Journal of Women's Health Care
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Cervical Cancer and Screening Method: Knowledge, Attitude and Practice among Women Living in Adama Town

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Introduction

Globally, cervical cancer is the third most common cancer in women in 2008 there were an estimated 529,000 new cases. Lowresource countries experience 85% of the global burden and in regions such as Eastern Africa and South-Central Asia, cervical cancer is the most common cancer in women accounting for 13% of all female cancers [1].

The majority of cervical cancer deaths occur in women who are never screened or treated and in women with well-described sexual and reproductive risk factors, such as an early sexual debut, a history of multiple sexual partners, and a high number of live births [2,3].

In Ethiopia, an estimated 19,836 new cases (26.4 per 100,000 women) and 16,283 deaths (18.4 per 100,000 women) of cervical cancer were reported in 2012. These figures most likely underestimate the actual number of cases given the low level of awareness for cervical cancer, limited access to, and lack of a representative population-based cancer registry. Sub-Saharan Africa contributed more than 85% of global burden of cervical cancer. It is a major cause of morbidity and mortality among women in resource-poor settings, especially in Africa [4].

Ethiopia has invested little effort in cancer awareness as maternal health and other communicable diseases have been targeted as key health priorities by the Federal Ministry of Health (FMOH) [5,6].

Cervical cancer screening offers protective benefits and is associated with a reduction. The World Health Organization (WHO), United States Preventive Services Task Force (USPSTF) and the American Cancer Society (ACS) recommended that allege eligible women should have cervical cancer screening at least once every three years. Ethiopia adopted the WHO recommendation and recommended women to begin cervical cancer screening at age of thirty. The “see and treat” strategy is being applied using Visual Inspection under Acetic acid (VAI) as screening method and cryotherapy as a treatment option [7-10].

The most common challenges in cervical cancer prevention programs in developing countries are, increasing women's awareness, increasing provider knowledge and skills, and effective monitoring and evaluation approach [11,12].

Knowledge, attitude and practice level of the community is very essential about the signs and symptoms of cervical cancer, risk factors, benefits of early diagnosis and treatment, availability of health services and prevention methods (HPV vaccination). The women’s knowledge and attitude about the disease is influenced by socio demographic factors and the availability and accessibility of health services. In turn, screening behavior is a complex outcome of many factors operating at individual, family, and community levels [13,14]. The aim of the study was to assess the level of knowledge, attitude and practice toward cervical cancer and screening method in Adama town.

Materials and Methods

The study was conducted in Adama town. Adama is located 99 kilometers southeast of Addis Ababa in the Great Rift Valley of East Africa. According to the census 2007 report of Central Statistical Agency of Ethiopia the population is more than 356,344 of whom male 176,487 and female 179,857. The town is divided into 6 sub cities.

A community based cross sectional design was conducted. The sample size was calculated using single proportion formula with the following assumption n=(Zα/2)2P(1-P)/d2 Where Z=95% confidence interval (1.96), d=Marginal error=5%, n=sample size P=estimated proportion(19%) [6,7]. Non-response rate 10% and design effect 1.5 is added. The total sample size was 390.

An interview method was employed by using a pretested structured questionnaire adapted from earlier studies related to cervical cancer and screening knowledge, attitude, and practices. The questionnaire was translated into Amharic and Oromic languages using professional linguists. The questionnaire is divided into 4 major areas that included: Background characteristics, Knowledge towards cervical cancer which assesses burden of the disease, risk factors, symptoms, screening procedure treatment and prevention method, attitude towards cervical cancer and screening method and practices towards cervical cancer screening.

Multi stage sampling technique was used to select the respondents of the study. There are 6 sub cities in Adama town. From these, two sub cities were selected by lottery system. From the two sub cities, two kebeles were selected from each sub cities. Then, the desired samples were selected using proportions.

Data was entered, cleaned and analyzed by SPSS version 20 statistical package. Descriptive summaries using frequencies and proportions were used to present the study results. Multivariable logistic regression was used to identify factors associated with the level of knowledge, attitude and practice of cervical cancer and screening method. Adjusted odds ratio at 95% confidence interval and p-value was used to measure the strength of association and identify statistical significant result. P-value<0.05 will be considered as a statistically significant association.

Results

Socio demographic characteristics

A total of 390 women participants were recruited in this study. Most of them were married, 247(63.3%). Half of them were aged between 30-44 years, 199(51%). Women who completed higher education were 125(32.1%). Nearly half of them were house wife, 161(41.3%) (Table 1).

Table 1: Socio demographic characteristics of women enrolled in this study, Adama, 2018.

Reproductive history

Of total 390 study participants half of them said that they have more than 4 children, 203 (52.1%). Women who responded their age of first sexual intercourse 21-30 years were 196 (50.3%). Majority of them said that they had one sexual partner in life time, 278 (71.3%). Most of them said that their first childbirth age was 21-30 years, 279 (84.4%). Women who had history of abortion were 86 (22.1%) (Table 2).

Table 2: Reproductive history of study participants, Adama, 2018.

Knowledge of cervical cancer

Out of 390 participants, 329(84.4%) reported that they have heard about cervical cancer before. From these, 183(46.9%) of them said that their source of information about cervical cancer was mass media whereas 44 (11.3%) of them was from health professionals. Of 329 participants, 152 (46.2%) of them knew about cervical cancer risk factors. Women who knew preventions methods of cervical cancer were 196 (59.6%).

Most of them didn’t know cervical cancer can be cured at early stage, 205(62.3%). Women who knew cervical screening method were 215(65.3%). Majority of participants knew sign and symptoms of cervical cancer, 250(76%) (Table 3).

