Background:Cervical cancer is the
fourth most frequent cancer in women globally. About 90% of its burden occur
in low- and middle-income countries. It is preventable through screening.
Knowledge and acceptance of cervical cancer screening among women of
reproductive age is low in developing countries. This study aimed at assessing knowledge,
perception, and acceptability of cervical cancer screening among women of
reproductive age in Ikwerre Local Government Area.
Methodology: A total of 213 women of reproductive age
participated and provided information on their biodata, reproductive history,
knowledge of cervical cancer, its screening, perception, and acceptability.
Data was analyzed using SPSS version 22 and results were presented in
frequency tables. Bivariate analysis was done using Chi (X2)
square test (P < 0.05).
Results: The mean age was 30.3 ± 7.9 years, 84 (39.4%)
had knowledge of cervical cancer, 13 (6.1%) had very good knowledge of
cervical cancer screening, 127 (59.6%) had a positive perception, and 156 (81.7%)
were willing to accept cervical cancer screening. Knowledge of cervical
cancer screening was associated with the level of education of respondents (X2
= 43.661; P <0.0001) and their sources of information about cervical
cancer (P < 0.00001).
Conclusion: The knowledge of cervical cancer as well as
its screening among women of reproductive age is poor while positive
perception and the acceptability of cervical cancer screening were high.
There is need for more health education programs on cervical cancer screening
in the rural areas to increase the level of knowledge of cervical cancer
screening.
Accepted:27/03/2024
Published:
31/03/2024
*Corresponding Author
Benjamin Osaro
E-mail: benjamin.osaro@ ust.edu.ng
Keywords:
Cervical
cancer, screening, Human Papilloma Virus, Rivers State.
INTRODUCTION
Cervical
cancer is currently a global public health problem accounting for an estimated
560,000 new cases and about 275,000 deaths in women yearly. Over 80% of these
occur in low- and medium-income countries (LMIC).1 It is the fourth
leading cause of death among women worldwide and the commonest gynecological
cancer among women in Sub-Saharan African.2,3 In Nigeria, cervical
cancer is only second to breast cancer among women of reproductive age with an
estimated cost of illness between $524 - $2,743.1,4 It is caused by
infection with some strains of Human Papilloma Virus (HPV) particularly
serotype 16 and 18, which accounts for about 70% of cases among sexually active
males and females.1 About 14,550 new cases of Human Papilloma Virus
(HPV) were reported in Nigeria in 2008.5 Cervical cancer can be prevented by primary
prevention strategy involving vaccination of young adults 9 – 15 years, before
they become sexually exposed and by secondary prevention through screening
using cervical cytology (Pap smear) or by visual inspection of the cervix
following the application of Acetic acid (VIA) or Lugol’s iodine. 3,6,7
In LMIC countries, the knowledge of cervical
cancer and its screening method among women of reproductive age is generally
low. For instance, studies done in Nigeria show that the awareness of cervical
cancer and screening method respectively was only 6.5% and 4.8% of women in
Ogun State Nigeria,8 16% of women of reproductive age have the
awareness of cervical cancer screening in Aba9 and 15.5% in Enugu
State.10 In other parts and populations in Nigeria the knowledge of
cervical cancer and screening is high for instance 68.4% of female
undergraduates in Babcock University had high knowledge of cervical cancer,11
66.9% have the awareness and 43.5% the knowledge of cervical cancer screening
among market women in Zaria.12
The acceptance of cervical cancer screening
among women of reproductive age in Nigeria is high and the provision of
screening services still limited to tertiary healthcare facilities located in
urban areas.13 Women of reproductive agewho were willing to accept cervical cancer
screening was reported by Balogun et al (2012) in their study to be 73.3% among
urban slum dwellers in Lagos Nigeria however Omowhara et al (2022) found only
4.3% among women of reproductive age in a rural community in Delta State,
Nigeria.3,13 This study sought to assess the knowledge, and
acceptance of cervical cancer screening among rural childbearing women in
Ikwerre Local Government Area of Rivers State Nigeria.
