Knowledge and Acceptability of Cervical Cancer Screening Among Female Student in the Federal University of Technology Owerri
CHAPTER ONE
Objectives Of Study
- To determine the prevalence of premalignant (abnormal smears) lesions of cervical cancer among female students attending Gynaecology Clinic in General Hospital Owerri.
- To assess the knowledge of cervical cancer screening among female students attending Gynaecology Clinic in the General Hospital Owerri.
- To determine the uptake of screening among female students of child bearing age group attending gynecology clinic in the General Hospital Owerri.
- To determine the prevalence of risk factors that are associated with cervical cancer among female students attending Gynaecology Clinic in the General Hospital Owerri.
CHAPTER TWO
LITERATURE REVIEW
Epidemiology
Literature review search strategy was done through Hinari access to research initiative, which is a programme, set up by world Health organization together with major publishers to enables developing countries to gain access to one of the world’s largest collections of biomedical and health literature. Over 6200 journal titles are now available to health institutions in 108 countries, were Nigeria is inclusive areas and territories benefiting many thousands health workers and researchers and in turn, contributing to improved health. Cervical cancer still remains a significant public health issue. It is one of the most prevalent forms of carcinoma affecting women worldwide as it accounts for 15% of all cancers, and global data have revealed an estimated 466,000 new cases of the disease annually. 39,40,41 The age-standardized mortality rate of cervical cancer in developing countries is 9.6 per 100,000 women, which is twice the rate in developed countries.42
The disparity in prevalence between the developing and developed worlds can be attributed in part to lack of effective cytological screening. Cytological screening (the Papanicolaou smear or Pap smear) has been one of the most successful public health measures available for cancer prevention.43 Cervical cancer screening is widely available in developed countries and in most cases lesions are detected at the pre-cancer or early cancerous stage.44
Benefits of cervical cancer screening programs in developed countries have been well documented. For instance, Denmark recorded a 25% decline in mortality following 40% coverage.45 In Norway, 5% coverage achieved a 10% fall in mortality.45
The overall age-adjusted incidence rate of cervical cancer is 8.4 per 100,000 women per year. The incidence is highest among Hispanics (12.1 per 100,000 women) and blacks (10.7) and lowest among non Hispanic whites (7.5), American Indians and Alaska Natives (7.5), and Asian and Pacific Islanders (7.7).48 Based on 2004 to 2008 (Surveillance Epidemiology and End Results) SEER data, the median age at diagnosis for cervical cancer in all women was 48 years.48 Half of all incident cervical cancer cases between 2004 and 2008 occurred in women between the ages of 35 and 55 years. The age-adjusted death rate for cervical cancer was 2.5 per 100,000 women in 2007,49 the median age for mortality was 57 years.48
The national target established in Healthy People 2010 was a mortality reduction to 2.0 deaths per 100,000 women. For 2010, SEER data estimate 12,200 new cases of cervical cancer and 4,210 deaths,47 with incidence frequently equating with mortality in the absence of healthcare facilities to deal with the condition. Mortality rates vary seventeen fold between the different regions of the world. Cervical cancer contributes over 2.7 million years of life lost among women between the ages of 25 and 64 worldwide some 2.4 million of which occur in developing areas and only 0.3 million in developed countries. In Nigeria cancer of the cervix is the commonest malignancy of the genital tract. In an atmosphere of opportunistic screening due to lack of national screening programs, studies are needed to determine patients at risk of premalignant lesions of the cervix. There are few published studies on the prevalence of abnormal cervical smear among female students attending gynecologic clinic of secondary health facilities.
Pathology
The cervix is the lower part of the uterus (womb). It is sometimes called the cervix uteri (figure 1).50 The cervix connects the body of the uterus to the vagina (birth canal). The part of the cervix closest to the body of the uterus is called the endocervix.50 The part next to the vagina is the exocervix (or ectocervix). The two main types of cells covering the cervix are squamous cells (on the exocervix) and glandular cells (on the endocervix). These two cell types meet at a place called the transformation zone. Most cervical cancers start in the transformation zone.
CHAPTER THREE
METHODOLOGY
Study Area
Imo State is the largest state in the country in term of (land mass) located in North geopolitical zone of Nigeria.38 The state capital is Owerri, other major towns are Bida, Kontagora, and Suleja. It was created in 1976 when the then North-western state was bifurcated into Imo State and Sokoto state. The state is named after the River Niger. Owerri which is also the headquarters of Chanchaga Local Government area has estimated population 235,581 in 2012 38 and with female population of 112,934 in 201238 with overall population of 4,814,215. The state General Hospital Owerri is situated in Chanchaga LGA of the State. It has a total of 625 beds spread over a number of clinical departments, a total number of about 10,000 patients are usually seen annually out of these about 200 gynaecology cases are seen per month. This hospital is the main public health facility in the state, this research will therefore be carried out in this facility.
