Journal of Womens Health, Issues and Care ISSN: 2325-9795

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Research Article, J Womens Health Issues Care Vol: 3 Issue: 3

Willingness to Utilize Cervical Cancer Screening Services Among, Antenatal Clinic Attendees in Selected Hospitals in Ibadan, Nigeria

Chizoma M Ndikom1*, Bola A Ofi1 and Folashade O Omokhodion2
1Department of Nursing, University of Ibadan, Nigeria
2Department of Community Medicine, University of Ibadan, Nigeria
Corresponding author : Dr. Chizoma M Ndikom
Department of Nursing, University of Ibadan, Nigeria
Tel: +2348023529101
E-mail:[email protected]
Received: February 02, 2014 Accepted: June 02, 2014 Published: June 06, 2014
Citation: Ndikom CM, Ofi BA, Omokhodion FO (2014) Willingness to Utilize Cervical Cancer Screening Services Among, Antenatal Clinic Attendees in Selected Hospitals in Ibadan, Nigeria. J Womens Health, Issues Care 3:3. doi:10.4172/2325-9795.1000149

Abstract

Willingness to Utilize Cervical Cancer Screening Services Among, Antenatal Clinic Attendees in Selected Hospitals in Ibadan, Nigeria

Women of childbearing age who are sexually active are at risk of Cervical Cancer (CC), since they may have been exposed to Human Papilloma Virus. Majority of the women with invasive cervical cancer were never screened for this disease which is known to be a major cause of cancer deaths among women, especially in developing nations.

Keywords: Cervical cancer screening; Willingness; Women�s awareness; Utilization

Keywords

Cervical cancer screening; Willingness; Women’s awareness; Utilization

Introduction

Mortality and morbidity arising from non communicable diseases like cancer have continued to pose as threat to the life of women. Cervical cancer is one of the common cancers and is responsible for the death of many women. Cervical cancer screening based on cytological examination is largely unavailable in developing countries or made available to a small select group of women in maternal child health sites, missing the age groups at highest risk for precancerous lesions [1]. Evidence has shown that, utilization of cervical cancer screening for the prevention of the disease is poor in Nigeria [2]. The major reason for the continuing high mortality resulting from cervical cancer in the developing world is the scarcity of well-organized, high-quality screening programs in those regions [3]. Study among nurses in Lagos revealed that, sixty percent of the nurses had not been screened for cervical cancer even though they understood that Pap smear could be used to detect precancerous stage of cervical cancer [4].
Many young women in Nigeria are not conscious of their predisposition to cervical cancer as shown in their early sexual exposure which has been known to be a risk factor of cervical cancer. Study among Female undergraduate in Ibadan, south west Nigeria, illustrates that sexual experience before the age of 20 years occurred in 51.7% of the respondents [5]. This puts them at greater risk especially when precautionary measures are not taken. A lot of the women in developing countries were not aware of cervical cancer as research in Uganda has also, shown a poor awareness of this disease among women [6].
Uptake of cervical cancer screening has remained low in developing countries. Many lack access to preventive health care services which further limits their chances of being screened. Pap smear use is associated with access to preventive care [7]. There are many barriers to cervical cancer screening uptake which include lack of awareness of cervical cancer and of ways preventing the disease, difficulty getting to clinics and hospitals, the need for multiple visits and high cost associated with screening. It was reported that, much of the anxiety associated with cervical screening results from ignorance among lay woman and the provision of insufficient information or magnification by health professionals [8]. Also, a Swedish Study reported that, non-attendance to cervical screening was positively associated with time-consuming and economic barriers [9]. Time is a problem because women have so many responsibilities thus cervical cancer screening could be given less priority in demanding real life situation like difficulty in taking time off work to go for screening [10]. Most screening programmes that rely on Pap smear are complex and costly to run and have failed to reach a significant proportion of women in developing countries where health systems and infrastructures are weak [11].
Other barriers to CCS identified by [12] were as follows: poor knowledge, underlying health and cultural beliefs, attitudes, language and unhelpful attitudes of health professionals to be important barriers to CCS. Age, non-white race/ethnicity, low educational level, low income, decreased access, in sufficient funding, and unfavourable attitudes towards screening were equally identified as hindrances to CCS [13]. Ignorance about cervical cancer, cultural constraint/beliefs about illness, economic factors, domestic gender power relations, alternative authoritative sources of reproductive health knowledge and unfriendly health care services could also hinder screening [6]. Despite all these barriers, a Nigerian study reported that 83.11% of the respondents admitted that if made available and affordable they would like to go for CCS test [14].
Cervical cancer screening is one of the reproductive health services that should be provided for women. More so, Nurse Practitioners are in position to address women’s beliefs about cervical cancer and provide information and services that are culturally sensitive and appropriate [15]. Are the women ready to utilize cervical cancer screening services? This study sought to determine willingness to utilize cervical cancer screening services among antenatal clinic attendees in selected hospitals in Ibadan, Nigeria.

