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Year : 2012  |  Volume : 11  |  Issue : 4  |  Page : 238-243  

Cervical cancer awareness and cervical screening uptake at the Mater Misericordiae Hospital, Afikpo, Southeast Nigeria


1 Department of Obstetrics and Gynaecology, Ebonyi State University Teaching Hospital, Abakaliki; Mater Misericordiae Hospital, Afikpo, Ebonyi State, Nigeria
2 Department of Obstetrics and Gynaecology, Ebonyi State University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria; University of Pretoria, South Africa
3 Department of Obstetrics and Gynaecology, Ebonyi State University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria

Date of Web Publication24-Oct-2012

Correspondence Address:
Justus N Eze
P. O. Box 323, Agulu 422102, Anaocha LGA, Anambra State, Nigeria

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1596-3519.102856

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   Abstract 

Background: Cervical cancer is the most common genital tract malignancy among women in developing countries.
Objective: To assess the awareness of cervical cancer among Igbo women in a rural population of Southeastern Nigerian and determine their uptake of cervical screening services.
Materials and Methods: A questionnaire-based descriptive cross-sectional study. Structured questionnaires were administered to female attendees to the antenatal and gynecological clinics of a secondary hospital in the outskirts of Afikpo, Southeast Nigeria over a six-month period (1 st July to 31 st December 2007). Data analysis was by SPSS.
Results: Five hundred questionnaires were given out. Three hundred and sixty were correctly filled (72%) and analyzed. The mean age of respondents was 36.2 years, 25.0% had tertiary education and 40.3% were self employed. All the respondents were sexually active. There were high incidences of premarital sex, multiple sexual partners and abnormal vaginal discharge and low condom use. Awareness of cervical cancer (37.5%), its preventable nature (31.9%), cervical screening (25%) and screening centers (20.8%) were generally low and screening uptake (0.6%) was abysmally low. Lack of awareness, non-availability of screening centers locally, cost and time were the main reasons adduced by respondents for not being screened. Overall, 62.5% of all the respondents indicated willingness to be screened.
Conclusion: The exposure to conditions that predispose women to cervical cancer was high, and the levels of awareness of cervical cancer and cervical screening uptake were low. Continued awareness creation, local provision of cheap and affordable services and poverty alleviation are needed to improve cervical screening uptake with the hope of reducing the incidence of cervical cancer in the long term.

   Abstract in French 

Contexte: Cancer du col utérin est la plus commune malignité du tractus génital chez les femmes des pays en développement.
Objectif: Pour évaluer la sensibilisation du cancer du col utérin chez les femmes dans une population rurale du sud-est nigérian Igbo et déterminer leur consommation des services de dépistage du col utérin.
Méthodes et matériaux: Une étude transversale descriptive par questionnaire. Questionnaires structurés ont été administrés aux participants féminins pour les dispensaires prénatals et gynécologiques d'un hôpital secondaire dans la banlieue d'Afikpo, sud-est du Nigeria sur une période de six mois (1 st juillet 31 st décembre 2007). L'analyse des données a été de SPSS.
Résultats: Cinq cents questionnaires ont été distribués. Trois cent soixante ont été correctement remplis (72%) et analysés. L'âge moyen des répondants était de 36,2 ans, 25,0% avait l'éducation tertiaire et 40,3% étaient des travailleurs autonomes. Tous les répondants étaient sexuellement actifs. Il y avait une incidence élevée de sexe avant le mariage, plusieurs partenaires sexuels et pertes vaginales anormales et préservatif faible. Sensibilisation du cancer du col utérin (37,5%) peuvent être évitées (31,9%), col de l'utérus dépistage (25%) et ses (20,8%) de centres de dépistage ont été généralement faibles et dépistage d'absorption (0,6%) a été incroyablement faible. Manque de sensibilisation, l'indisponibilité des locaux, les centres de dépistage coût et le temps ont été les principaux motifs invoqués par les intimés pour non testés. Dans l'ensemble, 62,5% parmi les répondants ont indiqué vouloir subir.
Conclusion: L'exposition à des conditions qui prédisposent les femmes au cancer du col de l'utérus était élevée, et les niveaux de sensibilisation du cancer du col de l'utérus et dépistage cervical absorption étaient faibles. Sensibilisation continue, prestation locale de services bon marchés et abordables et lutte contre la pauvreté sont nécessaires pour améliorer le dépistage cervical absorption avec l'espoir de réduire l'incidence du cancer du col utérin dans le long terme.
Mots clés: Sensibilisation, cancer du col utérin, dépistage, absorption

