ABSTRACT

Cancer of the cervix remains the most common malignant neoplasm of the female genitalia and the second most common cancer in women.. Cervical Cancer screening serves to detect the possibility that a cancer is present. The main objective of the study was to determine the knowledge and acceptability of Cervical Cancer Screening among Female Part- Time Students in University of Benin. The hypothesis for the study was: there is no relationship between knowledge of cervical cancer and acceptability of cervical cancer screening. Survey research design was used in the study. Simple random sampling was used to select the sample. The sample consisted of 200 Female Part- Time Students in University of Benin. Data was collected using questionnaire. The study findings revealed that slightly above half  more than half of (74%) of the respondents were between the age of 20-25 years, 58 (77%) respondents could not remember age of their first sexual intercourse, the majority 168(86%) of respondents have heard of cervical cancer, majority 126 (63%) of respondents heard about cervical cancer from media, hundred and two (51%) participants explained cervical cancer as abnormal lesion on the cervix, sixty four (32%) respondents stated that unprotected sexual intercourse is a risk factor of cervical cancer, sixty (30%) of respondents stated that abnormal vaginal bleeding is a sign of cervical cancer, 120 (60%) respondents stated that cervical cancer can be detected by cervical cancer screening, majority 194 (97%) of respondents stated that cervical cancer screening is done in hospital, majority 178 (89%) of respondents had never been screened for cervical cancer, majority 94 (47%) of respondents strongly agreed that cervical cancer screening is important, the majority 144(72%) of the respondents had no intention of going for cervical cancer screening, majority 80 (40%) of respondents stated that lack of awareness to cervical cancer screening is a major barrier to cervical cancer screening. The study recommends among others that nurses should engage more on giving Information Education and Communication (IEC) at all levels of Health Care Delivery toward cervical cancer screening. Cervical cancer screening center should be made available in university of Benin health center at subsidized amount so that female students can easily access the service.

 

TABLE OF CONTENTS

Cover page------------------------------------------------------------------

Title page-------------------------------------------------------------------------------------- i          

Certification-----------------------------------------------------------------------------------  ii

Abstract----------------------------------------------------------------------------------------  iii

Dedication-------------------------------------------------------------------------------------  iv

Acknowledgement----------------------------------------------------------------------------  v

Table of content-------------------------------------------------------------------------------  vi

CHAPTER ONE: INTRODUCTION

Background of study--------------------------------------------------------------------------1

Statement of problem-----------------------------------------------------------------------------4

Objective of study---------------------------------------------------------------------------------4

Significance of the study-----------------------------------------------------------------------5

Research Questions-------------------------------------------------------------------------------5

Hypothesis ………………………………………………..---------------------------------5

Limitation-------------------------------------------------------------------------------------------5

Scope of the study---------------------------------------------------------------------------------6

 Definition of terms-------------------------------------------------------------------------------6

CHAPTER TWO

 Literature Review----------------------------------------------------------------------------------8

Overview of the cervical cancer screening -----------------------------------------------------8

Knowledge of cervical cancer screening --------------------------------------------------------9

Acceptability of cervical cancer screening ----------------------------------------------------11

Barriers to cervical cancer screening ----------------------------------------------------------12

Factors That Influence knowledge and acceptability of cervical cancer screening------13

Risk factors for cervical cancer------------------------------------------------------------------16

Theoretical/Conceptual, frame work -----------------------------------------------------------18

 

CHAPTER THREE: RESEARCH METHODOLOGY

 Research Design----------------------------------------------------------------------------------20

Research Settings----------------------------------------------------------------------------------20

 Target population---------------------------------------------------------------------------------22

Samples size---------------------------------------------------------.------------------------------22

 Sampling Technique-----------------------------------------------------------------------------23

 Research Instrument------------------------------------------------------------------------------24

 Validity of the instrument-----------------------------------------------------------------------25

Reliability of the instrument …………………………………………………………­­­­­­­­­­­­...25

 Method of Data collection-----------------------------------------------------------------------25

 Method of Data Analysis------------------------------------------------------------------------26

 Ethical consideration-----------------------------------------------------------------------------26

 

CHAPTER FOUR

 Data Analysis-------------------------------------------------------------------------------------27

Presentation of findings--------------------------------------------------------------------------27

Testing of hypothesis ----------------------------------------------------------------------------45