METHODOLOGY
Study
area
The study was carried out in
Ikwerre Local Government Area (LGA), one of the twenty rural LGAs in Rivers
State Nigeria, located in Rivers East Senatorial District of Rivers State. Its
headquarters is Isiokpo. The LGA is comprised of twelve political wards: Isiokpo, Omagwa, Omudeme,
Elele, Omuanwa, Apani, Ipo, Omerelu, Igwuruta, Ubima, Ozuaha and Aluu. It has a
landmass of 667.5km2 and population of 271,700 with females being
91,355. 14,15 The occupation of the people includes farming,
trading, and other commercial ventures. Communication in the LGA is mainly
through the English language, local dialect (Ikwerre) as well as ‘pidgin
English.’ Health care services is basically at the level of primary healthcare
and is provided at the Primary Health Centre as well as in private health
facilities and patent medicine vendors in communities in the LGA.
The sample size was calculated
using the Cochran formula for single population, N = Z2 PQ)/d2where
N = Sample size, Z = Standard normal deviate corresponding to 95% level of
significance given as 1.96, P = Assumed prevalence of knowledge of screening
method13 = 0.094, Q = 1- P = 0.906, d = degree of precision = 0.05.
Thus, the calculated sample size was 131. However, this was increased to 213 to
accommodate for non-response.
Sampling technique: Respondents were recruited using a multistage
sampling technique by selection of one political ward (Isiokpo) through a
simple ballot, then two communities in the ward (Adanta and Omueke). A
proportionate sample was drawn to select 213 households from the selected two
communities and finally childbearing women in the households were approached to
participate in the study. Those who gave informed consent were recruited and
interviewed.However, in the event of refusal, a woman of reproductive
age in the next household was selected to participate in the study.
Data
collection: This was
done using a pretested structured survey questionnaire administered by trained
research assistants. Respondents provided information on their socio-demographic characteristics, knowledge on cervical cancer and screening, the source of
information about cervical cancer screening, and willingness to accept cervical
cancer screening and also the reasons for non-acceptance. Information was obtained from
respondents in English language and ‘pidgin English’ freely spoken in the LGA.
Data analysis: The
collected data was cleaned and entered into IBM
Statistical Package for Social Sciences (SPSS) software version 25 for
analysis. Categorical data were analyzed as simple proportions and continuous
data as mean and standard deviation and presented on frequency tables. Test for
association was done using Chi (X2) test at P < 0.05.
Outcome variables.
i. Knowledge of cervical cancer
screening was determined as percentage score derived from a set of nine
questions on knowledge about cervical cancer and cervical cancer screening. Scores of 70% and above were
rated as good knowledge, 50-69% as fair knowledge, and those less than 50% were
rated as poor knowledge.
ii. Acceptability of cervical
cancer screening was determined as percentage of participants who were willing
to accept cervical cancer screening.
Ethical considerations
Approval for this study was
obtained from the Ethics and Review Committee of Rivers State Primary
Healthcare Management Board. Written informed consent was obtained from all
participants after giving them detailed information of the study, the assurance
of confidentiality of their information and their liberty to refused
participation at any stage of data collection.
RESULTS
A total of 213
questionnaires administered to women of reproductive age in Ikwerre Local
Government Area was received giving a 100% response rate.
Table 1: Socio-demographic characteristics of respondents.
Variables
Frequency
(n = 213)
Percent
Age of respondents (yrs)
<20
14
6.6
20
-29
96
45.1
30
-39
71
33.3
40
- 49
32
15.0
Mean
(SD)
30.3
(7.9)
Marital status
Single
53
24.9
Married
152
71.4
Divorced/separated
5
2.3
Others
3
1.4
Educational status
None
3
1.4
Primary
29
13.6
Secondary
116
54.5
Tertiary
65
30.5
Occupation
Farming
18
8.5
Civil
servant
34
16.0
Fishing
2
0.9
Housewife
15
7.0
Petty
trading
19
8.9
Business
85
39.9
Others
40
18.8
Table 1 shows that
most (n = 152, 71.4%) of the respondents were married, 96 (45.1%) were
within age group 20 - 29 years and mean age as 30.3
± 7.9
years. About one third (n = 65, 30.5%) of the respondents have tertiary
education with the commonest occupation as business (n = 85, 39.9%).
