KNOWLEDGE, ATTITUDE AND HEALTH BELIEFS OF CERVICAL CANCER AMONG WOMEN IN AJUMAKO, EYAN, ESSIAM DISTRICT IN THE CENTRAL REGION OF GHANA

ABSTRACT
Cervical cancer is the second most common cancer prevalence among women worldwide with half a million cases each year. Cervical cancer incidence rate in Ghana is among the highest in the world.Low knowledge level, poor attitude and health beliefs are known to account for thelow level of cervical cancer screening in the Ghana.The study set out to explore the knowledge, attitude and health beliefs of cervical cancer and its screening among women in Ajumako-Enyan-Essiam district. A questionnaire was used to collect data from 240 women aged 18 to 60 from eight selected towns in the district. The study found a significant association between women’s level of knowledge on cervical cancer and practice of cervical cancer screening. There was also a significant association between women’s knowledge, health beliefs (34.2%) and practice of cervical cancer screening. In terms of attitude, the study found the respondents have positive attitude(44.3%) towards cervical cancer screening. Most of the respondents were of the view that they will be satisfied after having a pap smear. Majority (88.8%) of the respondents reported that regular Pap smear gave them a sense of control. Most respondents (79.6%) believed that cervical cancer test should be done on regularly basis. It is recommended that women should be educated on cervical cancer and screening because the formal education of women influence screening uptake.


CHAPTER ONE
INTRODUCTION 
Background to the study
Cervical cancer is the second most common cancer among women worldwide. About half a million new cases are recorded worldwide each year. Most of the cases occur in developing countries where victimsreport late when only palliative treatment can be given. Cancer is responsible for about 51 million deaths annually. About 83% of the cases occur in developing countries, representing 15% of all female-related cancers. Cervical cancer accounts for 8.5% of the death most in developing countries (Adanu, Seffah, Duda, Darko, Hill, & Anarfi,2010).

Cervical cancer is the leading cause of cancer-related death among women in Ghana and West Africa (Williams & Amoateng, 2012,). The World Health Organization (WHO) predicts that by the year 2025, 5000 new cases of cervical cancer and 3,361 cervical cancer deaths will occur annually in Ghana. Althoughthere is no formal cancer registry in Ghana, the International Agency for Research on Cancer has estimated that in 2008, 30,038 Ghanaian women developed cervical cancer and more than 2,006 Ghanaian women died because of cervical cancer (Williams & Amoateng, 2012). Despite the staggering statistics, cervical cancer prevention is not commonly promoted in Ghana.

An estimated 95% of women in developing countries have never been screened for cervical cancer (WHO, 2007) and only 2.1% of Ghanaian women have ever had a pap smear (Adanu etal., 2010). Diseases such as malaria, tuberculosis, HIV/AIDS, and most recently, breast cancer receive majority of health promotion resources. Cervical cancer has several unique characteristics that make prevention through screening and the treatment of pre-cancerous stages relatively less complex. The cause of virtually all cervical cancer cases is known to be the persistent infection with a restricted set of human papilloma viruses (HPVs).

Cervical cancer also exhibits an identifiable pre-cancerous condition and the time window from dysplasia to carcinoma is long (approximately 10 years on average). Several screening methods to detect pre-cancer and cancer are available, and can be performed safely and inexpensively in an outpatient setting. These methods include, but are not limited to, visual inspection with acetic acid (VIA) and careHPV. In addition to being used throughout many resource-limited countries around the world, these methods are also effective at treating pre-cancerous findings, thus, further decreasing the burden of disease.

Cervical cancer is therefore largely preventable by effective screening programs. A considerable reduction in cervical cancer incidence and deaths has been achieved in developed nations with systematic cytological smear screening programs. These tools (Pap Test and Visual Inspection with Acetic acid (VIA)) are available in both public and private hospitals throughout the country.

In Ghana, some public hospitals offer free cervical cancer screening. Additionally, the bivalent HPVvaccines have licensed for use in Ghana and are available in a few public hospitals in the country. Despite this, world health survey indicates that cervical cancer screening rates in urban and rural areas in Ghana are extremely low (3.2% and 2.2% respectively). The results of previous studies indicate that lack of knowledge among Ghanaian women as well as their attitude and beliefs may be a barrier to cervical cancer screening(Ebu,Siakwa&Sampselle, 2014). Pap smears are available only at a few locations, and most women lack knowledge of their availability or purpose. Studies conducted in African countries like Uganda, Botswana and Nigeria as well as Thailand and India by Wilson (2002) showed that women have limited knowledge and a negative attitude towards cervical cancer and pap smear screening which contributed to their non-participation in screening programs and for some, even though they were screened, they donot present themselves for follow-up for further healthcare once an abnormality isdetected in their smear results. Fortunately, measures that offer unprecedented opportunities for preventing cervical cancer are now given much attention: efficient, low-cost screening approaches suitable for low-resource areas and vaccines that are efficacious in preventing the infections and pre-cancerous changes that can lead to cervical cancer.However, the absence of organized screening programs in Ghana and other developing countries explain why presentation in late stages with resultant poor prognosis is common.