Summary of major findings ---------------------------------------------------------------------46

CHAPTER FIVE

 Discussion of findings---------------------------------------------------------------------------47

Implications of study to nursing ---------------------------------------------------------------50

 Summary-------------------------------------------------------------------------------------------51

 Conclusion-----------------------------------------------------------------------------------------52

 Recommendations--------------------------------------------------------------------------------53

Suggestion for further studies -------------------------------------------------------------------54

 References-----------------------------------------------------------------------------------------55

 

 

 

List of tables

Table 2.1         Stages of cervical cancer --------------------------------------------------16        

Table 2.2         Health Belief Model Relationship with the study-----------------------19

Table 3.1         Table showing number of dept, students and selected sample-------- 24

Table 4.1         Respondents marital status -------------------------------------------------28

Table 4.2         Participant’s age at first intercourse ---------------------------------------29

Table 4.3         Respondents who have heard of cervical cancer -------------------------30 

Table 4.4         Participants explanation of cervical cancer ---------------------------------31

Table 4.5         Respondents knowledge of risk factors of cervical cancer ---------------32

Table 4.6         Respondents knowledge of signs of cervical--------------------------------33

Table 4.7         Respondents knowledge on how cervical cancer can be detected -------34

Table 4.8         Acceptance of cervical cancer screening by respondents -----------------36

Table 4.9         Relationship between knowledge of cervical cancer and cervical cancer screening--------------------------------------------------------------------------40

Table 4.10       Relationship between knowledge of cervical cancer and intention of

going for cervical cancer screening ------------------------------------------41

Table 4.11       Relationship between knowledge of cervical cancer and important

of cervical cancer screening ---------------------------------------------------42

Table 4.12       Relationship between important of cervical cancer screening and barriers

to cervical cancer screening ---------------------------------------------------43

Table 4.13       Relationship between acceptability of cervical cancer screening and barrier

 to cervical cancer screening --------------------------------------------------44

Table 4.14       Description of ANOVA table ------------------------------------------------.45

Table 4.15       ANOVA analysis table --------------------------------------------------------46

List of figures

Figure 2.1        Diagram showing that stages of cervical cancer----------------------------15

Figure 4.1        Distribution of respondents by age -------------------------------------------28

Figure 4.2        Religion of respondents --------------------------------------------------------29

Figure 4.3        Participants number of children-----------------------------------------------30

 Figure 4.4       Respondents source of information about cervical cancer ----------------31

Figure 4.5        Respondents knowledge of where of cervical cancer screening can be done 35

Figure 4.6        Respondents ever been screened for cervical cancer ----------------------36

Figure 4.7        Respondents intention to go for cervical cancer screening ---------------37

Figure 4.8        Respondents views about barriers to cervical cancer screening----------38

Figure 4.9        Respondents views about barriers to cervical cancer screening ----------39

List of key words

Acceptability

Cancer

Cervix

Knowledge

Pap Smear

Papilloma Virus

Screening

List of abbreviations

ACCA             -           American Cervical Cancer Association

ACCP             -           Alliance of Cervical Cancer Prevention

ACS                -           America Cancer Association

CHW               -           Community Health Workers

CDC                -           Centre for Disease Control

CIN                 -           Cervical Intraepithelial Neoplasm

ICO                 -           Institute Catala d’ Oncology

IEC                 -           Information Education and Communication

HBM               -           Health Belief Model

HIV                 -           Human Immunodeficiency Virus

HPV                -           Human Papiloma Virus

JHPIEGO       -           John     Hopkins Program of International Education in         Gynaecology and  Obstetrics

SPSS               -           Statistical Package for the Social Science

UBTH             -           University of Benin Teaching Hospital

UK                  -           United Kingdom

USA                -           United States of America

USPSTF          -           United States Prevention Services Task Force

WHO              -           World Health Organization

 

APPENDICES

Appendix: I     Consent Form -----------------------------------------------------------------65

Appendix: ii    Questionnaire -----------------------------------------------------------------63

Appendix: iii   Letter of Permission to undertake the study ------------------------------66

 

 

 

                                                                               

 

 

 

 

 

 

 

 

 

 

CHAPTER ONE

INTRODUCTION

BACKGROUND OF STUDY

Cervical cancer is the most common malignancies among females worldwide especially in women of 20–39 years of age. Its contribution to cancer burden is significant across all cultures and economies. Cervical cancer also accounts for over 270,000 deaths worldwide, an overwhelming majority of which occur in the less developed regions (Imam, 2008).