Study Design
This is a cross-sectional, descriptive study carried out in the Gynaecology clinic of Owerri General Hospital, from January – March 30, 2013. There were 280 females attending the clinic during the time of the study. Therefore for each week there will be 70 new gynecologic cases.
CHAPTER FOUR
RESULTS
A total of 108 participants were included in the study. The response rate was 100%. The mean age was 36.7±10.4 years (range: 20–78 years), with 56.4% in the 20-39 year old range, 72.2% were Muslims and 93.5% are married. Majority (44.4%) of respondents had some form of tertiary education with the mean number of children reported as 4.7±2.6 and ranging from 1–12. More than two-thirds of respondents had 4–6 children, while only 73.6% of reported having one sexual partner in the last one year.
Comment: Approximately two third (66.7%) of respondents reported having heard about cervical cancer, 21% heard about it through health care provider. Eighty five percent believed the disease to be preventable, of which 20% said through the use of antibiotics, while 80% felt it could be curable, of which only 3.7% said through traditional healer.
Cytological results of PAP smears
Of the 108, 93 (86.1%) of the study participants had a Pap smear without abnormal findings according to the Bethesda system. However, 17% showed signs of inflammation. There were 13.9 % abnormal results consisting of low grade squaomous intraepithelial lesion (LSIL) seen in 12 specimens (11.11%) with 2 (1.9%) Human PapillomaVirus effects. During the study period no any high grade squaomous intraepithelial lesion or invasive cancer was detected.
CHAPTER FIVE
CONCLUSIONS AND RECOMMENDATIONS
CONCLUSIONS
The presented study provides prevalence data on cervical abnormalities and knowledge about cervical cancer screening uptake and risk factors for cervical abnormalities in Imo state, which will be useful for planning future cervical cancer control programs. One of the key implications of this study is the need for cervical cancer screening education programs to be carried out among this group of women at all levels of health care services especially among these women attending gynecologic clinic.
Despite the high level of awareness among the respondents, utilization remains low. Reproductive health education is highly needed to play an important role in reversing this trend. Clinics constitute one of most effective and reliable area where authoritative sources of information about health matters for the general populace especially women can be passed. These public health clinic-based education programs can provide women useful information that they can benefit and passed to others.
This study is not without important limitations. First, it was essentially a cross-sectional study, that is time bound with a Papanicolaou smear taken only once at recruitment. Follow-up with multiple Papanicolaou smears over a period of time would have been ideal, with more number of samples to increase the power of the test.
RECOMMENDATIONS
- Imo state Government should organized Public health education on cervical cancer, and screening activities be carried out among young women with intense public health campaign, be conducted on a recurring basis; providing cervical cancer education with emphasis on its aetiology, risk factors and methods of prevention.
- Policies should be put in place by the federal government that encourage or as appropriate mandate that all women coming for antenatal services are provided with the options of a Pap smear test, through sensitization, sharing of information materials such as posters and handbills reflecting how cervical cancer can be prevented and how to identify symptoms related to the diseases.
- The local authorities should introduce measures on public enlighten in local dilate on Improvement and behavioral modification that may reduce the risk of HPV infection among the women. This can be achieved by avoiding multiple sex partners (MSP) or safe practices.
- There is need to facilitate communication and inter-disciplinary collaboration in sharing of information between health care provider, public health epidemiologists and policy makers.
References
- Albert SO, Oguntayo OA, and Samaila MOA. Reducing deaths from cervical cancer, examining the prevention paradigms. Obstet Gynaecol Clin North Am 2012; 24: 599–611.
- World Health Organization. Comprehensive cervical cancer control: a guide to essential practice. Geneva, Switzerland, WHO 2006; 3.
- Patricia S. Braly, M. D. National Institutes of Health. Cervical Cancer. Consensus Statement. 1996; 14: 1–38.
- Ferlay J, Shin HR, Bray F, Forman D, Mathers C, P. D. Cancer Incidence and Mortality Worldwide: International Agency for Research on Cancer; 2010; <Available at: http://globocan.iarc.fr. >accessed 06/08/2013
- Parkin DM, Ferlay J, Hamdi-Cherif M, Sitas F, Thomas JO, Wabinga H, W. S. Cancer in Africa: Epidemiology and Prevention. 4.3Cervix Cancer. IARC Scientific Publications No 153. Lyon: IARC Press. 2003; 268–276.
- World Health Organization (WHO) and intitut Catala d Oncologia (ICO) Summary report on human papillomavirus and cervical cancer statistics in Nigeria. British Journal of cancer 2007; 90: 638-645.
- Serwadda D, Wawer MJ, Shah KV, Sewankambo N K, Daniel R, Li C, LorinczA, Meehan MP, Wabwire-Mangen F, G. R. Parkin DM The global health burden of infection associated cancer. J Infect Dis 1999; 180: 1316–1319.