Keywords: Awareness, cervical cancer, screening, uptake


How to cite this article:
Eze JN, Umeora OU, Obuna JA, Egwuatu VE, Ejikeme BN. Cervical cancer awareness and cervical screening uptake at the Mater Misericordiae Hospital, Afikpo, Southeast Nigeria. Ann Afr Med 2012;11:238-43

How to cite this URL:
Eze JN, Umeora OU, Obuna JA, Egwuatu VE, Ejikeme BN. Cervical cancer awareness and cervical screening uptake at the Mater Misericordiae Hospital, Afikpo, Southeast Nigeria. Ann Afr Med [serial online] 2012 [cited 2019 Jul 17];11:238-43. Available from: http://www.annalsafrmed.org/text.asp?2012/11/4/238/102856


   Introduction Top


Cervical cancer is the most common genital tract malignancy of women living in poor rural communities of developing countries. [1],[2] Such populations lack cervical screening facilities and other basic infrastructural and human resources essential for effective primary healthcare delivery. [1],[2],[3] The developing countries are responsible for 80% of the 500,000 new cases of cancer of the cervix diagnosed annually worldwide, and account for 85% of the 250,000 deaths recorded yearly from the disease. [1],[2],[4],[5] Cervical cancer is the predominant cause of cancer-related deaths among women of sub-Saharan Africa, and in Nigeria where the majority of cases present in the late stages of the disease, it is the prevalent genital tract malignancy. [2],[5],[6]

Sexually transmitted human papilloma virus infection leads to the development of cervical intraepithelial neoplasia and cervical cancer. [4],[7] Women with many sexual partners, and those whose partners have had many sexual consorts, or have been previously exposed to the virus, are most at risk of developing the disease. In developed countries of Europe and America that have organized national cervical screening programs, early detection and treatment of precancerous cervical lesions have resulted in a dramatic reduction in the incidence of and mortality from, cervical cancer. [2] Vaccination against human papilloma virus, where available and affordable, may further reduce the incidence of the disease. [7]

Knowledge and awareness of cervical cancer is low among the women in the developing countries, [5] and organized screening programs are virtually non-existent. [1],[2],[3],[4] Such cervical screening programs when available are opportunistic and sporadic, and are paradoxically located in urban-based tertiary medical institutions and other urban facilities far from the vulnerable rural population.

The present study assesses the perception of cancer of the cervix among Igbo women who live in a rural community of Ebonyi State, Southeast Nigeria, and evaluates their predisposition and attitude to cervical cancer screening as a means of preventing the disease.


   Materials and Methods Top


The investigation was conducted at Mater Misericordiae Hospital, a faith-based secondary hospital located in Afikpo town, Ebonyi State, Southeast Nigeria. The hospital has a well-developed Obstetrics and Gynaecology Unit attended to by a specialist and some resident doctors, but its cervical screening service is not organized and patients are screened only opportuistically.

