CHAPTER ONE

INTRODUCTION

Background to the study

Cervical cancer remains the commonest genital tract cancer yet it is largely preventable by effective screening programmes. Considerable reduction in cervical cancer incidence and deaths has been achieved in developed nations with systematic cytological smear screening

programmes.(Babatunde&Ikimalo,2010; Mutyaha,Mmiro& Weiderpass,2006).

One woman dies of cervical cancer in every two minutes worldwide, 80% of these deaths occur in developing nations.(Okunnu 2010 ).

For every two women who die of breast cancer, one dies from cervical cancer worldwide. It is 2nd most common cancer in women worldwide and most common in African women thus the most leading cause of cancer deaths in women in sub-Saharan Africa including Nigeria with a very poor 6-year survival rate.(Okunnu,2010; Obi,Ozumba& Onyebuchi,2008; Oguntayo Samaila,2008;Papadopoulos,Devaja,Cason &Raji,2000).

Most cervical cancers are caused by HPV infection with two prominent types, (16 and 18) which are responsible for about 70% of all cases. [National cancer institute, 2007]. They can both be prevented and

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detected early. Prevention can be achieved by immunizing young girls between the ages of 9-16 [before the age of sexual debut] while cervical screening is used for early detection. (Qiao, 2008, WHO, 2006).

Studies conducted in some parts of Africa, Nigeria inclusive reported that in Benin Nigeria, Carcinoma of the cervix constitute 74.6% of all malignant gynaecological tumors with stage IIb and above constituting 67.6%of all cases; in Zaria it accounted for 66.2% with advanced carcinoma of the cervix stage IIb and above making up 58.7% of the cases. In Kenya, 55% of patients presented with stage III diseases and beyond (stage iv-v).

Otolorin&sule (2008) also reported that in Nigeria, cervical cancer affects 29women per 100,000 women. Some factors have been implicated in this tragic and unnecessary loss of lives. WHO (2006), observed that many women do not attend screening programmes because of ignorance of the risk for cervical cancer and/or the benefit of screening in its early detection and cure.

Qiao (2008) from his clinical study reported that well organized cervical cancer prevention programmes based on primary screening with cervical cytology lead to impressive reductions in cervical cancer rates in developed Countries. Screening in the UK saves up to 5000 lives per year (Olaitan, 2008).

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Consequently in industrialized world, effective screening programme has helped identify precancerous lesions at a stage when they can be easily treated thereby leading to impressive reduction in cervical cancer death rates while lack of screening programmes in poorest countries means that the disease is not identified until it is too late resulting in high mortality (Ojiyi&Dike, 2010 ; Qiao, 2008).This is similar to what is prevalent in Nigeria where most cervical cancer cases seen in health facilities are in stages II and above.

Cervical screening is a health intervention used on population of woman at risk of developing cervical cancer [WHO, 2008]. It is not undertaken to diagnose the disease but to identify individuals with a high probability of having or developing the disease at the precancerous stage. The individual may actually feel perfectly healthy and may see no reason to visit a health facility. Preventing the incidence of cancer causing Human papilloma virus infection, significantly reduces the incidence of cervical cancer and the burden of the sickness on women, family and the nation at large.

There are different screening programmes that can be used to detect the precancerous changes so as to prevent the development of the diseases and curb its serious consequences. Some of these programmes include; visual method such as Pap smear or visual inspection with acetic acid

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(VIA), visual inspection with Lugol’s iodine (VLI), care Human papilloma virus [care-HPV], HPV-DNA based screening among others.

The screening programmes are performed by qualified health professionals and they serve as models to the public. They are generally believed to be well informed on health issues better than the public. Their attitude and practice transcends to society health behaviors. Female Health workers are expected to have a better understanding of the benefits of cervical screening than women in other spheres of life, thus be effective agents in creating and disseminating information about the importance of the screening programmes for the sexually active, post menopausal women as well as immunization for the girl child between the ages of 9- 16 years by example. Thus their attitude and practice towards screening for cervical cancer have a far reaching implications to its acceptance consequently contributing to the reduction in death of women from cervical cancer.

Statement of problem

Cervical cancer screening (CCS) has been identified as an effective instrument in early detection as well as cure for cervical cancer. Yet women are still dying of cervical cancer, which could have been prevented given the new technologies available. It has been observed that the commitment of health workers towards exclusive breastfeeding has served as a good motivator to the mothers, this has resulted in

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asignificant reduction of infant mortality. Ana, Mercedes, Jeremy,Jose,( 2001) observed thatexclusive breast feeding of infants aged 0-3 months and partial breast feeding for the remainder of the first year would prevent about 52 000 infant deaths a year in Latin America. They further observed that, promotion of breast feeding has an important role in increasing survival of infants. In the same vein if the female health workers are committed to cervical cancer screening, thiswill motivate the women to participate in the screening,thushelping in reduction of the incidence and mortality as has been observed with that of exclusive breastfeeding.

Women in other spheres of life without much knowledge about health issues look up to female health workers for positive health behaviours such as participating in the uptake of CCS, thus female health workers have strong influence on women and as such are role models in health issues. Reviewed literature revealed that there seem to be a problem of uptake of CCS among the womenfolk resulting in high incidence, mortality and poor treatment outcome of cervical cancer. It is in the light of these that the following pertinent questions are seeking for answers; What is the attitude of female health workers towards the uptake of cervical cancer screening; how do the female health workers in the studied institution practice CCS; how does profession influence the attitude of female health workers towards the uptake of cervical cancer

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screening; and how does profession influence the practice of cervical cancer screening by female health workers?

Purpose

The purpose of the study is to examine the attitude and practice of female health workers towards cervical cancer screening at university of Port Harcourt Teaching Hospital (UPTH), Rivers state.

Objectives

The objectives of this study are to;