Table 3: Knowledge assessment of participants toward cervical cancer, Adama, 2018.

Knowledge was assessed using 8 items questions regarding cervical cancer. Mean score value was used to select participants who had good or poor knowledge toward cervical cancer. The mean score was 4.2 Participants who score more than 4.2 were considered as good knowledgeable whereas less than 4.2 were poor knowledgeable toward cervical cancer. Based on this, 160(48.6%) of study participants had a good knowledge whereas 169(51.4%) had a poor knowledge toward cervical cancer (Figure 1).

Figure 1: Knowledge score of participants toward cervical ca, Adama, 2018.

Attitude toward cervical cancer

Of 329 participants, 206 (62.6%) of them agreed that cervical cancer is highly prevalent in Ethiopia. Half of them agree that all females can acquire cervical cancer, 183 (55.6%). Very few of them disagree that cervical cancer spreads person to person, 34 (10.3%).

Most of them agreed that precancerous cervical cancer screening method (VIA) doesn’t harm 219 (66.6%). Half of them agreed that precancerous cervical cancer screening method can help to prevent cervical cancer, 179 (54.4%) (Table 4). It was found that women who had positive attitude toward cervical cancer were 232(70.5%) (Figure 2).

Figure 2: Attitude of participants toward cervical cancer.

Table 4: Attitude assessment of participants toward cervical cancer, Adama, 2018.

Practice of cervical cancer screening

Of 329 study participants women who were screened for precancerous cervical lesion by VIA were 53 (16.1%). Commonly reported reasons for not being screened were shyness for the procedure and they think they were healthy (Table 5).

Table 5: Practice of precancerous cervical lesion screening.

Factors affecting KAP of study participants toward cervical cancer

Out of 160 women who had good knowledge about cervical cancer, 159(99.4%) of them were literate women. It was found that literates women were more likely to be knowledgeable by 22.7 times than women who were illiterates (COR=22.7 95% CI 3.0, 170.9 AOR=12.7 95% CI 1.6, 98.6).

Of 160 women who had a good knowledge, 124 (76.9%) of them were self and government employed. It was revealed that there was significant association between knowledge and occupational status. Women who were self-employed were more likely knowledgeable by 5.3 times (COR=5.3 % 95 CI 2.9, 9.7 AOR= 4.8 95% CI 2.2, 2.5) and women who were government employed by 2.1 times knowledgeable than women who were housewife (COR=2.1 95% CI 1.2, 3.7 AOR=1.6 95% CI .9, 2.9).

Of 53 women who were screened for cervical cancer, 36 (67.7%) of them were women who had positive attitude toward cervical cancer and screening method. It was revealed that having positive attitude is a significant factor for screening of cervical cancer (COR=1.2 95% CI 6, 2.2 AOR=1.8 95% CI .4, 1.5 P-value<0.05) (Table 6).

Table 6: Factors associated with KAP of participants toward cervical cancer, 2018.

Discussion

In this study 84% of study participants said that they have heard about cervical cancer before. This is higher than a study conducted among students in Mizan Tepi University (53.11%) and it was 71.3% among ART clients (16%) [15].

This study found that 46.5% of study participants had good knowledge about prevention method of cervical cancer. This is comparable with a study conducted in Hawassa where more than half of study participants knew prevention method of cervical cancer [16]. It is lesser than a study done among ART clients (75.3%) among Ethiopian health care providers was 85% [17].

In current study 48.6% of participants had good knowledge about cervical cancer. This is comparable with a study done among ART clients (43.8%) [17]. Similarly, in a study conducted in Hosana Ethiopia 46.3% of participants had good knowledge about cervical cancer [18]. Whereas in a study conducted in Nepal 87% of study participants had inadequate knowledge regarding cervical cancer [19].

In this, 62.6% of participants had positive attitude toward cervical cancer. In study conducted in Nepal 71.7% of participants, had positive attitude [19] and in a study done in Hosana Ethiopia 65.2% had positive attitude [18].

This study revealed that 16.1% of study participants were screened for cervical cancer. Similarly in study conducted in Nepal 86.4% [19] and in a study done in Hosana Ethiopia 9.9% of participants were tested for cervical cancer [18].

This study found that participants who had family history of cervical cancer more likely to be knowledgeable by 1.9 times than who had no family history of cervical cancer. In study conducted in Nepal also participants who had family history of cervical cancer were more likely to be knowledgeable by 2 times [19]. In current study literates women were more likely to be knowledgeable by 22.7 times than women who were illiterates. But in a study conducted in Nepal illiterate women were more likely to have a favorable attitude and go for cervical cancer screening (p=0.013; OR=0.54; 95% CI=0.33–0.88) [19].

In this study, commonly reported reasons for not being screened were shyness for the procedure and they think they were healthy. In a study in Nepal commonly reported reasons were screening was not needful without any symptoms, lack of awareness, screening was embarrassing and some answered they were too busy or careless [19]. Whereas in a study conducted in Hosana Ethiopia the most reported reasons were participants had no intention to be screened for cervical cancer, they had never heard about the disease and never had experienced the illness before [18,19].

Conclusion

Nearly half of study participants had good knowledge toward cervical cancer. Most of study participants had positive attitude but very few of them were tested for cervical cancer. The most associated factors for knowledge, attitude and practice for cervical cancer screening were educational status, occupational status, and family history of cervical cancer. Commonly reported reasons for not tested cervical cancer were shyness for the procedure and they think they were healthy.

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