For the screening methods to be fully utilized, women need to be aware of the availability of the methods, to have knowledge of the disease and screening methods. These will enhance uptake of the screening for pre-malignant lesions and hence reduction of morbidities and mortalities resulting from cervical cancer especially in Sub-Saharan Africa. Demographic factors such as age, education, ethnicity, and socio-psychological factors such as social class, personality, embarrassment, fear and lack of health insurance have been recognised to influence screening uptake. Additionally, structural factors such as beliefs, attitude and knowledge about cervical cancer and the smear test have been documented as determinants of an individual’s participation in cancer screening (Maait, 2002). Another reason for poor uptake in the cervical screening programme is attributed to the lack of communication between healthcare workers and patients regarding availability and benefits of the screening (Maait, 2002).

Problem Statement
Globally, cervical cancer is the third most common cancer among women.In 2008 there were an estimated 529,000 new cases and 275,000 deaths occur (Zahedi etal., 2014). WHO also pointed out that, cervical cancer is the second most frequent cancer among women; however, eighty five percent of cervical cancer deaths occur in low and middle-incomecountries and this has been a global burden experienced by these countries (WHO, 2013). In the WHO African region, 75,000 new cases were recorded in the same year and 50,000 women died of the disease.

It was also recorded that cervical cancer is the most common cancer in women accounting for 13% of all female cancers with global mortality incidence ratio at 52%. Globally, 270,000 women die of cervical cancer each year and nearly 90% of these women live in the developing world(WHO, 2013). The majority of cervical cancer deaths occur in women who were never screened or treated, as well as those who had an early sexual debut, and a history of multiple sexual partners. If detected early cervical cancer is usually curable. This is becausethe cause of virtually all cervical cancer cases is known to be the persistent infection with a restricted set of human papilloma viruses (HPVs). Cervical cancer also exhibits an identifiable pre-cancerous condition and the time window from dysplasia to carcinoma is long (approximately 10 years on average). In addition, several screening methods being used throughout many resource-limited countries around the worldare also effective at treating pre-cancerous findings, thus further decreasing the burden of disease. However, despite these, cervical cancer still remains a problem and a public health concern.

This is attributed to the poor knowledge, attitude and health beliefs of women on cervical cancer as indicated by espoused by Nakalevu (2009). This is a view held by Ebu,Siakwa and Sampselle (2014) that the health belief of women as well as their knowledge and attitude may be a barrier to cervical cancer screening. In developed countries, screening has proved to reduce the incidence of this malignancy effectively but screening coverage is still low in developing countries like Ghana, ranging from 2.0% to 20.2% in the urban areas and 0.4% to 14.0% in rural areas.

Cervical cancer remains a major public health problem in developing countries, especially in Africa of which Ghana forms part where women continue to be diagnosed with and die from this preventable disease despitethe time window from dysplasia to carcinoma being long (approximately 10 years on average).This plausibly indicates that Ghanaian women have little or no knowledgeabout cervical cancer and this has been confirmed by previous studies indicating that lack of knowledge among Ghanaian women as well as their attitude and beliefs may be a barrier to cervical cancer screening(Ebu,Siakwa&Sampselle, 2014). Again, Ebu,Siakwa and Sampselle (2014) observed that, the inhabitants of the municipality (Elmina) firmly believe that cervical cancer is a curse by the gods and as such they did not believe it can be prevented or cured when noticed early. Their knowledge base on cervical cancer was very low hence their poor attitude towards screening uptake. In this regard, delving more into cervical cancer will broaden their understanding and clear some of the health beliefs that societies or communities firmly hold on to thereby preventing them from utilizing screening programs. Furthermore, it has been reported that understanding health behaviors in the cultural context is paramount if the health status of high risk group is to be improved (Wilson, 2002).

It is for this reason that the study sets out to explore the knowledge base as well as attitude and health beliefs of cervical cancer among women in the Ajumako-Enyan-Essiam District of the central region of Ghana.

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Item Type: Ghanaian Project Material  |  Attribute: 108 pages  |  Chapters: 1-5
Format: MS Word  |  Price: GH110 ($20)  |  Delivery: Within 30Mins.
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