The hospital serves Afikpo town and the neighboring villages in Ebonyi and other surrounding States of Abia, Akwa Ibom, Cross River, Enugu and Imo. The indeginous and immigrant populations here are mainly small scale farmers, fishermen/women, traders, artisans and civil servants; they are mainly low income earners, with poor representation of the middle- and high-income group. [8]

This was a descriptive cross-sectional study. Data was collected prospectively over the six-month period from 1 st July to 31 st December 2007. The subjects, who were mainly of the Igbo tribe, consisted of women of reproductive age group and postmenopausal women, who attended the antenatal and gynecological clinics of the hospital for consultation. The main researcher recruited five first-year nursing students versed in the local dialects, from the hospital's School of Nursing and trained them as research assistants. Their duty was overseen by a staff nurse/midwife who worked in the labor ward of the hospital; she was not involved in the questionnaire administration.

Data collection was by a structured "interviewer or self-administered" questionnaire (Appendix 1). This was pre-tested on 20 female attendees to the antenatal and gynecological clinics of the General Hospital at Enuohia, also located at the outskirts of Afikpo and then modified to ensure clarity. Subjects were required to give consent (verbal) before inclusion in the study. Five hundred (500) questionnaires were administered.

Data obtained was analyzed with SPSS version 15. The frequency of items sought were calculated by simple percentages and Chi-squared test employed to test for significance where applicable, at 95% confidence interval (CI).

Ethical clearance was obtained from the hospital's Ethical Committee.


   Results Top


Of the 500 questionnaires, 360 or 72% were analyzed. The demographic features of the respondents are shown in [Table 1]. Their mean age was 36.2 (+ 11.4) years (SD). Two hundred and ninety five (81.9%) were Christians and the rest were either Moslems or practiced traditional religion. Twenty five percent of the women attained post-secondary education, while the others either stopped at secondary or primary levels, or did not receive any formal education. Three hundred and twenty (88.9%) of the subjects had been married, of which 7.8% (25) were widowed and 3.1% (10) divorced. More than 59% of the women were self employed (including traders and farmers) or independent, and the rest employed in the organized public and private sectors, unemployed or retirees [Table 2]. [Table 3] displays the sexual practices of the women and previous episodes of abnormal vaginal discharge. All the respondents were sexually active and all single respondents had had multiple sexual partners. Also, 50.9% of the married respondents had premarital sex and 62.2% engaged in extramarital sexual relationships. One hundred and eighty five (51.4%) of the subjects were aware of the condom. This consisted of 40 (100%) of the single respondents as against 45.3% of the married ones. Condom use was 21.9% (79) amongst the respondents and sporadic in all the cases. The single respondents recorded 57.5% condom use as against 16.3% by the married ones. Over 58% had previous episodes of abnormal vaginal discharge. This was commoner in the single respondents. As shown in [Table 4], their knowledge of cervical cancer, its preventable nature, cervical screening and screening centers were all below 40% and the uptake of cervical screening was 0.6%. Some of the respondents gave varied reasons for not doing cervical screening tests. These included lack of awareness (62.5%), no screening centers locally (20.8%), cost (19.4%) and time (16.4%). Some believed the test were for married people (7.5%), 5.8% were afraid of the possible outcome, 5.3% thought they were faithful and did not need the test, while 1.4% claimed they used herbs for the disease. Altogether, 62.5% indicated willingness to be screened
Table 1: Demographic characteristics of the respondents, n = 360

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Table 2: Occupation of respondents

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Table 3: Sexual practices and presence of abnormal vaginal discharge amongst the respondents

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Table 4: Respondents' knowledge and awareness of cervical cancer, its prevention, cervical screening and screening centers, previous screenings and willingness to be screened

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   Discussion Top


Cervical cancer is a major public health problem worldwide and it remains one of the most common malignancies of women in Nigeria. [9] This study set in a mission hospital at the outskirts of Afikpo, Southeast Nigeria, looked at a population not frequently reached by health activities in the cities. All three main religious groups in the country were represented, with Christians expectedly dominating [Table 1]. The unusually high Moslem proportion was due to the Moslem settlement at Uwana, near Afikpo. The roles played by sex in the development of cervical cancer are well established. Most of the women in the rural areas of Southeast Nigeria are highly predisposed to developing cervical cancer by virtue of their sexual life style. All the women in this study had been sexually active and exhibited high tendencies to having multiple partners, abnormal vaginal discharge and low condom use; about 90% of them had been married and there was high prevalence of pre- and extramarital sex. These findings may contribute to the high prevalence of cervical cancer in rural communities [1],[2] of Southeastern Nigeria.