Method

A Cross-sectional design was used for this study. The respondents were all women within child bearing age, utilizing Antenatal Clinic Services in selected hospitals in Ibadan, Oyo state in South West Nigeria. The choice of the hospitals was informed by the availability of Maternal and Child Health (MCH) services and client turnover. All the hospitals included in the study had high patient turnover. The hospitals include four secondary facilities and four Primary Health Centers (PHCs). The total population of women attending the clinic during the period of the study was 2,120. Data was collected from 846 using systematic random sampling method.
Instrument for the study was a structured questionnaire designed from reviewed literature. The final tool was translated to Yoruba by a research expert and a Yoruba translator as Yoruba is the common language spoken in Ibadan. Permission for the study was obtained from Oyo State Research Ethical Review Committee and Oyo State Hospital Management Board, Ibadan. Institutional approval was obtained from the various hospitals and Units studied. Informed consent was obtained from participants after being duly informed about the details of the study. Interviewer administered questionnaire was used to obtain information from the respondents. The statistical software package used for the data analysis was Statistical Package for Social Sciences (SPSS 15). Chi square test was used to determine association between variables for categorical data.

Results

Socio demographic characteristics of women
Table 1 shows the distribution of socio demographic characteristics of the respondents. The majority (62.6%) were aged between 21-30 years. Their mean age was 27.87 + 5.75 years. Majority (94.8%) was married, 49.1% attained secondary school level of education, 64.2% were traders and 68% earned less than N10, 000 as monthly income. Their husbands were mainly traders (64.7%).
Table 1: Women’s socio-demographic data.
Awareness and utilization of cervical cancer screening services
Table 2 below shows the awareness of women on cervical cancer, 132 (15.6%) of the respondents had heard about cervical cancer while 714 (84.4%) had never heard of it. Similarly, only 113 (13.3%) of the respondents had ever received information from the clinic.
Table 2: Women’s awareness and utilization of Cervical Cancer screening services.
The majority 828 (97.9%) of the women have never been screened for cervical cancer while only 18(2.1%) had undergone screening. However, 612 (73.6%) of the respondents were willing to utilize cervical cancer screening services but only 132 (15.5%) of the women indicated their awareness of where to go for cervical cancer screening.
Knowledge of women on cervical cancer
Figure 1 shows the overall knowledge of women on cervical cancer. Majority of the respondents 749 (88.6) had poor knowledge, 92 (10.8%) had fair knowledge while only, 5 (0.6) high.
Figure 1: Level of knowledge of women of cervical cancer.
Perceived hindrances to utilization of cervical cancer screening services
The possible hindrances to the uptake of screening by women are presented on Table 3. Unavailable services, 374 (44.2%) was the most critical factor, followed closely by lack of information 336(40.7%). Other factors include: lack of decision making ability 289 (34.2%), cost of obtaining services 255 (30.1%), Lack of support from husband 240 (28.4%), fear of being infected 218(25.8%), Distance from screening centre 199 (23.5%) and Invasion of one’s privacy158 (18.7%).
Table 3: Perceived Hindrances to the utilization of cervical cancer screening services.
Table 4 shows there was a significant association between awareness and willingness to utilize cervical cancer screening services (P=0.000). Also there was no significant association between age of respondents and willingness to utilize cervical cancer screening (P=0.834). The association between level of education and women’s willingness to utilize cervical cancer screening services was significant (P=0.019).
Table 4: Relationship between respondents’ characteristics and willingness to uptake cervical cancer screening services.