Table 2: Awareness and sources
of information on cervical cancer among respondents.
Variables
Frequency (N = 213)
Percent
Awareness of
cervical cancer
84
39.4
Sources of
information*
Doctor
38
17.8
Mass media
(TV/Radio)
24
11.3
Friends
22
10.3
Nurse
19
8.9
Community
16
7.5
Internet
14
6.6
Leaflet/Fliers
4
1.9
*multiple
options
Only
84 (39.4%) of the respondents have the awareness of cervical cancer. The
doctors (n = 38, 17.8%), mass media (n = 24, 11.3%) and friends (n = 22, 10.3%)
were the most common sources of information on cervical cancer (Table 2).
Table 3: Knowledge, perception, and acceptance of cervical cancer
screening among respondents.
Variables
Frequency
(N = 213)
Percent
Knowledge of cervical cancer screening
Poor
166
77.9
Fair
34
16.0
Good
13
6.1
Previously screened for cervical cancer
Yes
22
10.3
No
191
89.7
Willingness to accept cervical cancer screening (n = 191)
Yes
156
81.7
No
35
18.3
Reasons for non-acceptance of cervical cancer screening *
I
have only one partner
8
22.9
I
do not like exposing my body
7
20.0
I
have been with the same partner for a long time
6
17.1
I
have never been sexually active
6
17.1
I
think the screening will hurt me
6
17.1
It
is against my religious belief
4
11.4
It
is against my cultural belief
2
5.7
*Multiple
options
Majority
(n = 166, 77.9%) of the respondents had poor knowledge of cervical cancer
screening, and among respondents who have not previously been screened, 156
(81.7%) were willing to accept cervical cancer screening. ‘I have only one sex
partner’ was the commonest reason given for non-acceptance of cervical cancer
screening (Table 3).
Table 4: Factors associated
with the knowledge of cervical screening among the respondents.
Variables
Knowledge of
cervical cancer
X2
(P value)
Poor
Good
Very
good
Marital status
Single
40
8
3
3.148(0.79)
Married
114
25
9
Divorced/Separated
4
0
1
Others
2
1
0
Educational status
None
2
1
0
43.661
(<0.0001) *
Primary
23
5
0
Secondary
102
12
0
Tertiary
33
16
13
Occupation
Farmer
15
3
0
17.318
(0.138)
Civil
servant
18
9
6
Fisherwoman
2
0
0
Housewife
11
3
1
Market
seller
16
1
0
Businesswoman
67
13
4
Others
29
5
2
Sources of information
Leaflet/Fliers
0
2
2
18.366
(<0.0001) *
Media
media (TV/Radio)
7
10
5
29.819
(<0.0001) *
Internet
2
4
6
47.045
(<0.0001) *
Friends
6
11
4
31.639
(<0.0001) *
Community
11
4
1
0.940
(0.625)
*Statistically
significant (p < 0.05)
Table
4 shows a statistically significant association between knowledge of cervical
cancer screening and educational status (X2 = 43.661; P <0.0001)
and all the sources of information on cervical cancer screening (leaflets, mass
media, internet and friends) except community sources (X2 = 0.940; P
= 0.625).
DISCUSSION
This
study looked at knowledge, perception and acceptability of cervical cancer
screening among childbearing women in Ikwerre LGA. Cervical cancer has been
associated with the infection of Human Papilloma Virus (HPV) serotype 16 and
18. This disease is preventable by early diagnosis through screening. The
acceptability of cervical cancer screening in low- and medium-income countries
(LMIC) is still low compared to the developed countries.