Four educational levels were noted of which about 55% attained secondary or tertiary education [Table 1], indicating a literacy level similar to figures recorded for urban settings and among health professionals. [10],[11],[12],[13],[14],[15] Most of the women in the study were self-employed [Table 2] and engaged in various types of trade. Those employed in the organized public and private sectors were mostly low income earners, showing a high level of poverty amongst the women. Poverty is related to the high incidence of cervical cancer found in developing nations. [1],[3] Poverty may contribute by making women unduly dependent on their husbands for financial support and sustenance. Where these are not forthcoming, sexual promiscuity may result, with its attendant short- and long-term cervical cancer-related risks.

As shown in [Table 4], less than 40.0% of the women were aware of cervical cancer; about 30.0% knew that it was preventable; 25.0% were aware of cervical screening; 20.0% had knowledge of screening centers and only 0.6% had ever been screened. These findings differed from results obtained from studies conducted in the cities and among health professionals in some health institutions in Nigeria that reported high levels of awareness of cervical cancer (about 50.0 - 90.0%) and relatively higher levels of cervical screening uptake (about 4.0 - 20.0%), [10],[11],[12],[13],[14] but corroborated the results of the study from Enugu [15] where less than 1.0% of the population at risk was screened. The results show that the awareness of cervical cancer is variable in Nigeria, [5],[9],[11],[12],[13],[14] with women living in cities and female health and non-health professionals who work in health institutions showing higher levels of awareness than those living in rural areas. The uptake of cervical screening is, however, generally low, [5],[9],[11],[15] even amongst female health professionals, [12],[13],[14] but is abyssmally so at 0.6% cervical screening uptake in the rural population studied. However, it is noteworthy that following counselling in this study, more than 60.0% of the women showed positive attitude toward cervical screening, thus indicating that awareness creation may lead to improved screening uptake. Unfortunately, this positive attitude may wane if not met with accessible, culturally acceptable and affordable service, hence the need for immediate action. [9]

This study has shown that rural Igbo women of Southeast Nigeria have low levels of cervical cancer knowledge and cervical screening awareness, and very poor cervical screening uptake. Cervical cancer is a major public health concern for Nigeria and other countries of the developing world. Development of an effective, Government-sponsored, National cervical screening program with provision of outlets for screening of women in the rural areas is essential for the prevention and treatment of the disease. Allocation of adequate resources for broad-based advocacy [16] and aggressive public awareness education, establishment of the infrastructure, training of the necessary manpower, research, and organization of elaborate surveillance mechanisms, are essential for success of the program. As cytology-based cervical screening may be technically and financially difficult to decentralize, [1],[2],[3],[17],[18] cheaper alternatives such visual inspection of the cervix after application of 3-5% acetic acid (VIA) or Lugol's iodine (VILI) [2],[6],[17],[19] should, in the interim, be advocated.



 
   References Top

1.Cronjé HS. Screening for cervical cancer in the developing world. Best Pract Res Clin Obstet Gynaecol 2005;19:517-29.  Back to cited text no. 1
    
2.Roblyer D, Richards-Kortum R, Park SY, Adewole I, Follen M. Objective screening for cervical cancer in developing nations: Lessons from Nigeria. Gynecol Oncol 2007;107 Suppl 1:S94-7.  Back to cited text no. 2
    
3.Lazcano-Ponce E, Alonso P, Ruiz-Moreno JA, Hernández-Avila M. Recommendations for cervical cancer screening programs in developing countries The need for equity and technological development. Salud Publica Mex 2003;45 Suppl 3:S449-62.  Back to cited text no. 3
    
