TOPIC

ASSESSMENT OF KNOWLEDGE ATTITUDE AND PRACTICE OF CERVICAL

CANCER SCREENING AMONG WOMEN OF REPRODUCTIVE AGE ATTENDING

GYNAE CLINIC AT M.M.S.H KANO.

 CHAPTER ONE

1.0 Background of the Study

Cervical cancer is the fourth most frequent cancer in women with an estimated 570,000

new cases in 2018 representing 6.6% of all female cancers. Approximately 90% of death

from cervical cancer occurred in low and middle income countries. Cervical cancer is the

most malignances among female worldwide especially in women of 20-39 years of age.

Its contribution to cancer burden is significant across all cultures and

economics. Cervical cancer also accounts for over 270,000 deaths worldwide

on overwhelming majority of which occur in the less developed regions (Imam, 2014).

Globally there are over 500,000 new cases of cervical cancer annually and in excess of

270,000 deaths, accounting for 9% of female cancer deaths 85% of cases occur in

developing countries and in Africa (Campbell, 2014). Cervical cancer remained the

second leading cause of cancer death af

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d a disproportionate share of the burden and 80% of the

250,000 cervical cancer death in 2009 occurred there (WHO, 2012; Uysal & Birsel,

2014).

In Nigeria using the data from WHO, UN IARC Globiocan and the World Bank

cervical cancer in the country annually is recorded as 9,659 (Vanguard

Newspaper May 2013). Twenty Six Women loss their lives to cervical cancer daily,

and 14,000 women are diagnosed with cervical cancer if early (Adewole 2017).
In Zaria Northern, part of Nigeria, cervical cancer accounted for 77% of gynecological

malignancies with over 88% representing above stage II of the disease while in Kano

State cervical cancer has overtaken breast cancer as the most common cancer in

women (Department of O and G Murtala Muhammad Special Hospital.

Cervical Cancer occurs when the cells in the cervix begin to grow and replicate in an

abnormal uncontrollable way. When this happens there is a malfunction among cells.

As a result the cells form a mass that is called a tumor. The tumor is damaging to the

body system. This malignant tumor in the cervix at advanced stage can spread to other

part of the body thereby destroying normal cells.

Pap Smear screening can identify potentially precancerous changes. Treatment of

high-grade changes can prevent the development of cancer. Cervical Cancer is a major

risk in women today especially at the age of 20 years and above. Awareness of

screening program, preventive vaccination practice safe sex, quit smoking, diet are

preventive measures that reduce the incidence of cervical cancer.

In developed countries, the widespread of cervical screening programs has reduced the

incidence of increase cervical cancer by 50% or more (Population Reference Bureau,

2015). Cervical Cancer is the most common genetal tract malignantly of women living

in poor rural communities of developing countries (Farley, 2016), such population lack

cervical screening facilities and other basic infrastructural and human resources

essential for effective primary health care delivery.

Cervical cancer incidence and mortality rate have declined substantially in western

countries following the introduction of screening programmes.

The ideal age of the woman for screening are 30-40 years owning to high risk of

precancerous lesions one to being sexually active; and a precancerous lesion is

delectable for 10 years or more before a cancer develops (Olamijulo, 2015). Although

it has been already proven that the efficiency of regular pap tests reduced the morality

rate of cervical cancer, its application in the developing countries is less compared with

the developed countries.

This is one to lack of knowledge and screening practice among women in developing

countries (Yaren 2018).

In developed countries, the widespread use of cervical screening programs has reduced

the incidence of invasive cervical cancer by 50% or more. Cervical cancer is one of the

most preventable of all cancers through primary and secondary prevention,

prophylactic human papilloma virus (HPV) vaccination and cervical screening (Ezem,

2016)

About 40% of woman are half as likely to know the purpose of the human papilloma

virus test. Poor literacy was a better predictor of cervical cancer screening knowledge

than ethnicity or education (America journal of obstetrics and. gynecology 2012).

In a study conducted in Ghana on cervical cancer screening out of 1000 women only

100 women have knowledge about cancer screening initiation the remaining have lack

of information about how for obtain screening services.

Although screening is a known cost effective strategy used in reducing the burden of

cervical cancer worldwide its uptake particularity in developing countries is still

hopeless.

In Nigeria one of the barriers to access to cervical cancer screening is that most

cervical cancer screening services provided by governmental or non-governmental

agencies had been sporadic and poorly coordinated. Most services are urban based; the

rural and semi urban dwellers are often neglected. Also high cost of screening

contributes to the low use age of screening services.

In some hospital the cost of cervical cancer screening is as high as five thousand Naira.

In a county like Nigeria with a timid population of people living below the poverty line

and with a health care that is pudominantly dependent on out of pocket expenditure,

such cost of service could be huge barrier of assess.

In spite efforts from governmental and non-governmental organization to improve

access to cervical screening service in Nigeria, uptake has been appalling. Several

studies here documented factors associated with uptake of cervical cancer screening

tests in the country such factors includes age of the women, their marital status, parity,

risk perception, financial constraint and knowing someone who has cancer of the

cervix.
 An estimated 1.4 million women worldwide are living with cancer and 2 to 5 times

more up to 7 million worldwide may have precancerous conditions that need to be

identified and treated (ACCP, 2015). In the United Kingdom, cervical cancer is the

second most common cancer among females under 35 years of age accounting for 702'

new cases in 2007. According to the UK statistics report for 2010, 2,828 new cases

were diagnosed in 2007.

