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Influencing Elements Impacting the Participation in Cervical Cancer Screening Among Women of Childbearing Age at Jinja Regional Referral Hospital, Eastern Uganda

Belia Ngesa Etale

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

ABSTRACT

This research aimed to gauge cervical cancer screening participation and its influencing factors among Women of Reproductive Age (WRA) at Jinja Regional Referral Hospital (JRRH) in Eastern Uganda. Conducted from January to April 2021, the study utilized a cross-sectional descriptive design, surveying 370 WRA through pretested semi-structured questionnaires. Analysis was performed using SPSS version 20, presenting outcomes through tables, frequencies, percentages, and logistic regression analyses. Among the 370 respondents, merely 24.3% (90 individuals) had undergone cervical cancer screening. Of these, 14.1% had one screening, 7.0% had two screenings, and 3.2% had been screened three or more times. The primary mode of screening (11%) occurred during medical camps. Regarding awareness, 89.7% had heard of cervical screening, predominantly through radio broadcasts (41.0%), with 41.4% recognizing its purpose and 52.4% acknowledging its role in early detection and treatment. Furthermore, 94.3% viewed cervical cancer screening as a beneficial practice, with 81.1% advocating for other women to undergo screening, while 90% believed in promoting this practice. Culturally and religiously, the acceptance of cervical cancer screening was widespread. Demographically, most respondents (66.5%) fell within the 15-30 age bracket, with the majority identifying as Anglicans (33.8%) and 88.9% being Ugandan nationals. Educational attainment was predominantly at the secondary (37.0%) and tertiary (39.2%) levels. Regression analysis indicated that being Anglican significantly influenced the uptake of cervical cancer screening [OR=2.219(1.039 – 3.899); 95% CI, P=0.038)]. Despite increased knowledge and awareness about cervical cancer screening’s purpose, treatment, and associated complications, uptake remains below desired levels. Notably, a substantial number of women did not seek screening due to the absence of signs or symptoms and lack of advice from medical professionals, exposing a gap in primary healthcare significance. The study underscores the need for heightened health education across healthcare platforms to emphasize the critical importance of cervical cancer screening and encourage more women to partake in this essential preventive practice.

Keywords: Cancer, Women, Cervical cancer screening, Pap smear test.

INTRODUCTION

Cancer of the cervix is one of the most common cancers among women and the leading cause of gynecological cancer death in low to middle-income countries [1-3]. Cervical cancer screening is a systematic approach to identifying cervical abnormalities in an asymptomatic population and cervical cancer screening uptake is when a woman accepts willingly to undergo the screening process for cervical cancer. Women targeted for screening may feel perfectly healthy and see no reason to visit health facilities [4, 5]. The Pap smear test is acknowledged worldwide as being the most successful cancer screening test, yet women continue to die of carcinoma of the cervix, a theoretically preventable disease. Expectations of the pap test however exceeded its potential [6, 7]. Organized screening programs are required to decrease further the incidence and mortality of carcinoma of the cervix [8]. Cervical cancer is diagnosed following an abnormal cytology result or after the development of clinical symptoms. Women who have an abnormal high-grade cytology result for example from pap smears or symptoms are usually referred for further analysis [9]. A colposcopy is a stereoscopic, magnified examination of the cervix using a colposcope. The aim is to examine the cervical transformation zone and identify abnormal areas. A biopsy of the abnormal area is often performed to histologically confirm the diagnosis [9]. Screening of cervical cytology (Pap smear) should begin at age 21 and women under the age of 21 should not be screened regardless of the age of initiation of sexual activity or the presence of other behavioral related risk factors. Adolescent cervical cancer prevention programs need to focus on universal HPV vaccinations [10]. Globally cervical cancer is the leading cause of death in women [11]. In Uganda, cervical cancer is the number one cause of cancer-related death in women. According to the World Health Organization, approximately 3,915 women were diagnosed with cervical cancer and 2,160 of them died from the disease in 2014. Nationally, the prevalence of HPV among women in Uganda rates at 33.6% (which is high), and this combined with the low screening uptake has resulted in the country having one of the highest incidence rates of cervical cancer in the world at 47.5 per 100,000 women per year [12]. The high prevalence of cervical cancer may also be linked to the high rate of HIV/AIDS in Uganda. HIV/AIDS is a risk factor for cervical cancer [13-15]. Despite efforts by the Ministry of Health-Uganda, to encourage cervical cancer screening as a preventive measure among Ugandan women, its uptake in the country is still very low and women in Uganda are among the highest risk group of developing cervical cancer and at the same time are the least likely to be screened [7]. Particularly in the Eastern region, findings from Bugiri and Mayuge revealed a 4.8% cervical cancer screening uptake rate among women [16]. Additionally, to reduce cervical cancer incidence, morbidity, and mortality, cervical screening is paramount. Thus, it is on this background that the study is intended to determine the cervical screening uptake and associated factors among women of reproductive age at Jinja Regional Referral Hospital to guide decision-making and appropriate interventions to combat the increasing incidence rates of cervical cancer among Ugandan women.

