ABSTRACT
Cervical cancer is the second most common cancer among women. It is the leading cause of deaths among women worldwide. It is estimated that 493000 new cases and 274000 deaths occur every year due to this preventable disease (Ferlay et al, 2002). Chanchaga local government area is privileged to have a lot of screening centres, yet the debate is whether, having the screening programme, has impacted on all women aged 18 years and above, as low utilisation rates have been recorded. It is evident from the statistics that women in Niger State have not been utilizing the service, as the number of women who so far have accessed the service is still very low, at about 3% coverage. The aim of this study was to evaluate the awareness of the utilization of cervical cancer screening services by women in Chanchaga local government area.
This study was a non-interventional, descriptive cross-sectional study comprising of 368 respondents from four clinics. A multi stage sampling technique was used where the study population of women were chosen using the simple random sampling technique. The clinics were chosen using the fishbowl technique of sampling. The data was collected using a semi structured interview schedule. Data was processed and analysed using Statistical Package for Social Sciences (SPSS) version 22. Descriptive statistics was used to describe data. Furthermore, chi-square test was used to test associations between the outcome variable (utilisation) and other independent variables. The statistical significant level was set at confidence interval of 95%. Logistic regression analysis was also performed. The study, established that most respondents, 313 (84.6%) had heard of cervical cancer screening before but only 26% out of the 84.6% knew what it was. However, 148 (40%) had utilised the service before, of these 7 (5%) respondents went for screening willingly and 141 (95%) screened after observing a problem. In-line with attitudes 250 (67.9%) respondents were not interested in screening. Cultural beliefs, busy schedules and fear were the most common reasons women gave for not screening.
There was an association found between utilisation and social demographic characteristics such as education level, age and employment status, with p values of 0.05, 0.008 and 0.003 respectively.
Possible interventions included, good prompt and creative health education as important activities that should be rendered to all women. However, the study discovered that the knowledge levels of the women were low in relation to the utilization levels. There is need, therefore, to intensify efforts on promoting awareness towards cervical and screening of cervical cancer. When cervical cancer is found early, it is highly treatable and associated with long survival and good quality of life.
CHAPTER ONE INTRODUCTION
1.1 Introduction
This study focuses on factors influencing utilization of cervical cancer screening services by women at selected clinics of Chanchaga local government area. Cervical cancer screening involves testing apparently healthy women for signs indicating the development of cancer of the cervix (World Health Organisation (WHO), 2014; Centre for Infectious Disease Research in Nigeria (CIDRZ), 2014). This explains that cervical screening is a way of preventing cervical cancer by finding and treating early changes in the cervix. This chapter will look at the background information, Statement of the problem, study justification, theoretical/conceptual frame work, research objectives, research question, study hypothesis, conceptual definition of terms, operational definition of terms, literature review and variables and cut off points.
1.2 Background Information
Cervical cancer is the easiest gynaecologic cancer to prevent, with regular check-ups, screening tests and follow-ups (Centre of Disease Control (CDC), 2013). Cancer of the cervix is the major gynaecological health problem that has been on the increase and remains a leading cause of death among all cancers (WHO, 2013).
Cancer of the cervix is staged from 0 to IV, the lower the number, the less the cancer has spread. Stage 0 is the precancerous, Stage I (one) is the earliest stage and is the easiest to cure while stage IV (four) is the most advanced stage indicating that the cancer has spread to other parts of the body. The cure rate for stage I cancer is 85% to 90%, while the cure rate for stage IV cancer is only 5% to 10%. Invasive cancer of the cervix is treated with surgery, or radiation therapy and chemotherapy (Chirenje et al., 2012).