Furthermore WHO (2018) asserted that cervical cancer remain a major public health

problem. The report further indicates that approximately 500 women develop cervical

cancer and 274 deaths occur each year from cervical cancer in developing countries.

More than 80% of the world and less than 5% women in these settings were screened

and the rest have never been screened even once in their life time (Sanghur, Lacoste,

Mccormick, 2015).

Possible reasons for a low participation in cervical cancer screening include; ignorance

of the existence of such test, ignorance of important of screening or lack of risk

awareness and the risk factors to the development of cervical cancer, absence of

symptoms and lack of awareness of centers where such services are obtainable and

lack of motivation to get screened (Aniebue 2012).

1.1 Statement of the Problems

According to world Health Organization, cervical cancer is the 2nd most common

cancer in women worldwide. Grows very slowly over a period of time before it

actually develop into cancer. However, it can be treated or managed if detected in its

early stages (WHO, 2012).

World wild cervical cancer accounts for about 500,000 new diagnosis and 273,000

deaths every year, of the new cases 80% occur in developing countries like Nigerian

where the majority of cases presents in late 'stages of the disease. In Nigeria, the

national incidence of cancer is of the cervix is 250/100,000. Each year about 10,000

women develop cervical cancer and about 8,000 women die from cervical cancer in

Nigeria.

The level of awareness and practice of cervical cytology services among women in the

country is unclear as there is no reliable proportion-based cancer registry or prevention

program databases, and very few regional-based studies have been reported in the

country (Ahardro and Ikenyi, 2016)

In spite effort from governmental and non-governmental organization to improve

access to cervical cancer screening services in Nigeria. Uptake has been appalling.

Special studies have documented factors associated with uptake of cervical cancer

screening tests in the country. Such factors includes Age of the women, their marital

status, parity, risk perception, Financial constraints, and knowing someone who has

cancer of the cervix.

Knowledge and practice of cervical cancer screening is important in the reduction of

maternal mortality. Women with low levels of knowledge about cervical cancer and its

screening are less likely to access screening. Cancer prevention programme has

recorded various degree of successes, and are screened when they attend for other

gynecological complaints during clinic visits and consultation. (Gharoro and Ikeanyi,

2006). The researcher have been to gynecology ward and have come across several
 cases of cervical cancer which most of them were diagnosed in their late stages and

there is nothing chemotherapy will do to stop its already done damage and this is all

due to lack of screening to detect in its early stage.

Base on these studies about cervical cancer screening, the research project will focus

on the knowledge and practice of cervical cancer screening among Women of

reproductive age attending gynecology clinic in Murtala Muhammad Specialist

Hospital Kano.

1.2 Objective of the Study

1. To identify knowledge of cervical cancer screening among women of reproductive age

attending gynecology clinic in Murtala Muhammad Specialist Hospital Kano

2. To determine the level of practice of cervical cancer screening among women of

reproductive age attending gynecology clinic in Murtala Muhammad Specialist Hospital Kano

3. To find out strategies of improving cervical cancer screening.

1.3 Research Questions

1. What are the levels of practice of cervical cancer. Screening among woman of

reproductive age attending Murtala Muhammad Specialist Hospital Kano.

2. What is the level of knowledge of cervical cancer screening among women of

reproductive age attending Murtala Muhammad Specialist Hospital Kano.

3. What are the strategies of improving cervical cancer screening services.

1.4 Significance of the Study

Several studies stated that wide spreads use of cervical cancer screening programme help

to reduce the incidence of cervical cancer by 50% or more. Cervical cancer is one of the

most preventable of all cancers through primary and secondary prevention, prophylactic

human papilloma virus vaccination and cervical screening.

The research study will help to find out:

 Strategies to improve cervical cancer screening uptake among women. finding of the

research work will help in improving women knowledge on cervical cancer screening and

encourage them to go for screening services for early detection and treatment.

 It will help the community to know more about cervical cancer and its damage, and that

it's a inevitable disease if screened at early stage.

 It will help to reduce work load and emotional stress of Health care providers, if there is

good uptake of cervical cancer screening services there will be less cases of women

coming to hospital with advance stage cervical cancer. This will reduce workload and

allow them to focus on other services.

 Lastly it will also help government in implementation of strategies to improve cervical

cancer screening.

1.5 Limitations of the Study

Due to limited time and resources the researcher focuses on knowledge and practice of

cervical cancer screening among women attending gynecology clinic in Murtala

Muhammad Specialist Hospital Kano strategies to improve utilization of screening

service.
1.6 Operational Definition of Terms

Knowledge:
Knowledge: In this study knowledge means a woman who was able to define cervical cancer,

state risk factors, sign and symptoms and mentioned services available for detection and

prevention of cervical cancer.

Practice:
Practice: In this study practice means a woman has accessed the cervical cancer screening

services.

Cervical Cancer: In this study, cervical cancer means a growth or a tumor, in the cervix or

uterus.

Screening: Screening is a test use to detect the presence of cervical cancer cells.

Woman: An adult female human.

Reproductive Age: A period from puberty to menopause in which a woman can technically get

pregnant and bear children. It ranges from 12-51 years.

Gynecology Clinic: A facility in which women that have reproductive organs problems are seen

by doctors that are specialized in the field and manage as an outpatient.