The awareness of cervical cancer and
knowledge of its screening method among women of reproductive age is low in
Ikwerre LGA. This study found that slightly over one third (39.4%) of
respondents have the awareness of cervical cancer but only 6.1% have good
knowledge of its screening methods. Studies in similar population in Nigeria
have also reported low level of awareness of cervical cancer and its screening
methods. For instance, good knowledge of cervical cancer screening was found to
be 4.8% among rural women in Gombe16 4.1% in Ogun State8
and 9.4% in a rural LGA in Delta State, Nigeria.13
Other studies have however reported higher
prevalences of good knowledge of cervical cancer screening among market women
in Zaria (43.5%)12 and among undergraduates in Babcock University in
Ogun State, Nigeria (68.4%).11 The higher prevalence of knowledge of
cervical cancer screening in these studies may be due to the urban nature of
population surveyed and the level of education of the participants. They may
have had previous exposures to health messages from mass media or in health
institutions which is not common in rural settings. Also, these undergraduate
students are more enlightened compared to rural women and have access to health
information from internet sources more readily than rural women. This study
found an association between knowledge of cervical cancer screening and sources
of information; mass media (P < 0.0001) and internet (P < 0.0001).The awareness and knowledge of cervical
cancer screening is high in countries currently providing cervical cancer
services through prevention programs. Tapera et al (2019) reported that 73% of
women in Harare, Zimbabwe to have knowledge of cervical screening.17
The much lower prevalence of knowledge of cervical cancer screening in our
study may be due to lack of cervical cancer prevention programs and furthermore
cervical cancer screening currently is done in tertiary healthcare facilities
in Nigeria.18
Although the uptake of cervical cancer
screening is low in this study, the willingness to accept screening is high.
For instance, while only 10.3% of the women have screened for cervical cancer
previously, 81.7% of those yet to be screened are willing to accept screening.
Balogun et al (2012) in their study found that 73.3% of
urban slum dwellers in Lagos Nigeria were willing to accept cervical cancer
screening.3 Elsewhere the acceptance
of cervical cancer screening has been reportedly high among women in rural
Central Uganda (91.4%)19, the Gambia (86.7%)20 and in
Nepal (66.4%).21In other studies, the acceptance of cervical cancer
screening is reportedly low, 24.8% in Addis Ababa Ethiopia,22 21% in
Karnataka India,23 0.8% in Elmina,
Southern Ghana. 24
The acceptance of cervical cancer screening
has been shown in studies to be associated with knowledge of cervical cancer
and its screening methods.3 This study found a statistically
significant association between knowledge of cervical cancer screening and the
level of education of respondents (X2 = 43.661; P <0.0001) and
the sources of information on cervical cancer screening (P < 0.0001).
Majority of the respondents had ‘having only one sex partner’ as reason for
non-acceptance of cervical cancer screening in this study. The implication of
low knowledge of cervical cancer screening and reason for not willing to accept
screening found in this study is their low perception of susceptibility and
risk of infection by HPV and by extension the development of cervical cancer.
It is therefore imperative for governments and non-governmental organizations
providing sexual and reproductive health services in LMIC countries institute
prevention programs to educate childbearing women on the risk of Human
Papilloma Virus infection and cervical cancer. Other studies also found an
association between the knowledge of cervical cancer screening and attitude,
educational level, income, religion, availability of services and uptake of cervical
cancer screening.16 The limitation of this study is in its
generalizability since the study was done in a Ikwerre LGA Rivers State
Nigeria. Furthermore, information obtained from participants were subject to
memory recall bias.
CONCLUSION
The
acceptance of cervical cancer screening and its knowledge among childbearing
women in Ikwerre LGA is low. The perception of risk of HPV infection and
cervical cancer is also low. However, their willingness to accept screening
among the unscreened women is high. It is recommended that government and
health agencies initiate cervical cancer prevention programs to increase
knowledge of cervical cancer screening and to subsidize screening. Further
research on their perception of cervical cancer screening is also
recommended.
Funding: this research was
funded by the authors
Conflict
of interest:
Nil
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Cite this
Article: Osaro, BO; Ben-Osaro, NV; Ikewelu, GO; Abbi, LS;
Agbanyim, ME; Alale, JI; Atelibo, TR (2024). Knowledge and Acceptability of
Cervical Cancer Screening among Women of Reproductive Age in a rural community
in Rivers State Nigeria. Greener
Journal of Medical Sciences, 14(1): 24-30.
