DOWNLOAD PDF

Examining Prevalence and Influential Factors of Cervical Cancer Screening Among Women of Reproductive Age at Fort Portal Regional Referral Hospital in Fort Portal City

Mumere Mutahunga Robert

Faculty of Clinical Medicine and Dentistry Kampala International University Western Campus Uganda.

ABSTRACT

Globally, cervical cancer stands as a pressing health issue for women, ranking as the second most common cancer type among females worldwide. A study conducted at Fort Portal Regional Referral Hospital in Fort Portal City aimed to assess the prevalence and factors impacting the participation of women of reproductive age in cervical cancer screening tests. Employing a cross-sectional descriptive design with quantitative methods, the study utilized a consecutive sampling technique, surveying 96 respondents through self-administered questionnaires. Data analysis involved coding and entry via SPSS 20.1, with findings presented through tables, graphs, and pie charts. Results indicated that only a quarter of respondents (25%) had undergone cervical cancer screening, predominantly opting for Visual Inspection with Acetic Acid (VIA) (58.3%). Notably, a significant proportion of screened individuals (66.7%) hailed from rural areas, and the majority (66.7%) had a parity of 3 or fewer children. Moreover, 58.3% of those screened reported earning more than 400,000 shs per month. Unexpectedly, reluctance accounted for 44.8% of respondents’ reasons for not undergoing screening. In summary, despite free accessibility to the service, there’s a notably low prevalence of cervical cancer screening. Reluctance and fear associated with the procedure emerged as significant barriers hindering the uptake of cervical cancer screening among the surveyed population.

Keywords: Cervical cancer, Reproductive age, Mothers, Women, Human papillomavirus.

INTRODUCTION

Cervical cancer is a cancer that arises from the cervix and it is due to the abnormal growth of cells that can invade and spread to other body parts [1]. It is caused by persistent high-risk Human papillomavirus (HPV) infection. HPV infection is spread during sexual intercourse. Infection is very common following the onset of sexual activity and up to 80% of adults show serological evidence of previous infection [2]. Cervical cancer has been affecting women since 400 BC when Hippocrates noted that the disease was incurable. In 1928, Papanicolaou developed a technique that was used for screening. The introduction of the Pap test in the clinical setting faced major challenges both in Canada and the United States, where most Pap smear tests were introduced in Canadian centres as local trials (Patricia A S, 1999).In 1949, David Boyes and Fidler initiated cervical screening in British Colombia as a project to determine whether screening with Pap smear could reduce the incidence and mortality from invasive cervical carcinoma but in 1955, only 3% of the British Colombian women had ever been screened [3]. Cervical-vaginal screening increased greatly in the 1950s when the cancer societies in Canada and the United States endorsed the Pap smear test as an effective cancer prevention test, and promoted it in their campaigns [4]. In 1962, only 6.3% of Canadian women over the age of 25 were screened in a 12-month period; by 1967, this had increased to 26%. With the gradual adoption of the technique across the country, a reduction in both incidence and mortality from cervical carcinoma was documented the incidence dropped from 21.6 per 100,000 women in 1969 to 10.4 per 100,000 in 1990 and mortality dropped from 7.4 per 100,000 women in 1969 to 2.4 per 100,000 in 1992 [4].

Challenges to the provision of effective care in Uganda include competing health needs, misconceptions about cervical cancer screening, and poor prevention, screening, and treatment infrastructure, particularly in rural areas [5]. This study provides a cross-section of the prevalence and the sociodemographic and socioeconomic factors that influence the uptake of cervical cancer screening tests. Cervical cancer is almost entirely preventable through vaccination and screening, yet it remains one of the gravest threats to women’s lives [6]. Uganda has one of the highest cervical cancer incidence rates in the world (54.8 per 100,000) as a result of limited screening access and infrastructure [7]. Globally, cervical cancer is a health concern among women, presently ranking as the second to fourth most common cancer type among women in different parts of the world [8]. An estimated 528,000 new cases of cervical cancer were reported globally, with an estimated 266,000 women dying from this cancer [9]. The cancer grows slowly, begins in the cervix of women, and occurs mostly in women over the age of 30 years [10]. Cervical cancer is an entirely preventable disease as the different screening, diagnostic, and therapeutic procedures are effective. Pap smear has reduced the incidence of cervical cancer by nearly 80 percent and death by 70 percent. The incidence of cervical cancer is steadily declining in the developed world. It has been estimated that cervical screening prevents around 5,000 deaths every year in the UK alone. [8, 11]. Evidence shows that early detection through cervical pap smears has had a significant impact on the incidence and mortality associated with this cancer in many developed nations including the United Kingdom, the United States, and Australia [12]. Worldwide, over 85% of cervical cancer deaths occur every year in developing countries [13]. This is attributed to inadequate access to effective screening which results in less recognition of the disease during its early stages and higher chances of it developing to advanced stages with poor prospects of treatment [14].