CONCLUSION

Based on the findings of the study, uptake of cervical cancer among women of reproductive age is still non-satisfactory regardless of the increased knowledge and awareness about the purpose of screening, treatment, and complications associated with the disease in addition, this study has realized that a significant number of women didn’t screen because of not having signs and symptoms and not being advised by medical professionals which has shown gap in the significance of primary healthcare. Therefore, more emphasis should be put on more research and via various bodies of healthcare delivery to encourage more women to take up cervical cancer screening elaborating on its utmost importance.

Recommendations

Considering the results of this research, the study recommends the following should be implemented and/or explored for a better outcome concerning the level of uptake of cervical cancer screening services. Further research about other factors related to the poor uptake which this study may have not captured including the cost of the service, occupation of the women as a limiting factor, and knowledge and attitude of their spouses towards screening. This will provide a broader pool of factors leading to a low uptake of the services and also help in administering interventions to appropriate persons and on time. More sensitization and campaigns towards the benefit of screening and also the adverse effects of not screening; through engaging the mass leaders, especially religious leaders, political leaders, and other influential figures in the communities. Vaccination as a sure measure against the HPV virus should be instituted among the appropriate age groups to reduce the risk of developing the disease. Healthcare providers should always advise their clients on the benefits and how often they endeavor to go for cervical cancer screening services. Most importantly the Ministry of Health through its various levels of health care delivery should ensure that there is a reasonable funding gazette to outreaches especially involving sensitization and screening for cervical cancer.