4.Shafi MI. Premalignant and malignant disease of the cervix. In: Edmonds DK, editor. Dewhurst's Textbook of Obstetrics and Gynaecology. 7 th ed. Massachusetts: Blackwell Publishing; 2007. p. 614-24.  Back to cited text no. 4
    
5.Anorlu RI. Cervical cancer: The sub-Saharan African perspective. Reprod Health Matters 2008;16:41-9.  Back to cited text no. 5
    
6.Onah HE, Ezugwu FO, Eze JN. Cervical cancer screening: A survey of current practice among nigerian gynaecologists. Trop J Obstet Gynaecol 2001;18:78-81.  Back to cited text no. 6
    
7.Cutts FT, Franceschi S, Goldie S, Castellsague X, de Sanjose S, Garnett G, et al. Human papillomavirus and HPV vaccines: A review. Bull World Health Organ 2007;85:719-26.  Back to cited text no. 7
    
8.Eze JN, Ibekwe PC. Uterine rupture at a secondary hospital in Afikpo, Southeast Nigeria. Singapore Med J 2010;51:506-11.  Back to cited text no. 8
    
9.Thomas JO, Babarinsa IA, Ajayi IO, Fawole O, Ojemakinde KO, Omigbodun AO. Mobilization for cervical cancer screening: Lessons from a poor-urban Yoruba community in Nigeria. Afr J Med Med Sci 2005;34:81-5.  Back to cited text no. 9
    
10.Olusegun KA, Adepiti CA. Knowledge of cervical cancer and utilization of Pap smear among patients in a tertiary centre in South West Nigeria. Ibom Med J 2008;3:56-60.  Back to cited text no. 10
    
11.Ezem BU. Awareness and uptake of cervical cancer screening in Owerri, South-Eastern Nigeria. Ann Afr Med 2007;6:94-8.  Back to cited text no. 11
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12.Kabir M, Iliyasu Z, Abubakar IS, Mahboob S. Awareness and practice of cervical cancer screening among female health professionals in Murtala Mohammed Specialist Hospital, Kano. Niger Postgrad Med J 2005;12:179-82.  Back to cited text no. 12
    
13.Ayinde OA, Omigbodun AO. Knowledge, attitude and practices related to prevention of cancer of the cervix among female health workers in Ibadan. J Obstet Gynaecol 2003;23:59-62.  Back to cited text no. 13
    
14.Nwobodo EI, Malami SA. Knowledge and practice of cervical screening among female health workers in Sokoto, North Western Nigeria. Niger Postgrad Med J 2005;12:255-7.  Back to cited text no. 14
    
15.Obi SN, Ozumba BC, Nwokocha AR, Waboso PA. Participation in highly subsidized cervical cancer screening by women in Enugu, South-east Nigeria. J Obstet Gynaecol 2007;27:305-7.  Back to cited text no. 15
    
16.Sherris J, Agurto I, Arrossi S, Dzuba I, Gaffikin L, Herdman C, et al. Advocating for cervical cancer prevention. Int J Gynaecol Obstet 2005;89 Suppl 2:S46- 54.  Back to cited text no. 16
    
17.Walraven G. Prevention of cervical cancer in Africa: A daunting task? Afr J Reprod Health 2003;7:7-12.  Back to cited text no. 17
    
18.Adesina OA, Babarinsa IA, Fawole OA, Oladokun A, Adeniji AR, Adewole IF. Cervical cytology service in Nigeria: Providers' perspective. J Obstet Gynaecol 2003;23:416-8.  Back to cited text no. 18
    
19.Anorlu RI, Ola ER, Abudu OO. Low cost methods for secondary prevention of cervical cancer in developing countries. Niger Postgrad Med J 2007;14:242-6.  Back to cited text no. 19
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


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