Globally, 570000 new cases of cervical cancer were registered in 2018 and 311000 women died from it in the same year [14]. According to a projection by WHO [15], by 2025, about six thousand four hundred new cases and four thousand three hundred deaths will occur annually if no attempt is made to reduce the scourge. Uganda ranks 14th among countries with the highest incidence of cervical cancer, and over 65% of those diagnosed with the disease die from it [16]. Cervical cancer (CC) is the most frequent cancer and the leading cause of cancer-related deaths in Ugandan women [17], and the current estimates indicate that six thousand four hundred thirteen Ugandan women are diagnosed with CC annually and four thousand three hundred one deaths attributed to this disease occur annually [18]. Despite cervical cancer screening services being provided for free at the government health facilities, the baseline lifetime screening rate in Uganda is still very low at 4.8% to 30% among women aged 25 to 49 years [4, 12]. And yet screening by cytology (‘pap smears’) has prevented up to 80% of cervical cancers in high resource settings [18]. A key goal of Uganda’s national strategy for CC prevention and control is to have 80% of eligible women aged 25-49 years screened and treated for cervical precancerous lesions [19]. The prevalence of CC screening at Fort Portal RR Hospital is not known and the factors influencing the uptake of cervical cancer screening are not determined.

CONCLUSION

There is adequate awareness of cervical cancer screening among women of reproductive age. However, there is inadequate knowledge of the purpose of CCS for improving morbidity and mortality. Sociodemographic factors such as age, level of education, marital status, parity, place of residence, and religion influence the intention to perform CCS. The provision of CCS services for free as well as personal control of finances (earnings) does not increase the intention to screen for cervical cancer. Reluctance, transport costs, and fear of the procedure declined the uptake of cervical cancer screening.