A growing body of evidence (Balogun et al., 2012; WHO, 2013) has demonstrated that women can effectively be screened and clinically managed for cervical cancer using non- cytological modalities. Several screening tests exist and these include, conventional cytology, liquid-based cytology, Human Papilloma Virus (HPV) Deoxyribonucleic Acid (DNA) testing and the Visual Inspection with Acetate (VIA) (WHO, 2014; CDC, 2014). Visual inspection test includes naked eye inspection with or without acetate, visual inspection using magnification devices or after the application of Lugols iodine respectively (WHO, 2014). Nigeria, being a developing country, has adopted a cheaper but effective techniques for screening of cervical cancer called Visual Inspection with Acetate. VIA has been adopted in the “see and treat” methods that are less infrastructure-dependent (Balogun et al., 2012; WHO/ICO, 2013). Cervical cancer screening services in Nigeria were initially meant for Human Immuno-Deficiency Virus (HIV) positive women but due to the increased burden the service has been made available for every woman who needs to screen yearly (CDC, 2014). VIA is a recommended immediate diagnostic method to treat patients in a country with very few and less skilled clinicians (WHO, 2010). The debate now is whether, having launched the screening programme in most peri-urban areas has been utilised by women in a reproductive age group (between 15 and 49 years old) in responding to actual accessing of the CCSS (WHO, 2010). A world-wide pandemic of underutilizing cervical cancer screening services especially in developing countries has been established by various studies (WHO, 2010; CDC, 2012; CIDRZ, 2014).
Globally, an estimated 500,000 women are diagnosed with cervical cancer and over 250,000 die from it each year, more than 80% of women residing in resource-limited settings that have access to less than 5% of global health resources (Balogun et al., 2012; WHO/ICO, 2013). Nigeria has the second highest incidence of cervical cancer globally (Bateman et al., 2015). Cervical cancer ranks as the most frequent cancer among women between the ages of 15 and 44. In Nigeria, current estimates indicate that every year 1,839 women are diagnosed with cervical cancer and 1,276 die from the disease (WHO/ICO, 2010).
In order to mitigate the impact of CC, Chanchaga local government area under MOH and the Centre for Infectious Disease Research in Nigeria (CIDRZ) have undertaken measures such as training of Health workers to diagnose, treat CC and developed community programmes to educate the community about CC (CIDRZ, 2014). Amongst the notable achievements done towards the CCSS were; Nigeria introduced free CCSS in January, 2006, construction of referral hospital for Cancer Disease and Pink Ribbon Red Ribbon (PRRR) in December 2011 with a vision to ensure that all women and girls have access to high quality prevention for CC (CIDRZ, 2014; CDC, 2014; CDC, 2013).
While access to effective and affordable screening and treatment services is of central importance in the prevention of cervical cancer, most African countries have recorded the lowest utilization rates of Cervical Cancer screening awareness. The barriers to cervical cancer screening in Africa vary between and within countries. Sub-Saharan Africa hosts 12% of the world’s population but accounts for 20% (57,000) of estimated cervical cancer-related deaths (CIRDZ, 2014). It is believed that Sub-Saharan Africa has some of the highest cervical cancer-related mortality rates in the world (Campos et al., 2012).
Like most African countries, Nigeria experiences the same barriers other countries are experiencing (Balogun et al., 2012; WHO/ICO, 2013). The few screening programmes available are only confined to a few districts, making it difficult for other women especially those in hard to reach places to access, even though they are aware of this service. Women’s knowledge of cervical cancer as a disease and cervical cancer screening has been found to influence the decision to be screened. Previous report showed that the greatest risk for cervical cancer was the women’s lack of knowledge on prevention methods and ability to recognize the signs of the disease (Campos et al., 2012). Furthermore, the report stated that no women can prevent any disease and use available screening opportunities if she does not know about the disease (Maree, et al., 2012). Lack of awareness and deep-seated stigma associated with the disease also poses significant barriers to accessing this service (WHO, 2013). Unfortunately, due to lack of knowledge and a lot more barriers, only 5% of women in developing countries undergo screening for cervical cancer compared to over 40% in developed countries, and 70% or higher in countries that have shown marked reduction in incidence and prevalence of cervical cancer (CDC, 2013; Balogun et al., 2012; WHO/ICO, 2013). Thus, it can be speculated that there are a number of factors that may influence a woman’s ability and desire to participate in cervical cancer prevention programmes, and has an impact on a woman’s decision-making process. It is therefore essential that cervical cancer prevention efforts eliminate the most critical barriers that influence women’s participation, as well as identify and foster conditions that support their use of services.