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, 2008).

Cervical cancer remained the second leading cause of cancer deaths after breast cancer and the fifth most deadly cancer in women, accounting for approximately 10% of cancer deaths (Okonofua, 2007).  The developing countries have carried a disproportionate share of the burden and 80 % of the 250,000 cervical cancer deaths in 2005 occurred there (WHO, 2007; Uysal & Birsel, 2009).

Cervical cancer is the malignant cancer of cervix uteri or cervical area. This happens when normal cells in the cervix change into cancer cells (Arbyn, 2005).  Human Papilloma Virus (HPV) infection is a necessary factor in the development of nearly all cases of cervical cancer. Sexually transmitted human papilloma virus infection leads to the development of cervical intraepithelial neoplasia and cervical cancer (Colgan, 2006).  HPV is spread through sexual contact and although most women’s bodies can fight the infection, sometimes the virus leads to the development of cervical cancer. HPV types 16 and 18 cause 70% of cervical cancer cases, whereas types 6 and 11 cause 90% of genital warts cases. During persistent HPV infection, precancerous changes may be detected in the cervix, that is, readily detectable changes occur in the cells lining the surface of the cervix, therefore early detection and treatment of these changes is an effective strategy for the prevention of cervical cancer and forms the basis of cervical screening programmes (Stephen, 2006).

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 (WHO, 2007). 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 (WHO, 2007).

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 20years and above. Awareness of screening programme, preventive vaccination and diet are preventive measures that reduce the incidence of cervical cancer. In developed countries, the widespread use of cervical screening programmes has reduced the incidence of invasive cervical cancer by 50% or more (Population Reference Bureau, 2005).

Cervical cancer is the most common genital tract malignancy of women living in poor rural communities of developing countries (Ferlay, 2006). Such populations lack cervical screening facilities and other basic infrastructural and human resources essential for effective primary healthcare delivery. Symptoms of cervical cancer include; vaginal discharge containing blood, abnormal vaginal bleeding, pelvic pain, blood in urine, bowel symptoms, blood in stool, painful sex, unusual vaginal bleeding, unusual vaginal discharge, contact bleeding, vaginal mass, moderate pain during sexual intercourse, loss of appetite, weight loss, fatigue. Others are loss of appetite, weight loss, fatigue, pelvic pain, back pain, leg pain, swollen leg, heavy bleeding from the vagina and leaking of urine or faeces from the vagina in advanced cases (Duncan, 2005).

Cervical cancer incidence and mortality rates have declined substantially in Western countries following the introduction of screening programmes. The ideal ages of women for screening are 30– 40 years owing to high risk of precancerous lesions due to being sexually active; and a precancerous lesion is detectable for 10 years or more before a cancer develops (Olamijulo, 2005). Although it has been already proven that the efficiency of regular pap tests reduced the mortality rate of cervical cancer, its application in the developing countries is less compared with the developed countries.  The lack of knowledge concerning cervical cancer may be related to this fact (Yaren, 2008).

In developed countries, the widespread use of cervical screening programmes 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, 2006)

Cancer of the cervix remains the most common malignant neoplasm of the female genitalia and the second most common cancer in women (World Health Organization / Institute Catald' Oncology - WHO/ICO, 2010).  It's the common cause of death among middle aged women, with an estimated 529,409 new cases and 274,883 deaths in 2008 (WHO/ICO,2010).The hardest - hit regions are countries such as Central and Southern America, the Caribbean, Sub Saharan Africa and part of the Oceania and Asia with the highest incidence over 30/100,000 women (Alliance of Cervical Cancer Prevention- ACCP,2005).

An estimated 1.4 million women worldwide are living with cervical cancer and 2 to 5 times more up to 7 million worldwide may have precancerous conditions that need to be identified and treated(ACCP,2005).  In the United Kingdom (UK), 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 2008 asserted that cervical cancer remains 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 (WHO, 2008).  More than 80% of the world's new cases and deaths due to cervical cancer occur in the developing world and less than 5%women in these settings are never screened for cervical cancer even once in their life time (Sanghvi, Lacoste, McCormick, 2005).

---