REFERENCES

  • Black, E., Hyslop, F., & Richmond, R. (2019). Barriers and facilitators to uptake of cervical cancer screening among women in Uganda: a systematic review. BMC Women’s Health. 19, 108. https://doi.org/10.1186/s12905-019-0809-z
  • Ibiam, U.A., Uti, D.E., Ejeogo, C.C., Orji, O.U., Aja, P.M., Nwamaka, E.N., Alum, E.U., Chukwu, C., Aloke, C., Chinedum, K.E., Agu, P., & Nwobodo, V. (2023). In Vivo and in Silico Assessment of Ameliorative Effects of Xylopia aethiopica on Testosterone Propionate-Induced Benign Prostatic Hyperplasia. Pharmaceutical Fronts. 05, e64–e76. https://doi.org/10.1055/s-0043-1768477
  • Castle, P.E., Einstein, M.H., & Sahasrabuddhe, V.V. (2021). Cervical cancer prevention and control in women living with human immunodeficiency virus. CA Cancer J Clin. 71, 505–526. https://doi.org/10.3322/caac.21696
  • Eilu, E., Akinola, S., Odoki, M., Kato, C., & Adebayo, I. (2021). Prevalence of high-risk HPV types in women with cervical cancer in Eastern Uganda. Journal of Biomedical Science.
  • Fowler, J.R., Maani, E.V., Dunton, C.J., & Jack, B.W. (2023). Cervical Cancer. In: StatPearls. StatPearls Publishing, Treasure Island (FL).
  • Conradus, M.N., Conrad, M.O., & Eric, M.A. (2012). The Impact of Lifestyle Changes on the Prevalence of Cancer in Kenya.
  • Ampofo, A.G., Adumatta, A.D., Owusu, E., & Awuviry-Newton, K. (2020). A cross-sectional study of barriers to cervical cancer screening uptake in Ghana: An application of the health belief model. PLoS ONE. 15. https://doi.org/10.1371/journal.pone.0231459
  • Idowu, A., Olowookere, S.A., Fagbemi, A.T., & Ogunlaja, O.A. (2016). Determinants of Cervical Cancer Screening Uptake among Women in Ilorin, North Central Nigeria: A Community-Based Study. J Cancer Epidemiol. 2016, 6469240. https://doi.org/10.1155/2016/6469240
  • World Health Organization: World Malaria Report 2017. World Health Organization, Geneva.
  • Atuhairwe, C., Amongin, D., Agaba, E., Mugarura, S., & Taremwa, I.M. (2018). The effect of knowledge on uptake of breast cancer prevention modalities among women in Kyadondo County, Uganda. BMC Public Health. 18, 279. https://doi.org/10.1186/s12889-018-5183-5
  • Ai, P., M, P., Ce, J.-A. (2014). Associations between religion-related factors and cervical cancer screening among Muslims in greater Chicago. Journal of lower genital tract disease. 18. https://doi.org/10.1097/LGT.0000000000000026
  • Awad, A.B., & Fink, C.S. (2000). Phytosterols as Anticancer Dietary Components: Evidence and Mechanism of Action. The Journal of Nutrition. 130, 2127–2130. https://doi.org/10.1093/jn/130.9.2127
  • Finocchario-Kessler, S., Wexler, C., Maloba, M., Mabachi, N., Ndikum-Moffor, F., & Bukusi, E. (2016). Cervical cancer prevention and treatment research in Africa: a systematic review from a public health perspective. BMC Womens Health. 16, 29. https://doi.org/10.1186/s12905-016-0306-6
  • Gakwaya, A., Galukande, M., Luwaga, A., Jombwe, J., Fualal, J., Kiguli-Malwadde, E., Baguma, P., Kanyike, A., & Kigula-Mugamba, J. (2008). Breast cancer guidelines for Uganda (2nd Edition 2008). Afr Health Sci. 8, 126–132.
  • Maternal Health, https://www.afro.who.int/health-topics/maternal-health
  • Getachew, S., Getachew, E., Gizaw, M., Ayele, W., Addissie, A., & Kantelhardt, E.J. (2019). Cervical cancer screening knowledge and barriers among women in Addis Ababa, Ethiopia. PLoS One. 14, e0216522. https://doi.org/10.1371/journal.pone.0216522
  • Gatumo, M., Gacheri, S., Sayed, A.-R., & Scheibe, A. (2018). Women’s knowledge and attitudes related to cervical cancer and cervical cancer screening in Isiolo and Tharaka Nithi counties, Kenya: a cross-sectional study. BMC Cancer. 18, 745. https://doi.org/10.1186/s12885-018-4642-9
  • Fondjo, L.A., Owusu-Afriyie, O., Sakyi, S.A., Wiafe, A.A., Amankwaa, B., Acheampong, E., Ephraim, R.K.D., & Owiredu, W.K.B.A. (2018). Comparative Assessment of Knowledge, Attitudes, and Practice of Breast Self-Examination among Female Secondary and Tertiary School Students in Ghana. Int J Breast Cancer. 2018, 7502047. https://doi.org/10.1155/2018/7502047
  • Mohebi, Z., Heidari Sarvestani, M., Moradi, Z., & Naghizadeh, M.M. (2023). Female high school students’ knowledge and attitude toward breast cancer. BMC Women’s Health. 23, 41. https://doi.org/10.1186/s12905-023-02155-z