REFERENCES

  1. Obeagu, E., & Obeagu, G. An update on premalignant cervical lesions and cervical cancer screening services among HIV positive women. 2023; 6, 141. https://doi.org/10.35841/aajphn-6.2.141
  2. Alum, E. U., Famurewa, A. C., Orji, O. U., Aja, P. M., Nwite, F., Ohuche, S. E., Ukasoanya, S. C., Nnaji, L. O., Joshua, D., Igwe, K. U., & Chima, S. F. Nephroprotective effects of Datura stramonium leaves against methotrexate nephrotoxicity via attenuation of oxidative stress-mediated inflammation and apoptosis in rats. Avicenna Journal of Phytomedicine. 2023; 13(4): 377-387. doi: 10.22038/ ajp.2023.21903.
  3. Eilu, E., Akinola, S., Odoki, M., Kato, C., & Adebayo, I. Prevalence of high-risk HPV types in women with cervical cancer in Eastern Uganda. Journal of Biomedical and Clinical Sciences. 2021; 6(1):45-56.
  4. Aja, P. M., Agu, P. C., Ezeh, E. M., et al. Prospect into therapeutic potentials of Moringa oleifera phytocompounds against cancer upsurge: de novo synthesis of test compounds, molecular docking, and ADMET studies. Bulletin of the National Research Centre. 2021; 45(1): 1-18. https://doi.org/10.1186/s42269-021-00554-6.
  5. Eilu, E., Akinola, S.A., Tibyangye, J., Adeyemo, R.O., Odoki, M., Adamu, A.A., Onkoba, S.K., Kemunto, M.J., Abyola, I.A., & Kato, C.D. Assessment of alternative approaches of primary cervical cancer screening among women in low-income environments. JCREO, 2021; 13, 1–9. https://doi.org/10.5897/JCREO2020.0168
  6. Obeagu, G. U., & Obeagu, E. I. An update on premalignant cervical lesions and cervical cancer screening services among HIV positive women. Journal of Public Health and Nutrition. 2023; 6(2) 141.
  7. Nakisige, C., Schwartz, M., & Ndira, A. O. Cervical cancer screening and treatment in Uganda. Gynecol Oncol Rep. 2017; 20:37-40. doi: 10.1016/j.gore.2017.01.009.
  8. Shaw, P. A. The History of Cervical Screening I: The Pap. Test. Journal SOGC, 2000; 22(2),110–114. https://doi.org/10.1016/S0849-5831(16)31416-1.
  9. Decker, K. M., Turner, D., Demers, A. A., Martens, P. J., Lambert, P., & Chateau, D. Evaluating the effectiveness of cervical cancer screening invitation letters. J Womens Health (Larchmt). 2013; 22(8):687-93. doi: 10.1089/jwh.2012.4203.
  10. Centers for Disease Control and Prevention (CDC) Module 2 Cervical Cancer, 2013. https://www.cdc.gov/cancer/knowledge/provider- education/cervical/followup.htm.
  11. Ferlay, J., Soerjomataram, I., Ervik, M., Dikshit, R., Eser, S., Mathers, C., & Rebelo, M. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer., 2015; 136(5):E359-86. doi: 10.1002/ijc.29210.
  12. WHO, comprehensive_cervical_cancer_who_2013. WHO Library Cataloguing-in-Publication Data. Retrieved from (who.int/cancer/knowledge/provided/education/cervical.htm)
  13. Alum, E. U., Obeagu, E. I., Ugwu, O. P. C., Samson, A. O., Adepoju, A. O., & Amusa, M. O. Inclusion of nutritional counseling and mental health services in HIV/AIDS management: A paradigm shift. Medicine. 2023; 102:41(e35673). http://dx.doi.org/10.1097/MD.0000000000035673. PMID: 37832059.
  14. Obeagu, E.I., Alum, E.U., & Obeagu, G.U. Factors Associated with Prevalence of HIV Among Youths: A Review of Africa Perspective. Madonna University Journal of Medicine and Health Sciences, 2023; 3(1): 13-18. https://madonnauniversity.edu.ng/journals/index.php/medicine
  15. Alum, E. U., Ugwu, O. P. C., Obeagu, E. I., Aja, P. M., Okon, M. B., & Uti, D. E.  Reducing HIV Infection Rate in Women: A Catalyst to reducing HIV Infection pervasiveness in Africa. International Journal of Innovative and Applied Research. 2023; 11(10):01-06. DOI: 58538/IJIAR/2048. http://dx.doi.org/10.58538/IJIAR/2048
  16. Mukama, T., Ndejjo, R., Musabyimana, A., Halage, A. A., & Musoke, D. Women’s knowledge and attitudes towards cervical cancer prevention: a cross sectional study in Eastern Uganda. BMC Womens Health, 2017; 17(1):9. doi: 10.1186/s12905-017-0365-3.
  17. Wiegand, H., & Kish, L. 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 (1968). https://doi.org/10.1002/bimj.19680100122
  18. Jelastopulu, E., Karnaki, P., Bartsokas, C., Plotas, P., & Sissouras, A. Screening for Cervical Cancer – Uptake and Associated Factors in a Representative Sample in the City of Patras, West-Greece. Universal Journal of Public Health, 2013; 1:7-13.
  19. Aminisani, N., Fattahpour, R., Abedi, L., & Shamshirgaran, S.M. Determinants of Cervical Cancer Screening Uptake in Kurdish Women Living in Western Iran, 2014. Asian Pacific journal of cancer prevention: APJCP, 2016; 17 8, 3763-7.
  20. Ndejjo, R., Mukama, T., Kiguli, J., & Musoke, D. Knowledge, facilitators and barriers to cervical cancer screening among women in Uganda: A qualitative study. BMJ Open. 2017; https://doi.org/10.1136/bmjopen-2017-016282.
  21. Waiswa, A., Nsubuga, R., Muwasi, M., Kimera, I., Ndikabona, G., Tusingwire, P. D., & Akera, P. Knowledge and Attitude towards Cervical Cancer Screening among Females. Attending out Patient Department in Health Centre IIIs in Oyam District. Open Journal of Preventive Medicine. 2017; 07(04), 55–62. https://doi.org/10.4236/ojpm.2017.74005.
  22. Padela, A. I., Peek, M., Johnson-Agbakwu, C. E., Hosseinian, Z., & Curlin, F. Associations Between Religion-Related Factors and Cervical Cancer Screening Among. Muslims in Greater Chicago: Journal of Lower Genital Tract Disease, 2014;18(4), 326–332. https://doi.org/10.1097/LGT.0000000000000026.
  23. Jia, Y., Li, S., Yang, R., Zhou, H., Xiang, Q., Hu, T., et al. Knowledge about Cervical Cancer and Barriers of Screening Program among Women in Wufeng County, a High-Incidence Region of Cervical Cancer in China. PLoS ONE. 2013; 8(7): e67005. https://doi.org/10.1371/journal.pone.0067005

CITE AS: Belia Ngesa Etale (2023). Influencing Elements Impacting the Participation in Cervical Cancer Screening Among Women of Childbearing Age at Jinja Regional Referral Hospital, Eastern Uganda. IDOSR JOURNAL OF BIOCHEMISTRY, BIOTECHNOLOGY AND ALLIED FIELDS 8(3): 59-70. https://doi.org/10.59298/IDOSR/JBBAF/23/16.7351

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