1.2 Statement Problem
Reports from Ministry of Health (MOH) and its collaborative partners such as CDC have shown that the incidence and prevalence of cervical cancer are on an increase at about 82% and most women report late for treatment. Screening program utilisation can be improved with adequate emphasis on the sensitisation and aggressive marketing of the service (Zvavahera et al., 2012; WHO, 2012). WHO has shown that in Nigeria the mortality rate of cervical cancer stands at 38.6 per 100,000, though; clinically the death rate is even higher with 1,600 deaths out of 1,800 new cases of cervical cancer every year. In 2010, the Nigerian female population was 6,600,000 and in 2010 to 2015 only about 189,000 Nigerian women had utilised CCSS country wide (WHO, 2013). Table 1.1 below shows the population of women in Chanchaga local government area from study sites 194789 (Niger State health office, 2015). In 2013 only 2,896 (1.486%) of women screened for cervical cancer In 2014, 6,665 (3.422) women, and in 2015, 2,609 (1.339%) of women screened for cervical cancer.
1.3 Research Objectives
General Objective
To evaluate the factors that influence utilization of cervical cancer screening services by women in Lusaka urban district.
Specific Objectives
1. To determine the utilization of cervical cancer screening by women.
2. To determine the levels of knowledge on cervical cancer screening among women.
3. To identify the association between the socio demographic characteristics and
utilization of cervical cancer screening.
4. To assess women’s attitude towards utilization of cervical cancer screening.
5. To identify the barriers to cervical cancer screening utilizations’
1.4 Research Question
How do social demographic characteristics, women levels of knowledge and women’s attitude affect utilization of cervical cancer screening?
1.5 Study Hypotheses
Null hypothesis
There is no relationship between a woman’s level of knowledge and their likelihood to utilise cervical cancer screening services.
1.6 Significance of the study
This research would be significant to the health care industry, other researchers and public at large. First, the health care industry, more so Chanchaga Local Government Area Hospital, would benefit from the findings of this study by using it to lay strategies to position itself as a leading health care facility in provision of screening and treating cervical cancer in the region. Secondly, other researchers and academicians, it is hoped, would benefit by using the findings of this study for training and further research, as the study would lay the platform on which further research on the topic can be undertaken. The finding of this was built on scholarly work done on factors influencing the uptake of screening cervical cancer among women of reproductive age. Lastly, it is hoped that the general public especially women would benefit through embracing screening cervical cancer.
1.7 Limitation of the study
This study encountered some challenges. First, there were cases of uncooperative respondents. This was surmounted by directly engaging with the clients and also seeking the permission of hospital management to allow a member of staff to accompany me to the field. Secondly, there were cases where respondents gave socially acceptable responses for fear of victimization. To overcome this problem, the researcher assured the respondents that information so given would only be used for research purposes. In addition, some tools of collecting data like questionnaires were difficult to use because some respondents were illiterate. This limitation was overcome by engaging assistants who helped to interpret the questionnaire to the respondents.
1.8 Delimitation of the study
This study focused on factors influencing uptake of screening cervical cancer among women of reproductive age. It confined itself to Chanchaga Local Government Area, hospital staff and clients. Chanchaga Local Government Area was settled on because of the researcher‘s familiarity with the screening service and the proposed locality. Further, the researcher had worthy contacts and good working relationships with Chanchaga Local Government Area Hospital staff and clients and thus they fully cooperated.
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