  • Wiegand, H., & Kish, L. (1968). Survey Sampling. John Wiley & Sons, Inc., New York, London 1965, IX + 643 S., 31 Abb., 56 Tab., Preis 83 s. Biometrische Zeitschrift. 10, 88–89. https://doi.org/10.1002/bimj.19680100122
  • Twinomujuni, C., Nuwaha, F., & Babirye, J.N. (2015). Understanding the Low Level of Cervical Cancer Screening in Masaka Uganda Using the ASE Model: A Community-Based Survey. PLoS One. 10, e0128498. https://doi.org/10.1371/journal.pone.0128498
  • Monteiro, P.B., Filho, M.P.M., de Figueirêdo, J.T., Saintrain, M.V. de L., Bruno, Z.V., & Carvalho, F.H.C. (2017). Cytology-Based Screening During Antenatal Care as a Method for Preventing Cervical Cancer. Asian Pac J Cancer Prev. 18, 2513–2518. https://doi.org/10.22034/APJCP.2017.18.9.2513
  • Hyacinth, H.I., Adekeye, O.A., Ibeh, J.N., & Osoba, T. (2012). Cervical Cancer and Pap Smear Awareness and Utilization of Pap Smear Test among Federal Civil Servants in North Central Nigeria. PLoS One. 7, e46583. https://doi.org/10.1371/journal.pone.0046583
  • Lyimo, F.S., & Beran, T.N. (2012). Demographic, knowledge, attitudinal, and accessibility factors associated with uptake of cervical cancer screening among women in a rural district of Tanzania: Three public policy implications. BMC Public Health. 12, 22. https://doi.org/10.1186/1471-2458-12-22
  • Tekle, T., Wolka, E., Nega, B., Kumma, W.P., & Koyira, M.M. (2020). Knowledge, Attitude and Practice Towards Cervical Cancer Screening Among Women and Associated Factors in Hospitals of Wolaita Zone, Southern Ethiopia. Cancer Manag Res. 12, 993–1005. https://doi.org/10.2147/CMAR.S240364
  • Guido, R. (2018). Cervical Cancer Screening. Clin Obstet Gynecol. 61, 40–51 (2018). https://doi.org/10.1097/GRF.0000000000000336
  • Geng, L., Feng, J., Sun, Q., Liu, J., Hua, W., Li, J., Ao, Z., You, K., Guo, Y., Liao, F., Zhang, Y., Guo, H., Han, J., Xiong, G., Zhang, L., & Han, D. (2015). Nanomechanical clues from morphologically normal cervical squamous cells could improve cervical cancer screening. Nanoscale. 7, 15589–15593. https://doi.org/10.1039/C5NR03662C
  • Ebu, N.I. (2018). Socio-demographic characteristics influencing cervical cancer screening intention of HIV-positive women in the central region of Ghana. Gynecol Oncol Res Pract. 5, 3. https://doi.org/10.1186/s40661-018-0060-6
  • Lee, M.-S. (2019). Azmiyaty Amar Ma” Ruf, C., Nadhirah Izhar, D.P., Nafisah Ishak, S., Wan Jamaluddin, W.S., Ya’acob, S.N.M., Kamaluddin, M.N.: Awareness on breast cancer screening in Malaysia: a cross sectional study. Biomedicine (Taipei). 9, 18. https://doi.org/10.1051/bmdcn/2019090318
  • Nwabichie, C.C., Manaf, R.A., & Ismail, S.B. (2018). Factors Affecting Uptake of Cervical Cancer Screening Among African Women in Klang Valley, Malaysia. Asian Pac J Cancer Prev. 19, 825–831. https://doi.org/10.22034/APJCP.2018.19.3.825
  • Ncube, B., Bey, A., Knight, J., Bessler, P., & Jolly, P.E. (2015). Factors Associated with the Uptake of Cervical Cancer Screening Among Women in Portland, Jamaica. N Am J Med Sci. 7, 104–113. https://doi.org/10.4103/1947-2714.153922
  • Nyamambi, E., Murendo, C., Sibanda, N., & Mazinyane, S. (2020). Knowledge, attitudes and barriers of cervical cancer screening among women in Chegutu rural district of Zimbabwe. Cogent Social Sciences. 6, 1766784. https://doi.org/10.1080/23311886.2020.1766784
  • Obeagu, E., & Obeagu, G. (2023). An update on premalignant cervical lesions and cervical cancer screening services among HIV positive women. 6, 141. https://doi.org/10.35841/aajphn-6.2.141
  • Binka, C., Nyarko, S.H., Awusabo-Asare, K., & Doku, D.T. (2019). Barriers to the Uptake of Cervical Cancer Screening and Treatment among Rural Women in Ghana. Biomed Res Int. 2019, 6320938 (2019). https://doi.org/10.1155/2019/6320938

 CITE AS: Mumere Mutahunga Robert (2023). Examining Prevalence and Influential Factors of Cervical Cancer Screening Among Women of Reproductive Age at Fort Portal Regional Referral Hospital in Fort Portal City. IDOSR JOURNAL OF BIOCHEMISTRY, BIOTECHNOLOGY AND ALLIED FIELDS 8(3): 101-118. https://doi.org/10.59298/IDOSR/JBBAF/23/19.476

DOWNLOAD PDF