that screening is an effective tool for identifying the disease at several stages of its progression (Biewenga and Van der, 2011). Cervical cancer screening services (CCSS) have been found to be responsible for the decrease in cervical cancer-related morbidity and mortality in developed nations (Landy, Pesola, Castañón and Sasieni, 2016).

         Knowledge about cervix cancer and its screening is important in screening uptake. Women with low levels of knowledge about cervical cancer and its prevention are less likely to access screening services (Nwozor and Oragudosi, 2013). An important strategy towards the reduction of the incidence and mortality associated with cervical cancer is by increasing the screening rate of women that have not screened or those that screen infrequently (Dim, 2012). Previous studies done among female health workers have shown good knowledge of cervical cancer; however, cervical cancer screening attendance rates are still far from satisfactory in most countries (Nwobodo and Malami, 2005). Jamal, Bray, Centre, Farley and Ward (2011) are of the opinion that cervical cancers are a preventable disease through proper screening, treatment and follow up. Blair (2009) not only agree that early detection is a proven cost–effective intervention for cervical cancer control strategy but are also of the opinion that cervical cancer screening has its potentials to greatly reduce deaths occurring from cervical cancer. This study examines the perception and practices of cervical cancer screening among Nurses in Anua Hospital, Uyo.

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1.2 Problem Statement

       Nigeria as a developing country is yet to be exempted from the public health challenges caused by cervical cancer. Cervical cancer is rated the second most frequent cancer among women in Nigeria after breast cancer and about 24.8% of women in the general population are estimated to harbour cervical HPV infection at a given time (Akinremi and Nazeer, 2005). Cervical cancer is the second principal cause of cancer morbidity and mortality in Nigeria, with an estimated incidence of 14,943 cases and 10,403 deaths as recorded in 2018 (Bray F, Ferlay J, 2018). This pose a serious challenge to a country with a population of 36.6 million women aged 15 years and above who are at risk of developing cervical cancer. However anecdotal evidence has shown that utilization of cervical cancer screening for the prevention of the disease is poor in Nigeria. Most women lack the knowledge about prevention of cervical cancer tests and its indications. Also, the available CCS services in Nigeria are mostly opportunistic, inequitably distributed, and reach a small proportion of eligible women (Ekwunife & Lhachimi, 2017). It becomes worrisome knowing that only 8.7% of all eligible women have been reached with opportunistic screening in Nigeria (Ndikom & Ofi, 2012). Such poor screening rate has been linked to a spectrum of factors; weak health system, poor awareness, low-risk perception, sociocultural barriers, fear of positive result, poverty, and acceptability of available screening options. Given the above poor screening status of women in Nigeria, calls for addressing these missed opportunities for CCS in the country. Therefore, this study on perception and practices of cervical cancer screening among Nurses in Anua Hospital, Uyo intends to fill these gap.

1.3 Purpose of the Study

       The primary aim of this study is to examine the perception and practices of cervical cancer screening among Nurses in Anua Hospital, Uyo. The specific objectives are;

  1. To assess level of awareness of cervical screening services among Nurses in Anua Hospital.
  2. To determine the perception of Nurses in Anua Hospital, Uyo on cervical cancer screening.
  3. To ascertain whether there is a standard policy or protocol for cervical cancer screening in Anua Hospital, Uyo.

1.4 Research Questions

       To achieve the objective of this study, the following questions are formulated.

  1. Are Nurses in Anua Hospital fully aware of cervical screening services?
  2. What is the perception of Nurses in Anua Hospital, Uyo on cervical cancer screening?
  3. Is there any standard policy or protocol for cervical cancer screening in Anua Hospital, Uyo?

1.5 Research Hypotheses

       The following hypotheses will be tested in the course of the study;

H0: Nurses in Anua Hospital are not fully aware of cervical screening services.

H1: Nurses in Anua Hospital are aware of cervical screening services.

H0: There is no standard policy or protocol for cervical cancer screening in Anua Hospital, Uyo.

H2: There is a standard policy or protocol for cervical cancer screening in Anua Hospital, Uyo.

1.6 Significance of the Study

       It is often imperative to question what would be the significance of any endeavor, be it academic or otherwise. This is also applicable in this study. The researcher anticipates that at the completion of this study, will give a clear insight on the knowledge and perception towards cervical cancer screening services transmission and prevention among nurses in Anua Hospital, Uyo, Akwa Ibom State. The findings here will also add to the knowledge on cervical cancer related attitudes, and screening practices among nurses who are directly involved in the overall screening process. This study will generate robust evidence on the factors influencing cervical cancer screening (CCS) uptake among women in Nigeria. The research will revealed the level of awareness about CCS among Nurses in Akwa Ibom State and their relevance in making an informed decision when it comes to CCS. The findings of this study would add to the body of knowledge on perception and practice of cervical cancer screening services among nurses. Consequently, to scholars who may be interested in the same area of study, it will serve as a source of reference material and basis upon which further studies can be developed.

1.7 Scope and the Limitation of the Study

       This study focuses mainly on the perception and practices of cervical cancer screening among Nurses. The study focused on cervical cancer disease which poses a serious challenges to Nigeria. The study will be limited to health workers (Nurses) in the outpatient department of in Anua Hospital, Uyo. It will therefore, be carried out among the Nurses and women in Anua Hospital, Uyo, Akwa Ibom state. The researcher encounters some constrain which limited the scope of the study;

 a) Availability of Research Material: The research material available to the researcher is insufficient, thereby limiting the study      

b) Time: The time frame allocated to the study does not enhance wider coverage as the researcher has to combine other academic activities and examinations with the study.

1.8. Definition of Terms

 Perception: the ability to see, hear, or become aware of something through the senses.

Practice: Practice is simply the actual application or use of an idea, belief, or method, as opposed to theories relating to it.

Cervical Cancer: Cervical cancer is a type of cancer that occurs in the cells of the cervix — the lower part of the uterus that connects to the vagina. Various strains of the human papillomavirus (HPV), a sexually transmitted infection, play a role in causing most cervical cancer.

Screening: Screening, in medicine, is a strategy used to look for as-yet-unrecognized conditions or risk markers. This testing can be applied to individuals or to a whole population.

Awareness: This is the knowledge or perception of a situation or fact, information, and skills acquired through experience or education; it is the theoretical or practical understanding of a subject.

Nurse: A registered nurse is a nurse who has graduated from a nursing program and met the requirements outlined by a country, state, province or similar government-authorized licensing body to obtain a nursing license

Transmission: the action or process of transmitting something, or the state of being transmitted.

Prevention: Preventive healthcare, or prophylaxis, consists of measures taken for disease prevention. Disease and disability are affected by environmental factors, genetic predisposition, disease agents, and lifestyle choices and are dynamic processes which begin before individuals realize they are affected.



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