Discussion

All respondents in this study were pregnant women and sexually active. The women had access to modern health care facilities. It was important to study this group of women as they are at risk of cervical cancer. Majority of the women were aged between 21-30 years, were married, traders, earned less than N10, 000.00 per month and mainly had secondary education and their husbands were traders majorly. These women in the study were not really empowered financially.
Only, 15.6% of respondents have heard about cervical cancer. A study among women attending gynaecology clinics in a tertiary level medical care centre in South Eastern Nigeria affirmed that, twentyfive (12.6%) of the women were aware of the cervical cancer screening test [16]. Of the 25 respondents who were aware of the cervical cancer screening test, 15 (60.0%) had received at least a Pap smear test [16]. Majority had low level of knowledge. This is not surprising as the majority had never heard about the disease. A study of out-patients’ attendants’ knowledge and attitude towards cervical cancer in Nigeria revealed that among these women aged 20 to 65, only 15% had heard of the disease [17]. These reports are consistent with the present study which has shown that, awareness and knowledge about cervical cancer is still very low [14].
Similarly, a study of influences on uptake of reproductive health services in Nsanger Community in Uganda and their implications on uptake of cervical cancer screening showed that knowledge about cervical cancer among Ugandan women was very low [6]. Prominent in their finding was the fact that, patients were not given adequate information on cervical cancer and screening. Also, that some of the nurses had gaps in their knowledge of cervical cancer.
Although, these women have access to hospitals yet they were not given information on cervical cancer screening. This underscores the need for regular information dissemination in our hospitals especially Antenatal clinics as this will help the target group receive information that will be of benefit to their female children aged nine years and above before exposure to sexual intercourse.
Women’s willingness to uptake cervical cancer screening services
Majority of the women were willing to uptake cervical cancer screening. This is comparable to another Nigerian study [14]. Despite their willingness they were unable to utilize the services mainly because the services were not available. The hindrances to the uptake of screening by women in this study were mainly, unavailability services, cost of obtaining service, and lack of information about screening. Others were lack of decision making ability, invasion of one’s privacy. These were similar to findings by [12,13,18].
Furthermore the barriers identified by [6] were “ignorance about cervical cancer, cultural constraint/beliefs about illness, economic factors, domestic gender power relations, alternative authoritative sources of reproductive health knowledge and unfriendly health care services. Most of the screenings in developing countries were done as an opportunistic screening exercise [16]. Healthcare workers, who come into contact with women, should inform them about cervical cancer screening [19].
The Hypotheses tested on the association between various variables and willingness to utilize cervical cancer screening services. There was a significant association between level of awareness of cervical cancer and women’s willingness to utilize cervical cancer screening as well as between level of education and women’s willingness to utilize cervical cancer screening. The association between age of respondents and willingness to utilize cervical cancer screening was not significant. Significant association between the educational status and the knowledge of the cervical smear Pap test has been documented [16]. Similarly, Level of knowledge of cervical cancer prevention, university education, and age had a significant impact on the uptake of cervical cancer screening [18].

Limitation

This study is limited by the fact that it was carried out using selfreport among antenatal clinic attendees in Ibadan metropolis.

Implications for Further Studies

There is need to carry out a larger study using other zones in the country to make the findings more general.
A comparative study can be carried out in centers where there are services compared with willingness and uptake where screening services are not available.

Recommendations

Information on cervical screening should be given regularly to women. There is an urgent need for an aggressive awareness campaign and the provision of a screening program nationally.
Cervical cancer screening services should be incorporated in family planning services. Screening services should be available in all secondary facilities at subsidized rate. Developing countries should develop policy and framework on health screening. Reminder/Recall services should be in place to ensure compliance with appointments in order to increase utilization.

Summary and Conclusion

Cervical cancer is one of the common cancers in women. It is responsible for the death of many women. It is preventable through screening to detect precancerous lesions and appropriate treatment before the lesions develop into cancer. Various cervical cancer screening, diagnostic, and treatment methods are currently being used in developed and developing countries. Each method of screening has its advantages and disadvantages. Treatment should be available for women who under go screening. The study sought to determine awareness and willingness utilize of CCS services among Antenatal Clinic (ANC) attendees in selected hospitals in Ibadan.
Cross-sectional design was used for the study. Systematic random sampling was used to select 846 women attending ANC in the hospitals. Data were collected from the women using validated structured questionnaire. Data were analysed using Chi square at P ≤ 0.05
The women were willing to utilize CCS services but Uptake of CCS was low. Contributory factors to low uptake were non-availability of CCS services, lack of information on CCS and cost of services among others. There was a significant association between awareness and willingness to utilize CCS services as well as educational level and willingness to undergo screening. Age of respondents did not have significant association with willingness to utilize CCS services.
Though, the women were willing to utilize cervical cancer screening services, actual utilization was poor. There is need to provide more information on cervical cancer screening as well as make the services available at reduced cost.

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